Influence of bilateral nasal packing on sleep oxygen saturation after general anesthesia: A prospective cohort study

Shuwen Guan; Tingting Zhao; Jingying Ye; Junbo Zhang

doi:10.3389/fsurg.2023.1083961

Influence of bilateral nasal packing on sleep oxygen saturation after general anesthesia: A prospective cohort study

Front Surg. 2023 Jan 30:10:1083961. doi: 10.3389/fsurg.2023.1083961. eCollection 2023.

Authors

Shuwen Guan^{1

2}, Tingting Zhao³, Jingying Ye⁴, Junbo Zhang^{1

4}

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China.
² Department of Otorhinolaryngology, Head and Neck Surgery, Shenzhen University General Hospital, Shenzhen, China.
³ Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
⁴ Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.

Abstract

Objective: This study aims to evaluate the effect of bilateral nasal packing on sleep oxygen saturation and its influencing factors on the first night after general anesthesia.

Method: A total of 36 adult patients who underwent bilateral nasal packing with a nonabsorbable expanding sponge after general anesthesia surgery were prospectively studied. All these patients underwent overnight oximetry tests before and the first night after surgery. The following oximetry variables were collected for analysis: the lowest oxygen saturation (LSAT), the average oxygen saturation (ASAT), the oxygen desaturation index of ≥4% (ODI4), and the percentage of time with oxygen saturation below 90% (CT90).

Results: Among the 36 patients, the incidences of both sleep hypoxemia and moderate-to-severe sleep hypoxemia increased with bilateral nasal packing after general anesthesia surgery. All the pulse oximetry variables we studied deteriorated significantly after surgery: both LSAT and ASAT decreased significantly (P < 0.05), while both ODI4 and CT90 increased significantly (P < 0.05). In a multiple logistic regression analysis, body mass index (BMI), LSAT, and modified Mallampati grade were found to be independently predictive for a larger decrease in LSAT (≥5%) after surgery (all P's < 0.05).

Conclusion: Bilateral nasal packing after general anesthesia could induce or aggravate sleep hypoxemia, especially in patients with obesity, relatively normal sleep oxygen saturation, and high modified Mallampati grades.

Keywords: a prospective cohort study; bilateral nasal packing; first night after general anesthesia; operation on nasal cavity; sleep oxygen saturation.

Grants and funding

This study was supported by National High Level Hospital Clinical Research Funding (Interdepartmental Clinical Research Project of Peking University First Hospital) (2022CR26).