Nebulized Lidocaine Through a Channeled Endoscope for Office Laryngology Procedures

This study sought to compare topical lidocaine delivered through a channeled endoscope versus traditional anesthetic methods for office laryngology procedures.

A single-institution prospective, crossover study of adult patients undergoing office laryngology procedures from February 2023 to February 2024 was conducted. Patient-reported outcomes for procedural tolerance and anesthetic preference were compared between the investigational method of channel-nebulized lidocaine versus control anesthetic delivery (trans-tracheal or drip catheter), with each patient serving as his/her own control.

Twenty-two subjects were included in the study. Control topical anesthesia included: 13 (59.1%) trans-tracheal and 9 (40.9%) drip catheter. On bivariate analysis, the use of channel-nebulized lidocaine was associated with reduced lidocaine dosage (0.4 vs. 1.7 mL, p < 0.001), increased anesthesia delivery time (335 vs. 119 s, p < 0.001), and increased total procedure time (543 vs. 321 s, p < 0.001). No significant differences in anesthetic delivery time or total procedure time were observed when comparing channel-nebulized delivery with drip catheter. Discomfort during lidocaine administration (p < 0.001) and cough/gag during lidocaine administration (p < 0.001) were significantly lower with channel-nebulized lidocaine. Multiple linear regression revealed these improvements were not significantly influenced by indication for procedure, years undergoing procedures, or control method of anesthesia. A majority (63.6%) of patients preferred channel-nebulized lidocaine.

Topical laryngeal anesthesia for office laryngology procedures can be challenging due to patient tolerance. Nebulized lidocaine delivered through an endoscopic working channel may improve patient tolerance and reduce lidocaine dosage but may be associated with longer procedure time.