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Correspondence  |   March 1995
A Simple Adaptation to the Olympus LF1 and LF2 Flexible Fiberoptic Bronchoscopes for Instillation of Local Anesthetic
Author Notes
  • Jerry Vloka, M.D., Resident in Anesthesiology, Admir Hadzic, M.D., Resident in Anesthesiology, Eric Kitain, M.D., Assistant Professor of Anesthesia, Associate Director, Department of Anesthesiology, Department of Anesthesiology St. Luke's/Roosevelt Hospital Center College of Physicians and Surgeons of Columbia University, 1000 Tenth Avenue, New York, New York 10019.
Article Information
Correspondence
Correspondence   |   March 1995
A Simple Adaptation to the Olympus LF1 and LF2 Flexible Fiberoptic Bronchoscopes for Instillation of Local Anesthetic
Anesthesiology 3 1995, Vol.82, 792. doi:
Anesthesiology 3 1995, Vol.82, 792. doi:
To the Editor:—In the management of the difficult airway, flexible fiberoptic bronchoscopy plays an important role. During fiberoptic intubation the airway can be effectively anesthetized by instilling local anesthetic through the patent channel of the fiberoptic bronchoscope [1 ] instead of performing multiple nerve blocks. We use the Olympus LF1 and LF2 flexible fiberoptic bronchoscopes (FFB). The manual for the bronchoscope states that “… instillation of anesthetics can be performed through its 1.5 mm (internal diameter) channel.”
We have found that the method for injecting local anesthetic described in the manual is impractical and awkward. Instillation of local anesthetic requires firm pressure on the fiberoptic injection port, which can lead to unintentional movement of the FFB and image loss. This can add to the procedure time and may be responsible for failure to adequately anesthetize the aryepiglottic region and the vocal cords. Additionally, the significant deadspace of the injection port and possible leakage of local anesthetic during injection make it difficult to estimate the total amount of injected local anesthetic. To circumvent these problems, we have used the 4-inch filter straw from a PERIFIX Continuous Epidural Anesthesia Tray (Burron CE-1 8TK) to instill local anesthetic solution through the FFB injection port (Figure 1). The filter straw is first attached to a 10-ml syringe filled with local anesthetic and then inserted as deeply as possible through the injection port.
Figure 1. Attachment of the filter straw through the injection port of the fiberoptic bronchoscope.
Figure 1. Attachment of the filter straw through the injection port of the fiberoptic bronchoscope.
Figure 1. Attachment of the filter straw through the injection port of the fiberoptic bronchoscope.
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The filter straw bypasses the deadspace of the valve and firmly holds the syringe to the FFB during the procedure. Instillation of local anesthetic through this adaptation allows for exact dosing of local anesthetic and minimal interference with the FFB image and is less awkward, particularly when a single anesthesiologist performs the awake fiberoptic intubation.
Jerry Vloka, M.D., Resident in Anesthesiology, Admir Hadzic, M.D., Resident in Anesthesiology, Eric Kitain, M.D., Assistant Professor of Anesthesia, Associate Director, Department of Anesthesiology, Department of Anesthesiology St. Luke's/Roosevelt Hospital Center College of Physicians and Surgeons of Columbia University 1000 Tenth Avenue New York, New York 10019.
(Accepted for publication November 28, 1994.)
REFERENCES
Norley J, Lander C: Topicalization, oxygenation, and suction via a single-channel fiberoptic bronchoscope. ANESTHESIOLOGY 65:116. 1986.
Figure 1. Attachment of the filter straw through the injection port of the fiberoptic bronchoscope.
Figure 1. Attachment of the filter straw through the injection port of the fiberoptic bronchoscope.
Figure 1. Attachment of the filter straw through the injection port of the fiberoptic bronchoscope.
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