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Topical Anaesthesia (topical + anaesthesia)

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Medical Sciences	100%

Selected Abstracts

Topical anaesthesia before nasendoscopy: a randomized controlled trial of co-phenylcaine compared with lignocaine

CLINICAL OTOLARYNGOLOGY, Issue 1 2006
R. Douglas
Objective:, To evaluate the relative effectiveness of co-phenylcaine (lignocaine 5% with phenylephrine) and lignocaine 5% sprays when administered prior to rigid nasendoscopy. Design:, Randomized, double blind controlled study. Setting:, Teaching hospital otolaryngology unit. Participants:, Thirty patients requiring routine outpatient rigid nasendoscopy were administered five puffs of either co-phenylcaine or lignocaine 5% spray which had been randomly assigned to either the first or the second visit. Ten minutes later nasendoscopy was performed. Immediately after nasendoscopy the ease of performance of the procedure and the quality of the view achieved was rated on a visual analogue scale by the endoscopist and the patients recorded the level of pain experienced on a visual analogue scale. Two weeks later, the patients returned for a repeat nasendoscopy, receiving the alternate spray. Main outcomes measures:, Ease of performance and quality of view of achieved by endoscopists and pain experienced by patients, both measured with visual analogue scales. Results:, The ease of passage of the endoscope and quality of the view obtained was found to be greater after the administration of co-phenylcaine [visual analogue scores 84 (95% CI: 80,89) than after lignocaine and 77 (95% CI: 73,81) (P < 0.01)]. The two sprays produced similar levels of topical anaesthesia. Conclusions:, Nasendoscopy can be performed with minimal discomfort after the administration of either co-phenylcaine or lignocaine 5% sprays. The vasoconstricting action of co-phenylcaine increases the ease of passage of the endoscope and quality of the view obtained by the endoscopist. [source]

Airway topical anaesthesia and awake tracheal intubation using the Airtraq® laryngoscope alone

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010
F. S. Xue
No abstract is available for this article. [source]

Methodology of oral sensory tests

JOURNAL OF ORAL REHABILITATION, Issue 8 2002
R. Jacobs
Summary Different methods of oral sensory tests including light touch sensation, two-point discrimination, vibrotactile function and thermal sensation were compared. Healthy subjects were tested to assess the results obtained from two psychophysical approaches, namely the staircase and the ascending & descending method of limits for light touch sensation and two-point discrimination. Both methods appeared to be reliable for examining oral sensory function. The effect of topical anaesthesia was also evaluated but no conclusion could be drawn as too few subjects were involved. Newly developed simple testing tools for two-point discrimination and thermal sensation in a clinical situation were developed prior to this study and tested for their reproducibility. Thermal sensation could be reliably detected in repeated trials. Although the hand-held instruments have some drawbacks, the outcome of these instruments in a clinical environment is suitable for assessing oral sensory function. Three different frequencies (32, 128 and 256 Hz) were used to estimate the vibrotactile function. Different threshold levels were found at different frequencies. [source]

Bronchoscopy in Japan: A survey by the Japan Society for Respiratory Endoscopy in 2006

RESPIROLOGY, Issue 2 2009
Hiroshi NIWA
ABSTRACT Background and objective: In order to obtain information on the clinical application of bronchoscopy in Japan, the Japan Society for Respiratory Endoscopy (JSRE) conducted a postal survey. Methods: A questionnaire was sent to 526 authorized institutes of the JSRE. The subject was bronchoscopy procedures performed during 2006. Results: The response rate was 71.3%. The total number of bronchoscopies performed was 74 770. Of these, 74 412 were flexible bronchoscopies and 358 were rigid bronchoscopies. At least one JSRE-authorized specialist had worked with 97% of respondents. Eighty-five per cent of respondents performed bronchoscopy under topical anaesthesia for almost all patients. Seventy-five per cent of respondents routinely used the oral route. The reported numbers of diagnostic bronchoscopies was 12 509 for simple bronchoscopy, 25 971 for forceps biopsy, 26 289 for brush biopsy, 25 659 for bronchial washing, 1387 for transbronchial needle aspiration and 6716 for BAL. Three deaths were caused by forceps biopsy (0.012%). The morbidity rates for these diagnostic procedures ranged from 0.14% to 2.5%. The reported numbers of therapeutic bronchoscopies was 476 for tracheobronchial stent, 164 for neodymium (Nd): yttrium-aluminium garnet (YAG) laser photoresection (LPR), 40 for photodynamic therapy, 81 for balloon dilatation, 145 for endobronchial electrocautery, 120 for argon plasma coagulation, 109 for microwave coagulation (MWC), 116 for ethanol injection, 110 for foreign body removal and 89 for bronchial occlusion. Deaths occurred only as a consequence of Nd : YAG LPR (0.61%). The morbidity rates for these therapeutic procedures ranged from 0% to 5%. Conclusions: The preparation for, and practice of, bronchoscopy varied greatly between respondents. Diagnostic bronchoscopy was well tolerated and safe. Therapeutic procedures did not appear to be practised widely or frequently. [source]

