• S Scieszka, H Droste, M Mayer, and D Schlenkhoff.
• Institut für Anaesthesiologie und operative Intensivmedizin, Ruhr-Universität Bochum.
• Anaesthesist. 1988 Jul 1;37(7):420-4.

AbstractFiberoptic bronchoscopy is a valuable procedure in the diagnosis and treatment of pulmonary disorders and is usually performed under local anesthesia. The local application and ultrasonic nebulization of lidocaine is widely accepted for inducing topical anesthesia in the respiratory tract. We produced local anesthesia of the trachea and bronchial tree by nebulizing lidocaine via high-frequency jet ventilation (HFJV). At the same time, we measured serial plasma concentrations of lidocaine to determine the potential for toxicity due to systemic absorption from the tracheobronchial tree. METHOD. Twelve adult patients without known heart or liver disease were studied during diagnostic bronchoscopy. As premedication 0.5 mg atropine and diazepam (10 mg) or midazolam (5 mg) were given. After topical anesthesia of the oropharynx, all patients were intubated with a Hi-Lo jet endotracheal tube using a flexible bronchoscope. Spontaneous breathing was supported with a high-frequency jet ventilator (Acutronic MK 800). The humidification ventilator pump was used as a device for local anesthetic administration (lidocaine 0.5%). The following continuous application scheme was used: 0-5 min: 100 ml/h; 5-10 min: 50 ml/h; over 10 min: 5-25 ml/h. Plasma samples for lidocaine levels were taken intravenously 5 min after intubation and then at 5-min intervals. The last sample was taken 30 min after bronchoscopy. The plasma lidocaine concentration was determined by liquid chromatography. RESULTS. In general, this mode of lidocaine administration produced adequate anesthesia and was safe. None of the patients studied required additional lidocaine doses during bronchoscopy. Heart rates and blood pressures were stable.(ABSTRACT TRUNCATED AT 250 WORDS)

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