The feasibility of topical cocaine use in fiberoptic bronchoscopy

Authors

  • Emir Festic Departments of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL
  • Margaret M. Johnson Department of Critical Care Medicine and Division of Pulmonary Medicine, Mayo Clinic Florida
  • Jack P. Leventhal Departments of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL

Keywords:

Bronchoscopy, Sedation, Anesthesia, Cocaine

Abstract

Objective. To test the hypothesis that the application of 4%cocaine-soaked cotton pledgets to each piriform sinus for oneminute represents a safe and efficacious method of providingadditional topical anesthesia for fiberoptic bronchoscopy.Materials and Methods. We retrospectively reviewed all FBsperformed at Mayo Clinic Jacksonville from January 1999 toApril 2004. Data abstracted included periprocedural complicationsand doses of midazolam and fentanyl used in the FBswith or without topical cocaine application in addition to theusual anesthesia with topical xylocaine. The Wilcoxon ranksum test was used for statistical analysis. Results. We identified92 FBs where topical 4% cocaine was used. A sample of80 FBs without cocaine use served as the control group. Therewere no periprocedural complications in either group. Therewas significantly less fentanyl use in the cocaine versus thecontrol group (P<0.0001, the median dose 75 vs. 100 mcg,respectively). There was no significance in midazolam use inthe cocaine versus the control group (p = 0.16). Conclusions.Topical application of 4% cocaine to each piriform sinus inaddition to standard xylocaine is safe. Its use is associatedwith significantly less use of fentanyl. Clinical implications.The use of topical cocaine may allow FB to be performed withless systemic narcotic use.

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Author Biographies

Emir Festic, Departments of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL

Margaret M. Johnson, Department of Critical Care Medicine and Division of Pulmonary Medicine, Mayo Clinic Florida

Jack P. Leventhal, Departments of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL

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Published

2010-04-29

How to Cite

Festic, E., Johnson, M. M., & Leventhal, J. P. (2010). The feasibility of topical cocaine use in fiberoptic bronchoscopy. Acta Medica Academica, 39(1), 1–6. Retrieved from https://ama.ba/index.php/ama/article/view/69

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Section

Clinical Science