Atomised lidocaine for airway topical anaesthesia in the morbidly obese: 1% compared with 2%,

ANAESTHESIA, Issue 1 2010
C. Woodruff
Summary Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in morbidly obese patients was evaluated using two doses of local anaesthetic. In this randomised, blinded prospective study, 40 ml of atomised 1% (n = 11) or 2% (n = 10) lidocaine was administered with high oxygen flow as carrier. Outcomes included time for intubation, patient tolerance to airway manipulation, haemodynamic parameters, the bronchoscopist's overall satisfaction, and serial serum lidocaine concentrations. Patients receiving lidocaine 1% had a longer mean (SD) time from the start of topicalisation to tracheal tube cuff inflation than those receiving lidocaine 2% (8.6 (0.9) min vs 6.9 (0.5) min, respectively; p < 0.05). Patients in the 1% cohort demonstrated increased responses to airway manipulation (p < 0.0001), reflecting lower bronchoscopist's satisfaction scores (p < 0.03). Haemodynamic responses to topicalisation and airway manipulation were similar in both groups. Peak plasma concentration was lower in the 1% group (mean (SD) 1.4 (0.3) and 3.8 (0.5) ,g.ml,1, respectively; p < 0.001). Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in the morbidly obese is efficacious, rapid and safe. Compared with lidocaine 1%, the 2% dose provides superior intubating conditions. [source]

Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway,

ANAESTHESIA, Issue 5 2006
J. M. Huitink
Summary Awake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. The aim of this study was to investigate the feasibility of this technique. We studied prospectively 15 consecutive intubations in head and neck cancer patients before diagnostic or therapeutic surgical procedures. After topical anaesthesia, a fibrescope was introduced into the pharynx. Spontaneous respiration was maintained in all patients. Through the suction channel of the fibrescope a special suction catheter was advanced into the airway for carbon dioxide measurements. When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2,15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s. [source]

Impact of topical anaesthesia on pain alleviation and wound healing in lambs after mulesing

AUSTRALIAN VETERINARY JOURNAL, Issue 5 2008
S Lomax
Objective To investigate the impact of using the topical anaesthetic preparation Tri-Solfen® on pain alleviation and wound healing in lambs undergoing mulesing. Design Three separate trials, placebo controlled and/or randomised, were carried out over a 5 month period on three mobs of between 60 and 263 merino lambs undergoing routine mulesing. Procedure Wound pain was assessed using 10 and 75 g calibrated Von-Frey monofilaments to determine sensitivity to light touch and pain stimulation over a 4 to 8 h period. Pain-related behaviour was documented by trained, blinded observers using a numerical rating scale. Wound healing rates were determined using scaled digital photography and image analysis software to calculate contraction in wound surface area 2 and 4 weeks after mulesing. Results There was rapid (3 min) and prolonged (up to 8 h) wound analgesia as shown by pain response scores (P , 0.01), with absent or significantly diminished primary and secondary hyperalgesia (P , 0.01) and significant reduction in pain-related behaviour (P < 0.001) in treated versus untreated lambs. In addition there was improved wound healing in the treated lambs (P , 0.05). Conclusion Tri-Solfen® effects rapid and prolonged wound analgesia, reduction in pain-related behaviour and improved wound healing in lambs undergoing routine mulesing, providing effective alleviation of pain associated with routine mulesing in sheep. [source]

