Figured I'd get a lot more flame over the anxiety statement, probably after
Monday. I don't have a clue of how I'd predict, reliably, a panic attack by a
patient after beginning a procedure, given adequate anesthesia. My approach has
been to use focus with the patient, a one on one rapport, breathing and the
slowly progressing. Some folks it works with some it doesn't or their too
young. Hypnosis, in a fashion. Have I sedated a patient for a procedure, sure,
just not the rule and mostly an exception.
I've used a couple of concoctions of TAC. One hospital pharmacy substituted
benedryl for cocaine, at the direction of the P&T committee, "reasoning" that
cocaine was such a dangerous and potentially addictive (we ED folks might become
addicted if we were in the same room) substance .... Well, it didn't work worth
a flip. We use buffered lidocaine, both straight and with epi. We have felt
that there is much less pain on infiltration than without buffering.
Not topical, though.
David G. Ward, M.D.
Le Bonheur Children's Medical Center
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