Letters to the Editor: Letters & Announcements
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, Madhya Pradesh, India
1. McConkey PP. Postobstructive pulmonary oedema: A case series and review. Anaesth Intensive Care 2000;28:72–6.
2. Dolinski SY, MacGregor DA, Scuderi PE. Pulmonary hemorrhage associated with negative-pressure pulmonary edema. Anesthesiology 2000;93:888–90.
3. Von Schoenberg M, Robinson P, Ryan R. Nasal packing after routine nasal surgery: Is it justified? J Laryngol Otol 1993;107:902–5.
4. Walton SL. Postextubation foreign body aspiration: A case report. AANA J 1997;65:147–9.
5. Hashmi SM, Gopaul SR, Prinsley PR, Sansom JR. Swallowed nasal pack: A rare but serious complication of the management of epistaxis. J Laryngol Otol. 2004;118:372–3.