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4 results

  • The use of lidocaine spray (Xylocaine) as a topical anaesthetic for minor ear procedures

  • G McNally, S Izzat
  • Journal:
    The Journal of Laryngology & Otology / Volume 136 / Issue 8 / August 2022
    Published online by Cambridge University Press:
    17 November 2021, pp. 734-736
    Print publication:
    August 2022
  • Background

    Injectable anaesthetic agents, topical creams and aqueous solutions have previously been used to anaesthetise the tympanic membrane for minor ear procedures. Topical creams take 20–30 minutes to work and injectable anaesthetics can cause canal swelling. The effectiveness of lidocaine spray has not previously been investigated in patients undergoing minor ear procedures.

    Methods

    Eighteen participants attending for out-patient grommet insertion or intratympanic steroid injection were prospectively recruited for this study over six months. Post-operatively, they were asked about their perceived level of pain and overall experience.

    Results

    The median level of pain measured on an 11-point visual analogue scale was 2 out of 10. Forty-four per cent reported the overall experience as pleasant, with the remainder selecting slightly unpleasant (66 per cent). All participants stated they would undergo the procedure again.

    Conclusion

    Xylocaine spray is simple to administer, rapid-acting and well tolerated by patients for anaesthesia of the tympanic membrane during minor ear procedures in the out-patient setting.

  • Co-Phenylcaine Spray: can we improve the taste? A randomised, double-blind, crossover study

  • S Bailey, B Panizza, P Cabot, B Wallwork
  • Journal:
    The Journal of Laryngology & Otology / Volume 132 / Issue 2 / February 2018
    Published online by Cambridge University Press:
    07 July 2017, pp. 138-142
    Print publication:
    February 2018
  • Objective:

    Co-Phenylcaine Forte is a nasal spray routinely prescribed by otolaryngologists in Australia. The taste of Co-Phenylcaine Forte is typically described as unpleasant. This study sought to improve the overall patient experience associated with Co-Phenylcaine Forte by generating a Co-Phenylcaine Forte formulation, referred to as Co-Phenylcaine Zest, which contains an added vanilla flavour and masking agent.

    Methods:

    Participants were randomised to receive two actuations of Co-Phenylcaine Forte in each nostril followed by two actuations of Co-Phenylcaine Zest, or vice versa. There was a 6–36-hour washout period between each treatment. After the administration of each spray, participants completed a questionnaire to rate various sensory attributes of each formulation on seven-point ordinal scales. Patients reported their overall formulation preference after receiving both treatments.

    Results:

    A total of 86 participants completed the trial. Seventy-four per cent of patients preferred Co-Phenylcaine Zest, 21 per cent preferred Co-Phenylcaine Forte and 5 per cent had no preference (p < 0.001). The satisfaction score associated with Co-Phenylcaine Zest was 1.22 points greater than with Co-Phenylcaine Forte (p < 0.001).

    Conclusion:

    A novel formulation of Co-Phenylcaine Forte was created by adding a flavour and a masking agent; this formulation was preferred by most patients.

  • 30 - Asthma

  • from Section 5 - Respiratory emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 203-207

  • Summary

    This chapter discusses the diagnosis, evaluation and management of status epilepticus. Seizures, which may be the result of central nervous system (CNS) infection, require early and empiric antibiotics, antivirals, and possibly steroids, ideally before lumbar puncture is performed. Seizures may require additional treatment and can be refractory to first-line agents (i.e., benzodiazepines) and second-line agents (i.e., phenytoin, phenobarbital, and valproate). If seizures are refractory to first- and second-line agents, levetiracetam or lacosamide, or induction with general anesthesia by inhalational anesthetics has to be considered. The most likely causes for sudden decompensation are airway compromise/respiratory failure, sepsis/septic shock, and recurrent seizure activity. Patients requiring multiple boluses of medications or continuous infusions should be considered for intubation for airway protection. Patients with an infectious etiology may rapidly progress to sepsis and require additional hemodynamic support. Prolonged seizure activity with or without overt muscle twitching is associated with increased mortality.