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Local anesthesia is applied to the nasal, oral, and laryngeal mucosa by either an atomizer, gargle, nose drops, or pledget .
Aerosols produced when excess blood is expelled from the needle tip can be minimized if the syringe is held vertically and the blood deposited directly on a cotton pledget .
Pulmonary infection after cardiac surgery has been reported as a sequelae of Teflon pledget or graft erosion into adjacent lung parenchyma, resulting in cardiopulmonary fistula and hemoptysis.
The pledgets are placed on the atrial side of the mitral annulus.
Cotton pledgets soaked in vasoconstrictor and anesthetic should be placed in the anterior nasal cavity, and direct pressure should be applied at both sides of the nose for at least five minutes.
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