A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation

Katz, Robert I.; Hovagim, Alec R.; Finkelstein, H.; Grinberg, Yair; Boccio, Remigio V.; Poppers, Paul J.

doi:10.1016/0952-8180(90)90043-3

Cited by 79 publications

(50 citation statements)

References 5 publications

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“…In addition, ample use of lubricants; nasal decongestion with cocaine, epinephrine, or oxymetazoline; and warming of the tube may be used to facilitate tube passage. 40,41 The management of nasotracheal injury depends on its severity. Mucosal abrasions, tears, and hematomas usually resolve with conservative management, such as nasal humidification and nasal pressure.…”

Section: Injury By Anatomic Sitementioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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Although endotracheal intubation is commonly performed in the hospital setting, it is not without risk. In this article, we review the impact of endotracheal intubation on airway injury by describing the acute and long-term sequelae of each of the most commonly injured anatomic sites along the respiratory tract, including the nasal cavity, oral cavity, oropharynx, larynx, and trachea. Injuries covered include nasoseptal injury, tongue injury, dental injury, mucosal lacerations, vocal cord immobility, and laryngotracheal stenosis, as well as tracheomalacia, tracheoinnominate, and tracheoesophageal fistulas. We discuss the proposed mechanisms of tissue damage that relate to each and present their most common clinical manifestations, along with their respective diagnostic and management options. This article also includes a review of complications of airway management pertaining to video laryngoscopy and supraglottic airway devices. Finally, potential strategies to prevent intubation-associated injuries are outlined.

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Section: Injury By Anatomic Sitementioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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“…If the tracheal tube could not be advanced in the nasal pathway, it was withdrawn and inserted into the other nostril in the same way. After the tracheal tube was advanced into the oropharynx, the severity of epistaxis was evaluated under direct laryngoscopy using a 4-point scale: no epistaxis; mild epistaxis (blood on the tracheal tube only); moderate epistaxis (blood pooling in the pharynx); or severe epistaxis (blood in the pharynx sufficient to impede intubation) [6]. Tracheal intubation was performed, if required, using Magill forceps.…”

mentioning

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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“…A number of strategies have been suggested to potentially decrease the risk of epistaxis. These include immersing the NTT in a bottle of warm sterile water or saline (thermo-softening) to soften the tube prior to use (4,5); the use of soft flexible nasotracheal tube (such as the Portex ® Ivory PVC cuffed tube, Sims Portex Ltd., Kent, UK) (6); the use of a Parker-Flex tip ETT (7), application of a vasoconstricting nasal spray to the nasal mucosa prior to intubation (8); generous use of a lubricant to facilitate entry of the NTT through the nose (9); telescoping the NTT through a redrubber catheter (10); using the right nostril (11), preselecting the nare prior to placing the NTT using nasopharyngoscopy (12); and using a bronchoscope as an intubation guide (13). Other complications in addition to hemorrhage and inability to place the NTT are additionally possible including perforation of the pyriform fossa causing subcutaneous and/or mediastinal emphysema (14).…”

Section: Discussionmentioning

confidence: 99%

Unanticipated Difficult Nasal Intubation Due to a Prominent Anterior Tubercle of the First Cervical Spine

Watton¹,

Hung²

2016

J Anesth Perioper Med

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Nasal intubation is frequently used for airway management in patients undergoing many surgical procedures. This is a case report of an unanticipated difficult nasal intubation due to a prominent anterior tubercle of the first cervical spine vertebra (C1) resulting in aspiration of blood and hypoxemia following intubation. The subsequent airway management of the rescheduled elective case is also described. The specific difficulties in securing the airway for nasal intubation are described as well as the management strategies to circumvent this anatomical variant. This case report will be of interest to health care practitioners providing airway management via the nasal route for different populations.

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A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation

Cited by 79 publications

References 5 publications

Complications of Airway ManagementDiscussion

Complications of Airway ManagementDiscussion

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

Unanticipated Difficult Nasal Intubation Due to a Prominent Anterior Tubercle of the First Cervical Spine

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