The feasibility of topical cocaine use in fiberoptic bronchoscopy


  • 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


Bronchoscopy, Sedation, Anesthesia, Cocaine


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


Ernst A, Silvestri G, Johnstone D. Interventional Pulmonary Procedures; Guidelines from the American College of Chest Physicians. Chest. 2003;123:1693-717.

Lenox RJ. A proper balance. Chest. 2004;125(1):13-4.

Pickles J, Jeffrey M, Datta A, Jeffrey AA. Is preparation for bronchoscopy optimal? Eur Respir J. 2003;22(2):203-6.

British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001;56(Suppl I):i1-21.

Verlender JM Jr, Johns ME. The clinical use of cocaine. Otolaryngol Clin N Am. 1981;14(3):521-31.

Johnson PE, Belafsky PC, Postma GN. Topical nasal anesthesia for transnasal fiberoptic laryngoscopy: a prospective, double-blind, cross-over study. Otolaryngology-Head & Neck Surgery.


Graham DR, Hay JG, Clague J, Nisar M, Earis JE. Comparison of three different methods used to achieve local anesthesia for fiberoptic bronchoscopy. Chest. 1992;102(3):704-7.

Middleton RM, Shah A, Kirkpatrick MB. Topical nasal anesthesia for flexible bronchoscopy. A comparison of four methods in normal subjects and in patients undergoing transnasal bronchoscopy. Chest. 1991;99(5):1093-6.

Teale C, Gomes PJ, Muers MF, Pearson SB. Local anaesthesia for fibreoptic bronchoscopy: comparison between intratracheal cocaine and lignocaine. Respir Med. 1990;84(5):407-8.

Feldmann H. Diagnosis and therapy of diseases of the larynx in the history of medicine. Part III. After the invention of laryngoscopy. Laryngo-Rhino-Otologie. 2002;81(8)596-604.

The merits of cocaine. Laryngoscope. 1996;106(6):680.

Goodell JA, Gilroy G, Huntress JD. Reducing cocaine solution use by promoting the use of a lidocaine-phenylephrine solution. Am J Hosp Pharm. 1988;45(12):2510-3.

Osula S, Stockton P, Abdelaziz MM, Walshaw MJ. Intratracheal cocaine induced myocardial infarction: an unusual complication of fibreoptic bronchoscopy. Thorax. 2003;58(8):733-4.

Davies L, Mister R, Spence DP, Calverley PM, Earis JE, Pearson MG. Cardiovascular consequences of fibreoptic bronchoscopy. Eur Respir J. 1997;10(3):695-8.

Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest. 1999;115(5):1437-40.

Addington WR, Stephens RE, Goulding RE. Anesthesia for the superior laryngeal nerves and tartaric acid-induced cough. Arch Phys Med Rehab. 1999;80(12):1584-6.

Sant’Ambrogio G, Sant’Ambrogio FB. Role of laryngeal afferents in cough. Pulm Pharm. 1996;9(5-6):309-14.

Yoshida Y, Tanaka Y, Hirano M, et al. Sensory innervation of the pharynx and larynx. Am J Med. 2000;108(Suppl4)a51S-61S.

Kuna ST, Woodson GE, Sant’Ambrogio G. Effect of laryngeal anesthesia on pulmonary function testing in normal subjects. Am Rev Respir Dis. 1988;137(3):656-61.

Prakash UB, Offord KP, Stubbs SE. Bronchoscopy in North America: the ACCP survey. Chest. 1991;100:1668-75.

Shelley MP, Wilson P, Norman J. Sedation for fibreoptic bronchoscopy. Thorax. 1989;44:769-75.

Tsunezuka Y, Sato H, Tsukioka T, Nakamura Y, Watanabe Y. The role of codeine phosphate premedication in fibre-optic bronchoscopy under insufficient local anaesthesia and midazolam sedation. Respir Med. 1999;93(6):413-5.

Colt HG, Morris JF, Fiberoptic bronchoscopy without premedication: a retrospective study. Chest. 1990;98:1327-30.

Hatton MQ, Allen MB, Vathenen AS, Mellor E, Cooke NJ. Does sedation help in fibreoptic bronchoscopy? BMJ. 1994;309(6963):1206-7.

Pearce SJ. Fiberoptic bronchoscopy: is sedation necessary? BMJ. 1980;281:779-80.

Stolz D, Chhajed PN, Leuppi JD, Brutsche M, Pflimlin E, Tamm M. Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: a randomised, double blind, placebo controlled trial. Thorax.


Schleupner CJ, Hamilton JR. A pseudoepidemic of pulmonary fungal infections related to fiberoptic bronchoscopy. Infection Control. 1980:1(1):38-42.

Steere AC, Corrales J, von Graevenitz A. A cluster of Mycobacterium gordonae isolates from bronchoscopy specimens. Am Rev Respir Dis. 1979;120(1):214-6.

Greig JH, Cooper SM, Kasimbazi HJ, Monie RD, Fennerty AG, Watson B. Sedation for fibre optic bronchoscopy. Respir Med. 1995;89(1):53-6.

Hattotuwa K, Gamble EA, O’Shaughnessy T, Jeffery PK, Barnes NC. Safety of bronchoscopy, biopsy and BAL in research patients with COPD. Chest. 2002;122:1909-12.

Mendes de Leon C, Bezel R, Karrer W, Brändli O. [Premedication in fiber optic bronchoscopy from the patient’s and the physician’s viewpoint--a randomized study for the comparison of midazolam and hydrocodone]. Schweiz Med Wochenschr. 1986;116(37):1267-72.

Homsi J, Walsh D, Nelson KA. Important drugs for cough in advanced cancer. Support Care Cancer. 2001;9:565-74.

Hug CC Jr. Opioids: Clinical use as anesthetic agents. J Pain Symptom Manag. 1992;7(6):350-5.




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



Clinical Science