title: Topical vasoconstrictor use for nasal intubation during pregnancy complicated by cardiomyopathy and preeclampsia.
abstract: Ankylosing spondylitis presents challenges for the obstetric anesthesiologist in administering neuraxial anesthesia or managing the airway. A pregnant patient with ankylosing spondylitis, cardiomyopathy and preeclampsia requiring cesarean delivery was managed with an awake nasotracheal fiberoptic intubation. The use of topical cocaine, epinephrine, phenylephrine, and oxymetazoline to produce nasal vasoconstriction is discussed. Selective alpha-2 agonists that can potentially provide nasal mucosa vasoconstriction and placental vasculature vasodilation are also discussed.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. arendt.katherine@mayo.edu
authors.forename: K W
authors.initials: KW
authors.lastname: Arendt
authors.forename: K
authors.initials: K
authors.lastname: Khan
authors.forename: T B
authors.initials: TB
authors.lastname: Curry
authors.forename: L C
authors.initials: LC
authors.lastname: Tsen
mesh_terms: D000287:Administration, Topical; D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000494:pharmacology; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000494:pharmacology; D000328:Adult; D000769:Anesthesia, Inhalation; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology; D009202:Cardiomyopathies / Q000150:complications*; D003042:Cocaine / Q000008:administration & dosage / Q000494:pharmacology; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D014663:Nasal Decongestants / Q000008:administration & dosage*; D009297:Nasal Mucosa; D055100:Optical Fibers; D010109:Oxymetazoline / Q000008:administration & dosage / Q000494:pharmacology; D010656:Phenylephrine / Q000008:administration & dosage / Q000494:pharmacology; D011225:Pre-Eclampsia; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D013167:Spondylitis, Ankylosing / Q000150:complications
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D000316:Adrenergic alpha-Agonists; D000779:Anesthetics, Local; D014663:Nasal Decongestants; D010656:Phenylephrine; D010109:Oxymetazoline; D003042:Cocaine; D004837:Epinephrine