Xylometazoline During Nasal Flexible Bronchoscopy

Overview

Flexible bronchoscopy is a commonly performed procedure and is usually performed transnasally. The optimal topical anesthesia regimen for bronchoscopy is investigational. Topical Vasoconstrictors like xylometazoline produce decongestion of nasal mucosa and may make insertion of bronchoscope easier. The addition of topical vasoconstrictor to lignocaine may have advantage in terms of patient comfort and for reducing local complications. Although evaluated in the settings of nasal endoscopy and nasotracheal intubation, randomized trials on the role of topical vasoconstrictors during flexible bronchoscopy are not available. The aim of this randomized trial is to study the effect of topical nasal xylometazoline administration during flexible bronchoscopy.

Full Title of Study: “Effect of Xylometazoline Administration During Nasal Flexible Bronchoscopy: A Double Blind, Randomized, Placebo-controlled Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Health Services Research
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: December 18, 2018

Detailed Description

Study design: Randomized double-blind placebo controlled study Study setting: Bronchoscopy room in Department of pulmonary medicine and sleep disorders at AIIMS, New Delhi Sample size: 200 patients (100 in each arm)

Inclusion criteria:

a) All adults > 18 years of age undergoing flexible bronchoscopy via nasal route

Exclusion criteria:

1. Uncontrolled hypertension

2. coronary artery disease

b) Pregnancy c) refusal of consent d) Hypoxemia (oxygen saturation [by pulse oximetry] < 92% with Fio2 of ≥ 0.3 e) Bronchoscopy not performed by nasal route f) Bronchoscopy performed through an artificial airway

Randomisation:

Computer generated Block randomisation with block size of 10 will be used to generate list of random numbers based on which subjects will be allocated to either of the groups.

Procedure of study The operator, assistant, drug administrator and outcomes assessor will be blinded. Patients meeting eligibility criteria will be randomized to receive either study drug Xylometazoline (0.1% nasal drops) (Otrivin, Novartis) (3 drops into each nostril) or 0.9% saline (3 drops into each nostril) placebo. This will be administered as ten minutes before bronchoscopy. This will be followed by the standard topical anesthesia procedure followed in our institution involving 5ml of 2% lignocaine gel into the nostril and 4 sprays of 10% lignocaine to the pharynx. Nebulized lignocaine shall not be administered. Transnasal flexible bronchoscopy will be performed with additional 1% lignocaine solution administered as "spray as you go" method. All diagnostic procedures or airway inspection procedures will be included. Patients shall undergo hemodynamic monitoring throughout the procedure. Procedures shall be performed without administration of upfront sedation and intraprocedural sedation shall be at the discretion of the operator.

Data will be recorded on a predesigned proforma. Baseline patient characteristics will be compared between the two groups. Categorical variables will be summarised by frequency (%) and chi-square test of proportion will be used to compare between the two groups.Quantitative variables will be summarised by mean±SD or median(IQR),as appropriate. Student's t-test or Wilcoxon rank sum test as appropriately be used to compare distribution of quantitative variables between the two groups. Stata statistical software will be used for data analysis.

Interventions

  • Drug: Xylometazoline
    • Nasal administration of Xylometazoline
  • Drug: Saline
    • Nasal administration of 0.9% Saline

Arms, Groups and Cohorts

  • Experimental: Xylometazoline
    • Patients receiving topical xylometazoline nasally during bronchoscopy
  • Placebo Comparator: Saline placebo
    • Patients receiving topical saline nasally during bronchoscopy

Clinical Trial Outcome Measures

Primary Measures

  • Operator rated difficulty in nasal bronchoscope negotiation (VAS)
    • Time Frame: At study completion approximately 4 months
    • Visual Analogue scale

Secondary Measures

  • Assistant rated Faces Pain scale for discomfort on nasal bronchoscope insertion
    • Time Frame: At study completion approximately 4 months
    • 10 point scale divided into six categories
  • Patient rated nasal pain on procedure completion (VAS)
    • Time Frame: At study completion approximately 4 months
    • Visual Analogue scale
  • Operator rated nasal mucosal trauma (VAS)
    • Time Frame: At study completion approximately 4 months
    • Visual Analogue scale
  • Complications
    • Time Frame: At study completion approximately 4 months
    • Proportion of patients developing complications

Participating in This Clinical Trial

Inclusion Criteria

  • All adults > 18 years of age undergoing flexible bronchoscopy via nasal route

Exclusion Criteria

  • Uncontrolled hypertension
  • coronary artery disease
  • Pregnancy
  • refusal of consent
  • Hypoxemia (oxygen saturation [by pulse oximetry] < 92% with Fio2 of ≥ 0.3
  • Bronchoscopy not performed by nasal route
  • Bronchoscopy performed through an artificial airway

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • All India Institute of Medical Sciences, New Delhi
  • Provider of Information About this Clinical Study
    • Principal Investigator: Karan Madan, Karan Madan, MD DM, Assistant Professor, Pulmonary Medicine and Sleep Disorders – All India Institute of Medical Sciences, New Delhi
  • Overall Official(s)
    • Karan Madan, MD, DM, Principal Investigator, All India Institute of Medical Sciences, New Delhi

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