Local anesthesia as compared with general anesthesia, in which the entire body is rendered unconscious and asensate, local anesthesia “numbs” a local area, most commonly with lidocaine injected into the tissues to be operated upon.
Thulium Laser Surgery, With Local Anesthetic Injection, to Treat Leukoplakia
Leukoplakia, about to be treated with laser (1 of 4)
Leukoplakia of the vocal cords in a patient radiated years earlier for glottic cancer. This disease is mostly benign, but foci of carcinoma-in-situ have also been removed twice in the operating room, yet with rapid return of leukoplakia. The patient has had no glottic voice. In an effort to avoid total laryngectomy, we are managing these visual abnormalities with the thulium laser in an outpatient videoendoscopy room.
Injection of local anesthetic (2 of 4)
Since this patient cannot tolerate aggressive laser therapy with topical anesthesia alone, we are here adding injection of local anesthetic. Note the blanching of tissue surrounding the needle.
Injection of local anesthetic (3 of 4)
Further injection of the local anesthetic.
Right after thulium laser treatment (4 of 4)
At the completion of aggressive laser coagulation of abnormal tissue. Compare with photo 1. The patient will return in a month for additional laser treatment as indicated.
Local Rather than Topical Anesthesia can Permit Fairly Major Tracheal Surgery
Obstructive papillomas (1 of 4)
This middle aged man has had lifelong RRP due to HPV 11. Primary focus of his recurrences for many years has been the trachea. Prior operative removals under general anesthesia have been challenging and recent work has used the thulium laser in an office setting. The papillomas seen here explain his mild pre-procedure stridor. His tracheal lumen should be approximately the size of the dotted circle.
Local injections (2 of 4)
A needle catheter passed through the channel of the scope is embedded at arrow, and is injecting 1% lidocaine with epinephrine (see blanched area). Numerous areas are similarly injected.
Removal of papilloma (3 of 4)
Here a large chunk of papilloma (stuck to the laser fiber at arrow) is being pulled away.
Improved breathing with papilloma removal (4 of 4)
An additional chunk is being detached. The patient’s breathing at the conclusion of this procedure is much improved. The tracheal lumen will be even larger when a lot of remaining coagulated papillomas slough away.
