Nasal Bleeding, Nasotracheal Intubation
Conditions
Keywords
Nasal bleeding, Nasotracheal intubation, adrenaline pack, xylometazoline nasal drops
Brief summary
The goal of this trial is to compare efficacy of xylometazoline nasal drops and adrenaline nasal pack in participants undergoing elective oromaxillofacial surgeries. The main question aim to answer is xylometazoline nasal drops better than adrenaline nasal packing in terms of nasal bleeding during nasotracheal intubation. Researchers are comparing 2 groups of participants. Participants in group Xylometazoline are receiving 0.1% xylometaxoline nasal drops. Participants in group Adrenaline are receiving adrenaline nasal packing.
Detailed description
This study is conducting after permission from institutional ethical committee. Participants came for elective OMF surgery under general anesthesia are enrolled in this study who fulfilled the inclusion criteria. Informed consent is taken from the participants. Brief history about demographic data was taken from each participant. All participants are examined for airway assessment, cardiovascular and respiratory examination before undergoing anesthesia. Participants are divided into 2 groups by simple lottery method in group xylometazoline and group adrenaline. Group Xylometazoline: receive 3 to 5 drops of 0.1% xylometazoline nasal drops in selected nostril 15 mins before transfer to OT. Group Adrenaline: receive intranasal packing with adrenaline soaked gauze piece in selected nostril. Packing is done 15 mins before transfer to OT and removed after 7 to 10 minutes. Proper monitoring of vital signs will be done in preoperative area. Anesthesia machine and accessories are checked, and drugs including emergency drugs are kept ready. Baseline BP, heart rate, ECG, and peripheral oxygen saturation is obtained and recorded from multipara monitor. All participants are preoxygenated by 100% oxygen for 5 mins. Induction is done with propofol (1%) 2mg/kg and atracurium 0.5 mg/kg by senior anesthesiologist present. The anesthetist present in OT is blind to both groups. Laryngoscopy is done by an experienced anesthesiologist using a MAC 3 or 4 blade based on participants' anatomy. Nasotracheal intubation is done by a cuffed lubricated (with lidocaine 2%) nasal tube of appropriate size. Anesthesia is maintained with atracurium 0.1 mg/kg and isoflurane in 60% O2 at 3L flow. The anesthesiologist will record incidence and severity of bleeding at the time of intubation and extubation. Data will be analyzed on SPSS version 20. Chi square test will be used to compare the incidence of nasal bleeding in both groups. Effect modifiers are controlled through stratification of age, gender, diabetes mellitus, hypertension to see the effect of these on the outcome variables. Post stratification chi square test will be applied taking P-value of \<0.05 as statistically significant.
Interventions
DRUG0.1% xylometazoline nasal drops
Xylometazoline is direct acting, non selective, adrenergic agonist binding with alpha 1&2 receptors, used for vasoconstriction to decrease nasal bleeding.
DRUGAdrenaline nasal pack
Adrenaline is direct acting, non selective, adrenergic agonist binding with alpha and beta receptors both, used for vasoconstriction to decrease nasal bleeding.
Sponsors
Shaheed Mohtarma Benazir Bhutto Institue of Trauma
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
This study is single blind, assessor is kept blind because participants are difficult to mask due to well distinguished treatment plan.
Intervention model description
Group Xylometazoline will receive xylometazoline nasal drops and Group Adrenaline will receive adrenaline nasal pack
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* ASA 1 and 2 * Age group between 18-60 years * Mallampati score 1 and 2 * Either gender * Participants who undergo elective oromaxillofacial surgery
Exclusion criteria
* Lack of consent * Participants with anticipated difficult airway * Participants receiving anticoagulant therapy * History of nasal abnormality (nasal surgery, trauma, polyp, obstruction) * History of repeated epistaxis * History of uncontrolled hypertension, diabetes, pregnancy, and any other cardiac or cerebral events.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Nasal bleeding | At the time of Intubation and Extubation |
Countries
Pakistan
Contacts
Primary ContactDr Sidra Javed Consultant Anaesthetist, MBBS, FCPS, PAIN FELLOW
Backup ContactDr Mirza Shahzad Baig Consultant Anaesthetist, MBBS, MCPS, FCPS
Outcome results
None listed