NEBULIZED LIDOCAINE ADMINISTERED TO INFANTS AND CHILDREN UNDERGOING FLEXIBLE BRONCHOSCOPY

Study objectives: The purpose of this study was to evaluate the safety and efficacy of nebulized lidocaine hydrochloride as a topical anesth etic for use during flexible bronchoscopy in infants and children. Des ign: This was a prospective, randomized, double-blind study. Patients: Twenty consecutive patients scheduled for flexible bronchoscopy who w ere not intubated and had no known cardiac or hepatic disease comprise d the study group. Interventions: The patients were randomized to rece ive either 8 mg/kg or 4 mg/kg of nebulized 2% lidocaine by face mask p rior to bronchoscopy. Setting: The study took place in a bronchoscopy suite at an academic medical center. Measurements: To determine system ic absorption, serum lidocaine levels were obtained. To assess efficac y of nebulized lidocaine as a topical anesthetic, changes in heart rat e and blood pressure were recorded, and the bronchoscopist (mho did no t know the lidocaine dose used) rated the ease of passage of the bronc hoscope through nose, vocal cords, trachea, bronchi, and all sites ove rall, and the degree of cough. Results: Nebulized lidocaine was safe, was well-tolerated, and provided adequate anesthesia for half of the p atients. The serum lidocaine levels were much lower than the levels in the toxic range. There was a trend toward easier passage of the bronc hoscope in the high-dose group at all sites noted previously that were evaluated. Conclusion: Nebulized lidocaine in doses up to 8 mg/kg app ears to be safe and moderately effective as a topical anesthetic for f lexible bronchoscopy in infants and children. The serum levels were re markably low. Fifty percent of the subjects required no supplemental l idocaine.