A Suitable Substitute for 4% Cocaine before Blind Nasotracheal Intubation

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Abstract
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 (x ± 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 < 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 < 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. The authors conclude that for nasotracheal intubation, topical 3% lidocaine in 0.25% phenylephrine is as effective as 4% cocaine. Because of cocaine's toxicity and the potential for its abuse, the use of a lido-caine-phenylephrine mixture should be encouraged. Address correspondence to Dr. Gross, Department of Anesthesia (112), Philadelphia Veterans Administration Medical Center, University and Woodland Avenues, Philadelphia, PA 19104. Presented in part at the annual meeting of the International Anesthesia Research Society, Reno, NV, March 1984. Accepted for publication June 18, 1984. The authors wish to thank the staffs of the operating and recovery rooms, as well as Dr. Anthony Checchio and the members of the Oral Surgery Department of Nazareth Hospital for their help in completing this study; we also thank Jeffrey L. Apfelbaum, MD, McIver W. Edwards, MD, and Carole McMonagle for their help in reviewing the manuscript. © 1984 International Anesthesia Research Society...

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