Häntschel Maik, Zahn-Paulsen Mariella, Ehab Ahmed, Böckeler Michael, Spengler Werner, Lewis Richard A, Hautmann Hubert, Hetzel Jürgen
Department of Medical Oncology and Pneumology, Eberhard Karls University, D-72076 Tübingen, Germany.
Department of Internal Medicine-Pneumology, Cantonal Hospital Winterthur, CH-8401 Winterthur, Switzerland.
J Clin Med. 2021 Oct 18;10(20):4773. doi: 10.3390/jcm10204773.
Local anaesthesia of the pharynx (LAP) was introduced in the era of rigid bronchoscopy (which was initially a conscious procedure under local anaesthetic), and continued into the era of flexible bronchoscopy (FB) in order to facilitate introduction of the FB. LAP reduces cough and gagging reflex, but its post-procedural effect is unclear. This prospective multicentre trial evaluated the effect of LAP on coughing intensity/time and patient comfort after FB, and the feasibility of FB under propofol sedation alone, without LAP.
FB was performed in 74 consecutive patients under sedation with propofol, either alone (35 patients, 47.3%) or with additional LAP (39 patients, 52.7%). A primary endpoint of post-procedural coughing duration in the first 10 min after awakening was evaluated. A secondary endpoint was the cough frequency, quality and development of coughing in the same period during the 10 min post-procedure. Finally, the ease of undertaking the FB and the patient's tolerance and safety were evaluated from the point of view of the investigator, the assistant technician and the patient.
We observed a trend to a shorter cumulative coughing time of 48.6 s in the group without LAP compared to 82.8 s in the group receiving LAP within the first 10 min after the procedure, although this difference was not significant ( = 0.24). There was no significant difference in the cough frequency, quality, peri-procedural complication rate, nor patient tolerance or safety. FB, including any additional procedure, could be performed equally well with or without LAP in both groups.
Our study suggests that undertaking FB under deep sedation without LAP does to affect post-procedural cough duration and frequency. However, further prospective randomised controlled trials are needed to further support this finding.
咽部局部麻醉（LAP）始于硬质支气管镜检查时代（最初是在局部麻醉下的清醒操作），并延续至可弯曲支气管镜检查（FB）时代，以利于FB的插入。LAP可减轻咳嗽和 gag反射，但其术后效果尚不清楚。这项前瞻性多中心试验评估了LAP对FB术后咳嗽强度/时间和患者舒适度的影响，以及仅在丙泊酚镇静下（无LAP）进行FB的可行性。
74例连续患者在丙泊酚镇静下接受FB，其中单独使用丙泊酚（35例患者，47.3%）或联合LAP（39例患者，52.7%）。评估了苏醒后最初10分钟内术后咳嗽持续时间的主要终点。次要终点是术后10分钟内同一时期的咳嗽频率、性质和咳嗽发展情况。最后，从研究者、辅助技术人员和患者的角度评估了进行FB的难易程度以及患者的耐受性和安全性。
我们观察到，术后前10分钟内，未接受LAP的组累积咳嗽时间有缩短趋势，为48.6秒，而接受LAP的组为82.8秒，尽管这一差异不显著（P = 0.24）。咳嗽频率、性质、围手术期并发症发生率、患者耐受性或安全性方面均无显著差异。两组中，无论有无LAP，FB（包括任何附加操作）的完成情况均同样良好。
我们的研究表明，在深度镇静下不进行LAP进行FB不会影响术后咳嗽持续时间和频率。然而，需要进一步的前瞻性随机对照试验来进一步支持这一发现。
