Lidocaine (Intranasal/Topical ENT)

§2 (verbatim): 'Lidocaine 10 mg/metered dose. Excipient(s) with known effect: Each depression also delivers 1 mg of propylene glycol (an excipient of the banana essence). Also contains ethanol.' The SPC prints '10 mg/metered dose'; it does not print a percentage or mg/mL concentration. §4.1 (verbatim, ENT and related uses): 'Otorhinolaryngology Anaesthesia prior to minor non-invasive procedures in the nasal cavity, pharynx and epipharynx including rhinoscopy and laryngoscopy.' 'Insertion of instruments and catheters into the respiratory and digestive tract Provides surface anaesthesia for the oropharyngeal and tracheal areas to reduce reflex activity, attenuate haemodynamic response and to facilitate insertion of the catheter or the passage of instruments during endotracheal intubation, laryngoscopy, bronchoscopy, oesophagoscopy and gastroscopy.' General: 'This product is non-sterile and therefore not recommended for use prior to procedures that require aseptic techniques.' The SPC also lists obstetric supplementary pain control and dental practice, which are not this page's use and are not dosed here. VERBATIM §4.2: 'As with any local anaesthetic, reactions and complications are best averted by employing the minimal effective dosage. Debilitated or elderly patients and children should be given doses commensurate with their age and physical condition.' 'Each activation of the metered dose valve delivers 10 mg lidocaine base. It is unnecessary to dry the site prior to application. No more than 20 spray applications should be used in any adult to produce the desired anaesthetic effect. The number of sprays depend on the extent of the area to be anaesthetised.' For dental practice it prints '1–5 applications to the mucous membranes' and for obstetrics 'Up to 20 applications (200 mg lidocaine base)' (neither is this page's use); for 'Insertion of instruments and catheters into the respiratory and digestive tract Up to 20 applications (200 mg lidocaine base) for procedures in pharynx, larynx, and trachea.' The SPC prints NO separate spray count for the nasal cavity, pharynx or epipharynx uses beyond the general adult limit of 20 sprays, and no per-spray count specific to nasoendoscopy; the figures above are the only ones printed. Method (§4.2): 'Xylocaine spray is administered using the supplied nozzle. ... Nozzles are non- sterile single patient single use only. Appropriate measures should be undertaken to avoid cross contamination (see Section 6.6).' 'Xylocaine Spray should not be used on cuffs of endotracheal tubes (ETT) made of plastic (see also section 4.4).' NO PAEDIATRIC DOSE is printed in the SPC (only 'children should be given doses commensurate with their age and physical condition'), so none is written. ASPIRATION (§4.4): 'The oropharyngeal use of topical anaesthetic agents may interfere with swallowing and thus enhance the danger of aspiration. This is particularly important in children because of their frequency of eating. Numbness of the tongue or buccal mucosa may increase the danger of biting trauma.' ABSORPTION (§4.4): 'Absorption from mucous membranes is variable but is especially high from the bronchial tree. Such applications may therefore result in rapidly rising or excessive plasma concentrations, with an increased risk of toxic symptoms, such as convulsions.' The SPC prints no fasting interval after use, so none is stated.