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

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.