Postextubation foreign body aspiration: a case report

Endoscopic sinus surgery performed on a healthy young male could have resulted in a fatal outcome when a surgically placed nasal pack became dislodged upon extubation and unknowingly was aspirated. Unlike the "missing" nasal packs or posterior pharyngeal packs placed intraoperatively, this particular pack was to remain in place 12 to 24 hours postoperatively, status postseptoplasty. At the conclusion of the case and after extubation, all visible knots, ties, and steri-strips appeared to be intact. However, the patient displayed signs of hypoxia and stridor. Excessively high ventilating pressures were required to oxygenate the patient with the subsequent need for an emergency reintubation. A diagnosis of foreign body aspiration was made. Using the fiberoptic bronchoscope, it was discovered that one of the packs placed intraoperatively had indeed become dislodged and aspirated into the tracheal bronchial tree. This became a life-threatening situation with the patient showing signs of compromised oxygenation, hypercarbia, tachycardia, and hypertension. The combined efforts of the surgeon, the anesthesia team, and the operating room personnel allowed for the prompt retrieval of the foreign body using the fiberoptic bronchoscope equipment.