Pulmonary Procedures |

Reduction in Lidocaine Dose Administration for Flexible Bronchoscopy Following Order Set Implementation FREE TO VIEW

Dan Pearson, MD; Cameron McLaughlin, DO; David Shutak, RN; Pedro Lucero, MD; Michael Morris, MD
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San Antonio Uniformed Services Health Education Consortium, Converse, TX

Chest. 2015;148(4_MeetingAbstracts):808A. doi:10.1378/chest.2274659
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SESSION TITLE: Interventional Pulmonology Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The recommended total dose of lidocaine during bronchoscopy is 8.2mg/kg. However, lidocaine doses up to 15.4mg/kg may be used without serious adverse events. In our institution, the average of dose of lidocaine administered without an order set was above 12mg/kg. The bronchoscopy teams favored variability of 1 to 2% lidocaine below the vocal cords and 2-5 ml of 2% in the nares with the goal of not to exceed 11mg/Kg. Subsequently, an electronic order set was developed to standardize lidocaine administration during flexible bronchoscopy procedures.

METHODS: As part of a performance improvement project, data was collected from 1 January 2014 to 31 December 2014 regarding doses of lidocaine administered for flexible bronchoscopy procedures performed in our Pulmonary Clinic. Procedures utilizing general anesthesia for sedation were excluded from the data set.

RESULTS: 216 flexible bronchoscopy procedures were reviewed. The average dose of lidocaine administered was 411±100mg for a population with an average maximum dose of 660±141mg resulting in an average dose of 5.3mg/kg. The average lidocaine dose was 65±20% of the recommended maximum, with 95% of procedures administering less than the recommended maximum. Furthermore, there was no increase in complication rate, delayed sedation recovery times or symptoms consistent with lidocaine toxicity.

CONCLUSIONS: After standardization of the lidocaine order set we noted a remarkable decrease in total lidocaine dosage used during flexible bronchoscopy compared to liberal dosages or current guidelines. There were no increases in procedural complications or prolonged recovery times. The implementation of a standardized order set in our electronic medical record reduced the average dose of lidocaine to 5.3mg/kg without impact to procedural success. While the maximum safe dose of lidocaine is controversial, we suggest that lower doses well within the accepted range are adequate to achieve goals of flexible bronchoscopy.

CLINICAL IMPLICATIONS: Patients undergoing flexible bronchoscopy had a significant reduction of procedural lidocaine administration to 5.3 mg/kg after the implementation of an order set with no impact to our practice or post-conscious sedation recovery times.

DISCLOSURE: The following authors have nothing to disclose: Dan Pearson, Cameron McLaughlin, David Shutak, Pedro Lucero, Michael Morris

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