Pre-emptive nebulization of lidocaine epinephrine before anesthesia for rigid bronchoscopy in pediatric: a randomized controlled study

Abstract

Background: Foreign body aspiration in pediatrics is usually managed by rigid bronchoscopy, which is associated with plenty of adverse events. Objective: We tried to compare the effect of nebulized saline, lidocaine or combined lidocaine with epinephrine on postoperative respiratory complications.
Patients and methods: This prospective study included 90 children, who were divided into three groups according to the nebulized solution; NS group (normal saline 0.9%), L group (lidocaine 1% 4 mg.kg- 1) and LA group [4 mg.kg- 1 lidocaine 1% and adrenaline (1:1000) 3 mg). Our primary outcome was the incidence of post-operative respiratory complications, while the secondary ones included hemodynamic changes and the incidence of intraoperative cough or desaturation. Results: All pre-procedural data were insignificant among the three groups. The LA group expressed higher heart rates, while the L group showed a significant reduction when compared to NS group. Propofol consumption showed a significant decline in two studied groups compared to the NS group. Intraoperative cough was higher in NS group in comparison to L and LA groups. Although, intraoperative desaturation per case along with post-operative sedation showed no significant difference among the three groups, post-operative cough frequency attacks and severity were higher in NS group when compared to L and LA group and when L group were compared to LA group. Post-operative stridor was insignificant among the three groups.
Conclusion: Nebulized lidocaine/adrenaline combination is appropriate option to achieve proper intraoperative sedation and upper airway conditions with reduction of post-operative negative respiratory outcomes together with minor hemodynamic changes.