The agents most widely used to produce anesthesia for peroral endoscopy are tetracaine (Pontocaine) and cocaine. They are potent drugs and both are toxic in relatively small doses. When they are instilled into the tracheobronchial tree, the absorption of these agents approaches the speed of an intravenous injection. The combination of toxicity and rapid absorption makes untoward reactions to the anesthetic relatively common, and occasionally a death will result.4
Because the hazard has been recognized, such reactions to cocaine and tetracaine have been studied in detail.1 The conclusions, which correspond to clinical experience, suggest the untoward reactions to these topical anesthetic agents are a result of overdosage rather than drug sensitivity. Rigid dose control is, therefore, required to reduce the hazards of toxicity. This is achieved by reducing the concentration of the solution and limiting the volume administered so that rigid maximum dose control is achieved.
KLEITSCH WP. Safe Anesthesia for Peroral Endoscopy: A Subsequent Report. AMA Arch Otolaryngol. 1959;69(1):45–47. doi:10.1001/archotol.1959.00730030049006
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