Topical vasoconstrictor use for nasal intubation during pregnancy complicated by cardiomyopathy and preeclampsia

Arendt, Katherine W.; Khan, Khyrul; Curry, Timothy B.; Tsen, Lawrence C.

doi:10.1016/j.ijoa.2010.11.010

Cited by 8 publications

(7 citation statements)

References 34 publications

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“…Severe complications can occur during NTI, including bleeding, laceration of the mucosa, and trauma to the nasopharyngeal airway [ 2 3 4 5 ]. To decrease these complications, various methods have been developed, including lubrication with a water-soluble jelly, atraumatic tube design, use of topical vasoconstrictors, thermo-softening of the endotracheal tube (ETT), and obturation of the tube tip with a balloon or esophageal stethoscope [ 6 7 8 9 10 11 12 ]. Of these methods, topical vasoconstrictors (cocaine, epinephrine, phenylephrine, xylometazoline, and oxymetazoline) have been used to decrease epistaxis and have shown similar reduction in the incidence of epistaxis.…”

Section: Introductionmentioning

confidence: 99%

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

Song

2017

J Dent Anesth Pain Med

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BackgroundVarious 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.MethodsPatients 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.ResultsNo 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.ConclusionXylometazoline spray is a good alternative to nasal packing for nasal preparation before nasotracheal intubation.

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Section: Introductionmentioning

confidence: 99%

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

Song

2017

J Dent Anesth Pain Med

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“…We have included 136 reports, both full publications and abstracts, covering 158 cases (see also Supporting Information, Appendices S1–S6) . Case reports largely fall into two groups: those describing equipment, or a technique, for provision of general anaesthesia; or those identifying a woman who had predicted airway difficulty, who was managed with regional analgesia or anaesthesia with the aim of avoiding of general anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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We reviewed the literature on management of general and regional anaesthesia in pregnant women with anticipated airway difficulty. We identified 138 publications comprising 158 cases; these either described equipment or techniques for the provision of general anaesthesia, or the management of women with regional analgesia or anaesthesia, with the aim of avoiding general anaesthesia. Most of the former group described women requiring caesarean section alone, or in combination with other surgery, which was sometimes airwayrelated. Management techniques were largely similar to those in non-obstetric patients requiring surgery who have airway difficulties, although suggested differences related to physiological changes of pregnancy and avoidance of nasal intubation. In the reports discussing regional anaesthesia, consideration was often given to the possible requirement for urgent out-of-hours anaesthetic intervention, and the predicted difficulty of management of general anaesthesia should it be required. In a number of reported cases, multidisciplinary planning led to the conclusion that elective caesarean section should be performed in order to avoid emergency airway management. Based on this literature review, we advise antenatal planning that includes: assessment of the patient's clinical characteristics; consideration of the equipment and personnel available to provide safe airway management out-of-hours; and elective caesarean section should these be lacking. If general anaesthesia is required, a risk assessment must be made as to the probability of safe airway management after the induction of anaesthesia, and awake tracheal intubation should be used if this cannot be assured. Decision aids are provided to illustrate these points. Online appendices include a comprehensive compendium of case reports on the management of a number of rare syndromes and airway conditions.

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“…AFOI is an important technique used for managing patients with anticipated difficult airways; however, there are surprisingly few reports in the literature describing the use of AFOI in patients with anticipated difficult airways requiring Cesarean delivery. [12][13][14][15] Summary details for the indications for AFOI and anesthetic management from Table 1 Summary of articles describing awake fibreoptic intubations in parturients Ghaly et al 12 Neumann et al 13 Arendt et al None documented AFOI = awake fibreoptic intubation; CD = Cesarean delivery; ACM = Arnold-Chiari malformation these case reports are summarized in the Table 1. Successful AFOI is dependent on careful planning and preparation prior to the procedure.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a parturient with VACTERL association undergoing Cesarean delivery

Hilton

Mihm

Butwick

2013

Can J Anesth/J Can Anesth

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This case highlights the challenges that anesthesiologists face when managing parturients at extremely high risk for perioperative anesthetic morbidity due to the presence of severe pre-existing disease, anticipated difficult airway, and major spinal abnormalities complicating neuraxial anesthesia. We used a combined general and epidural anesthetic approach to control ventilation, provide effective postoperative analgesia, and reduce the risk of anesthetic-related perioperative morbidity. An individualized approach should be considered for the anesthetic management of high-risk pregnant patients with complex and multiple medical and surgical morbidities undergoing labour and delivery.

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Topical vasoconstrictor use for nasal intubation during pregnancy complicated by cardiomyopathy and preeclampsia

Cited by 8 publications

References 34 publications

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

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

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

Anesthetic management of a parturient with VACTERL association undergoing Cesarean delivery

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