Intranasal xylometazoline hydrochloride to reduce intraoperative nasal hemorrhage in dogs undergoing ala-vestibuloplasty for BOAS: A prospective, randomized study.

OBJECTIVE: To assess whether intranasal administration of xylometazoline hydrochloride 0.1% reduces intraoperative hemorrhage during ala-vestibuloplasty in dogs undergoing surgical correction for brachycephalic obstructive airway syndrome (BOAS). STUDY DESIGN: Prospective, randomized, placebo-controlled clinical trial. SAMPLE POPULATION: A total of 30 client-owned brachycephalic dogs undergoing surgery for BOAS with ala-vestibuloplasty. METHODS: Dogs were randomly assigned to receive xylometazoline hydrochloride 0.1% or 0.9% saline intranasally before ala-vestibuloplasty. Total hemorrhage was quantified by weighing cotton-tipped applicators and surgical swabs before and after use. Hemorrhage normalized to bodyweight, percentage estimated blood volume loss, time to hemostasis and rescue hemostatic interventions were recorded. RESULTS: A total of 17 dogs received xylometazoline and 13 received saline. Median total intraoperative hemorrhage was lower with xylometazoline than saline: 6.27 g, interquartile range (IQR): 4.57-7.45 g versus 16.49 g, IQR: 15.15-25.47 g; p < .0001. This represented a 62% reduction and corresponded to estimated median blood volumes of 5.9 and 15.6 mL, respectively. Hemorrhage normalized to bodyweight was also lower with xylometazoline: 0.69 g/kg versus 1.74 g/kg; p < .0001. Estimated percentage blood-volume loss was lower with xylometazoline: 0.76% versus 1.93%; p < .0001. Median time to hemostasis was shorter with xylometazoline: 14.0 versus 20.0 min; p = .0001. Rescue hemostatic intervention was required in 10/13 saline-treated dogs and 0/17 xylometazoline-treated dogs; p < .001. CONCLUSION: Intranasal xylometazoline reduced measured intraoperative hemorrhage and shortened observed time to hemostasis in dogs undergoing ala-vestibuloplasty for BOAS. CLINICAL SIGNIFICANCE: Topical xylometazoline may improve local hemorrhage control and surgical field visibility during ala-vestibuloplasty.