Local anesthetics with vasoconstrictors should not be used in the [[nose]], [[fingersfinger]]s, [[toes]] and [[penis]], because the arteries here are [[End artery|end arteries]], so the vasoconstrictor effect could cause [[ischemia]] and even [[gangrene]] of the affected part.<ref>[http://books.google.se/books?id=dixpEL1mVugC&pg=PA292 Page 292] in: {{cite book |author=O'Brien, Denise; Burden, Nancy; Quinn, Donna M. DeFazio |title=Ambulatory surgical nursing |publisher=W.B. Saunders |___location=Philadelphia |year=2000 |pages= |isbn=0-7216-6847-X |oclc= |doi= }}</ref> Rather, a local anesthetic ''without'' vasoconstrictor should be used for local anesthesia in such parts.