title: Comparison of 4% and 6% topical cocaine solutions for reduction of epistaxis induced by nasotracheal intubation.
abstract: BACKGROUND
  Nasotracheal intubation (NTI) provides a good field for surgeons in patients undergoing oromaxillofacial surgery; however, NTI is often complicated by epistaxis. The aim of this study was to compare the efficacy of 4% and 6% topical cocaine solutions in reducing epistaxis during NTI.
  
  
  METHODS
  A total of 79 patients (16-65 years old) undergoing oromaxillofacial surgery were randomly assigned to two groups treated with either 4% cocaine (n = 39) or 6% cocaine (n = 40). Topical cocaine (1 mL) was sprayed onto the selected nasal cavity prior to NTI. All intubations were performed by an expert anesthesiologist using a GlideScope. The incidence and severity of epistaxis was examined along the nasal cavity up to the nasopharynx using a fiber optic bronchoscope. The hemodynamic responses to stimuli during the peri-NTI period were also recorded.
  
  
  RESULTS
  The incidence of epistaxis was 43.59% (17/39) in the 4% cocaine group and 50% (20/40) in the 6% cocaine group (p = 0.57). The severity of epistaxis did not differ between the two groups (p = 0.46). High resistance during NTI and epistaxis were closely correlated and the major bleeding sites were located at the nasopharynx. Compared with the 4% cocaine group, treatment with 6% cocaine resulted in a higher heart rate and mean arterial pressure (both p < 0.05). There was no statistically significance difference between the two groups with respect to the hemodynamic responses to NTI.
  
  
  CONCLUSIONS
  The spraying of either 4% or 6% topical cocaine into the nasal cavity gives comparable effects for intubation-related epistaxis. However, 6% cocaine may increase the hemodynamic responses while being sprayed. Therefore spraying with 4% topical cocaine had advantages with respect to 6% cocaine and is recommended for use prior to NTI.
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: I-Cheng
authors.initials: IC
authors.lastname: Lu
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Hui
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Hung-Te
authors.initials: HT
authors.lastname: Hsu
authors.affiliation: Division of Oral Maxillofacial Surgery, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Chung-Ho
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Oral Maxillofacial Surgery, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Kuang-Yi
authors.initials: KY
authors.lastname: Tseng
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: 770234anesthesia@gmail.com.
authors.forename: Kuang-I
authors.initials: KI
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D003042:Cocaine / Q000008:administration & dosage*; D004844:Epistaxis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D012996:Solutions; D013515:Surgery, Oral
chemical_list: D012996:Solutions; D003042:Cocaine
keywords: bronchoscopes; cocaine; epistaxis; fiber optic technology; intubation, intratracheal: nasal