Evaluation of Preprocedural Airway Anesthesia Protocols Compared to Spray-as-you-go Anesthesia Protocols in Bronchoscopy

Evaluation of Preprocedural Airway Anesthesia Protocols Compared to Spray-as-you-go Anesthesia Protocols in Bronchoscopy

Background and goals

Fiberoptic bronchoscopy involves various topical airway anesthesia protocols that may impact patient comfort, procedural ease, and overall outcomes. The aim of this study was to compare preprocedural lignocaine spray (PPL) airway anesthesia and spray-as-you-go (SAYG) airway anesthesia in terms of patient discomfort and operator comfort during fiberoptic bronchoscopy.

Methods

A single-blind, randomized controlled trial was conducted from March 2021 to March 2022 in the Department of Pulmonology, Shaikh Zayed Hospital, Lahore, Pakistan. Fifty participants were randomly assigned to two groups (n = 25 each). Standard sedation with midazolam and 2 mL of 4% lignocaine spray in the oropharynx was used to suppress the gag reflex. Additionally, a 2% lignocaine spray (3 mg/kg) was administered via oral insertion of an endoscope during the procedure, depending on body weight. Cough severity, pain perception, and operator comfort were assessed using the visual analogue scale, facial pain rating scale, and 4-point Likert scale, respectively.

Results

Demographic characteristics were comparable between groups, with a small age difference (PPL: 53.25 years vs. SAYG: 50.88 years).P= 0.017). No significant differences in pain perception, cough scores, or procedure duration were observed between the PPL and SAYG groups. Operator comfort scores showed a trend in favor of PPL (60% rated it “comfortable” or “very comfortable” versus 28% for SAYG), although the difference was not statistically significant (P= 0.108).

Conclusions

This study concludes that PPL spray and SAYG protocols are comparable in terms of effectiveness in FOB, with no significant differences in patient-reported pain, discomfort, cough, or procedure duration. Operator comfort was slightly higher with the preprocedural protocol, although this difference did not reach statistical significance. However, even a small improvement in operator comfort could potentially lead to less fatigue, better concentration and higher performance. Further studies with larger cohorts are needed to validate these observations.

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