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Acta Anaesthesiol Taiwan. 2014 Mar;52(1):17-21. doi: 10.1016/j.aat.2014.05.001. Epub 2014 Jun 17.

Comparison of 4% and 6% topical cocaine solutions for reduction of epistaxis induced by nasotracheal intubation.

Author information

1
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
2
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
3
Division of Oral Maxillofacial Surgery, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
4
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: 770234anesthesia@gmail.com.

Abstract

BACKGROUND:

Nasotracheal intubation (NTI) provides a good field for surgeons in patients undergoing oromaxillofacial surgery; however, NTI is often complicated by epistaxis. The aim of this study was to compare the efficacy of 4% and 6% topical cocaine solutions in reducing epistaxis during NTI.

METHODS:

A total of 79 patients (16-65 years old) undergoing oromaxillofacial surgery were randomly assigned to two groups treated with either 4% cocaine (n = 39) or 6% cocaine (n = 40). Topical cocaine (1 mL) was sprayed onto the selected nasal cavity prior to NTI. All intubations were performed by an expert anesthesiologist using a GlideScope. The incidence and severity of epistaxis was examined along the nasal cavity up to the nasopharynx using a fiber optic bronchoscope. The hemodynamic responses to stimuli during the peri-NTI period were also recorded.

RESULTS:

The incidence of epistaxis was 43.59% (17/39) in the 4% cocaine group and 50% (20/40) in the 6% cocaine group (p = 0.57). The severity of epistaxis did not differ between the two groups (p = 0.46). High resistance during NTI and epistaxis were closely correlated and the major bleeding sites were located at the nasopharynx. Compared with the 4% cocaine group, treatment with 6% cocaine resulted in a higher heart rate and mean arterial pressure (both p < 0.05). There was no statistically significance difference between the two groups with respect to the hemodynamic responses to NTI.

CONCLUSION:

The spraying of either 4% or 6% topical cocaine into the nasal cavity gives comparable effects for intubation-related epistaxis. However, 6% cocaine may increase the hemodynamic responses while being sprayed. Therefore spraying with 4% topical cocaine had advantages with respect to 6% cocaine and is recommended for use prior to NTI.

KEYWORDS:

bronchoscopes; cocaine; epistaxis; fiber optic technology; intubation, intratracheal: nasal

PMID:
24999214
DOI:
10.1016/j.aat.2014.05.001
[Indexed for MEDLINE]
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