Case Report *Resident, Department of Anesthesia †Staff Physician/Director, Stanford Sinus Center ‡Professor of Anesthesiology Address correspondence to Dr. Brock-Utne at the Stanford University Medical Center, Department of Anesthesia, 300 Pasteur Dr., Rm. H358, Stanford, CA 94305-5640. E-mail: brockutn@leland.stanford.edu Received for publication January 17, 2001; revised manuscript accepted for publication November 29, 2001. Airway Complication Following Functional Endoscopic Sinus Surgery Jeffrey P. Holden, MD,* Winston C. Vaughan, MD,† John G. Brock-Utne, MD, PhD‡ Department of Anesthesia, Stanford University School of Medicine, Stanford, CA Difficulty breathing after upper airway surgery requires immediate evaluation and treatment. We present a case of airway compromise after sinus surgery due to edema of the uvula. The patient was admitted for observation overnight and discharged the next day. A discussion of potential airway changes after sinonasal surgery is presented. Keywords: Airway, edema, sinus surgery, uvula. Introduction Chronic sinusitis is one of the most commonly reported medical conditions. 1 Initial treatment is medical; however, many patients will require surgical procedures. Functional endoscopic sinus surgery (FESS) is the most commonly used technique for the surgical treatment of chronic sinusitis. 2 This technique is usually performed on an outpatient basis and involves the use of endoscopes and small instruments to remove diseased tissue so as to widen drainage pathways thus improving sinus function. FESS also has been shown to improve pulmonary function in some patients with asthma. 3 Primary complications of FESS may include bleeding, infection, and orbital or intracranial injury. 3–6 Secondary complications associated with general anesthesia such as aspiration, embolism, or myocardial infarction (MI) may also occur. We report another complication, namely, severe uvular edema leading to respiratory difficulty following FESS. Other airway issues that may arise after sinonasal surgery, for which the anesthesiologist may be called to evaluate, are also discussed. Case Report A 28-year-old ASA physical status I male with chronic sinusitis was scheduled for FESS after failure of medical management. Past medical history and physical examination were unremarkable. On the morning of the procedure, he was afebrile with a normal white cell count and hemoglobin (Hb; 14 mg%). An intravenous (IV) cannula was established and midazolam 2 mg was given in the preoperative area before transport to the operating room (OR). Monitoring included electrocardiography (ECG), noninvasive blood pressure (BP) moni- toring, pulse oximetry, and capnography. After preoxygenation, an uneventful induction of anesthesia with fentanyl 100 g, midazolam 1 mg, and propofol 200 Journal of Clinical Anesthesia 14:154 –157, 2002 © 2002 Elsevier Science Inc. All rights reserved. 0952-8180/02/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0952-8180(01)00376-2