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 anesthetic for use during flexible bronchoscopy in infants and children. Design: This was a prospective, randomized, double-blind study. Patients: Twenty consecutive patients scheduled for flexible bronchoscopy who were not intubated and had no known cardiac or hepatic disease comprised the study group. Interventions: The patients were randomized to receive either 8 mg/kg or 4 mg/kg of nebulized 2% lidocaine by face mask prior to bronchoscopy. Setting: The study took place in a bronchoscopy suite at an academic medical center. Measurements: To determine systemic absorption, serum lidocaine levels were obtained. To assess efficacy of nebulized lidocaine as a topical anesthetic, changes in heart rate and blood pressure were recorded, and the bronchoscopist (mho did not know the lidocaine dose used) rated the ease of passage of the bronchoscope through nose, vocal cords, trachea, bronchi, and all sites overall, and the degree of cough. Results: Nebulized lidocaine was safe, was well-tolerated, and provided adequate anesthesia for half of the patients. The serum lidocaine levels were much lower than the levels in the toxic range. There was a trend toward easier passage of the bronchoscope in the high-dose group at all sites noted previously that were evaluated. Conclusion: Nebulized lidocaine in doses up to 8 mg/kg appears to be safe and moderately effective as a topical anesthetic for flexible bronchoscopy in infants and children. The serum levels were remarkably low. Fifty percent of the subjects required no supplemental lidocaine.