Cocaine applications in otorhinolaryngologic anesthesia

Cocaine applied by knowledgeable otolaryngologists is an excellent topical anesthetic agent. For procedures of the upper respiratory tract, it is unrivaled by the synthetic anesthetics. It possesses a short latency, an adequate duration of action, and a valuable inherent vasoconstrictive capability. To prevent accidental injection of cocaine solutions, we recommend that the solutions be colored by the pharmacy. Our recommended total dose for most adult procedures is 200 to 300 mg of cocaine. In the uncommon case in which this amount may be inadequate, injections of lidocaine with dilute epinephrine can be used to supplement the cocaine. To prevent overdosing, we recommend starting with a known amount, recording the amount given, and not exceeding this total dose. Familiarity with the pharmacology of cocaine is essential for its safe application in otolaryngology.