Topical Nasal Anesthesia in Flexible Bronchoscopy--A Cross-Over Comparison between Two Devices

Thomas Fuehner; Jan Fuge; Meike Jungen; Anna Buck; Hendrik Suhling; Tobias Welte; Jens Gottlieb; Mark Greer

doi:10.1371/journal.pone.0150905

Topical Nasal Anesthesia in Flexible Bronchoscopy--A Cross-Over Comparison between Two Devices

PLoS One. 2016 Mar 15;11(3):e0150905. doi: 10.1371/journal.pone.0150905. eCollection 2016.

Authors

Thomas Fuehner¹, Jan Fuge¹, Meike Jungen¹, Anna Buck¹, Hendrik Suhling¹, Tobias Welte¹, Jens Gottlieb¹, Mark Greer¹

Affiliation

¹ Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL).

Abstract

Introduction: Topical airway anesthesia is known to improve tolerance and patient satisfaction during flexible bronchoscopy (FB). Lidocaine is commonly used, delivered as an atomized spray. The current study assesses safety and patient satisfaction for nasal anesthesia of a new atomization device during outpatient bronchoscopy in lung transplant recipients.

Methods: Using a prospective, non-blinded, cross-over design, patients enrolled between 01-10-2014 and 24-11-2014 received 2% lidocaine using the standard reusable nasal atomizer (CRNA). Those enrolled between 25-11-2014 and 30-01-2015, received a disposable intranasal mucosal atomization device (DIMAD). After each procedure, the treating physician, their assistant and the patient independently rated side-effects and satisfaction, basing their responses on visual analogue scales (VAS). At their next scheduled bronchoscopy during the study period, patients then received the alternative atomizer. Written consent was obtained prior to the first bronchoscopy, and the study approved by the institutional ethics committee.

Results: Of the 252 patients enrolled between 01-10-2014 and 30-01-2015, 80 (32%) received both atomizers. Physicians reported better efficacy (p = 0.001) and fewer side effects (p< = 0.001) for DIMAD in patients exposed to both procedures. Among patients with one visit, physicians and their assistants reported improved efficacy (p = 0.018, p = 0.002) and fewer side effects (p< = 0.001, p = 0.029) for the disposable atomizer, whereas patients reported no difference in efficacy or side effects (p = 0.72 and p = 0.20). No severe adverse events were noted. The cost of the reusable device was 4.08€ per procedure, compared to 3.70€ for the disposable device.

Discussion: Topical nasal anesthesia via a disposable intranasal mucosal atomization device (DIMAD) offers comparable safety and patient comfort, compared to conventional reusable nasal atomizers (CRNA) in lung transplant recipients. Procedural costs were reduced by 0.34€ per procedure.

Trial registration: clinicaltrials.gov NCT02237651.

MeSH terms

Administration, Intranasal
Administration, Topical
Adult
Bronchoscopy / methods*
Cross-Over Studies
Female
Humans
Male
Middle Aged
Prospective Studies

Associated data

ClinicalTrials.gov/NCT02237651

Grants and funding

TW, JG are members of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung), Biomedical Research in Endstage And ObsTructive Lung Disease Hannover (BREATH). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.