Cocaine or phenylephrine/lignocaine for nasal fibreoptic intubation?

Latorre, Federico; Otter, W.; Kleemann, P. P.; Dick, W.; Jage, J.

doi:10.1046/j.1365-2346.1996.00015.x

Cited by 16 publications

(26 citation statements)

References 16 publications

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“…Thus, smooth transit of the tracheal tube through the nasal passageway is essential to reduce the incidence of epistaxis [14]. Currently, thermosoftening [15], the use of vasoconstrictors [6,16] and lubrication are widely used to reduce nasal bleeding following nasotracheal intubation. Several strategies have also been suggested to prevent epistaxis during nasotracheal intubation, including obturation of the tracheal tube [17], and using a nasopharyngeal airway [18] or a red rubber catheter [19] as a guide.…”

Section: Discussionmentioning

confidence: 99%

The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial

et al. 2014

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SummaryDuring nasotracheal intubation, the tracheal tube passes through either the upper or lower pathway in the nasal cavity, and it has been reported to be safer that the tracheal tube passes though the lower pathway, just below the inferior turbinate. We evaluated the use of a nasogastric tube as a guide to facilitate tracheal tube passage through the lower pathway, compared with the ‘conventional’ technique (blind insertion of the tracheal tube into the nasal cavity). A total of 60 adult patients undergoing oral and maxillofacial surgery were included in the study. In 20 out of 30 patients (66.7%) with the nasogastric tube‐guided technique, the tracheal tube passed through the lower pathway, compared with 8 out of 30 patients (26.7%) with the ‘conventional’ technique (p = 0.004). Use of the nasogastric tube‐guided technique reduced the incidence and severity of epistaxis (p = 0.027), improved navigability (p = 0.034) and required fewer manipulations (p = 0.001) than the ‘conventional’ technique.

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Section: Discussionmentioning

confidence: 99%

The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial

et al. 2014

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“…Past studies typically were performed in periprocedural settings, lacked a placebo group, and compared patient hemodynamics before and after administration as a secondary objective (15, 16, 18, 19, 34, 35). These study designs may be confounded by concurrent medications and procedures, particularly in the case of nasal intubation, which independently can produce hypertension (16, 20).…”

Section: Discussionmentioning

confidence: 99%

Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial

Nichols

et al. 2018

The Journal of Emergency Medicine

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Background: Treatment for epistaxis includes application of intranasal vasoconstrictors. These medications have a precaution against use in patients with hypertension. Given that many patients who present with epistaxis are hypertensive, these warnings are commonly overridden by clinical necessity. Objectives: To determine the effects of these medications on blood pressure. Methods: We conducted a single-center, randomized, double-blind, placebo-controlled trial from November 2014 through July 2016. Adult patients being discharged from the emergency department (ED) at Mayo Clinic (Rochester, Minnesota) were recruited. Patients were ineligible if they had a contraindication to study medications, had a history of hypertension, were currently taking antihypertensive or antiarrhythmic medications, or had nasal abnormalities such as epistaxis. Subjects were randomized to 1 of 4 study arms (phenylephrine 0.25%; oxymetazoline 0.05%; lidocaine 1% with epinephrine 1:100,000; or bacteriostatic 0.9% sodium chloride [saline]). Blood pressure and heart rate were measured every 5 minutes for 30 minutes. Results: Sixty-eight patients were enrolled in the study; of these, 63 patients completed the study (oxymetazoline, n=15; phenylephrine, n=20; lidocaine with epinephrine, n=11; saline, n=17). We did not observe any significant differences in mean arterial pressure over time between phenylephrine and saline, oxymetazoline and saline, or lidocaine with epinephrine and saline. The mean greatest increases from baseline in mean arterial pressure, systolic and diastolic blood pressure, and heart rate for each treatment group also were not significantly different from the saline group. Conclusion: Intranasal vasoconstrictors did not significantly increase blood pressure in patients without a history of hypertension. Our findings reinforce the practice of administering these medications to patients who present to the ED with epistaxis, regardless of high blood pressure.

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“…No adverse cardiovascular effects were noted 8 . Another study on 10 healthy volunteers compared co‐phenylcaine with lidocaine nasal spray, specifically looking for cardiovascular effects 9 . Both study and control solutions produced increases in pulse and blood pressure, the increases being greater in the study spray.…”

Section: Discussionmentioning

confidence: 99%

“…Several researchers have studied combinations of lidocaine with the decongestant xylometazoline 4,7 . More recently, attention has focused on co‐phenylcaine, a solution that contains 5% lidocaine and 0.5% phenylephrine 8–11 . Phenylephrine is a sympathomimetic agent with mainly alpha‐agonist action; it acts principally as a vasoconstrictor with minimal effect on the central nervous system or bronchi 12…”

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confidence: 99%

A comparison of cocaine and 'co-phenylcaine' local anaesthesia in flexible nasendoscopy

Smith

Rockley

2002

Clin Otolaryngol

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Cocaine is widely used as a local anaesthetic in the nose. However, it is potentially toxic, a known drug of addiction, and its spray delivery devices can theoretically transfer infection. This two-part study investigates a less toxic alternative, 5% lidocaine and 0.5% phenylephrine ('co-phenylcaine') solution, presented in a disposable spray. In the first part, the efficacy of co-phenylcaine was assessed in 25 healthy volunteers. Serial acoustic rhinometry showed a significant, sustained nasal decongestion after co-phenylcaine administration. Visual analogue scale (VAS) scores in response to a painful nasal stimulus confirmed a significant anaesthetic effect. In the second part, co-phenylcaine was compared with 10% cocaine spray in a randomized double-blind trial in 74 patients undergoing out-patient transnasal fibrescopic laryngoscopy. VAS pain ratings and nasal inspiratory peak flow recordings showed no difference between the two solutions. No adverse effects were noted. It is concluded that co-phenylcaine is an excellent alternative to cocaine nasal spray.

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Cocaine or phenylephrine/lignocaine for nasal fibreoptic intubation?

Cited by 16 publications

References 16 publications

The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial

The use of a nasogastric tube to facilitate nasotracheal intubation: a randomised controlled trial

Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial

A comparison of cocaine and 'co-phenylcaine' local anaesthesia in flexible nasendoscopy

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