Effect of removal of subglottic blood during endoscopic sinus surgery

ABSTRACT

Postoperative pulmonary complications may occur after endoscopic sinus surgery, secondary to leakage of blood into the trachea from the surgical field. We investigated the effects of removal of subglottic fluid, including blood, during endoscopic sinus surgery on the incidence of postoperative hypoxia and high fever. We first retrospectively confirmed whether the incidence of fever >38°C and hypoxia [SpO[2]< 95%] in the first 24 h after endoscopic sinus surgery was higher than that after tympanoplasty [total n=99]. Next, the amount and characteristics of subglottic fluid were prospectively evaluated in the two groups, and the incidences of fever and hypoxia in the first 24 h postoperatively were compared between the two groups [total n=90].Data were analyzed using SPSS for Windows version 11.0 [SPSS Inc., Chicago, IL, USA]. Normally distributed continuous data were analyzed using Student's /-test. Continuous data not normally distributed were analyzed using the Mann-Whitney U-test. Categorical data were analyzed using the x[2] test. Statistical significance was defined as p< 0.05. The retrospective study showed that the incidences of fever and hypoxia were significantly higher after endoscopic sinus surgery than tympanoplasty [fever, p=0.001; hypoxia, p=0.024]. The prospective study showed that the amount of subglottic secretions was significantly higher after endoscopic sinus surgery than tympanoplasty [p=0.006]. The pH values of subglottic and oral fluid were significantly higher after endoscopic sinus surgery than tympanoplasty [subglottic fluid, p=0.04; oral fluid, p<0.001]. However, there were no significant differences between the two groups in the incidence of fever over 38°C and hypoxia in the first 24 h postoperatively. An increase in subglottic fluid, including blood, during endoscopic sinus surgery might cause fever and hypoxia postoperatively. Removal of the fluid is likely an effective technique for preventing pulmonary complications