Pre-emptive epinephrine nebulization prior to nasotracheal intubation for mandibular fracture fixation surgeries: Does it really differ? A randomised controlled clinical trial

Figures & data

Table 1. The degree of epistaxis during intubation was estimated as the following.

The degree of bleeding	Definition	Laryngeoscopic view
None	No bleeding	No interference with the laryngoscopic view
Minimal	Tinge of blood	Just blood-tinged ETT but no blood on the vocal cords or mouth floor
Moderate	Blood on the vocal cords and mouth floor	Interferes with the laryngoscopic view, but is easy to confirm the laryngeal structure
Severe	Blood on the vocal cords and mouth floor	Hard to visualize the laryngeal structure without suction because of bleeding.

Table 2. Patient’s demographics and surgical data.

Parameters	Group EL No. (60)	Group OL No. (60)	P- value
Age, Years (mean± SD)	31.765± 6.8	30.725± 6.0	0.235
Height, cm (mean± SD)	157.980± 3.16	158.216± 3.62	0.442
Weight, Kg (mean± SD)	72.020± 6.12	73.451± 8.92	0.337
Sex	Males: 95% Females: 5%	Males: 96.66% Females: 3.33%	0.647
ASA grade:			0.46
ASA I	36(60%)	32(53.3%)
ASA II	24(40%)	28(46.7%)
Type of mandibular fracture	Condylar fracture (28%) Parasymphiseal (72%)	Condylar fracture (35%) Parasymphiseal (65%)	0.432

*Significant difference (p-value <0.05); SD: Standard deviation.

Table 3. Intubation measures and incidence of epistaxis in the studied groups.

Intubation Measures	Group EL No. (60)	Group OL No. (60)	P- value
Intubation time in seconds (mean± SD)	37.8±6.32	42.16±5.1	0.000028*
Severity of bleeding during intubation by percentage			0.01 *
Nil	45/60=75%	29 /60=48.33%
Mild	11/60=18.33%	24/60= 40%
Moderate	4/60=6.66%	7/60=11.66%
Severe	0.00%	0.00%
Severity of bleeding 5 minutes after the intubation by percentage			0.085
Nil	48/60=80%	37/60=61.66%
Mild	9/60=15%	18/60=30%
Moderate	3/60=5%	5/60= 8.33%
Severe	0.00%	0.00%

*Significant difference (p value <0.05); SD: Standard deviation.

Hemodynamic variations measured over different intervals were all non-significant results except for the mean blood pressure, which was measured 10 minutes after the intubation. Two of the patients in the inhalation group suffered sinus tachycardia associated with elevated mean blood pressure. In that group, 3.33% of the patients required labetalol treatment. The mean and standard deviation measures were higher in the EL group than the OL group, (86.27± 11.5) and (84.62 ± 7.2), respectively; p-value = 0.029. The intraoperative blood loss was a highly significant statistical measure, showing a higher priority for the EL group in decreasing intraoperative blood loss. The mean ± SD measures in the EL and OL groups were (406.86± 89.6) and (468± 139), respectively, with a p-value of 0.00026*.Epinephrine mixed with lidocaine administered by inhalation was beneficial in reducing intraoperative opioid consumption. The mean ± SD measures of intraoperative fentanyl consumption were 144.13± 9.2 and 166.66± 58.3, respectively, with a p-value of 0.005 in the EL and OL groups, respectively (Table 4).

Table 4. Intraoperative measures in the studied groups.

HR and mean BP Measures	Group EL No. (60)	Group OL No. (60)	P- value
Basal HR	88±8.5	86.471± 10.4	0.27
Basal mean BP (mean± SD)	77.8±10.1	79.235±8.7	0.45
HR just after the intubation	92.41±7.4	91.6±7.33	0.25
BP just after the intubation (mean± SD)	86.92±6.8	88.4±8.1	0.36
HR 10 minutes after the intubation	90.4±13.3	89.23±8.4	0.36
BP 10 minutes after the intubation (mean± SD)	86.27±11.5	84.62±7.2	0.029*
HR 30 minutes after the intubation	84.29±10.1	85.05±12.6	0.33
BP 30 minutes after the intubation (mean± SD)	81.58±6.8	82.58±9.4	0.228
HR after the extubation	96.78±7.2	94.94±9.2	0.224
BP after the extubation (mean± SD)	98.07±8.5	98.7±9.7	0.266
Patients who needed labetalol	2/60= 3.33%	0/60	0.78
Intraoperative fentanyl consumption (mean± SD)	144.1±39.2	166.66±58.3	0.005*
Intraoperative blood loss (mean± SD)	406.86±89.6	468.6±139	0.00026*

*Significant difference (p value <0.05); SD: Standard deviation.

Table 5. Post-extubation measurements.

Parameters	Group EL No. (60)	Group OL No. (60)	P- value
Intensity of postoperative nasal pain VAS (mean± SD)	2.96±1.5	3±1.61	0.2
Postoperative nasal obstruction			0.015*
Nil	52/60=86.66%	40/60=66.66%
Mild	7/60=11.66%	12/60=20%
Moderate	1/60=1.66%	8/60=13.33%
Severe	o.0%	0.0%
Incidence of epistaxis just after extubation	0.00%	0.00%	0.5
Incidence of epistaxis before discharge from PACU	0.00%	0.00%	0.5

*Significant difference (p value <0.05); SD: Standard deviation.

Table

MENA	Middle East and North Africa
RTA	Road traffic Accident
ASA	American society of anesthesiologists
EL	Epinephrine lidocaine group
OL	oxymetazoline lidocaine group
ETT	Endotracheal tube
NTI	Nasotracheal intubation
PACU	post-anesthesia care unit.