For a child prepared for flexible fiberoptic bronchoscopy, which local anesthetic should be administered?

• A. Cetacaine
• B. Succinylcholine
• C. Isoflurane
• D. Levalbuterol

Answer: (A)

Before airway procedures like flexible fiberoptic bronchoscopy, numbing the mucosa of the oropharynx and upper airway helps suppress coughing and gagging, making the exam smoother and safer.

Cetacaine is the topical anesthetic of choice because it rapidly provides mucosal anesthesia when sprayed onto the airway surfaces. Its mix of benzocaine, tetracaine, and butamben is formulated for fast onset on the mucous membranes, allowing the bronchoscope to be passed with less patient discomfort.

The other options don’t serve as topical airway anesthetics. Succinylcholine is a muscle relaxant used for paralysis, not anesthesia. Isoflurane is an inhaled general anesthetic, not a local spray. Levalbuterol is a bronchodilator, not an anesthetic.

Note: dosing in children should be careful to minimize the risk of systemic toxicity or methemoglobinemia associated with benzocaine-containing products.