Effect of Simulated Mouth Breathing on Emergence Agitation After Nasal Surgeries

Abstract

Objective: To evaluate the effectiveness of preoperative simulated mouth breathing training in reducing the severity and incidence of emergence agitation among adult patients undergoing nasal surgery under general anesthesia
Study Design: Randomized controlled trial study
Place and Duration of Study: This study was conducted at the Department of Anesthesiology and Pain Medicine, Shifa International Hospital, Islamabad, from 1st October 2025 till 31st March 2026.

Methodology: The trial included 180 adults aged 18–65 years with ASA physical status I–II undergoing sinonasal surgery with nasal packing. Ninety patients received simulated mouth-breathing training at three preoperative time points and 90 received standard preoperative care. Richmond Agitation-Sedation Scale (RASS) scores were recorded at extubation and 15 and 30 minutes later.

Results: Mean RASS scores were lower with mouth-breathing training at extubation (1.02±0.85 vs 1.32±0.99), 15 minutes (0.99±0.99 vs 1.37±1.15), and 30 minutes (0.66±0.77 vs 1.04±0.95). The overall mixed-model treatment effect was −0.36 RASS points (95% CI −0.56 to −0.15; p<0.001), with no treatment-by-time interaction (p=0.845). EA at 15 and 30 minutes was less frequent in the intervention group. However, the proportion experiencing at least one EA episode during the full 30-minute period was 51.1% versus 61.1% (RR 0.84, 95% CI 0.64–1.09; p=0.176).

Conclusion: Preoperative simulated mouth-breathing training reduced the severity of emergence agitation and the repeated probability of agitation during early recovery. It did not significantly reduce the proportion of patients who experienced at least one EA episode.