A review of peripheral nerve blockade as local anaesthesia in the treatment of palmar hyperhidrosis

BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2003
M.J. Hayton
Summary Injection of botulinum toxin type A (BTX-A) is an effective method of controlling palmar hyperhidrosis. It is, however, an uncomfortable procedure without adequate anaesthesia. We outline the techniques used, the reasons for them and potential pitfalls that can be avoided, with an outline of the neural anatomy relevant to the palmar injection of BTX-A. We have been using peripheral nerve blockade as local anaesthesia during BTX-A treatment of palmar hyperhidrosis for the last few years, and have found it an effective method of providing pain relief during the procedure, giving greater anaesthesia than that given by topical anaesthetic cream under occlusion and ice. It has been our experience that patients prefer wrist blockade to topical anaesthesia and ice when receiving BTX-A injections for treatment of palmar hyperhidrosis. [source]

1225: Anaesthesia in cataract surgery

ACTA OPHTHALMOLOGICA, Issue 2010
P BODROGI
I would like to give a review of anaesthetic methods used in cataract surgery. Retrobulbar (RB) anaesthesia via injection provides not only painlessness, but also akinesia and cuts off autonomic reflexes. Although unfortunatelly it has many possible sideeffects, like perforation of the globe, retrobulbar haemorrhage or injury of the optic nerve, it is still widely used. Parabulbar (PB) anaesthesia was introduced to eliminate traumatic sideeffects of RB, but it did not fulfill all expectations. There are also subconjunctival and sub-Tenon anaesthesia, the latter also results in akinesia. Since the introduction of phacoemulsification topical anaesthesia has become current. Due to the gentle surgical technique, if the wound is corneal and there is no severe fluctuation of depth of the anterior chamber, it can provide sufficient anaesthesia. They apply it in form of drops, gel or special sponge. It can be replenished with intracameral Lidocain. Before surgery it is widely used to apply systemic sedatives, which helps to attenuate the patients' angst because of surgery. Supporting attitude of medical crew and positive verbal communication is also beneficial at this task. General anaesthesia is still the only possibility used in cataract surgery of children and other people unable to cooperate. [source]

Isometric force development in human horizontal eye muscles and pulleys during saccadic eye movements

ACTA OPHTHALMOLOGICA, Issue 8 2009
Gunnar Lennerstrand
Abstract. Purpose:, The connective tissue elements forming the check ligaments and portals of the human eye muscles have recently been ascribed with a pulley function. Active positioning of the pulleys over orbital layer contraction during eye movements has been suggested. Other studies have instead demonstrated fibrous tissue connections between all parts of the muscle and the pulleys. We aimed to compare the isometric force developed at the muscle tendon and at the pulleys of the horizontal eye muscles, and to investigate which eye muscle structures might exert force on the pulleys. Methods:, Isometric force development was recorded from the lateral and medial rectus muscles in six patients operated for strabismus under topical anaesthesia. Two strain gauge probes were used, each attached with 5,0 silk sutures either to the muscle tendon or to the pulley. The eye muscles were activated by horizontal saccadic eye movements in steps from 30 degrees in the off-direction to 30 degrees in the on-direction of the muscles. Results:, The forces developed at the tendon and pulley were almost identical with respect to amplitude and other parameters. No differences were found in forces developed at the pulleys of the medial and lateral rectus muscles. Conclusions:, The results support the presence of fibrous tissue connections between all eye muscle fibres and pulley structures, rather than orbital fibre control of the pulley. [source]

