Foster W M, Hurewitz A N
Department of Environmental Health Science, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
Am Rev Respir Dis. 1992 Aug;146(2):520-2. doi: 10.1164/ajrccm/146.2.520.
Conventional aerosol techniques were used to determine if inhalation of lidocaine can supplement topical anesthesia applied during bronchoscopy. Aerosols of either saline or lidocaine (50 mg at either 2 or 4% concentrations) were generated by jet nebulizer and administered with or without intermittent positive-pressure breathing. Patients (n = 38) after aerosol inhalation were administered 2% lidocaine (atomized and instilled) for suppression of the gag reflex, control of cough, and airway anesthesia. For five of the patients, prior to bronchoscopy, additional studies with radioaerosols and scintillation scans were accomplished with the same aerosol methodology to demonstrate lung distribution of deposited aerosol. For five patients who received 2% lidocaine aerosol prior to bronchoscopy, the subsequent topical dose of anesthetic required for the procedure was 186 +/- 34 (SEM) mg lidocaine. Nine patients in a control group received saline aerosol and required significantly more anesthetic, i.e., 308 +/- 26 mg; procedures were completed on average within 50 min. The largest difference was in the amount delivered to the upper airway (naris, pharynx, epiglottis, and larynx), i.e., 144 +/- 26 mg for saline control versus 48 +/- 16 mg for lidocaine aerosol protocol. Airways distal to the cords required less anesthesia also, on average, 77 mg for the saline control versus 46 mg for the lidocaine aerosol protocol (p < 0.05). Topical anesthetic dosage data were replicated in 12 additional patients studied by a different bronchoscopist. No additional benefit was afforded by premedication with 4% lidocaine aerosol rather than the 2% aerosol (n = 12). We conclude that aerosol modalities can supplement topical anesthesia during bronchoscopy, primarily by reducing the dose required to anesthetize the upper airway.
采用传统的气雾剂技术来确定吸入利多卡因是否能够补充支气管镜检查期间应用的局部麻醉。通过喷射雾化器产生盐水或利多卡因（浓度为2%或4%，剂量为50毫克）的气雾剂，并在有或无间歇性正压通气的情况下给药。吸入气雾剂后的患者（n = 38）接受2%利多卡因（雾化和滴注）以抑制咽反射、控制咳嗽和进行气道麻醉。对于其中5名患者，在支气管镜检查前，使用相同的气雾剂方法完成了放射性气雾剂和闪烁扫描的额外研究，以证明沉积气雾剂在肺部的分布。对于5名在支气管镜检查前接受2%利多卡因气雾剂的患者，该操作随后所需的局部麻醉剂量为186±34（SEM）毫克利多卡因。对照组的9名患者接受盐水气雾剂，所需麻醉剂明显更多，即308±26毫克；操作平均在50分钟内完成。最大的差异在于输送到上呼吸道（鼻孔、咽部、会厌和喉部）的量，即盐水对照组为144±26毫克，而利多卡因气雾剂方案组为48±16毫克。声带远端的气道所需麻醉剂也较少，平均而言，盐水对照组为77毫克，而利多卡因气雾剂方案组为46毫克（p < 0.05）。另外12名由不同支气管镜检查医生研究的患者重复了局部麻醉剂量数据。与2%气雾剂相比，4%利多卡因气雾剂的术前用药没有额外益处（n = 12）。我们得出结论，气雾剂方式可在支气管镜检查期间补充局部麻醉，主要是通过减少麻醉上呼吸道所需的剂量。
