Cocaine has been used topically as an anesthetic in flexible fiberoptic bronchoscopy (FFB). There are reports of cardiac ischemic and arrhythmic complications following intratracheal cocaine instillation. We propose that application of 4% cocaine-soaked cotton pledgets to each piriform sinus via Jackson forceps for one minute represents a safe and efficacious method of providing additional topical anesthesia for FFB.
We retrospectively reviewed all FFBs performed at Mayo Clinic Jacksonville from January, 1999 to April, 2004. Data abstracted included periprocedural complications and doses of midazolam and fentanyl used in the FFBs with or without topical cocaine application in addition to the usual anesthesia with topical xylocaine. For the subgroup of patients who had FFBs both with and without cocaine, doses of midazolam and fentanyl were compared. The Wilcoxon rank sum test was used for statistical analysis.
We identified 60 FFBs where topical 4% cocaine use was documented. A random sample of 80 FFBs without cocaine use was obtained by reviewing every 16th FFB performed and served as the control group. There were no periprocedural complications in either group. There was significantly less fentanyl use in the cocaine versus the control group (p=0.009, median 75 vs. 88 mcg, respectively). There was a nonsignificant trend towards less midazolam use in the cocaine versus the control group (p=0.48). Eleven patients had FFBs done both with and without topical cocaine use. There was a trend towards less midazolam use(median values 2 vs. 3 mg, p=0.07) and less fentanyl use(median values 50 vs. 75 mcg, p=0.24) in this subgroup when cocaine was used versus no cocaine use, respectively.
Topical application of 4% cocaine to each piriform sinus in addition to standard xylocaine appears to be safe. Its’ use is associated with significantly less use of fentanyl and a trend towards less use of midazolam.
The use of topical cocaine may allow FFB to be performed with less systemic narcotic use.
E. Festic, None.