Preliminary medication
Pethidine hydrochloride (Opystan®) 35 mg/1 mL is injected intravenously at the following doses:
Weight >50 kg → 0.5 mL
Weight ≤50 kg → 0.25 mL
Age >80 years old → 0.25 mL
Age ≤80 years old → 0.5 mL
Local anesthesia before bronchoscopy
A total of 5 mL of 4 % lidocaine is applied using a Jackson spray to anesthetize the pharyngeal and laryngeal areas
Sedation before bronchoscopy
Midazolam 10 mg/2 mL (Dormicum®) is diluted in 8 mL of saline to make a 10-mL solution; 2–3 mL of this diluted solution is administered intravenously as follows:
Weight >50 kg → 3 mL
Weight ≤50 kg → 2 mL
Age >80 years old → 2 mL
Age ≤80 years old → 3 mL
Local anesthesia and sedation during bronchoscopy
If severe coughing occurs, 1–2 mL of 2 % lidocaine is injected through the working channel of the bronchoscope. Additional 1–2 mL of diluted midazolam solution may be administered intravenously
9.2 Preparation
- 1.
Laryngopharyngeal anesthesia using lidocaine spray (Fig. 9.1):
Fig. 9.1
Preparation for laryngopharyngeal anesthesia
- (a)
5 mL of 4 % lidocaine
- (b)
Jackson nebulizer
- (c)
Gauze
- (d )
Kidney basin or cup
- (a)
- 2.
Sedatives and analgesics:
- (e)
Pethidine hydrochloride, 35 mg/1 mL (Opystan®)
- (f)
Midazolam, 10 mg/2 mL (Midazolam®)
- (e)
- 3.
Anesthesia during bronchoscopy:
- (g)
1-mL aliquots of 2 % lidocaine
- (g)
9.3 Actual Procedure
Instruct patients not to eat or drink anything 4 h prior to the procedure. Before administration of topical anesthesia, secure and ensure patent venous access. In the endoscopic examination room, ask the patient to be seated, and apply lidocaine spray using Jackson nebulizer for laryngopharyngeal anesthesia (Fig. 9.1). To anesthetize the entire pharynx to the larynx/glottis adequately, ensure clear vision of the pharynx so that the nozzle of the Jackson nebulizer is able to reach the deeper end of the pharynx while taking care to avoid mucosal contact and trauma.
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