Lidocaine in Bronchoscopy

Topical lidocaine is commonly used to obtain airway mucosal anesthesia during flexible bronchoscopy. Although its safety profile is excellent and there are few reports of adverse effects and allergies, precautions are necessary to avoid using lidocaine inappropriately and to avoid excess administration in patients at risk for lidocaine-related adverse events. The purpose of this article is to identify indication and profiles of various forms of lidocaine preparations, describe the properties of lidocaine and other topical and local anesthetics of the amide and ester groups used for bronchoscopy, to briefly identify adverse events related to toxicity and review existing literature pertaining to allergic reactions, and to discuss a practical decision-making approach to assure patient safety in case of documented or suspected lidocaine allergy.