This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Larijani, G. E. Articles by Goldberg, M. E. Search for Related Content PubMed PubMed Citation Articles by Larijani, G. E. Articles by Goldberg, M. E.

---

CASE REPORTS

The Efficacy and Safety of EMLA^® Cream for Awake Fiberoptic Endotracheal Intubation

Department of Anesthesiology, Cooper Health System, University of Medicine and Dentistry of New Jersey, Camden, New Jersey

Address correspondence and reprint requests to G. E. Larijani, PharmD, Department of Anesthesiology, One Cooper Plaza, Camden, NJ 08103. Address e-mail to larijage{at}umdnj.edu

EMLA^® Cream (EC; Astra, Westborough, MA) has been widely used as a local anesthetic. Limited safety information is available with respect to the application of EC to the oral mucous membranes. The purpose of this pilot study was to evaluate the efficacy and safety of EC when applied to oral mucosa for fiberoptic intubation. Twenty ASA physical status I–IV patients (11 women and 9 men), 28–57 yr old, who were scheduled for awake, fiberoptic, intubation participated in this open-label study. A total of 4 g of EC was used for 5 min until the patient showed no evidence of a gag reflex (this was evaluated clinically by the patient’s acceptance of the William’s airway and considered the endpoint for assessing adequate topicalization of the oropharynx). The measured peak plasma concentration of lidocaine or prilocaine did not reach toxic levels in any patient. Methemoglobin levels did not exceed normal values (1.5%) in any patient, and there was no relationship between methemoglobin levels and patient weight, amount of EC used, measured peak plasma concentration, or times to measured peak concentrations of prilocaine or lidocaine. We conclude that EC provided satisfactory topical anesthesia allowing for successful oral fiberoptic intubation in all patients and should be considered a safe alternative for anesthetizing the airway of patients requiring awake oral fiberoptic intubation.

Implications: EMLA^® Cream (Astra, Westborough, MA) provides satisfactory topical anesthesia of the oropharynx and should be considered a safe and effective alternative for anesthetizing the airway for awake oral fiberoptic intubation.

This article has been cited by other articles:

				Intraoral Use of EMLA Cream for Fiberoptic Intubation Journal Watch Emergency Medicine, November 15, 2000; 2000(1115): 9 - 9. [Full Text]