Posterior packs and the nasopulmonary reflex

Abstract

Increased mortality and arterial hypoxemia have long been associated with posterior nasal packs placed for control of severe epistaxis. Several authors have postulated a nasopulmonary reflex to partially explain this clinically observed phenomenon. In ten young, healthy subjects, using a multiparameter pulmonary evaluation, posterior nasal packs were placed and no significant changes were observed in lung volumes, flow and alveolar gas exchange, especially oxygenation. These findings suggest that aspiration, sedation, and degeneration of pulmonary function with age, not a nasopulmonary reflex, have not been adequately emphasized in previously performed studies.

Packing and Postoperative Rhinoplasty Management: A Survey Report

“…9 In contrast, an examination of 59 patients undergoing septal surgery by Nunez et al 4 demonstrated no significant difference in complication rates (adhesions, crusting/mucosal atrophy, or granuloma formation) between patients packed with Vaseline gauze versus those without packing. 10 In addition, Nunez et al reported higher pain on postoperative day 1 in the Vaseline gauze group (p < .05). Von Schoenberg et al 5 discussed similar findings in a series of 95 patients undergoing routine nasal procedures, with higher pain being reported by patients packed with Bismuth iodoform paraffin paste or Tefla (p < .001).…”

Is nasal packing really required after septoplasty?

“…Patients with nasal packing have an increased risk of hypoxaemia, cardiac arrhythmias and mortality (20). The hypoxia and its consequences have been explained as a result of the nasopulmonary reflex (21,22).…”

Response of nasal airway and heart rate variability to controlled nasal breathing

“…Clinically, bilateral nasal obstruction can cause significant hypoxia and is associated with an increased risk of cardiac arrhythmias and mortality which has been observed in patients with bilateral nasal packing [1]. There have been extensive investigations of the cardiopulmonary changes that appear after bilateral nasal obstruction.…”