1. Spray cetacaine over the patient's tongue and pharynx. Three to four sprays should suffice. Do not spray cetacaine excessively. I once saw one of my fellows produce methemoglobinemia in a patient due to excessive use of spray.
  2. Drip 2 cc's of 2% xylocaine behind the patient's tongue over the epiglottis with a curved nozzle.
  3. Soak a cotton swab in 4% xylocaine and hold it on the pyriform fossa for one minute. Repeat the procedure for the opposite side.
  4. Wear gloves. Insert your finger beyond the tongue and gently pull the epiglottis forward. Instruct the patient not to bite your fingers. Position the curved nozzle beyond the epiglottis and instill 2 cc's of 2% xylocaine into the larynx.
  5. The patient will cough if the procedure is successful. Instruct the patient to spit out the excess anesthetic to minimize the dose.
  6. Allow the patient to lay down and be comfortable. Start an IV line and titrate versed. I give 1-2 mg at a time, watching the patient's response. Older patients are very sensitive to versed. Therefore, 1 or 2 mg may suffice. Never push 10 mg in one stroke. Versed makes the procedure go smoothly and provides amnesia. An excessive dose can induce respiratory depression. In the past, I used valium with good results. However, I find versed to be better.

    Let me share an anecdote with you. I once got into trouble with valium. One of my patients stopped breathing after only 2 mg of valium. I has removed his breathing aids and he could not hear my commands to breath. I quickly intubated and bagged him for a few minutes. He started respirations on his own and I was then able to complete the procedure.

    Valium induced respiratory depression can be overcome. The patient will respond to your instructions to take a deep breath. I got into trouble by removing my patient's hearing aids.

  7. Drape the patient and cover the eyes. I like to wear a surgical scrub suit and gloves. The procedure cannot be done under sterile conditions. However, it should be done under clean conditions.

Fiberoptic bronchoscopy can be done easily with topical anesthesia and is the current standard. Let us discuss, in more detail, anesthetizing the patient for a bronchoscopy. There are choices to be made for the following:

  1. Type of anesthesia
  2. Medications for topical anesthesia
  3. Mode of delivery of the local anesthesia
  4. Method of anesthetizing the larynx

The choice of anesthesia used for bronchoscopy are:

  1. Topical
  2. General: General anesthesia may be indicated in children, uncooperative adults and when performing a rigid bronchoscopy


  1. Carden, E. Recent improvements in techniques for general anesthesia for bronchoscopy. Chest 73:697-700, 1978.

If you take care to anesthetize your patient properly, the procedure will go smoothly.