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Nasal Mucosal Vasoconstriction — FRCA Final MCQ

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EasyAirway ManagementNasal Mucosal VasoconstrictionFRCA Final

A 28-year-old man (ASA I) is having wisdom teeth extraction under general anaesthesia with a nasal intubation. The surgeon applies a topical vasoconstrictor to the nasal mucosa before intubation to reduce bleeding. Which topical agent is most commonly used for nasal mucosal vasoconstriction?

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Correct answer: B — Xylometazoline or co-phenylcaine (lidocaine with phenylephrine)

For nasal mucosal preparation before nasal intubation, xylometazoline (alpha-adrenergic nasal decongestant) or co-phenylcaine spray (5% lidocaine with 0.5% phenylephrine) are most commonly used in UK practice. They provide vasoconstriction (reducing bleeding and nasal mucosal swelling) and anaesthesia (lidocaine component). Topical cocaine (4-10%) was historically used and provides both vasoconstriction and anaesthesia in a single agent, but is now less commonly used due to its controlled drug status, cardiac toxicity risk, and regulatory requirements.

Reference: RCOA – 2023 – ENT/dental anaesthesia; AAGBI – 2020 – Nasal intubation preparation