During a bronchoscopy, if a child begins to cough as the bronchoscope advances, what should the specialist recommend?

When a child begins to cough during a bronchoscopy, it indicates an airway reflex to irritation. In this scenario, the use of Cetacaine, which is a topical anesthetic containing benzocaine, is appropriate because it can help numb the throat and airway tissues. By reducing the sensitivity of these areas, Cetacaine can minimize coughing reflexes, which is particularly beneficial during a bronchoscopy to allow for a smoother procedure and to prevent potential complications caused by excessive coughing.

The other options may not serve the immediate purpose as effectively in this context. Succinylcholine is a neuromuscular blocker that could be used for intubation but is not the first-line response to manage a cough reflex during a procedure. Racemic epinephrine is typically used for airway edema or stridor rather than directly addressing coughing due to bronchoscopy irritation. Ketamine is an anesthetic that provides sedation and analgesia, but it may not directly mitigate the reflexive cough at that moment.

Thus, recommending Cetacaine is the most suitable choice as it directly addresses the discomfort and irritation causing the cough during the procedure.