Comparative Efficacy of Two Different Concentrations of Intranasal Topical Adrenaline and Xylometazoline to Reduce Fibreoptic-guided Nasotracheal Intubation-associated Epistaxis

Background: Epistaxis is the most common complication associated with nasotracheal intubation (NTI). Topical vasoconstrictors are an effective method for minimising this. We compared the efficacy of xylometazoline 0.1% and adrenaline in 1:100,000 and 1:50,000 concentrations in preventing epistaxis during fibre-optic NTI. Materials and Methods: One hundred and eighty patients requiring NTI were randomised into three groups each of 60. Groups receiving topical drops were X1: adrenaline (1:100,000), X2: adrenaline (1:50,000) and X3: xylometazoline 0.1%. Three drops of medication were instilled into patient’s patent nostril 10 min prior to fibre-optic NTI. After passing lubricated, cuffed PVC endotracheal tube, epistaxis was assessed and graded as: none, mild, moderate and severe. Results: Incidence of epistaxis after application of drug X1, drug X2 and drug X3 was 54.4%, 33.3% and 43.1%, respectively. Reduction in incidence of bleeding was observed with drug X2 when compared with drug X1 ( P = 0.024). The difference in incidence of bleeding was not significant in comparison of drug X1 with X3 ( P = 0.226) and drug X2 with X3 ( P = 0.281). Regarding the severity of epistaxis, there were no statistically significant differences among adrenaline 1:50,000, adrenaline 1:100,000 and xylometazoline groups ( P > 0.05). Haemodynamic changes in the three study groups were minimal and comparable ( P > 0.05). Conclusion: Topical adrenaline 1:50,000 is more efficacious than adrenaline 1:100,000 in reducing the incidence of epistaxis; however, in xylometazoline group, reduction in incidence of epistaxis was not significantly different from the other two groups.