Three Cases of Middle-Ear Disease with Intracranial Complications
Authors: H. M. Wharry
Journal: BMJ (1926)

INTRACRANIAL COMPLICATIONS. f TnrTl= 85 reported that anaestlhesia was not quite so good as it lhad previously been with the cocaine solution.In 5 cases, all of whom had been previously anaestlhetized with 0.5 solution of cocaine, 1 per cent.solution was used.In the first it was for the passage of a Kollmann's dilator, anid in the second of a cystoscope; the reml-ainiing tlhree.were cases of gonor.rhoea in which silver nitrate solution was beinig instilled into the posterior utretlhra.All the patients reported that borocaine gave them better anaesthesia than the 0.5 per cent.solution of cocaine.In 3 cRses 2 per cent.solution was usred before the passage of a Kolliman's dilator.All these patients had lhad frequent previous injections of cocaine.It was also uised for two cases of cystoscopy wlhere tlhere wvas no history of previous instrumentation.In the first three of these cases thie patients reported perfect anaesthesia and relaxation was improved, as evidenced by the fact that dilatationi w-as higher than usual.In the twto cases of cystoscopy aniaestlhesia and relaxation were peifect, and I conisider decidedly better than it would liave been w-itlh a 0.5 per cent.solution of cocaine.A 5 per cent.solution was tried in tlhe three cases of urethral stricture, witlh perfect results as far as anaesthesia and relaxationi were con- cerned, but really there was no advantage over thle 2 per cent.solution.Onie of tlheso thllee patients comiiplainied for about two or three miiniutes of a feelinig wlhich h-e, described as ratlher like a lutmp in the tlhroat, but tllis passed off, and there were no furtlher snmptoims.In two cases 2 pe cent.solution of niorocaine hlyidro- clhloride was used as a control.These p)atienlts lhad botl hiad frequent inijectionis of 0.5 per cent.solutiosi of cocaine lhydroclhloride for tlhe passage of a Kollmiianaii's (ilator.They reported that alnaesthesia wAas not so good as befole and relaxation was less, in that (lilatation fell slhort of tlle poinit reachled oni previous occasionis. Conclusions.A 2 per celnt.solution of borocain-e borate was a con- siderable implrovemiienit over 0.5 per cent.soluitioni of cocainle in respect botlh of anaestlhesia anid relaxation, and there w-as no sign of toxicity.The 2 per cent.solution of nlorocaine - hydrochloride fell slhort of a 0.5 per cenit.solutioni of cocaine.A 1 per cent.solution of borocain-e borate gives better anae6thesia tlla a 0.5 per cent.solution of cocainie.A 0.5 per cent.solution of borocaine borate has nio advantage over a 0.3 per cent.solutioni of cocaine.Tlhe cocaine solutioln used at All Saints' Hospital is miiade up witlh 0.5 per cent.sodium bicarbonate and 1 in 40 cami:phlor water.A 1 per cent.solution of cocaine lhas niot beein tlied owing to the risk of toxicity.BETA-EUCAT.NE BOntATE.This was used on patients who lhad pireviouslv had frequent injections of 1/2 per cent.cocainCe lhydrocihloride solution.The following results were obtained.Bcta-Eucaine Borate 112 per cciat.-Thiswas used in two cases for dilatation of urethral stricture witlh a Kollmann's dilator.Both patients reported that they had niever lhad suich pelfect aniaesthesia, and relaxation was also very good.Bita-Eucaine Boratc 114 per cc7it.-TIhiswaas used in two cases of uretliral stricture before the passage of a Kollmanin's dilator.Both patients reported that they saw nio differencre between this and their previous injection, and iclaxation was the same.B!cta-Etcaine Boratc 118 per ccnzt.-Tbiswas tused in two cases of urethlral stricture, for the passage of a Kolilmain's dilator in one case and a gum-elasti6 bougie in the other.Both patients reported rather more pain than they usually got with 1/2 per ceiit.cocaine.Conclussion s.