Topical anesthesia refers to the loss of sensation confined to mucosal surfaces (as when pontocaine, benzocaine, or lidocaine is applied to the surface).

See also: general anesthesia; local anesthesia

One Way to Deliver Topical Anesthesia Despite A Powerful Gag Reflex…

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Powerful gag reflex (1 of 4)

The usual method of dripping topical anesthesia into larynx, subglottis, and trachea from above through an Abraham cannula is difficult due to a powerful gag reflex. Here, the tip of a short 25 gauge needle has entered through the cricothyroid membrane, just below the anterior commissure.

Patient inhaling (2 of 4)

2% lidocaine has just begun to squirt through the needle with the patient inhaling.

Patient coughs (3 of 4)

Half a second later, the topical anesthetic is splattering (see streaks) and as the patient coughs. This will fully anesthetize the area topically.

Topical anesthesia applied (4 of 4)

The topical anesthesia established by this method now allows injection of kenalog (see white submucosal bulge) into the posterior tracheal wall as a means of managing this patient’s subglottic stenosis likely due to forme fruste Wegener’s granulomatosis.

TA-only Paresis before and after Voice Gel Injection

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TA weakness, intact LCA + PCA (1 of 5)

TA weakness indicated by bowed margin and “spaghetti-linguini” difference between the cords. Medial turning of vocal process (arrow) suggests intact LCA; abducted position suggests intact PCA function. Blood is from cricothyroid membrane puncture to instill topical anesthesia.

Prephonatory instant (2 of 5)

Before voice gel injection at prephonatory instant. Wasting of left cord (right of photo), and capacious ventricle on the left (right of photo) clearly evident.

Gel injection (3 of 5)

At beginning of voice gel injection (needle at white arrow).

Straight vocal cord margin (4 of 5)

At conclusion of voice gel, note straight left cord margin (right of photo). Compare with photos 1 and 3.

Phonation (5 of 5)

Phonation after injection complete. Voice dramatically strengthened. Compare with photo 2.