ORL; journal for oto-rhino-laryngology and its related specialties
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 1992
Randomized Controlled Trial Clinical TrialEffects of topical laryngeal lidocaine on sympathetic response to rigid panendoscopy under general anesthesia.
The sympathetic response to rigid bronchoscopy, laryngoscopy and esophagoscopy, performed under general anesthesia with isoflurane, was examined in patients who either received 5 ml of 2% lidocaine (n = 7) or 5 ml of saline (n = 7), sprayed on larynx and upper trachea under direct laryngoscopy, 2 min before the introduction of the rigid bronchoscope. Blood pressure, heart rate and plasma catecholamine and lidocaine levels were measured at specific time points of the study. Topical lidocaine led to a rapid and prolonged increase in plasma lidocaine levels. ⋯ Blood pressure and heart rate response during rigid panendoscopy, isoflurane requirements and time interval from termination of panendoscopy to extubation were not different between the two groups. However, in contrast to the control group, patients who had received lidocaine had no significant rise in blood pressure and heart rate from baseline following the introduction of the rigid bronchoscope. The benefit of this moderate hemodynamic stabilizing effect of lidocaine has to be weighted against the risk of decreased protective airway reflexes due to topical laryngeal lidocaine during recovery from anesthesia.
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ORL J. Otorhinolaryngol. Relat. Spec. · Jan 1992
Case ReportsVentricular fibrillation following local application of cocaine and epinephrine for nasal surgery.
We report the case of a 17-year-old female patient, scheduled for septoplasty under general anesthesia, who developed ventricular fibrillation after intranasal application of cocaine (350 mg) and submucosal injection of lidocaine (20 mg) with epinephrine (100 micrograms). Resuscitation by external chest compression was successful, and normal sinus rhythm was reestablished after lidocaine injection (50 mg, i.v.). The cardiac risk of the combined administration of cocaine and epinephrine during general anesthesia are discussed.