title: Is Nebulized Lidocaine Adequate Topical Anesthesia for Diagnostic Transnasal Tracheoscopy?
abstract: OBJECTIVE
  To evaluate if nebulized 4% lidocaine alone provides adequate laryngopharyngeal anesthesia for office-based diagnostic transnasal tracheoscopy (TNT).
  
  
  METHODS
  A retrospective chart review (January 2011 to June 2014) and a prospective case series (July 2014 to December 2014) of patients who underwent diagnostic TNT were performed at a university voice and swallowing center. TNT cases were categorized by method of topical laryngopharyngeal anesthesia: nebulized 4% lidocaine and 4% lidocaine drip (phase I) and nebulized 4% lidocaine only (phase II).
  
  
  RESULTS
  TNT was performed a total of 59 times on 38 patients. Eleven (69%) of 16 phase I TNT procedures involved significant patient discomfort and severe cough following the lidocaine drip. Forty-two (98%) of 43 phase II TNT procedures were completed comfortably; 1 case required additional anesthesia by lidocaine drip. Retrospectively, 100% (n=8) of patients who underwent both phase I and phase II TNTs were noted to prefer anesthesia with nebulizer alone. In a prospective case series of 14 phase II TNT cases, 6 (86%) of 7 patients who previously underwent phase I TNT reported preference for anesthesia with nebulizer alone.
  
  
  CONCLUSIONS
  Nebulized lidocaine appears to provide sufficient laryngopharyngeal anesthesia for diagnostic TNT. It is preferred by patients over laryngeal drip.
authors: University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA.
authors: Giriraj K
authors: GK
authors: Sharma
authors: University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA verma@uci.edu.
authors: Sunil P
authors: SP
authors: Verma
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D009666:Nose; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: laryngeal anesthesia; laryngeal drip; laryngeal gargle; transnasal tracheoscopy