title: Modified technique of iontophoretic anesthesia for myringotomy in children.
abstract: A modified technique is described for iontophoretic anesthesia in children who require myringotomy and insertion of a tube (tympanostomy). Principal modifications include the following procedures: (1) preoperative parenteral sedation; (2) relatively painless injection of lidocaine hydrochloride-epinephrine hydrochloride solution into the external auditory canal skin after iontophoresis alone to eliminate the extreme bony canal wall tenderness; (3) injection of lidocaine-epinephrine solution into an atelectatic middle ear to anesthetize the promontory for painless tube insertion; (4) substitution of a disposable ECG electrode for a metal plate electrode to eliminate the possibility of electrical burn from metal-to-skin contact. These modifications enhance the effectiveness and the safety of iontophoretic anesthesia, minimize the need for general anesthesia, and liberalize the indications for tympanostomy.
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004432:Ear, Middle; D004566:Electrodes; D004837:Epinephrine; D006801:Humans; D007478:Iontophoresis; D008012:Lidocaine; D014432:Tympanic Membrane / Q000601:surgery*
chemical_list: D008012:Lidocaine; D004837:Epinephrine