Vasovagal attack during anterior nasal packing in patients with epistaxis

Abstract

Introduction: The incident of fainting during nasal packing to manage epistaxis is not so uncommon. Objective: To observe the effect of anterior nasal packing on blood pressure and heart rate, during the management of epistaxis. Method: Nepalese male patients (n=40; age more than 13 years) attended in Tribhuvan University Teaching Hospital, Kathmandu presenting with active nose bleeding in the Department ENT and Head and Neck Surgery were taken for the study in the time period between July 2005-June 2008. This prospective comparative study was analysed using Z test. Results: The blood pressure and heart rate in patients presented with epistaxis show significantly lower during anterior nasal packing (104±14.08/67±9.35 mmHg, 67±3.81/min) compared with same patients before packing (130±20.3/83±14.89 mm Hg, 73±34.82/min). Conclusion: Nasal packing during the management of epistaxis shows bradycardia and hypotension and sometimes vasovagal syncope which are mostly due to reflex action through stimulation of vagus nerve and stimulation sympatho-vasodilator fibres of the skeletal muscle.

Keywords

• Vasovagal attack
• Blood pressure
• Heart rate
• Anterior nasal packing
• Epistaxis