Topical lidocaine through the bronchoscope reduces cough rate during bronchoscopy
Topical lidocaine through the bronchoscope reduces cough rate during bronchoscopy
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DOI：
10.1111/j.1440-1843.2009.01587.x
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发表时间：
2009-08-01
期刊：
影响因子：
6.9
通讯作者：
Worsnop, Christopher
中科院分区：
文献类型：
--
作者：
Antoniades, Nick;Worsnop, Christopher
背景和目的：局部利多卡因常通过支气管镜给药，以减少过度咳嗽和患者不适。随着镇静剂（包括具有中枢止咳作用的阿片类药物）的使用越来越多，以及严重临床毒性的可能性，需要关于局部利多卡因疗效的证据。本研究评估了局部利多卡因通过支气管镜是否可以减少咳嗽和喘鸣率。方法：49例接受可弯曲支气管镜检查的患者进行了随机对照试验。在对上气道进行镇静和局部麻醉后，患者随机接受2%利多卡因或安慰剂（N-盐水），通过支气管镜进入声带和气管支气管树。通过录音带记录咳嗽和喘鸣率。支气管镜医师和护士评估咳嗽与视觉模拟scales.Results：有两组之间的基线人口统计学和镇静水平没有显着差异。利多卡因组每分钟咳嗽频率（平均值（SD））为12.20（7.99），n = 18，低于安慰剂组27.50（10.74），n = 31（P < 0.001）。利多卡因组的喘鸣率为0.22（0.60）/min，低于安慰剂组的0.80（1.35）/min，但差异无显著性（P = 0.095）。利多卡因组医生和护士的咳嗽评分均显著低于利多卡因组（P < 0.001）。咪达唑仑2.1 mg（1.1 mg）与利多卡因联合使用比安慰剂3.4 mg（1.9 mg）少，P = 0.02;芬太尼81.9 mg（34.1 mg）与98.4 mg（20.4 mg）联合使用比安慰剂少，P = 0.04。结论：经支气管镜局部使用利多卡因可显著减少咳嗽频率和支气管镜检查所需镇静剂的总剂量。
Background and objective:Topical lidocaine is often administered through the flexible bronchoscope in an attempt to reduce excessive coughing and patient discomfort. With the increasing use of sedation, including opiates that possess central cough suppressant effects, and the potential for serious clinical toxicity, the need for evidence regarding the efficacy of topical lidocaine is important. This study assessed whether topical lidocaine through the bronchoscope could reduce cough and stridor rate.Methods:A randomized controlled trial of 49 patients undergoing flexible bronchoscopy was conducted. Following sedation and topical anaesthesia to the upper airway, patients were randomized to receive either lidocaine 2% or placebo (N-saline) through the bronchoscope to the vocal cords and tracheobronchial tree. Cough and stridor rates were recorded by audiotape. Bronchoscopists and nurses assessed coughing with visual analogue scales.Results:There were no significant differences in baseline demographics and level of sedation between the two groups. The cough rate per minute (mean (SD)) was lower (P < 0.001) in the lidocaine group, 12.20 (7.99), n = 18, than in the placebo group, 27.50 (10.74), n = 31. The stridor rate was lower with lidocaine, 0.22 (0.60) per minute than with placebo 0.80 (1.35), but the difference was non-significant at P = 0.095. Both doctors' and nurses' scores for cough were significantly lower in the lidocaine group (P < 0.001 for both). Less midazolam 2.1 mg (1.1) was used with lidocaine than with placebo 3.4 mg (1.9), P = 0.02 and less fentanyl 81.9 mg (34.1) versus 98.4 mg (20.4), P = 0.04.Conclusions:Topical lidocaine through the bronchoscope significantly decreased cough frequency and the total dose of sedation required during flexible bronchoscopy.