TABLE 21–1. Pharmacology Comparing Lidocaine and Tetracaine
• Inadvertent application of topical anesthetics to the pharynx may suppress the gag reflex.
• It is important to apply local anesthesia not only to structures that will be directly instrumented but also structures that may be touched or bumped during the procedure, such as the middle turbinate.
• A stepwise approach can be highly effective—first with atomizer followed by topical application with pledget or cotton ball, and then infiltration of mucosa as needed.
• An example of this stepwise approach could be to atomize 4% lidocaine and oxymetazoline into the nasal cavity, followed by placement of pledgets treated with 2% tetracaine; leave the pledget in placed for at least 15 minutes; then inject certain sites as needed with 1% lidocaine with 1:100 000 epinephrine.
Be Prepared to Manage Bleeding
• Consider having bipolar or monopolar cautery available.
• Prepare a kit with various packing options available to manage bleeding.
• Most common bleeding associated with in-office procedures can be manage with topical application of oxymetazoline on nasal packing.
Nasal Endoscopy with Debridement
• One of the more common in office procedures performed in the ENT office
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