J Dent Anesth Pain Med.  2017 Dec;17(4):281-287. 10.17245/jdapm.2017.17.4.281.

A comparison of the effects of epinephrine and xylometazoline in decreasing nasal bleeding during nasotracheal intubation

• Song J

• KMID: 2399798
• DOI: http://doi.org/10.17245/jdapm.2017.17.4.281

Abstract

BACKGROUND
Various techniques have been introduced to decrease complications during nasotracheal intubation. A common practice is to use nasal packing with a cotton stick and 0.01% epinephrine jelly. However, this procedure can be painful to patients and can damage the nasal mucosa. Xylometazoline spray can induce effective vasoconstriction of the nasal mucosa without direct nasal trauma. In this study, we aimed to compare the efficacy of these two methods.
METHODS
Patients were randomly allocated into two groups (n = 40 each): xylometazoline spray group or epinephrine packing group. After the induction of general anesthesia, patients allocated to the xylometazoline spray group were treated with xylometazoline spray to induce nasal cavity mucosa vasoconstriction, and the epinephrine packing group was treated with nasal packing with two cotton sticks and 0.01% epinephrine jelly. The number of attempts to insert the endotracheal tube into the nasopharynx, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. An anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5 min after intubation and postoperative complications.
RESULTS
No significant intergroup difference was observed in navigability (P = 0.465). The xylometazoline spray group showed significantly less epistaxis during intubation (P = 0.02). However, no differences were observed in epistaxis 5 min after intubation or postoperative epistaxis (P = 0.201). No inter-group differences were observed in complications related to nasal intubation and nasal pain.
CONCLUSION
Xylometazoline spray is a good alternative to nasal packing for nasal preparation before nasotracheal intubation.

Keyword

Endotracheal Intubation; Epinephrine; Epistaxis; Xylometazoline

MeSH Terms

Anesthesia, General
Bronchoscopy
Epinephrine*
Epistaxis*
Hemorrhage
Humans
Intubation*
Intubation, Intratracheal
Methods
Mucous Membrane
Nasal Cavity
Nasal Mucosa
Nasopharynx
Postoperative Complications
Vasoconstriction
Epinephrine

Figure

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  Fig. 1 Flow chart illustrating patient selection throughout the trial.

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