Clin Exp Otorhinolaryngol.  2017 Jun;10(2):158-163. 10.21053/ceo.2016.00563.

Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study

• Åžahin ML
• KökoÄŸlu
• Güleç S
• Ketenci L
• Ãœnlü Y

• KMID: 2380434
• DOI: http://doi.org/10.21053/ceo.2016.00563

Abstract

OBJECTIVES
To identify the optimal pharmacological method of preparing patients for nasal endoscopy.
METHODS
Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded.
RESULTS
The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically.
CONCLUSION
Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.

Keyword

Anesthetics; Nasal Decongestants; Lidocaine; Oxymetazoline; Endoscopy

MeSH Terms

Anesthetics
Blood Pressure
Double-Blind Method*
Endoscopes
Endoscopy*
Healthy Volunteers
Heart Rate
Humans
Lidocaine
Methods*
Nasal Decongestants
Oxymetazoline
Premedication*
Prospective Studies*
Volunteers
Anesthetics
Lidocaine
Nasal Decongestants
Oxymetazoline

Figure

• 

  Fig. 1. Flowchart of the method. NS, normal saline; Decong., decongestant; Anest., anesthetic; VAS, visual analog scale.

• 

  Fig. 2. Visual analog scale (VAS) questionnaires.

• 

  Fig. 3. Distribution of visual analog scale (VAS) scores of discomfort due to the spray. Numbers in brackets show the type of the spray combination. [1] placebo; [2] decongestant; [3] anesthetic; [4] decongestant plus anesthetic. Numbers before the names of the sprays show the order in that combination. NS, normal saline.

• 

  Fig. 4. Distribution of visual analog scale (VAS) scores of nasal pain and decongestion. Numbers in brackets show the type of the spray combination. [1] placebo (NS+NS); [2] decongestant (NS+oxymeta-zoline); [3] anesthetic (NS+lidocaine); [4] decongestant plus anesthetic (oxymetazoline+lidocaine). NS, normal saline.

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  Fig. 5. Distribution of durations of the endoscopic examinations. NS, normal saline.

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  Fig. 6. Distribution of changes of the mean blood pressure from the beginning to 10 minutes after spray application and from that point to just after endoscopy. NS, normal saline.

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  Fig. 7. Distribution of changes of the pulse rate from the beginning to 10 minutes after spray application and from that point to just after endoscopy. NS, normal saline; BPM, beats per minute.

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