Lidocaine
Lidocaine is the chemical name for a common topical and local anesthetic. When applied topically, lidocaine numbs the mucosa for between 15 and 30 minutes; when infiltrated via injection, the duration is about the same, unless a small amount of epinephrine is added, in which case the numbing effect may last 1 ½ hours or so.
Lidocaine Injection for Aggressive “Office” Laser Treatments
Laser ablations performed in office (1 of 6)
After radiotherapy a few years earlier for vocal cord cancer, this patient continually develops exuberant leukoplakia with severe dysplasia and fragments of carcinoma in situ within weeks after each procedure to remove it, including two aggressive laser excisions in the O.R. In an attempt to avoid hemilaryngectomy or even total laryngectomy, a series of laser ablations is being performed just weeks apart in an “office” videoendoscopy procedure room. Needle for anesthesia is aiming for the spot indicated by the dot, left vocal cord (right of image)
Infiltrating anesthetic (2 of 6)
The needle shaft is seen at close range, infiltrating local anesethetic (lidocaine) into the vocal cord because the procedure is too uncomfortable to do with topical anesthesia alone.
Thulium laser procedure (3 of 6)
At the beginning of this “aggressive” laser procedure. The blue fiber is delivering thulium laser energy to coagulate the abnormal tissue. These vocal cords lost their ability to vibrate long before this procedure.
Post-surgery (4 of 6)
At the conclusion of this episode of treatment, aggressively coagulated tissue which will slough off in coming days and weeks.
Six weeks post-surgery (5 of 6)
Six weeks later, at beginning of next thulium laser treatment.
Second laser sugery (6 of 6)
Near the end of this subsequent thulium laser treatment.
Office-Based Surgery When General Anesthesia Is too Risky
Involuntary inspiratory voice (1 of 6)
This elderly man is tracheotomy-dependent due to inability to open the vocal cords. Here while breathing in, there is a posterior “keyhole” from the divots caused by pressure necrosis of the breathing tube. Still, due to inspiratory airstream, he produces involuntary inspiratory voice. General anesthesia for laser widening of the airway (posterior commissuroplasty) would be very risky due to his diabetes and many other medical problems. Hence, the decision to attempt this with patient awake and sitting in a chair.
Laser posterior commissuroplasty (2 of 6)
The posterior right vocal cord is injected with lidocaine with epinephrine, in preparation for office laser posterior commissuroplasty. F = false vocal cord. T = true vocal cord, near its posterior end. The left vocal cord is injected similarly prior to the procedure that follows.
During the commissuroplasty (3 of 6)
The thulium laser fiber is being used to excavate the posterior commissure. Note the existing divot of the opposite (right) vocal cord (dotted lines) which will also be enlarged (next photos).
Deepening divot (4 of 6)
With view rotated clockwise approximately 45 degrees, work is commencing to deepen the right vocal cord divot.
Inspiratory indrawing decreased (5 of 6)
At the conclusion of the procedure. Not only is the ‘keyhole’ seen in photo 1 larger, but inspiratory indrawing of the rest of the vocal cords is greatly diminished.
Phonation (6 of 6)
Now phonating, voice is similar to the beginning of the procedure, because the vibrating part of the vocal cord was not disturbed. Of course, number of words per breath is slightly lower, due to increased use of air through the keyhole—air wasting.
Injected Local Anesthetic Causes Blanching
Infiltrating anesthetic (1 of 3)
A 27-gauge needle tip is poised to infiltrate local anesthetic lidocaine with epinephrine into the papillomas (within dotted line) located just below the anterior commissure. In a moment, the needle will enter the papillomas at the “X”.
Blanching (2 of 3)
The needle is buried and the tissue is blanching due to hydrostatic pressure of the injected fluid. The green dot is for reference with photo 3.
Subglottis being injected (3 of 3)
Farther below the vocal cords, the anterior subglottis is seen here being injected. The green dot is for reference with photo 2. The shank of the needle guide looks like a “Doctor Octopus” arm!
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