Topical Nasal Anesthesia in Flexible Bronchoscopy--A Cross-Over Comparison between Two Devices

Area of Science:

• Pulmonary Medicine
• Anesthesiology
• Transplant Surgery

Background:

• Topical airway anesthesia improves patient tolerance and satisfaction during flexible bronchoscopy (FB).
• Lidocaine spray is the standard for FB anesthesia.
• Assessing new atomization devices is crucial for optimizing outpatient procedures.

Purpose of the Study:

• To evaluate the safety and patient satisfaction of a disposable intranasal mucosal atomization device (DIMAD) for nasal anesthesia during outpatient flexible bronchoscopy.
• To compare DIMAD with the conventional reusable nasal atomizer (CRNA) in lung transplant recipients.

Main Methods:

• Prospective, non-blinded, cross-over study design.
• Patients received lidocaine via CRNA or DIMAD.
• Physicians, assistants, and patients rated side effects and satisfaction using visual analogue scales (VAS).
• Patients crossed over to the alternative device at their next bronchoscopy.

Main Results:

• Physicians reported significantly better efficacy and fewer side effects with DIMAD (p=0.001).
• Patients reported no significant difference in efficacy or side effects between the two devices (p=0.72 and p=0.20).
• No severe adverse events were observed. DIMAD reduced procedural costs by €0.34 per procedure.

Conclusions:

• The disposable intranasal mucosal atomization device (DIMAD) is a safe and effective alternative for topical nasal anesthesia in lung transplant recipients undergoing flexible bronchoscopy.
• DIMAD offers comparable patient comfort and potentially reduces procedural costs.
• Physician-reported outcomes favor DIMAD, highlighting its potential benefits in clinical practice.