Randomized controlled trial showing the efficacy of prophylactic nasal drops of oxymetazoline versus ephedrine in reducing the incidence of bleeding following nasotracheal intubation

Authors : Yassin Eltahir Awad Gassim, Hadab A. Mohamed, Sireesha Bala, Sateesh Arja, Tarig Fadlallah Altahir Ahmed

DOI : 10.18231/j.ijpp.2019.022

Volume : 6

Issue : 3

Year : 2019

Page No : 99-102

Introduction: Nasotracheal intubation (NTI) is the method of choice when orotracheal intubation is not feasible (Patients with limited mouth opening), where orotracheal intubation is predicted to be difficult and in patients having airway related mechanical issues (angioedema, Ludwig’s angina, tongue haematomas, jaw fracture etc.).
A common problem facing anaesthetist while performing nasotracheal intubation is bleeding which might affect the course of intubation, surgery and recovery of the patient.
Oxymetazoline is a selective ?1 and a partial ?2 adrenergic receptors agonist. Since vascular beds widely express ?1 receptors, the action of oxymetazoline results in vasoconstriction. The mechanism of action of ephedrine is shown to be increasing the effects of NE by mobilizing and releasing the NE from the mobile pool.
Aims: To evaluate and compare the effect of using prophylactic nasal drops of oxymetazoline versus ephedrine on the incidence of nasal bleeding when nasotracheal intubation is performed.
Materials and Methods: This interventional randomized single blinded controlled study was conducted in Khartoum Dental Hospital during the period from September to October 2017. Sixty patients undergoing dental surgery were selected and were randomly assigned into two groups to receive either 1 ml of oxymetazoline 0.05% nasal drops (30 patients) or 1 ml of Ephedrine 1% nasal drops (30 patients) 5 minutes before induction. The incidence and severity of epistaxis, the incidence of the commonest complications related to nasal bleeding and the mode of recovery were assessed following NTI. 
Data was collected through predesigned data collection sheet then analyzed using a statistical package for the social sciences version and presented as tables and figures.
Results: Among 60 participants, 53.3% had no bleeding with oxymetazoline application compared to 30% with those who used ephedrine. Fair recovery was reported in 96.7% patients who received oxymetazoline compared to 63.3% from those who received ephedrine. Complicated recovery was significantly more in patients who received ephedrine (36.7%)) compared to a single patient 3.3% from oxymetazoline group.
Conclusion: the study concluded that patients undergoing NTI had no or minimal bleeding and lower rate of complications with the use of oxymetazoline 0.5% compared to ephedrine nasal drops.

Keywords: Ephedrine, Oxymetazoline, Nasotracheal intubation, Nasal bleeding.

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