Risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery Nuray Bayar Muluk a, * , Alpaslan Apan b , Sibel O ¨ zc ¸akır b , Osman Ku ¨rs ¸at Arıkan a , Can Koc ¸ c a ENT Department, School of Medicine, Kırıkkale University, Turkey b Anesthesiology Department, School of Medicine, Kırıkkale University, Turkey c Outpatient Clinic, Turkey Received 17 June 2007; accepted 19 December 2007 Available online 7 March 2008 Abstract Objective: This prospective study investigated the risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery; and effects of nasal packing on consciousness level while the patients were awake or asleep, measured by Bispectral Index (BIS). Methods: The study group consisted of 15 adult patients (10 male, 5 female), who were applied nasal packing at the end of nasal surgery. The control group consisted of 15 adult patients (10 male, 5 female), who received general anesthesia for various reasons. In the study and control groups, BIS index, respiratory rate, peripheral oxygen saturation, pulse per minute and blood pressure were measured at seven different times. Results: There was no statistically significant difference between BIS indexes of the study and control groups. In the fourth hour after sleep (AS-4 h), respiratory rate of the study group was significantly lower than that of the control group. In the fourth hour after the anesthesia (AA- 4 h), oxygen saturation value of the study group was lower than that of the control group. Conclusion: We conclude that in patients who are applied nasal packing at the end of nasal surgery; at AA-4 h and AS-4 h times, there may be risk of decrease in the oxygen saturation and respiratory rate parameters, respectively. Therefore, it is necessary to monitor non-invasive respiratory parameters and to give enriched oxygen by an oral catheter. # 2008 Published by Elsevier Ireland Ltd. Keywords: The Bispectral Index (BIS); Respiratory rate; Oxygen saturation; Nasal packing; Nasal surgery; Enriched oxygen; Anesthesia 1. Introduction The Bispectral Index (BIS) is a mathematically derived electroencephalographic (EEG) derivative that has been introduced to monitor depth of anesthesia [1] and to predict the level of sedation in patients undergoing conscious sedation [2]. BIS is a single number composed of from different EEG features, is drug independent and changes with increasing doses of hypnotics in an almost linear way [3]. The sensation of comfortable nasal breathing is a complex phenomenon. In optimal nasal respiration, air passes over the maximum amount of nasal mucosa with resulting humidifica- tion, cleansing and warming but without the sensation of dyspnea [4]. When there is a blockage in nasal breathing due to nasal packing after nasal surgeries, there may be a disturbance in patient’s sense of well-being resulting from problems with nasal respiration. In patients with nasal packing, oxygen saturation may be decreased and carbon dioxide level may be increased. In addition, nasal packing may affect patient’s sedation level while the patient is awake or asleep. In the present study, we investigated the risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery; and the effects of nasal www.elsevier.com/locate/anl Auris Nasus Larynx 35 (2008) 521–526 * Corresponding author at: Birlik Mahallesi, Zirvekent 2, Etap Sitesi, C-3 blok, No: 62/43, 06610 C ¸ ankaya, Ankara, Turkey. Tel.: +90 312 4964073/532 7182441; fax: +90 318 2252819. E-mail addresses: nbayarmuluk@yahoo.com, nurayb@hotmail.com (N.B. Muluk). 0385-8146/$ – see front matter # 2008 Published by Elsevier Ireland Ltd. doi:10.1016/j.anl.2007.12.007