Tension pneumocephalus following nasal polypectomy

Subdural tension pneumocephalus in a 80-year-old man following nasal polypectomy, presenting clinically with progressive weakness of both legs, is reported and the pathogenesis is discussed. The diagnosis of tension pneumocephalus and the options of management are considered.     

Infections after endoscopic polypectomy using nasal steroids.

BACKGROUND: Topical nasal steroids such as beclomethasone dipropionate and fluticasone propionate have been widely used in the treatment of rhinitis and polyposis. An increase in infection has occurred with the use of fluticasone propionate after endoscopic polypectomy. OBJECTIVE: The purpose of this study was to determine the prevalence of nasal and paranasal infections with the use of topic nasal steroids after endoscopic polypectomy and to compare the recurrence rates of the polyposis. DESIGN AND SETTING: We conducted a prospective, comparative, open, experimental, longitudinal study at an academic tertiary referral medical center. METHODS: One hundred sixty-two patients in whom endoscopic polypectomy had been indicated were randomly divided into 3 groups of 54 patients each. The patients from the first group were treated with saline lavage only. Patients from the second group also received fluticasone propionate 400 microg/day in nasal spray after lavage. Patients from the third group received beclomethasone dipropionate 600 microg/day after lavage. The prevalence of infections and recurrence of polyposis was compared in the 3 groups. RESULTS: Three patients, 2 in the placebo group and 1 in the beclomethasone group, developed infections during the first 3 months after surgical procedure. The recurrence of polyps in the group without steroids was 44%. In contrast, 15% from the patients treated with fluticasone showed recurrence of polyposis; furthermore, 26% of the patients treated with beclomethasone showed recurrence of polypsosis, with a minimum follow-up of 12 months. CONCLUSIONS: The use of nasal steroids does not seem to increase the prevalence of infections after endoscopic polypectomy.     

鼻内镜术后鼻腔填塞患者真实体验的质性研究

目的了解慢性鼻-鼻窦炎患者鼻内镜术后鼻腔填塞期间内心真实体验,为采取针对性护理干预减轻鼻内镜术后患者鼻腔填塞痛苦提供参考。方法以立意抽样方法抽取15例慢性鼻-鼻窦炎行鼻内镜手术后鼻腔填塞患者,采用半结构式深度访谈法收集患者资料,以现象学7步分析法进行编码、归纳、提炼主题。结果共提炼4个主题,即躯体功能紊乱、躯体形象受损、负性情绪、对术后康复的期待。结论鼻内镜术后鼻腔填塞患者易出现躯体形象、舒适度改变,并存在焦虑情绪。医护人员需结合患者内心真实感受采取针对性、个性化的护理措施,以提高其舒适度,舒缓焦虑情绪,促进患者康复。     

术后鼻腔填塞患者的舒适护理研究进展

阐述术后鼻腔填塞患者常见不适症状的发生原因、特点及其舒适护理的措施,为护理人员采取有效护理措施提供参考,减轻患者术后不适,提高生活质量,促进医患和谐。     

Evaluation of time of nasal packing after nasal surgery: a randomized trial.

A randomized, prospective trial was carried out to compare the rate of hemorrhagic complications after removal of nasal packing left for 24 and 48 hours. A total of 104 patients underwent nasal surgery and were randomly assigned to 1 of 2 groups: group 1, 24 hours of nasal packing; group 2, 48 hours of nasal packing. No statistical difference was observed between the groups in terms of occurrence of hemorrhagic complications. Hypertension was the only prognostic factor for postoperative bleeding. The routine use of 48-hour postoperative nasal packing after nasal surgery is not justified because of the low incidence of bleeding and the potential associated morbidity. At the end of the procedure, surgeons should evaluate the risk of postoperative bleeding (ie, presence of hypertension) and decide whether 24-hour nasal packing is enough.     

