Tekirdag Corlu State Hospital, Corlu, Turkey.
Nisantasi University, Istanbul Safak Hospital, Istanbul, Turkey.
BMC Anesthesiol. 2019 Jul 8;19(1):121. doi: 10.1186/s12871-019-0786-7.
Pharyngeal packing (PP) is commonly performed to reduce the incidence of perioperative blood ingestion (PBI) in nasal surgery (NS), and thus the incidence and severity of postoperative nausea and vomiting (PONV). This study examined the effects of PP on the perioperative gastric volume (GV) and PONV in patients undergoing NS, by ultrasound assessment.
Patients undergoing elective NS [septoplasty, septo-rhinoplasty (SRP) and functional endoscopic sinus surgery (FESS)] were randomised to receive or not receive PP. In the PP group, pharyngeal packs were placed after the orotracheal intubation. Ultrasound assessments were performed for all patients preoperatively (before the anaesthesia induction) and postoperatively (before the extubation). The antero-posterior (AP) and cranio-caudal (CC) antral diameters, antral cross-sectional area (ACSA), and total GV were calculated. PONV incidence and severity were rated. These variables were compared between timepoints and groups, and in the subgroup analyses according to the surgery type. Pearson correlation analysis was performed to assess correlations between the variables.
AP and CC diameters and ACSAs were greater postoperatively than preoperatively in the PP and non-PP groups (n = 44 each; all p < 0.05). Postoperative AP and CC diameters and the ACSA were greater in the non-PP than in the PP group (all p < 0.05). Postoperative AP diameters were greater than preoperatively in patients undergoing SRP and FESS, and the postoperative CC diameter and ACSA were greater than preoperatively in patients undergoing SRP (all p < 0.05). Surgery duration was correlated positively with postoperative AP diameter (r = 0.380, p < 0.05), CC diameter (r = 0.291, p < 0.05), and ACSA (r = 0.369, p < 0.05). Patients who underwent septoplasty surgery, PP was decreased PONV incidence and severity at the first four hours, postoperatively (p < 0.05).
The study findings indicate that PP reduces the increase in the perioperative GV due to PBI in an elective NS. It is therefore a useful and safe means of reducing the risk of perioperative pulmonary aspiration in such surgeries.
Australian New Zealand Clinical Trials Registry (ANZCT), ACTRN12619000487112 , 25/03/2019, Trial registration retrospectively registered.
咽部填塞（PP）常用于减少鼻外科手术（NS）围手术期血食（PBI）的发生率，从而减少术后恶心和呕吐（PONV）的发生率和严重程度。本研究通过超声评估，研究了 PP 对接受 NS（鼻中隔成形术、鼻中隔成形术-鼻成形术（SRP）和功能性内窥镜鼻窦手术（FESS））患者围手术期胃容积（GV）和 PONV 的影响。
选择择期接受 NS（鼻中隔成形术、鼻中隔成形术-鼻成形术和功能性内窥镜鼻窦手术）的患者，随机接受或不接受 PP。在 PP 组，在气管插管后放置咽部填塞物。所有患者在术前（麻醉诱导前）和术后（拔管前）进行超声评估。计算前-后（AP）和头-尾（CC）窦腔直径、窦腔横截面积（ACSA）和总 GV。评估 PONV 的发生率和严重程度。比较组间和组内各时间点的差异，并根据手术类型进行亚组分析。Pearson 相关性分析用于评估变量之间的相关性。
PP 组和非 PP 组患者术后 AP 和 CC 直径及 ACSA 均大于术前（每组 n=44；均 p<0.05）。非 PP 组患者术后 AP 和 CC 直径及 ACSA 均大于 PP 组（均 p<0.05）。SRP 和 FESS 术后患者的 AP 直径大于术前，SRP 术后患者的 CC 直径和 ACSA 大于术前（均 p<0.05）。手术时间与术后 AP 直径（r=0.380，p<0.05）、CC 直径（r=0.291，p<0.05）和 ACSA（r=0.369，p<0.05）呈正相关。接受鼻中隔成形术的患者，术后前 4 小时 PONV 发生率和严重程度降低（p<0.05）。
研究结果表明，PP 可减少择期 NS 围手术期因 PBI 导致的 GV 增加，因此是降低此类手术围手术期误吸风险的一种有用且安全的方法。
澳大利亚和新西兰临床试验注册中心（ANZCT），ACTRN12619000487112，2019 年 3 月 25 日，试验注册 retrospectively registered。