Factors affecting ocular rigidity in normal human eyes

ACTA OPHTHALMOLOGICA, Issue 2009
AI DASTIRIDOU
Purpose To measure the ocular rigidity coefficient and evaluate its relation with axial length (AL), age and mean systemic blood pressure (SBP). Methods Sixty three patients (63 eyes) undergoing cataract surgery, with different refractive errors and no ocular or systemic pathology were enrolled in this study. An invasive, computer controlled device comprising a microdosimetric pump and a pressure sensor, is connected to the anterior chamber under topical anaesthesia with drops. The system is used to raise the intraocular pressure (IOP) from 15 to 40mmHg, by infusing the eye with a saline solution. After each 4 ul infusion step, the IOP is continuously recorded for 2 seconds. From an initial level of 40mmHg an IOP decay curve of 1 minute is obtained. SBP and pulse rate are measured during the procedure. The rigidity coefficient is calculated by an exponential fit to the pressure volume data after correction for outflow. The study was approved by the Institutional Board and performed under the patient's informed consent. Results Mean AL was 24.8 (range 21.2-32.5). Mean age and SBP was 59 (12) years and 93.7 (10.5) mmHg respectively. The mean ocular rigidity coefficient was 0.021 (0.005) ul-1. Increasing axial length is associated with a decrease in the rigidity coefficient (r=-0.61, p<0.01). A positive correlation between the rigidity coefficient and age of the patients is found (r=0.31, p=0.01), whereas similar findings were not observed for SBP (p>0.05). Conclusion This manonetric approach of measuring ocular rigidity provides a normative database of this parameter in living human eyes. Axial length and age influence ocular rigidity. These results may have implications on tonography and ocular pulse studies. [source]

Viscoanaesthesia in cataract surgery: a prospective, randomized clinical trial

ACTA OPHTHALMOLOGICA, Issue 4 2009
Juha Välimäki
Abstract. Purpose:, We aimed to compare viscoanaesthesia (VisThesia) with intracameral lidocaine in cataract surgery carried out under topical anaesthesia. Methods:, In this prospective study 98 patients were randomly assigned to receive VisThesia (group 1, n = 49) or 0.5 cc of 1% unpreserved lidocaine (group 2, n = 49). All surgery was carried out by one surgeon using clear corneal technique. Pachymetry, the status of the cornea and anterior chamber, and intraocular pressure (IOP) were checked pre- and postoperatively. Results:, Mean pain scores were 0.12 (maximum: 3) in group 1 and 0.37 in group 2; the difference between the groups was not statistically significant (95% confidence interval [CI] 0.003,0.487; p = 0.05). A total of 48 patients in group 1 (98%) and 49 in group 2 (100%) reported no discomfort or only mild discomfort. No significant differences in flare and cells in the anterior chamber or IOP were found between the two study groups. There was a significantly greater frequency of corneal oedema in group 1 (p = 0.001). Postoperative central corneal thickness values were also significantly higher in group 1 (95% CI 11.64,57.24; p = 0.003). Conclusions:, Results suggest that viscoanaesthesia provides a level of comfort during cataract surgery under topical anaesthesia similar to that facilitated by intracameral lidocaine. However, patients who are given viscoanaesthesia may have increased risk for postoperative corneal oedema. [source]

Subjective visual sensations during cataract surgery performed under topical anaesthesia

ACTA OPHTHALMOLOGICA, Issue 8 2008
Zsolt Biró
Abstract. Purpose:, To examine the patient's subjective visual sensations during cataract surgery performed under topical anaesthesia. Methods:, Prospective, non-randomized, cohort study. One hundred and thirty-two patients were interviewed by standard questionnaire within 1 hr of uncomplicated cataract surgery performed under topical anaesthesia. Results:, Everyone saw lights of different and changing intensity. One hundred and twenty-six (95.5%) patients saw different colours; 18 (13.6%) patients saw a rainbow-like scale of colours. Ninety-eight (74.2%) patients could see clear shapes and forms (mainly circle, square, rectangle, ellipse). Forty-nine (37.1%) patients could see instruments, and 35 (26.5%) patients saw the fingers of the surgeon during surgery. Twenty-six patients (19.7%) considered the strong light of the microscope very disturbing and uncomfortable. Forty-seven patients made drawings of the visual sensations that they experienced during surgery. Conclusion:, Consistent with our review of the literature, we found no relation between intraoperative visual sensations and patient's age, sex, preoperative visual acuity, duration of surgery or cataract severity. We found that it is helpful to inform the cataract patients of potential visual sensations before their surgery. [source]

Limbal anaesthesia versus topical anaesthesia for clear corneal phacoemulsification

