The feasibility of topical cocaine use in fiberoptic bronchoscopy
Keywords:Bronchoscopy, Sedation, Anesthesia, Cocaine
AbstractObjective. 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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