Effect of Bilateral Complete Nasal Packing on Extubation Status after Sinonasal Surgeries

To compare on-table respiratory events during extubation in patients undergoing sinonasal surgery with bilateral occlusive nasal packing versus those without nasal packing.

An experimental study. Place and Duration of the Study: Department of ENT, Head and Neck Surgery and Department of Anaesthesiology, Dow University Hospital, Karachi, Pakistan, from January to December 2022.

A total of 410 patients meeting the inclusion criteria were enroled, with 205 in each group (with and without nasal packing). The primary outcome was respiratory distress during extubation requiring intervention. The chi-square and Fisher's exact tests were applied to assess differences between the groups. A p-value <0.05 was considered statistically significant.

Respiratory distress requiring intervention after extubation occurred in 6.8% of the nasal packing group and 10.2% of the non- packing group. Smokers experienced more difficult extubation events than non-smokers (p = 0.001), with a relative risk (RR) of 2.7 (95% CI: 1.48-5.20). Males had a higher frequency of poor extubation outcomes regardless of pack placement (p = 0.053).

Respiratory distress during extubation may occur following nasal surgery, irrespective of nasal packing, with a higher risk observed in smokers. Preoperative counselling, meticulous surgical technique, and careful airway management at the time of extubation are advised. Complete nasal packing should be avoided in high-risk patients.

Nasal surgery, Nasal packing, General anaesthesia, Extubation, Respiratory distress.