Introduction To anaesthetise the vocal cords during bronchoscopy there are 2 methods in general use, transcricoid lidocaine or lidocaine administered directly through the bronchoscope (direct vision). The choice between the two methods is down to individual operator choice and there has been little work comparing each method. We performed a survey assessing several aspects of bronchoscopy to see if there was a difference between the 2 approaches.

Methods The bronchoscopist (one of three consultants and two registrars) and two nurses assessed patients degree of coughing, choking, sedation and overall tolerance of the procedure using a 10-point visual analogue scale. All patients were given 2–4 mg of midazolam as a sedative as is normal practice in our trust. Method of local anaesthesias and outcome of the bronchoscopy were noted. Results were analysed with a paired t test.

Results 33 patients were assessed, 14 patients had direct vision lidocaine and 19 had transcricoid lidocaine. 2 of the procedures were abandoned due to patient’s intolerance (both in the direct vision group). There was a significant reduction in coughing (3.5 vs. 5.7 p value 0.009) choking (1.9 vs. 3.9 p 0.004) and overall tolerance was better in the transcricoid group (8.0 vs. 5.6 p 0.003). There was no difference in the degree of sedation ( 5.4 vs. 4.9 p 0.4). There was no significant difference in the amount of successful biopsies performed in each group. There was no difference in the amount of midazolam given to each group (2.65mg vs. 2.68mg) and the differences were preserved despite the individual bronchoscopist.

Conclusions In this small pilot study The transcricoid group coughed and choked less and tolerated the procedure better in this survey. There was no difference between the groups in terms of sedation, total midazolam dosage or operator suggesting that this difference may due to the differing methods of local anaesthesia. A previous patient survey in our trust has shown patients themselves tolerated the transcricoid approach well. Further studies are needed to fully assess the differences between these two approaches and inform further practice.