[Local anesthesia in operations of the head-neck area]

Many operations in the head and neck area can be performed under local anesthesia. However, the use of local anesthesia does not automatically reduce the risk for the patient undergoing surgery.

In the present paper, the authors discuss local anesthetics used in surgical procedures in the head and neck region. Aminoesters are currently the most commonly used local anesthetics. Local anesthetics vary with respect to the onset and duration of the local anesthetic effect. The choice of local anesthetic depends on the estimated duration of the surgical procedure. Possible side effects of these substances may affect the central nervous as well as the cardiovascular system. Certain changes in serum electrolytes (i.e., hyperkalemia) as well as hypoxia and hypercapnia significantly increase the cardiotoxic potential of local anesthetics. Different vasoconstrictor agents are used in addition to local anesthetics to prolong the duration of the local anesthetic effect and to provide the surgeon with a nearly bloodless field. The two groups of vasoconstrictors used in these days are catecholamines (epinephrine) and vasopressin analogs. Systemic side effects of catecholamines include cardiovascular reaction, mainly in patients with typical risk factors (i.e., coronary heart disease, high blood pressure, or chronic heart failure). Vasopressin analogs produce fewer side effects than epinephrine. Even so, an overdose of these vasoconstrictors might still result in severe cardiac complications. The recommended maximum doses of these drugs should be strictly observed.

For several reasons, local anesthesia has become popular for a variety of surgical procedures in the head and neck in recent years. Even though the use of local anesthetics and vasoconstrictors in head and neck procedures has its advantages for both the patient and the surgeon, the limitations for the use of these drugs must always be taken into consideration.