Discussion
blindness, throat, postoperative agitation, agitation, mouth-breathing
BLINDNESS
This randomized controlled trial showed that preconditioning with nasal splint and mouth-breathing training preparation significantly decreased the incidence of ED after FESS by more than 50%. The intraoperative sufentanil dosage of the preconditioning group was significantly improved by 20.0 µg. Post-hoc analysis suggested that patients with ED required more postoperative hospital stay, and younger, males, with smoking status, with FESS with septoplasty, with aasal septum deviation with obstruction and without nasal splint were more likely to present ED.Otorhinolaryngology operations, or surgeries involving the ear, nose, and throat (ENT), were reported to be associated with increased risks of postoperative agitation and ED [The identified incidence of ED in this study was 25.8%, which was consistent with the previously evidence. For example, a retrospective study reviewing 792 adults who underwent general anesthesia for nasal surgery reported the overall incidence of emergence agitation at 22.2% [This randomized trial potentially balanced many baseline characteristics and preoperative parameters between two groups; however, the occurrence of ED could be influenced by numerous unknown factors. For example, the intraoperative dosage of sufentanil was significantly higher in preconditioning group than that in the control group. To further eliminate the possibility that the observed difference in ED incidence was due to differences in other factors rather than the preconditioning treatment, we applied a post-hoc case-control analysis to confirmed the independent risk factors of ED. Our results identified age, gender, smoking, FESS with septoplasty and surgery category were independent risk factors of ED, which were consistent from previous evidences [There were several limitations in this study. Firstly, the study was a single center study with relatively limited samples size, hence our conclusion might not be stable and extension of our conclusion to other patients should be verified in further multi-center or multi-regional, well-designed, large-scaled randomized trials. Secondly, in this study the identification of ED mainly depended on the subjective assessment from physicians based on the postoperative evens and intraoperative signs. Also, the blindness of intervention for intraoperative anesthesiologist could not be achieved. All these might raise the uncontrolled bias for outcome assessment and introduced the misclassification bias. More objective evaluation of ED by anesthesiologist and nurse with blindness at PACU was necessary. Thirdly, although this is a drug-free intervention and had almost no side effects, this study did not include a positive parallel control to eliminate the non-drug modality with pharmacological treatment (e.g., dexmedetomidine) [