Local superficial anesthesia in rhinolaryngology

In the first years of my activity in Kazan as an otolaryngologist, I used a 20% solution of hydrochloric cocaine for surface anesthesia, but, noticing frequent cases of poisoning, I replaced it with a 10% solution. However, even when smearing with this solution, we also observed symptoms of poisoning quite often, although the percentage of cases of the latter and its degree were much less than with the 20% solution. This indicates that cocaine poisoning depends not only on the predisposition, but also on the concentration of the solution. Wishing to be completely free from the unpleasant consequences of superficial cocaine anesthesia during operations in the nose, nasopharynx and larynx, I replaced cocaine solutions with strong solutions of novocaine. It turned out, however, that while subcutaneous injections of 1/2% novocaine give good anaesthesia during operations on the maxillary cavity, on the mastoid process, etc., with surface anaesthesia even with the strongest solutions of this substance I did not get good results, and the patients felt severe pain during all manipulations in the above mentioned organs, so I had to return to strong solutions of cocaine.