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Topical Anesthesia in Office-Based Laryngeal Surgery

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Office-Based Laryngeal Surgery

Abstract

The resurgence of office-based laryngeal surgery is ascribed in part to the successful application of topical anesthesia to the upper airway. Several topical anesthetics are readily available for use by otolaryngologists, and these are classified as amides such as lidocaine, prilocaine, and etidocaine, and esters such as tetracaine, benzocaine, and procaine. Each of these topical anesthetics has a recommended dosage, time of onset of action, and duration. Topical anesthesia to the pharynx is commonly administered by spraying the oral cavity, oropharynx, and hypopharynx with 4% lidocaine, or Cetacaine (Cetylite, Pennsauken, NJ), a combination of benzocaine 14%, butamben 2%, and tetracaine hydrochloride 2%. Alternatively, topical anesthesia may be applied directly by using a cotton ball held by a curved forcep at the base of the tongue, epiglottis, and even pyriform sinuses. Similarly, topical anesthesia to the larynx may be administered using several methods. These include dripping the local anesthetic via the working channel of the flexible nasopharyngoscope, dispersing the local anesthetic via a small catheter introduced through the working channel of the flexible nasopharyngoscope, or delivering the local anesthetic via a curved suction or cannula introduced perorally while asking the patient to phonate, breathe or gargle. Other commonly described techniques include the use of a pressurized nebulizer to inhale the anesthetic, or injection of the local anesthetic into the airway using a needle inserted percutaneously via the cricothyroid membrane or trachea. Nerve block of the internal laryngeal branches of the superior laryngeal nerves is used less frequently but can be extremely effective.

There is no consensus on the best anesthetic approach/technique for unsedated office-based laryngeal surgery. The choice of approach/technique is left to the discretion of the surgeon who needs to take into consideration patient-related factors such as anatomy and tolerance, as well as comorbidities. This chapter reviews the methods used to apply topical anesthesia to the upper airway. The effect of topical anesthesia on the sensation and function of the laryngo-pharyngeal complex is reviewed, and associated systemic toxicities are discussed.

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Authors and Affiliations

  1. Otolaryngology, Head & Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon

    Abdul-latif Hamdan

  2. Department of Otolaryngology Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA

    Abdul-latif Hamdan

  3. Otolaryngology – Head and Neck Surgery, Drexel University, Philadelphia, PA, USA

    Robert Thayer Sataloff & Mary J. Hawkshaw

Authors
  1. Abdul-latif Hamdan
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  2. Robert Thayer Sataloff
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  3. Mary J. Hawkshaw
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Corresponding author

Correspondence to Abdul-latif Hamdan .

1 Electronic Supplementary Material

Transnasal application of topical anesthesia. Note the laryngeal gargle dispersing the anesthetic solution in the larynx and pharynx (MP4 19501 kb)

Transoral application of topical anesthesia (MP4 1834 kb)

Transcervical (percutaneous) injection of the topical anesthetic (2% lidocaine) via the cricothyroid membrane (MP4 21779 kb)

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Hamdan, Al., Sataloff, R.T., Hawkshaw, M.J. (2022). Topical Anesthesia in Office-Based Laryngeal Surgery. In: Office-Based Laryngeal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-91936-8_6

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  • DOI: https://doi.org/10.1007/978-3-030-91936-8_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-91935-1

  • Online ISBN: 978-3-030-91936-8

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