Effect of pharyngeal packing during nasal surgery on postoperative nausea and vomiting

Objective

The aim of this study was to evaluate the efficacy of pharyngeal packing in reducing postoperative nausea and vomiting (PONV) after nasal surgery by taking into consideration the surgery types.

Study Design

A prospective, randomized, controlled trial.

Setting

A tertiary referral center.

Subjects and Methods

After the study was approved by the local ethics committee, this study was conducted in the Otorhinolaryngology clinic with the collaboration of the Anesthesiology clinic. The development of PONV within 24 hours after surgery was evaluated in patients who were applied a pharyngeal pack (Group 1) or not (Group 2) during nasal surgery.

Results

There were 104 adult patients for routine nasal surgery included in the current study, yielding 100 (group 1, n = 50; group 2, n = 50) evaluable subjects. No significant difference was found in the incidence of PONV between the two groups at two (P = 0.41), four (P = 0.54), eight (P = 0.51), and 24 hours. According to surgery type, the incidence of PONV after two hours was 71 percent in septorhinoplasty, 68 percent in endoscopic sinus surgery, and 50 percent in septoplasty; after four hours it was 59 percent in septorhinoplasty, 53 percent in endoscopic sinus surgery, and 37 percent in septoplasty; and after eight hours it was 35 percent in septorhinoplasty, 39 percent in endoscopic sinus surgery, and 21 percent in septoplasty. PONV was not seen at 24 hours. Compared to the septoplasty group for which pharyngeal packing was used, significantly lower rates of PONV at four and eight hours were found in the septoplasty group in which pharyngeal packing was not used (P = 0.02).

Conclusion

Pharyngeal packing in nasal surgery has no impact on PONV.     

The efficacy of pharyngeal packing during routine nasal surgery--a prospective randomised controlled study

The efficacy of pharyngeal packing in the prevention of postoperative nausea and vomiting (PONV) in patients undergoing nasal surgery was evaluated in a prospective randomised controlled study. The effect of the presence of the pharyngeal pack on the incidence of postoperative sore throat was also assessed. One hundred patients were randomly allocated to one of two groups; the first had packing and the second received no packing. The placement of a pharyngeal pack was found to have no effect on the incidence of PONV but was associated with a significantly increased incidence of sore throat. The absence of a pharyngeal pack was not associated with an increase in postoperative aspiration or vomiting. We conclude that the routine placement of pharyngeal packs during uncomplicated nasal surgery has no effect on the incidence of PONV and will increase the incidence of postoperative sore throat.     

Management of airway obstruction caused by nasal packing material in a trauma patient

Airway management of patients with facial trauma is challenging. This case report presents an unusual cause of partial airway obstruction by nasal packing saturated with blood clots. We stress on the importance of careful examination of the airway before instrumentation and of being aware that the distal end of the nasal packing material could migrate downward and cause airway obstruction.     

Effectiveness of hypopharyngeal packing during nasal and sinus surgery in the prevention of PONV.

OBJECTIVE: Evaluate the hypopharyngeal packing effectiveness on prevention of postoperative nausea and vomiting (PONV) in nasal surgery. STUDY DESIGN AND SETTING: A randomized clinical trial was conducted from July 2004 to October 2005. The intervention group was submitted to hypopharyngeal packing after orotracheal tube placement. The control group had no hypopharyngeal packing. Occurrence of nausea, vomiting, use of antiemetic drugs, and throat pain were checked blindly on recovery period. RESULTS: One hundred forty-four patients were included in the study. There was no difference related to postoperative nausea (RR 1.34; CI 0.72-2.48), vomiting (RR 0.52; CI 0.19-1.47), use of antiemetic drugs (RR 1.54; CI 0.80-2.95), and throat pain (RR 0.91; 0.62-1.34) between both groups. A beta error could not be excluded. CONCLUSION: Results suggest there is no benefit in hypopharyngeal packing on PONV prevention in nasal surgery. New studies with a greater number of patients should be carried out in order to confirm these results.