Hemodynamic Effects of Topical Oxymetazoline During Pediatric Flexible Bronchoscopy

Abstract

BACKGROUND: Bleeding is a well-recognized complication in flexible bronchoscopy, especially with advanced procedures. Oxymetazoline is a topical vasoconstrictor often used to reduce or treat bleeding in the nares and airways. METHODS: A retrospective cohort study was conducted on pediatric patients undergoing flexible bronchoscopy from 2015 to 2025. Language processing was used to analyze bronchoscopy-related procedures, and mixed-effects logistic regression models were used to compare blood pressure, heart rate, and rescue medication use in cohorts that were exposed to nasal, endobronchial, and no oxymetazoline. RESULTS: A total of 2874 patients (41% female, mean age: 5.8 y) underwent 3978 bronchoscopies, 66 (2%) of which were exposed to endobronchial oxymetazoline and 1039 (26%) to nasal oxymetazoline. Endobronchial oxymetazoline was associated with higher systolic blood pressure (β=5.73; 95% CI: 2.48-8.98; P=0.00067), diastolic blood pressure (β=3.68; 95% CI: 1.41-5.96; P=0.0016), and lower heart rate (β=-6.91; 95% CI: -10.84 to -3.00; P=0.00054). These effects were more pronounced when bleeding was reported. Endobronchial oxymetazoline was associated with increased bradycardia (OR: 1.92; 95% CI: 1.09-3.40; P=0.024), but not with increased rescue medication use (OR: 0.69; 95% CI: 0.38-1.24; P=0.21). CONCLUSION: Endobronchial and nasal oxymetazoline use during pediatric flexible bronchoscopy is associated with a mild increase in blood pressure and a decrease in heart rate, although it is well-tolerated and appears to be safe without an increased need for clinical intervention.