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Current methods of local anesthesia for peroral endoscopy are unsatisfactory because of (1) the toxic results of the effective surface anesthetics, (2) the discomfort—to put it mildly—to the patient caused by peroral endoscopies under local anesthesia, and (3) the lack of relaxation of the structures underlying the mucosa of the pharynx and larynx. A surface anesthetic does not relax the deeper structures such as the base of the tongue and the cricopharyngeus muscle (the "pinchcock of the esophagus"). The upper front teeth and their gums remain sensitive to the unavoidable pressure of the endoscope. The patient with long upper teeth and/or a short, muscular neck is a dreaded prospect for peroral endoscopies.
I have devised a method whereby the conventional surface anesthetics can be avoided almost completely. The usual preoperative medication (barbiturates, narcotics, and atropine) is given. The area to be described below is anesthetized by injecting a procaine-hyaluroni-dase mixture
Adler HJ. NEW METHOD FOR LOCAL ANESTHESIA IN PERORAL ENDOSCOPYPRELIMINARY REPORT. JAMA. 1955;159(2):111–112. doi:10.1001/jama.1955.02960190017006
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