Now that I am doing more fiberoptic nasopharyngoscopes, this issue is coming up more and more frequently. I've been using NP scopes mainly to check for laryngeal edema in the setting of angioedema. These recent photos visualize a normal epiglottis and normal laryngeal anatomy, respectively.
Tricks of the trade: Anesthetizing the nasopharyngeal tract
There is no pain-free way to place NG tubes and insert NP-scopes, but this 2-step approach worked amazingly well in my last patient in whom we performed a NP-scope.
I use 4 cc of 4% lidocaine in a nebulizer unit and face mask.
I inject about 5 cc of 2% viscous lidocaine into a nostril.
The patient "snorts in" the lidocaine.
The patient "snorts in" the lidocaine.
Yes, this 2-step process takes a little more time. If time permits, these extra few minutes are worth it. Just be sure to perform the procedure immediately after the nebulizer treatment is completed. The topical lidocaine wears off quickly.
What techniques do you use?