PURPOSE: To determine whether routine performance of transtracheal block (TTB) with 2% Lidocaine prior to flexible fiberoptic bronchoscopy carries acceptable risk, reduces the dosage of medications used for moderate sedation and reduces the dosage of Lidocaine injection into the airway.
METHODS: We retrospectively analyzed all bronchoscopies performed on non-mechanically ventilated patients by one author (MLS) in 2005, who utilized transtracheal blocks in all patients in whom there were no contraindication to its use. All patients received as pre-medication, IM Vistaril 25 mg and IM Atropine 0.4-0.6 mg unless contraindicated and topical anesthesia. All patients received 2 mls of 2% aqueous Lidocaine (L) transtracheally, i.e., injected via the cricothyroid membrane, prior to insertion of the bronchoscope, unless contraindicated. We compared the rate of complications and the average total dosage of Midazolam (M), Fentanyl (F) and Lidocaine (L) between the group that did (TTB+) and the group that did not (TTB-) receive TTB.
RESULTS: 22 patients underwent TTB. 41 patients did not undergo TTB. No complications occurred in either group. Although operative time was not measured, we observed easier bronchoscopic intubation in the TTB+ group. Average dosage of M for the TTB+ group measured 2.5 mg, 2.6 mg for the TTB- group. Average dose of F for the TTB+ group measured 83 mcg, 97 mcg for the TTB- group. Average amount of L administered for the TTB+ group measured 17.2cc and 16.3 cc for the TTB- group.
CONCLUSION: TTB can be performed with a minimal rate of complications. Bronchoscopic intubation may be less difficult. Its use, allowed reduction in the dosage of F but, did not decrease the M or L requirements associated with bronchoscopy.
CLINICAL IMPLICATIONS: In experienced hands, TTB may be used safely and routinely in selected patients as part of local anesthesia and moderate sedation during bronchoscopy. Its use may ease bronchial intubation, reduce the dosage requirements for moderate sedation, thereby reducing the risk of sedation-related adverse events and allowing for more rapid recovery from flexible fiberoptic bronchoscopy.
DISCLOSURE: Michael Scharf, None.