Ann Oto Rhinol Laryn
-
Despite the strong trend toward use of general anesthesia for laryngoscopy, local anesthesia retains inherent advantages from the standpoint of patient safety and maintenance of physiologic function of the larynx during endoscopy. Topical anesthesia produces incomplete sensory blockade and is unsatisfactory for suspension laryngoscopy. A method of infiltration anesthesia is described whereby profound anesthesia of the base of the tongue, valleculae, and larynx can be achieved to allow suspension laryngoscopy.
-
Ann Oto Rhinol Laryn · Sep 1975
Special new low resistance to flow tube and endotracheal tube adapter for use during fiberoptic bronchoscopy.
This paper describes endotracheal tubes and adapters which are designed specially for fiberoptic bronchoscopy; the tubes are designed in such a way that they are wide at the upper part but are narrow and thin walled in the part of the tube which goes through and below the cords. By designing tubes in this manner, the resistance to flow of gas through the tube when the fiberoptic bronchoscope is in place is very much reduced and the safety of the whole precedure is enhanced. ⋯ A plug is available for the hole in the diaphragm when the fiberoptic bronchoscope is not being used. Clinical and laboratory data show that these pieces of equipment perform the function for which they were designed.
-
Almost a half century following attempts to ban its use, cocaine remains at the pinnacle of topical anesthesia in otolaryngology. To understand how nonaddicting synthetic substitutes such as procaine, dibucaine, tetracaine and lidocaine have not totally supplanted cocaine, requires an in-depth analysis of its unique pharmological properties, untoward effects and potential substitutes. Almost all of the reported cocaine deaths occurred after subcutaneous injection; when used topically, cocaine's toxicity has been confined to an occasional reaction. ⋯ Of other local anesthetics possessing topical effectiveness tetracaine is about six times more toxic than cocaine. Dibucaine is as toxic as tetracaine, and lidocaine, while relatively nontoxic, provides only a 15 minute duration of topical anesthesia. A review of cocaine and its potential substitutes thus leads to the conclusion that cocaine is still a vital and necessary instrument in the otolaryngologist's armamentarium, singularly providing excellent topical anesthesia of usable duration, vasoconstriction, and shrinkage of mucous membranes, all with a quite acceptable margin of safety.