Acta Oto-Laryngologica. 2014; 134: 390–394 ORIGINAL ARTICLE Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications MELIH CAYONU 1 , AYDIN ACAR 2 , EYUP HORASANLI 3 , AYTUG ALTUNDAG 4 & MURAT SALIHOGLU 5 1 Department of Otolaryngology and Head Neck Surgery, Amasya University Training and Research Hospital, Amasya, 2 Department of Otolaryngology and Head Neck Surgery, Ankara Numune Training and Research Hospital, Altındag, 3 Department of Anesthesiology, Kecioren Training and Research Hospital, Ankara, 4 Division of Otolaryngology, Istanbul Surgery Hospital, Istanbul and and 5 Department of Otolaryngology and Head Neck Surgery, Gulhane Military Medical Academy Haydarpas ¸a Training Hospital, Istanbul, Turkey Abstract Conclusion: The patients who underwent septoplasty with bilateral totally occlusive nasal packing had an increased risk of experiencing respiratory distress (RD). Objective: To compare the immediate RD rates during recovery from anesthesia and surgical complications of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique. Methods: A total of 150 patients were assigned to one of three groups according to the technique utilized following septoplasty: transseptal suturing, internal nasal splint, or Merocel (nasal dressing without airway). To determine RD related to anesthesia in the operating theatre, the criterion was defined as any unanticipated hypoxemia, hypoventilation or upper airway obstruction (stridor or laryngospasm) requiring an active and specific intervention. Postoperative hemorrhage, infection, synechia formation, and septal perforation were evaluated. Results: Patients in the Merocel group were 3.6 times more likely to have RD than patients in the transseptal suture and internal nasal splint groups. Also, patients who smoked had an increased risk of RD during the recovery phase of anesthesia after the septoplasty. In addition, all three techniques resulted in similar complication rates after septoplasty, with the exception of minor hemorrhage, which had a significantly higher rate in the transseptal suture group. Keywords: Nasal packing, hemorrhage, septal deviation, smoking Introduction Respiratory tract-related complications in the post- tracheal extubation phase are three times more com- mon than in the tracheal intubation and induction of anesthesia phases [1]. For this reason, in spite of all the developments in surgical techniques and anes- thetic medications and their administrations, tracheal extubation remains the most risky phase of anesthesia [2]. Especially in upper respiratory tract surgeries, such as adenotonsillectomy and direct laryngoscopy, the most imminent complications are respiratory tract complications, such as coughing, laryngospasm, and bronchospasm, which develop perioperatively and cause a decrease in oxygen saturation [3,4]. One of the most common reasons for nasal obstruc- tion is nasal septal deviation, and septoplasty is one of the most frequently performed operations in otorhi- nolaryngology practice [5,6]. The surgical methods for these procedures can differ, but many surgeons traditionally use nasal packing to prevent complica- tions such as postoperative bleeding, adhesions, hematoma formation, and recurrence of septal devi- ation [7]. There are various packing materials that Correspondence: Dr Aytug Altundag, Istanbul Surgery Hospital, Division of Otorhinolaryngology, Sisli, Istanbul, 34365, Turkey. Tel: +90 212 296 94 50. Fax: +90 212 296 94 82. E-mail: aaltundagkbb@gmail.com (Received 9 November 2013; accepted 8 December 2013) ISSN 0001-6489 print/ISSN 1651-2251 online Ó 2014 Informa Healthcare DOI: 10.3109/00016489.2013.878476 Acta Otolaryngol Downloaded from informahealthcare.com by Ondokuz Mayis Univ. on 03/16/14 For personal use only.