Unilateral Rhinorrhea and Sneezing After Upper Gastrointestinal Endoscopy Under Intravenous Propofol Sedation With Supplemental Oxygen Administered via a Nasal Cannula: A Case Report

Abstract

We present a rarely described complication of unilateral rhinorrhea and sneezing in a patient who received intravenous sedation with propofol and supplemental oxygen via a nasal cannula during upper gastrointestinal endoscopy. The literature is reviewed and a mechanism is proposed. Mechanical irritation of the nasal mucosa is felt to be the trigger. Suggestions to avoid and to treat are offered.

Bilateral Postprocedural Rhinitis After Intravenous Sedation With Supplemental Nasal Oxygen (PRAISE SNOG) After Cataract Surgery

“…Nonallergic rhinitis (sneezing and/or rhinorrhea with or without tearing) following endoscopy (which included both esophagogastrodenoscopy and full-length colonoscopy) was originally reported in a study involving 836 patients; all of the patients had received intravenous sedation and supplemental oxygen [6]. Subsequently, unilateral rhinorrhea and sneezing after upper gastrointestinal endoscopy under intravenous propofol sedation with supplemental oxygen administered via a nasal cannula was described in a case report [7]. In addition, this phenomenon has been mentioned on the internet by individuals who develop rhinitis immediately after awakening from sedation following a colonoscopy for which they received intravenous sedation and supplemental nasal oxygen; the comments -currently from 183 patients as of December 22, 2020 -can be found as Google blog posts accompanying an article on "Sneezing, runny nose and tearing after colonoscopy" [12].…”

“…She treated her symptoms with over-the-counter antihistamines and a nasal decongestant spray; they resolved within five days. Six months later, she subsequently had a colonoscopy using propofol sedation and supplemental oxygen with the same nasal cannula; however, the oxygen was administered via an oral route, and she did not develop PRAISE SNOG [7].…”

“…The prong tips of the nasal cannula were capable of eliciting sufficient nasal mucosal injury to result in nasal vestibule mechanoreceptor stimulation. Subsequently, this activated not only the nasonasal reflexes (involving cholinergic efferent and afferent responses) but also the local axonal reflexes (with symptomatic responses on both the ipsilateral and contralateral sides of the nose) [7].…”

“…Several interventions have been suggested that might prevent PRAISE SNOG from occurring ( Table 1) [6,7]. Li et al recommended shortening the nasal cannula prongs or using a nasal mask [6].…”

“…It is usually provided using a nasal cannula. Postprocedural rhinitis after sedation with supplemental oxygen administered via a nasal cannula during endoscopy -a noninflammatory variant of nonallergic rhinitis -has been observed [6,7].…”