Topical Anesthetics

The medications that can be used for topical anesthesia are:

• Tetracycline (cetacaine):
  I use cetacaine spray to anesthetize the oropharynx. Four to five sprays should suffice.

  One death and five serious complications have been reported due to the misuse of cetacaine. You should not use excessive amounts for fear of inducing methemoglobinemia.

• Xylocaine (lidocaine):
  Lidocaine (xylocaine): I use lidocaine to anesthetize the patient's larynx and tracheobronchial tree. If the transnasal approach is selected, I start with lidocaine jelly. A cotton swab with lidocaine jelly is gently passed into both nostrils. I then drip 4% lidocaine over the swab and advance the swab. I repeat this procedure until the pharynx is reached.

  For the transoral approach, initially spray the oropharynx with cetacaine. Each pyriform fossa can then be blocked by the application of cotton balls soaked in 4% lidocaine. Then drip 2 cc's of lidocaine beyond the tongue to anesthetize the epiglottis.

• Cocaine:
  Cocaine is an ideal anesthetic for topical nasal anesthesia. It causes the turbinates to shrink and facilitates passage of the scope and minimizes bleeding. Unfortunately, cocaine is misused by our society and is difficult to control. The criminal elements start invading the department once they know there is cocaine. Due to this problem, I do not use cocaine.

  If you are interested in the use of cocaine for topical anesthesia, read the following reference:

  References:

  1. Yrigoyen, E, et al. Flexible fiberoptic bronchoscopy anesthesia, technique and results. Western J of Med 122:117-22, 1975.
• Dyclonine:
  0.5% dyclonine gargle is used by some as an initial procedure to anesthetize the oral cavity.