Nasal and Sinus Topical Anesthesia Delivery
Topical anesthetics are routinely used to provide anesthesia for the nasal mucosa, oral mucosa and bronchotracheal area. Agents available for topical anesthesia are benzocaine, cocaine, lidocaine, prilocaine, and tetracaine. Cocaine was used widely in the past for nasopharyngeal anesthesia due to its vasoconstrictive properties. However, due to its Schedule-II status, its use is very limited. Prilocaine is only available as a topical anesthetic in a cream or ointment preparation, and hence, its use is also limited. Therefor, the most commonly used topical anesthetics for naso/oropharyngeal, laryngotracheal and airway administration are benzocaine, tetracaine (in combination with benzocaine) and lidocaine.
However, the toxicity of local anesthetics is well documented and is influenced by the amount of drug administered as well as the route of administration. For this reason, administration of topical anesthetics should be performed with accuracy to ensure that a premeasured amount of drug is administered to allow for the intended effect while minimizing the risk of toxicity. Topical vasoconstrictors are also often employed during procedures where mucosal shrinkage is desired or in situations where bleeding is either a risk (nasal procedures) or is already present (epistaxis). Commonly used topical vasoconstrictors include cocaine, oxymetazoline and phenylephrine.
All of the MAD family of products provide the clinician with the ability to deliver premeasured doses of both topical anesthetics as well as vasoconstrictors to ensure that the exact dose desired is delivered over a broad surface area – enhancing efficacy as well as improving safety. MAD nasal products have a soft conical tip designed specifically to deliver nasal mucosal drugs in a rapid, atraumatic fashion. MADgic products provide a long, flexible stylette with an atomizer on the distal end, allowing directed delivery of exact doses of medication into narrow areas such as the nasopharynx, hypopharynx, and glottic opening – an ideal product for airway management and endoscopy. MADomizer bottle atomizers provide a reusable pump with disposable tips that can deliver multiple incremental doses of drug at 0.1 ml per pump – convenient for high volume clinic settings as well as home use. MAD surgical products can be used in a number of surgical settings to provide topical peritoneal and wound anesthesia, resulting in reduced postoperative pain.