Does Cocaine Still Have a Role in Nasal Surgery?

  title={Does Cocaine Still Have a Role in Nasal Surgery?},
  author={Federico Latorre and Ludger Klimek},
  journal={Drug Safety},
Endonasal surgery is already very common and its importance is increasing. Successful anaesthesia in endonasal sinus surgery is of critical importance for the success of the procedure and many surgeons prefer to use cocaine for this purpose. However, there is a great body of evidence that suggests that use of cocaine, even in experienced hands, can cause rapid, unexpected and severe toxic reactions. Therefore, its use in endonasal surgery can no longer be recommended, especially since better… 
Cocaine toxicity after laryngoscopy in an infant.
  • M. Rezvani, D. Hartfield
  • Medicine
    The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique
  • 2006
Iatrogenic cocaine toxicity was observed in a 5-month-old male who received intranasal cocaine as a topical anesthetic for laryngoscopy and required 3 doses of IV lorazepam.
Nasal and instrument preparation prior to rigid and flexible nasendoscopy: a systematic review
The evidence suggests that local anaesthetic is not beneficial when performing flexible nasendoscopy, neither alone nor in combination with a vasoconstrictor, and water is better than lubricant for flexible endoscope passage and gives a superior optical outcome.
Myocardial ischaemia following cocaine and adrenaline exposure in a child during an ophthalmological procedure.
A 23-month old girl who presented with bilateral epiphora who underwent bilateral lacrimal probing and syringing, during which a cocaine adrenaline solution was used, developed acute pulmonary oedema secondary to myocardial ischaemia two hours after the procedure.
Efficacy of Lidocaine with or without Epinephrine in Rigid Nasal Endoscopy
  • M. Al-Qudah
  • Medicine
    American journal of rhinology & allergy
  • 2014
Adding epinephrine to lidocaine has no advantages in patients undergoing diagnostic rigid nasal endoscopy and there were no significant differences in pain, discomfort or ease of exam between the two groups.
Effects of Lidocaine Infiltration on Cost of Rhinoplasty Made Under General Anesthesia
In rhinoplasties under GA, the lidocaine + adrenaline combination infiltration not only decreased inhaled anesthetic requirement and cost but also supported the hemodynamic stability and surgical satisfaction increased in the lido- adrenaline group because of small number of agitated patients during the recovery period.
Toxicidade Cardiovascular da Cocaína de Natureza Iatrogénica. Caso Clinico
The case of a 29-year-old patient, with no known cardiovascular risk factors, admitted for elective nasal surgery, under general anesthesia combined with topical application of cocaine, who developed hemodynamic instability in the context of ventricular arrhythmias during surgery, after which she presented evolving electrocardiographic changes and increased levels of myocardial necrosis markers.
Focused local anesthesia and analgesia for head and neck surgery.
  • A. Herlich
  • Medicine
    International anesthesiology clinics
  • 2012
Facility in the use of head and neck regional blocks will provide excellent perioperative analgesia and patient satisfaction and Supplemental sedation will be more precise with the intended result of less hangover and nausea and vomiting.
Effects of Remifentanil on Hemodynamic Responses of Exogeneous Epinephrine during Endoscopic Sinus Surgery
Evaluated dose response effects of remifentanil infusion attenuate hypertension and tachycardia induced by epinephrine with little side effects to suppress these adverse responses without delaying emergence.


Anaesthesia for laryngoscopy
The present study was designed to compare the effects of lignocaine and cocaine on systemic blood pressure, cardiac rate and rhythm, and to assess the efficacy of propranol in the prevention and treatment of the cardiovascular effects of cocaine.
Functional endoscopic sinus surgery. Technique.
The purpose of functional endoscopic sinus surgery is to reestablish ventilation and mucociliary clearance of the sinuses by the endoscopic removal of disease from key areas of the anterior ethmoid and middle meatus.
Anesthesia in Endoscopic Sinus Surgery
A high level of patient satisfaction with the current anesthetic techniques is indicated, while identifying issues with postoperative nausea and vomiting are identified.
Microscopic Endonasal Surgery: Clinical Update for Treatment of Chronic Sinusitis with Polyps
The operative experience in a group of 325 patients who were treated for chronic sinusitis with polyposis nasi using microscopic endonasal surgery is detailed to detail the need for specialized instrumentation, general anesthesia, and difficult visualization of angular views.
Endoscopic Endonasal Surgery—Concepts in Treatment of Recurring Rhinosinusitis. Part II. Surgical Technique
  • H. Stammberger
  • Medicine
    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
  • 1986
Excellent results with this method indicate that there is seldom need for a Caldwell-Luc operation as the state-of-the-art procedure in chronic recurring sinusitis, and the dependent larger sinuses usually heal without having been touched.
Microscopic endonasal surgery of the paranasal sinuses and the parasellar region.
The anatomic principles and operative techniques currently applied to functional endoscopic endonasal surgery have allowed for significant refinements in another approach to regional pathology that
Microscopic Sinus Surgery, Transnasal Ethmoidectomy and Sphenoidectomy
The addition of the operating microscope with a special self‐retraining retractor speculum is presented in a series of 87 patients over 7 years, 49 of these having had transethmo‐sphenoidectomy, and there were no complications.
Lesson of the Week: Cocaine and adrenaline paste: a fatal combination?
Cocaine and adrenaline paste is most commonly used by otorhinolaryngologists for operations on the nose, including rhinoplasty and submucous resection and is an effective topical anaesthetic with an intense vasoconstrictor action that facilitates surgery and improves haemostasis.
Endonasal sinus surgery with endoscopical control: from radical operation to rehabilitation of the mucosa.
The radical operations of the paranasal sinuses with total removal of the diseased mucosa very often produced postoperative disability due to scar formation and nerve irritation. A new concept of
Endoscopic sinus surgery for mucoceles: A viable alternative
This paper presents the preliminary experience with 18 mucoceles in which endoscopic sinus surgery was attempted, and finds no disease recurrence has been noted to date with endoscopic follow‐up of up to 42 months.