Question

While you are performing an awake fi beroptic , the patient starts coughing when your bronchoscope contacts the posterior side of the epiglottis. Which of the following maneuvers will most likely correct this problem?

A. Bilateral injections of 2 mL of 1% lidocaine into the base of the anterior tonsillar pillar
B. An injection of 4 mL of 4% lidocaine through the cricothyroid membrane into the trachea
C. Bilateral injections of 2 mL of 1% lidocaine at the level of the thyrohyoid membrane just below the greater cornu of the thyroid cartilage
D. Placing local anesthetic-soaked swabs against the inferior aspects of the palatoglossal folds
E. Bilateral injections of 10 mL of 1% lidocaine at the posterior border of the sternocleidomastoid at and near the level of C4

Answer 1

To correct coughing during an awake fiberoptic bronchoscopy, injecting 4 mL of 4% lidocaine through the cricothyroid membrane into the trachea is the most effective option as it anesthetizes the tracheal mucosa and reduces the cough reflex.

Step-by-step explanation:

When a patient starts coughing during an awake fiberoptic procedure as the bronchoscope contacts the posterior side of the epiglottis, a likely solution is to apply topical anesthesia to mitigate the cough reflex. The cough is triggered as a protective reflex when the bronchoscope stimulates the area, which is rich in sensory innervations that link to the cough reflex. To correct this problem, the recommended maneuver is to provide anesthetic to the appropriate area to minimize the cough reflex and allow for the completion of the procedure.

Among the options provided, B. An injection of 4 mL of 4% lidocaine through the cricothyroid membrane into the trachea is likely the most effective. This is because injecting lidocaine directly into the airway can anesthetize the tracheal mucosa, the cough reflex pathways, and the lower airway, hence reducing coughing during the procedure.