Feasability of flexible bronchoscopy under sedation without local anaesthesia of the pharynx

Background and objectives: Local anaesthesia of the pharynx (LAP) is traditionally used for flexible bronchoscopy (FB). Nevertheless, its additional benefit to sedation concerning the reduction of cough and gagging is unclear. This prospective multicenter trial evaluated the feasibility of FB under sedation alone versus in combination with LAP and tested for non-inferiority. Material and methods: FB was performed in 72 consecutive patients either under sedation with propofol alone (33 patients 45.8%) or with additional oxybuprocaine 1% for LAP (39 patients, 54.2%). Assessment of patient characteristics (including sex, age, preexisting disease and smoking), periinterventional cardiorespiratory monitoring and sedation, and postinterventional coughing, (recorded with a microphone over 10 minutes as the primary objective) were conducted. Results: Demographic data (age, body mass index, preexisting lung disease and smoking history) were balanced between both groups. FB could be carried out in all patients as previously planned. Sedation dose, duration of the procedure and vital parameters did not differ between the groups. Within the first 10 minutes postintervention we observed a shorter cumulative coughing time of 51.4 s in the group without LAP compared to 79.7 s in the group receiving LAP. However, this difference was not significant (p = 0.46). In addition, there was no difference in complication rate and patient discomfort. Conclusions: FB under sedation without LAP can be adequately performed without disadvantages. Furthermore, it seems to be associated with less postinterventional coughing when compared to FB with additional LAP.