Effect of nasal clamping and mouth breathing training in reducing emergence delirium post endoscopic sinus surgery - randomised controlled study

Emergence delirium is a short term state of dissociation of consciousness during the recovery from general anaesthesia along with motor agitation,incoherence ,inconsolability and unresponsiveness.(1-3) It is the most common neuropsychiatric complications after surgery . Emergence delirium is self-limiting but sometimes the agitated behaviour may result in post anaesthesia care unit accidents.(4) Emergence delirium may be associated with increased risks of long term adverse outcomes like cognitive dysfunction and negative behaviour that cause lower quality of life, readmission to hospitals ,and even deaths.(5,6) Emergence delirium may arise by an imbalance between the patient’s arousal state and the recovery of consciousness. Interventional strategies like medical interventions - Gabapentin, Dexmeditomidine , Melatonin and Remelteon and non pharmacological interventions such as time and place orientation are employed to reduce the incidence of emergence delirium.(7,8)

During the emergence from anaesthesia, obstruction by nasal packing cause breathing difficulties and a feeling of suffocation due to forceful mouth breathing which increases the risk of emergence delirium. Risk factors for emergence delirium are age,smoking , pre-operative anxiety, types of operation, postoperative pain,etc .(9,10)

The study aims at evaluating the efficacy of preoperative patient training and training with nasal clamping and mouth breathing training on prevention of emergence delirium and to identify associated risk factors for emergence delirium.