Nebulized lidocaine and ketamine vs. lidocaine before fiberoptic bronchoscopy

Abstract

<bold>Objectives:</bold> To compare nebulized lidocaine and ketamine (LK) vs. lidocaine (L) as premedication for fibreoptic bronchoscopy regarding reduction of cough episodes, patient comfort, hemodynamic stability and drug toxicity. <bold>Methods:</bold> A prospective randomized controlled study that recruited adult patients referred to Alexandria Main University Hospital for bronchoscopy between September 2024 and February 2025 irrespective of their underlying lung pathology. The patients were subjected either to nebulized LK (60 mg/150 mg) or nebulized L (60 mg) alone or lidocaine 2% spray (LS) as premedication pre-bronchoscopy. Oxygen saturation (SpO2), blood pressure (BP) and heart rate (HR) were recorded before, during and after bronchoscopy. Cough score, patient discomfort and side effects were recorded. <bold>Results:</bold>125 patients were included (41 LK, 52 L, 32 LS). There was no significant difference between the groups regarding pre-bronchoscopic SpO2, HR, BP (P>0.05). However, SpO2 was significantly higher during/after bronchoscopy for LK vs. L and LS groups (P<0.001) but not BP or HR. The cough score was significantly lower in LK group compared to others (P=0.005). 91% and 41% of LS group had significant discomfort and pain respectively vs. none in the others (P<0.001). During and post-bronchoscopy discomfort were significantly lower in LK compared to L and LS groups (P<0.01). 15% and 73% of LK group had transient disequilibrium and dizziness (P<0.01). There was no statistically significant difference between the groups regarding the sedation dose given during bronchoscopy (P>0.05). <bold>Conclusion:</bold> Nebulized combined LK before bronchoscopy is effective, safe with less hypoxia and no hemodynamic instability during/after the procedure