ACTA OPHTHALMOLOGICA, Issue 1 2006
Carlo Cagini
Abstract. Purpose:,To compare the safety and clinical efficacy provided by limbal anaesthesia with topical anaesthesia in cataract surgery. Methods:,A total of 117 consecutive patients undergoing routine cataract surgery were randomly assigned to receive limbal or topical anaesthesia. Limbal anaesthesia was administered with a cellulose ophthalmic sponge soaked in preservative-free lidocaine hydrochloride 4% applied to the temporal perilimbal area for 45 seconds immediately before surgery. For topical anaesthesia lidocaine 4% was instilled in each patient at 10-min intervals four times before surgery. We studied phaco time, perioperative pain, visual outcome and intraoperative complications. The level of intraoperative pain was scored on a scale of 1,10, where 1 = no pain and 10 = severe pain. Results:,55 patients (91.6%) in the topical group and 54 patients (94.7%) in the limbal group tolerated the procedure well, giving pain scores of 1,3, with no statistical difference. No patients in either group required supplemental anaesthesia and no intraoperative complications were recorded. No eyes had epithelial defects at the end of surgery or at postoperative check-ups. Conclusion:,Limbal anaesthesia in cataract surgery is safe and the two anaesthesia techniques do not present differences in the degree of analgesia achieved. [source]

Topical versus peribulbar anaesthesia for cataract surgery

ACTA OPHTHALMOLOGICA, Issue 6 2003
Gangolf Sauder
Abstract. Background:,To assess and compare the efficacy and safety of topical versus peribulbar anaesthesia in patients undergoing routine cataract surgery. Methods:,The unicentre, prospective, randomized, clinical interventional trial included 140 consecutive patients undergoing routine cataract surgery performed by one of two surgeons. The patients were randomly distributed to either peribulbar anaesthesia or topical anaesthesia. To assess intraoperative pain, each patient was asked immediately after surgery to quantitate his/her pain using a 10-point pain rating scale. Results:,The study groups did not differ significantly in pain score (p = 0.54), duration of surgery (p = 0.52), anaesthesia-related intraoperative difficulties (p = 0.17), postoperative visual acuity (p = 0.94), overall intraoperative surgical complication rate, blood pressure rise (p = 0.16) or blood oxygen saturation (p = 0.74) Conclusions:,Patient comfort and surgery-related complications did not differ between topical anaesthesia and peribulbar anaesthesia. As there are no significant differences between the two techniques in terms of subjective pain experienced by patients, intraoperative complications and postoperative visual outcome, and in view of the minimally invasive character of topical anaesthesia compared to peribulbar anaesthesia, the present study suggests the use of topical anaesthesia for routine cataract surgery. [source]

Randomized clinical trial of the efficacy and safety of tropicamide and phenylephrine in preoperative mydriasis for phacoemulsification

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2003
Philip TH Lam FRCOphth
Abstract Purpose: To compare the mydriatic effect and safety between different concentrations of tropicamide and phenylephrine in preoperative mydriasis for phacoemulsification. Methods: Two hundred and seventeen consecutive eyes in the same number of Chinese patients undergoing phacoemulsification under local or topical anaesthesia in a university-based eye hospital were analyzed. Patients were randomized into two groups by cluster randomization, each group receiving a different preoperative mydriatic regimen. Regimen A consisted of tropicamide 1.0% with phenylephrine 2.5%, and Regimen B consisted of tropicamide 0.5% with phenylephrine 0.5%. The main outcome measures were horizontal pupillary diameter, systolic, diastolic and pulse pressure and pulse rate. Results: The group who received Regimen A attained a mean horizontal pupillary diameter of 7.00 ± 1.06 mm. Their pupils were significantly larger than those receiving Regimen B (6.61 ± 1.03 mm, P = 0.007). No untoward cardiovascular effects were noted in either groups. Conclusion: Regimen A attained better preoperative mydriasis for phacoemulsification than Regimen B. Both regimens were safe with regard to their cardiovascular effects. The combination of tropicamide 1.0% and phenylephrine 2.5% is recommended as preoperative mydriatic for phacoemulsification in Chinese patients who have darkly pigmented irides. [source]