Abstract: Slide Presentations |

High Dose Lidocaine use in Fiberoptic Bronchoscopy FREE TO VIEW

William C. Frey, MD*; Ethan E. Emmons, MD
Author and Funding Information

Brooke Army Medical Center, San Antonio, TX


Chest. 2004;126(4_MeetingAbstracts):707S. doi:10.1378/chest.126.4_MeetingAbstracts.707S-b
Text Size: A A A
Published online


PURPOSE:  Topical lidocaine during fiberoptic bronchoscopy (FOB) improves patient comfort. The maximum dose tolerable without toxicity isn’t clearly established. A maximum dose of < 8.2 mg/kg is advocated. Review of our institution’s lidocaine use revealed a mean of 12.1 mg/kg. We prospectively evaluated the safety of topical lidocaine during FOB.

METHODS:  Our institutional FOB preparation includes 5-10 ml 4% nebulized lidocaine, 5-10 ml 2% viscous lidocaine (nasal mucosa), 10-20 ml 2% aqueous lidocaine (vocal cords), as needed 1% aqueous lidocaine (tracheobronchial tree), and conscious sedation with cardiac monitoring. Post-procedure data was collected from FOB patients, including total lidocaine, symptoms of toxicity, potential drug interactions, and procedure indication. Serum lidocaine and blood methemoglobin levels were obtained 45 minutes post-procedure. Statistical interpretation included t-tests and ANOVA. FOB operators were blinded. The study was approved by the Institutional Review Board.

RESULTS:  Of 170 consecutive FOBs, data was available for 135 patients with mean age 64.7 years (range 20-89), 84 (62.2%) male, and 43 (31.9%) receiving beta-blockade. The most common indication (58.5%) was mass/adenopathy. None had significant hepatic disease. Symptoms of euphoria or dizziness were reported in 84 (62.2%) post-procedure. No abnormalities on cardiac monitoring were noted. Total mean lidocaine usage was 15.2 ± 4.4 mg/kg. Usage in females was significantly more than males (17.1 ± 4.5 versus 14.0 ± 3.8 mg/kg, p= < 0.0001). There was no difference in usage based on age, indication, beta-blockade, or presence of symptoms. Mean post-procedure lidocaine level (normal 1.2 –5.0 mcg/ml) was 1.6 ± 0.7 (range 0.8 –5.1) mcg/ml. Mean methemoglobin level (normal 0.4 –1.2 percent) was 0.7 ± 0.3 (range 0.1 –1.9) percent. There was no difference based on sex, age, indication, beta-blockade, or presence of symptoms.

CONCLUSION:  Our use of lidocaine in FOB is higher than commonly recommended. This does not translate into significantly elevated patient serum lidocaine or methemoglobin levels.

CLINICAL IMPLICATIONS:  Higher doses of lidocaine than are currently recommended may be safely used in FOB.

DISCLOSURE:  W.C. Frey, None.

Monday, October 25, 2004

10:30 AM- 12:15 PM




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543