Postoperative airway management after nasal endoscopic sinus surgery: A comparison of traditional nasal packing with nasal airway

Abstract

Background:Nasal packing after the nasal surgery can be extremely hazardous and can lead to airway complications such as dyspnea and respiratory obstruction.Objective:The present study aimed at comparing the traditional nasal packing with nasal airway during the immediate postoperative period in patients undergoing fibreoptic endoscopic sinus surgery (FESS) under general anaesthesia (GA) with regards to airway management.Materials and Methods:The study groups consisted of 90 ASA grade I and II patients aged 16 to 58 years who underwent FESS under GA. Patients were randomly assigned into three groups: Group NP, UA and Group BA of 30 patients each. At the end of surgery, Group NP patients were managed with traditional bilateral nasal packing while a presterilized 5 mm ID uncuffed ETT was cut to an appropriate size and inserted into one of the nostrils in UA and bilaterally in BA group patients. During postoperative period following parameters and variables were observed over the next 24 hours: Any respiratory distress or obstruction, pain and discomfort, oxygen saturation, heart rate, blood pressure, bleeding episode, ease of suctioning through nasal airway, anaesthesiologists and surgeons satisfaction during postoperative period, discomfort during removal of nasal airway and any fresh bleeding episode during removal of nasal airway. The data was compiled and analyzed using Chi-square test and ANOVA with post-hoc significance. Value of P < 0.05 was considered significant and P < 0.0001 as highly significant.Results:The post-op mean cardio-respiratory parameters showed significant variations among NP group (P < 0.05) and the patient of UA and BA groups while intergroup comparison between UA and BA was non-significant (P > 0.05). Pain and discomfort, bleeding episode, ease of suctioning through nasal airway, pain and bleeding during removal of nasal airway (P < 0.0001) as well as surgeons and anaesthesiologists satisfaction criteria showed significant results among the NP group as compared to UA and BA groups (P < 0.05).Conclusion:The present intervention to maintain airway patency can be termed as excellent with additional benefits like ease of suctioning; oxygen supplementation and a possible haemostatic effect due to pressure on the operated site. The low cost of the modified nasal airway and easily replicable design were the standout observations of the present study.

Nitroglycerine, esmolol and dexmedetomidine for induced hypotension during functional endoscopic sinus surgery: A comparative evaluation

“…At the end of the surgery, the nasal packing was done keeping a cut piece of small size endotracheal tube to allow the patient to breathe through the nose postoperatively. [ 17 ] The residual neuromuscular blockade was antagonized with neostigmine 0.05 mg/kg and glycopyrrolate 0.1 mg/kg intravenously and extubation was done when the patient was fully awake, breathing regularly with adequate tidal volume. Total intra-operative fentanyl consumption, duration of surgery and total anesthesia time were recorded.…”

The management of postoperative airway after nasal endoscopic sinus surgery

“…Sukhminder et al study reported also the similar type of findings regarding satisfaction level in surgeons and anaesthesiologists. 30 In this study dexmedetomidine was used before induction of anaesthesia which can decreases the anaesthetic and analgesic requirements besides reducing the incidence of shivering and maintain haemodynamic variables in pre-operative and postoperative period. Similar interventions were used by Sukhminder et al and Bajwa et al which showed similar result as compared to our findings.…”

“…Similar interventions were used by Sukhminder et al and Bajwa et al which showed similar result as compared to our findings. 30,31 The hypopharyngeal packing can reduces the nasal bleeding during surgery on nasal sinuses. Basha et al and Piltcher et al study also reported the reduction of bleeding during nasal surgery.…”

A comparative study of postoperative airway management between traditional nasal packing and modified nasal airway after nasal surgeries

“…College.2022;13 (1):304-308. Attribution 4.0 International (CC BY 4.0) airway edema, and obstruction can also precipitate postoperative complications [4] .…”

“…Airway obstruction after head & neck surgery is the most common known complication. For various pathologies of the nose and paranasal sinuses, Functional endoscopic sinus surgery (FESS) and conventional surgeries widen the nasal cavity and promote paranasal sinus drainage [1,2] . The primary aim and the basic principle of nasal surgery are to relieve nasal obstruction, improve nasal patency and induce mucociliary clearance [3] .…”