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Nasal Pack Causing Upper Airway Obstruction

Eipe, Naveen MD; Choudhrie, Ashish MS

doi: 10.1213/01.ANE.0000156690.65025.47
Letters to the Editor: Letters & Announcements

Department of Anesthesia, (Eipe)

Department of Surgery, Padhar Hospital, Padhar, Madhya Pradesh, India (Choudhrie)

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To the Editor:

We report a serious and life-threatening complication resulting from nasal packing. A 14-yr-old boy underwent right dacrocystorhinostomy with nasal packing under general anesthesia. He was shifted to the recovery unit awake and breathing comfortably and monitored with a pulse oximeter (Spo2 100%). He coughed and began to struggle 5 min later. Within seconds he developed inspiratory stridor (Spo2 90%). Restoring the patency of the airway was now urgent. Suctioning followed by assisted ventilation (bag and mask) did not break the spasm (Spo2 80% and falling). Laryngoscopy revealed that the blood-soaked distal end of the nasal pack had prolapsed into the glottis. This was deftly removed into the oral cavity with a Magill’s forceps and the trachea was intubated. The tracheal tube had pink frothy sputum and a diagnosis of postobstructive pulmonary edema was made (1,2). He was successfully treated with diuresis, morphine, and oxygen supplementation (with positive pressure ventilation).

Nasal packing has been previously reported to result in complications (3–5). A nasal pack causing upper airway obstruction and postobstructive pulmonary edema has not been reported previously. This patient had aspirated the nasal end of the pack after tracheal extubation. This case highlights the need for close postoperative monitoring in patients with nasal packs.

Naveen Eipe, MD

Department of Anesthesia

Ashish Choudhrie, MS

Department of Surgery

Padhar Hospital

Padhar, Madhya Pradesh, India

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© 2005 International Anesthesia Research Society