A suitable substitute for 4% cocaine before blind nasotracheal intubation: 3% lidocaine-0.25% phenylephrine nasal spray.
To assess the efficacy of potential substitutes for cocaine as a topical anesthetic before nasal intubation, the authors performed a double-blind study comparing the hemodynamic effects of blind nasotracheal intubation in 75 patients receiving one of three nasal sprays: 4% cocaine (C), a mixture of 3% lidocaine in 0.25% phenylephrine (L-P), and 0.25% phenylephrine alone (P). Three minutes after 0.5 ml of one of the solutions was sprayed into each nostril, anesthesia and paralysis were induced with thiopental (5 mg/kg) followed by succinylcholine (1 mg/kg); immediately after induction, mean arterial pressure (MAP) and heart rate (HR) were recorded. After blind nasotracheal intubation was accomplished, MAP and HR were recorded for 5 min while anesthesia was maintained with 70% N2O in O2. In patients receiving L-P, mean MAP during the 5 min after intubation decreased 2.3 +/- 2.2 mm Hg (mean +/- SEM); this was significantly different from the increase of 6.2 +/- 1.7 and 8.5 +/- 2.0 mm Hg in MAP after intubation of patients receiving C and P, respectively (P less than 0.005). Although mean HR decreased during the 5 min after intubation in all groups, this decrease was significantly greater (9.6 +/- 1.4 beats/min) in patients receiving L-P than in those receiving C (3.1 +/- 1.6 beats/min) or P (0.1 +/- 1.7 beats/min) (P less than 0.005). Changes in HR and MAP were similar in patients receiving C and P. There was no significant difference in the incidence or severity of epistaxis among the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)
D000772:Anesthesia, Local; D001794:Blood Pressure / Q000187:drug effects; D003042:Cocaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004338:Drug Combinations; D004844:Epistaxis / Q000517:prevention & control; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage*; D014663:Nasal Decongestants; D009297:Nasal Mucosa; D010656:Phenylephrine / Q000008:administration & dosage*; D011897:Random Allocation; D013390:Succinylcholine; D013874:Thiopental
D004338:Drug Combinations; D014663:Nasal Decongestants; D010656:Phenylephrine; D008012:Lidocaine; D003042:Cocaine; D013390:Succinylcholine; D013874:Thiopental