The feasibility of topical cocaine use in fiberoptic bronchoscopy

Objective. To test the hypothesis that the application of 4% cocaine-soaked cotton pledgets to each piriform sinus for one minute represents a safe and efficacious method of providing additional topical anesthesia for fiberoptic bronchoscopy. Materials and Methods. We retrospectively reviewed all FBs performed at Mayo Clinic Jacksonville from January 1999 to April 2004. Data abstracted included periprocedural complications and doses of midazolam and fentanyl used in the FBs with or without topical cocaine application in addition to the usual anesthesia with topical xylocaine. The Wilcoxon rank sum test was used for statistical analysis. Results. We identified 92 FBs where topical 4% cocaine was used. A sample of 80 FBs without cocaine use served as the control group. There were no periprocedural complications in either group. There was significantly less fentanyl use in the cocaine versus the control group (P<0.0001, the median dose 75 vs. 100 mcg, respectively). There was no significance in midazolam use in the cocaine versus the control group (p = 0.16). Conclusions. Topical application of 4% cocaine to each piriform sinus in addition to standard xylocaine is safe. Its use is associated with significantly less use of fentanyl. Clinical implications. The use of topical cocaine may allow FB to be performed with less systemic narcotic use.