Study On The Effect Of Piriform Recess Instillation With Lidocaine In Bronchoscopy Anesthesia

PART Ⅰ:Piriform recess instillation combined with lidocaine spray for local anesthesia in bronchoscopyBackground: Preoperative lidocaine spray is one of the recommended methods of local anesthesia for bronchoscopy,with the main purpose of reducing airway reactivity,but there is still a high incidence of coughing caused by strong stimulus during bronchoscopy.According to the literature,lidocaine spray is superior to lidocaine nebulized inhalation or the combination of lidocaine spray and nebulized inhalation in terms of local anesthesia.However,there have been few clinical studies on the use of lidocaine spray in conjunction with other methods.Ultrasound-guided internal branch block of the superior laryngeal nerve has been documented to be more effective than lidocaine spray.But blocking the internal branch of the superior laryngeal nerve by instillation in the piriform recess has not been reported.Therefore,this study was proposed to compare the effectiveness and safety of lidocaine spray combined with piriform recess instillation for local anesthesia in bronchoscopy.Methods: This was a single-center,randomized,double-blinded study designed to assess the effect and safety of lidocaine spray combined with piriform recess instillation for local anesthesia in bronchoscopy.76 patients were randomized 1:1 to either group.All the subjects were administered 4 sprays of 10% lidocaine.In the spray combined with the piriform recess instillation group,each side of the piriform recess was instilled with 1m L 2% lidocaine,whereas an equal volume of normal saline was instilled in lidocaine spray group.The primary outcome was the overall procedure satisfaction score via endoscopists.Secondary outcomes included patient-rated VAS score for cough,cough count,usage of lidocaine,heart rate,the willingness of subjects to repeat the operation,and complications(hypoxemia,sore throat,nausea,and vomiting,etc.).Results: In the piriform recess instillation combined with lidocaine spray group,the VAS score for operator-rated overall procedure satisfaction was significantly higher70(60,86.25)vs 60(50,70),P<0.001.And the patient VAS score for cough was significantly lower 50(30,62.5)vs 70(60,85),P<0.001.Cough counts were significantly lower 3(1.5,2.5)vs 5(3,7),P=0.016.Lidocaine cumulative dose lidocaine was significantly higher in piriform recess instillation combined with lidocaine spray group280(280,285)vs 260(260,260),P<0.001.A significantly higher proportion of subjects(P=0.031)were willing to undergo a repeat bronchoscopy in the piriform recess group(86.8%)than in spray group(65.8%).There was no statistical difference(P>0.05)in the incidence of perioperative complications between the two groups of subjects.In neither group were any adverse lidocaine-related events seen.Conclusion: Piriform recess instillation combined with lidocaine spray can enhance the endoscopist’s experience,greatly lessen patient discomfort throughout the surgery,and successfully decrease choking symptoms.PART Ⅱ:Study of piriform recess instillation with lidocaine for reducing cough after general anesthesia in bronchoscopyBackground: Patients who undergo general anesthesia for bronchoscopy frequently experience throat discomfort after awakening due to the pressure of the mask capsule and the bronchoscope rubbing back and forth against the mucous membrane of the throat.As a result,postoperative cough and sore throat are common complications following bronchoscopy under general anesthesia.This study aims to investigate the efficacy of piriform recess instillation with lidocaine to suppress postoperative cough and sore throat,and further improve patient comfort after general anesthesia for bronchoscopy.Methods: Patients with American Society of Anesthesiologists(ASA)physical status I-Ⅲ planned for bronchoscopy were randomized to piriform recess instillation with lidocaine or saline.The primary outcome was the incidence of coughing 10 min after extubation.Secondary outcomes included cough severity 10 min,6h after extubation(cough severity was classified according to the count of coughs,0: no cough;mild: 1 cough;moderate: more than 1 cough with a single cough lasting less than 5s;severe: cough lasting more than 5s),sore throat score at 10 min and 6 h after extubation(numerical rating scale(NRS),0-10,with 0 indicating no pain,1-3 indicating mild,4-6indicating moderate,and 7-10 indicating severe),the quality of recovery-40(Qo R-40)score and the subject’s satisfaction score 24 h postoperatively(A 100 mm horizontal line was drawn on the paper,with 0 at one end of the line indicating unsatisfactory and 100 at the other end indicating most satisfactory).Results: Eighty-eight patients completed the study protocol.There was a significantly lower incidence and severity of cough at 10 min after extubation in the lidocaine group than saline group(63.6% vs 86.4%,P=0.014;Mild:36.4% vs 11.4%,P=0.006;Severe:9.1% vs 43.2%,P<0.001).Compared to the saline group,sore throat score was significantly lower at 10 min after extubation in the lidocaine group,0(0,0)vs1(0,2),P<0.001.And the lidocaine group showed the greatest subject-rated overall anesthesia satisfaction compared to saline group,84.8(±6.2)vs 76.6(±8.6),P<0.001.There were no differences(P>0.05)in sore throat score at 6h,cough severity at 6h,or Qo R-40 at 24 h between groups.Conclusion: Piriform recess instillation with lidocaine before bronchoscopy is a simple and effective method to reduce the cough incidence and cough severity,alleviate early sore throat.It also effectively relieves the discomfort associated with early intubation and friction.