Comment by bookofjoe

Being significantly older than you (I retired from the practice of anesthesiology at age 67 in 2015) I am able to recount my experience with cocaine use to prepare patients for nasal intubation.

When I began my residency at the UCLA Department of Anesthesiology in the fall of 1977, I was instructed on how to use cocaine.

First, one requested a 2cc glass vial of cocaine hydrochloride solution (4-10% strength, prepared from cocaine powder).

The patient in the O.R. was then sedated heavily to both eliminate fear and anxiety and decrease the stinging and discomfort resulting from the imminent application of the cocaine solution against the nasal mucosa.

Cotton pledgets on thin wooden sticks about 6 inches long were submerged in the cocaine solution until saturated, then very slowly and delicately introduced into both nostrils simultaneously and rotated while being advanced deep into the nasal cavity: usually they went in about half their length.

A nice aid to successful intubation: As a rule, we chose to intubate via the nostril which most easily and deeply accommodated the pledget.

We then waited for 15-20 minutes for maximum local anesthesia and vasoconstriction, then removed the pledgets and proceeded with nasal intubation.

I continued to use cocaine for nasal intubation until I moved to the University of Virginia in 1983; for whatever reasons, the drug wasn't part of our therapeutic armamentarium there, rather lidocaine with epinephrine was employed in the same manner as cocaine solution and produced equivalent results.