Post-procedure Rhinitis After Use of Sedatives and Supplemental Nasal Oxygen

Abstract

Post-procedure rhinitis is a form of nonallergic rhinitis that is a common but underreported complication occurring after procedures requiring sedation and the use of supplemental oxygen via nasal cannula. Symptoms occur immediately after awakening from sedation and may be so unbearable, that it impairs work, daily functioning, sleep patterns, and quality of life. This case describes a 67-year-old male who developed these symptoms after esophagogastroduodenoscopy (EGD) under sedation with supplemental oxygen via nasal cannula. The proposed pathophysiology is thought to be due to the impingement of the cannula against mechanoreceptors in the nasal mucosal membrane causing parasympathetic overactivity. Based on this pathogenesis, the reported patient failed to show improvement with oral antihistamines but instead benefited from a topical anticholinergic agent. Patients at risk should be informed of the possibility of this adverse event and advised on proper treatment if it occurs.

Using Ipratropium Bromide Nasal Spray Response as a Screening Tool in the Diagnostic Workup of Cerebrospinal Fluid Rhinorrhea

“…UCTR in these scenarios has been presumed to be due to a hyperactive or unopposed parasympathetic state. Reinforcing this notion, some of the patients in these series reported rhinorrhea reduction after initiating IBNS 21,22,24,25 …”

“…There have been multiple reports of UCTR being caused by non-CSF conditions, including rhinitis, 21,22 cervical sympathetic chain surgery, 23 post-procedural rhinorrhea after sedation and supplemental oxygen use, 24 head trauma or skull base fractures, 21,22,25 anterior and lateral skull base surgeries, 12,21,22,26 and other sinonasal surgeries as well. 22 UCTR in these scenarios has been presumed to be due to a hyperactive or unopposed parasympathetic state.…”

“…Reinforcing this notion, some of the patients in these series reported rhinorrhea reduction after initiating IBNS. 21,22,24,25 IBNS is a quaternary amine anticholinergic medication that binds and inhibits muscarinic receptors on nasal mucosal glands. 17,27,28 IBNS has been shown to decrease the amount and duration of rhinorrhea in various forms of rhinitis in both males and females 6 years or older.…”