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Nasal Packing After Septoplasty Cardiopulmonary Impact

Sarfaraz M. Banglawala, MD1; Mandeep S. Gill, MD1; Navpreet Dhillion, BSc1; James S. Khan, MD2; Michael K. Gupta, MD, FRCSC1; Alkis Psaltis, MD, PhD, FRACS3; Rodney Schlosser, MD, FRCS3; Doron D. Sommer, MD, FRCSC1
[+] Author Affiliations
1Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
2Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada
3Department of Ear, Nose and Throat, Medical University of South Carolina, Charleston
JAMA Otolaryngol Head Neck Surg. 2014;140(3):253-258. doi:10.1001/jamaoto.2013.6335.
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Importance  Bilateral anterior nasal packing is used after septoplasty with the goals of decreasing the risk of postoperative bleeding and adhesions. However, multiple studies caution against the use of nasal packing because of the risk of cardiopulmonary complications.

Objective  To evaluate the cardiopulmonary risks associated with bilateral anterior nasal packing after septoplasty.

Evidence Review  A literature review was conducted by 2 independent reviewers using EMBASE, Ovid, Medline, PubMed, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and reference list review from January 1966 to September 2012 to identify studies assessing nasal packing after septoplasty. The studies were reviewed and assigned an Oxford level of evidence grade, Detsky score, and Methodological Index for Nonrandomized Studies (MINORS) score. Data were extracted for arterial blood gases, oxygen desaturations, oxygen saturations, and adverse outcomes. Pooled estimates for randomized studies were performed when possible.

Findings  Fourteen studies conducted between 1973 and 2011 were included: 2 randomized clinical trials (RCTs) with a total of 119 patients and 12 prospective observational studies with a total of 356 patients. Nine studies showed a significant change within 1 of the cardiopulmonary parameters investigated. However, there was no consistency in changes across both observational and randomized studies. Furthermore, pooled estimates for cardiopulmonary parameters were all nonsignificant: standard mean differences of the pooled results of the RCTs were 0.05 (95% CI, −0.31 to 0.41) for arterial pH, 0.08 (95% CI, −0.30 to 0.46) for Paco2, and −0.32 (95% CI, −1.28 to 0.63) for Pao2. There were no major cardiopulmonary complications after nasal packing.

Conclusions and Relevance  Bilateral anterior nasal packing does not seem to cause adverse cardiopulmonary changes after septoplasty.

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Pooled Analysis of Both Randomized Clinical Trials That Reported Postoperative Arterial pH, Paco2, and Pao2

A, pH; B, Paco2; C, Pao2. There was no significant difference in the mean pH, Paco2, or Pao2 between the packing and no packing groups; df indicates degrees of freedom; SMD, standard mean difference.

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