To the Editor.—I agree with Chiu et al1 that caution must be used when employing topical cocaine nasal anesthesia; however, in some situations, it may be better to block the actions of the cocaine directly, rather than to use nitrates or calcium channel blockers as they suggest.
I am speaking from direct experience, since during the four years of my residency, I witnessed three cases of cocaine-induced operating room crisis. There were several factors common to all: (1) All patients were local standby, healthy young adults, without history of cardiovascular problems. (2) All patients were anxious and had not been premedicated. (3) All patients had application of 200 mg of 4% cocaine solution (on 2.2 × 7-cm neurosurgical cottonoids), followed within a few minutes by injection through a 25- or 27-gauge needle of from 5 to 10 ml of 1% lidocaine with epinephrine 1:100 000. (4) All patients
GORDON BR. Topical Cocaine Nasal Anesthesia. Arch Otolaryngol Head Neck Surg. 1987;113(2):211. doi:10.1001/archotol.1987.01860020103026
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