Adaptation of the de Vilbiss atomizer for the delivery of topical anesthesia

A de Vilbiss atomizer was adapted for delivery of topical anesthesia to the nasal, oral, pharyngeal, laryngeal, and tracheal tissues prior to outpatient bronchoscopy under monitored anesthesia care for a patient who must remain in the sitting position. The adaptation, utilizing a Baxter Airlife oxygen tubing attached on one end to an oxygen source and the other to the port of a de Vilbiss atomizer, contained a small perforation on the oxygen tubing that allowed for thumb-controlled oxygen flow and delivery of local anesthesia. Anesthetization of the oropharyngeal membranes and suppression of the gag reflex was accomplished primarily by gargling with dyclonine (1%) and dyclonine (.5%) administered through this adapted atomizer. An oral airway lubricated with 2% lidocaine jelly was inserted to direct the delivery of the local anesthetic spray since a laryngoscope was unable to be inserted safely in the sitting position. Local anesthesia of lidocaine (4%) was administered transtracheally and dyclonine (.5%) was delivered through the atomizer along the oral airway with each inspiration to anesthetize the larynx and trachea for a total of 220 mg lidocaine and 300 mg dyclonine, respectively. This method of local anesthetic application for outpatient bronchoscopy proved to be successful in the patient with a compromised cardiac and pulmonary status who is unable to lie flat.