Topical Lidocaine Does Not Exaggerate Laryngomalacia in Infants During Flexible Bronchoscopy Under Propofol Anesthesia.
BACKGROUND
Topical lidocaine has been found to result in overestimation of the severity of laryngomalacia in infants undergoing flexible bronchoscopy under conscious sedation with midazolam and nalbuphine. This effect has never been confirmed and may depend on the level of sedation and the drugs used. We assessed the effect of topical lidocaine on laryngomalacia in infants undergoing flexible bronchoscopy under general anesthesia with propofol.


METHODS
Thirteen infants with congenital stridor referred to diagnostic flexible video-bronchoscopy were studied under propofol anesthesia before and 3 minutes after topical lidocaine administration to the larynx at a dose of 3 mg/kg body weight. Laryngomalacia was scored using 60 seconds video recordings of the larynx before and after lidocaine administration in random order by 2 independent blinded observers using the previously described arytenoid score (AS), epiglottis score (ES), and the total score (TS=AS+ES).


RESULTS
No significant differences in AS, ES, and laryngomalacia score were found between the prelidocaine and postlidocaine assessments by the 2 raters. The intraclass correlation coefficients were 0.995 (95% confidence interval, 0.986-0.998) and 0.975 (0.930-0.991) and 0.989 (0.971-996) for AS, ES, and TS, respectively.


CONCLUSIONS
The assessment of laryngomalacia is not affected by topical lidocaine under propofol anesthesia. The lidocaine effect on laryngomalacia may vary depending on the medication regime used and the depth of procedural sedation.
*School of Medicine and Pharmacology, The University of Western Australia †Department of Anesthesia and Pain Management, Princess Margaret Hospital for Children §School of Public Health, Curtin University, Perth, WA, Australia Divisions of ‡Pulmonary and Critical Care Medicine ∥Anesthesia, University Children's Hospital, University of Basel, Basel, Switzerland.
Britta S
BS
von Ungern-Sternberg
Daniel
D
Trachsel
Guicheng
G
Zhang
Thomas O
TO
Erb
Jürg
J
Hammer
D000287:Administration, Topical; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001999:Bronchoscopy / Q000009:adverse effects* / Q000295:instrumentation; D000013:Congenital Abnormalities / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000453:epidemiology* / Q000209:etiology; D007830:Larynx / Q000002:abnormalities*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D015742:Propofol / Q000008:administration & dosage*; D012135:Respiratory Sounds / Q000175:diagnosis*; D020535:Video-Assisted Surgery
D000779:Anesthetics, Local; D008012:Lidocaine; D015742:Propofol