Pre-operative nasal probe tests with adrenaline and lidocaine ease insertion during flexible bronchoscopy and reduce post-operative bleeding: a randomized controlled trial.

Abstract

BACKGROUND:

Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy; however, the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion. This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis, improve the first-pass success rate and patients' tolerance, and reduce postoperative bleeding.

METHODS:

This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: control group, simple cotton bud detection group (CD group), and adrenaline + lidocaine detection group (AD group). The primary outcome was the time to pass the glottis. Secondary outcomes included the first-pass success rate, the patients' tolerance scores, and post-operative bleeding. One-way analysis of variance, Kruskal-Wallis H test, Chi-squared test, Fisher's exact test, and Bonferroni's multiple comparison tests were used in this study.

RESULTS:

In total, 189 men and 111 women were enrolled in this study, with a mean age of 55.72 ± 12.86 years. The insertion time was significantly shorter in the AD group than in the control group (18.00 s [12.00-26.50 s] vs . 24.00 s [14.50-45.50 s], P = 0.005). Both the AD (99% vs . 83%, χ2 = 15.62, P < 0.001) and CD groups (94% vs . 83%, χ2 = 5.94, P = 0.015) had a significantly higher first-pass success rate than the control group. Compared with the control group, post-operative bleeding (1% vs . 13%, χ2 = 11.06, P < 0.001) was significantly lower in the AD group. However, no significant difference was found in the patients' tolerance scores.

CONCLUSIONS:

Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis, improve the first-pass success rate, and reduce post-operative nasal bleeding. Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy.

TRIAL REGISTRATION:

Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000032668; http://www.chictr.org.cn/showprojen.aspx?proj=53321 .

• Authors: Wenjun Zhu, Yuchen Zhang, Jingyu Shi, Xiaoqin Wang, Renjiao Li, Jia Liu, Ping Li, Dan Liu, Fengming Luo
• Journal: Chinese medical journal (Chin Med J (Engl)) Vol. 135 Issue 15 Pg. 1808-1813 (Aug 05 2022) ISSN: 2542-5641 [Electronic] China
• PMID: 35838535 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.

Chemical References

• Lidocaine
• Epinephrine

Topics

• Adult
• Aged
• Bronchoscopes
• Bronchoscopy (methods)
• Epinephrine (therapeutic use)
• Female
• Humans
• Lidocaine (therapeutic use)
• Male
• Middle Aged
• Postoperative Hemorrhage (prevention & control)
• Prospective Studies