Topical anaesthesia of the nasal mucosa for fibreoptic airway endoscopy.

We have compared four methods of topical anaesthesia of the nostril for fibreoptic airway endoscopy in a randomized study with 31 unpremedicated volunteers, each serving as his or her own control. Lignocaine spray, EMLA cream, three cotton swabs soaked in 4% lignocaine solution, or 2% lignocaine gel was applied in a nostril for 3 min. Application of lignocaine spray was rated as the most unpleasant and EMLA cream the least unpleasant. Spray and gel caused an increase in arterial pressure. Anaesthesia of the mucosa, tested by passing a bronchoscope through the nose to the oropharynx was best with lignocaine spray or gel. Gel or EMLA, but not the local anaesthetic applied with swabs, obscured vision. When slight obscurity of vision is not a problem, local anaesthetic gel is recommended for anaesthesia of the nasal mucosa. Premedication or sedation is recommended for all the methods described here.