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December 1966

Local Anesthesia for Peroral Endoscopy: Using Superior Laryngeal Nerve Block With Topical Application

Arch Otolaryngol. 1966;84(6):654-657. doi:10.1001/archotol.1966.00760030656012

LOCAL ANESTHESIA remains the technique of choice for direct laryngoscopy in medical teaching institutions in the United States. Of those institutions replying to a questionnaire circulated in 1962, 70% reported using local anesthesia predominantly.1 Presumably a similar figure applies for bronchoscopy and esophagoscopy. The generally accepted method involves application of topical anesthetic agents to oral and pharyngeal surfaces, followed by transmucosal blocking of the superior laryngeal nerves with applicators placed in the pyriform sinuses. The agent is then dripped onto the vocal cords and into the trachea using indirect visualization. Commonly used anesthetics are 5% cocaine and 2% tetracaine, the maximum safe dosage of each being only 4 ml.2 More dilute solutions may be used to allow greater volume, but their anesthetic qualities will be proportionately reduced. We have found it difficult to stay within the safe-dosage limit of these agents and still achieve adequate anesthesia. The procedure