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pandemic by 11 March, 2020. As of December 29, 2020, more than 79.2 million cases and more than 1.7 million deaths have been documented globally. 4 The main means of person-to-person transmission are droplets spread through coughing or sneezing, and direct contact with an infected person infected with SARS-CoV-2.5, 6 Facial masks (medical masks, surgical masks and N95 respirators in Fig. 1) can effectively reduce person-to-person infection through droplet transmission.7, 8 For health-care workers and the general public, self-isolation with masks is recommended during the COVID-19 epidemic.9, 10 Compared with N95 masks and surgical masks, the effectiveness of medical masks in preventing viral respiratory infections is not inferior to that of surgical masks. 8, 11 So medical masks can be used effectively, especially when there is a shortage of N95 masks and surgical masks. With the using of masks, people pay more and more attention to its safety. Many researchers have reported that healthcare providers wearing a mask may experience headaches and nasal pressure, 12,13 N95 respirators can reduce PaO2 in patients with end-stage renal disease.14 In healthy subjects, masks wearing during short-term moderate-intensity aerobic exercise is associated with an increase in end-tidal carbon dioxide (EtCO2 ).15 The perianesthesia nursing areas have been impacted by COVID-19. 16 High risk of potential infection from exposure to respiratory droplets or aerosols during airway management by 7 anesthesiologists and nurses.17 Coughing and bucking are common and unpredictable events during extubation. Therefore, during the COVID-19 epidemic, postoperative anesthesia care units (PACU) recommended that patients undergoing general anesthesia should wear masks after extubation. 18 As respiratory adverse events such as hypoxemia are important and common postoperative complications after extubation, 19 PACU nurses should detect and care for patients when they are at greatest risk of developing respiratory complications. 20 Unfortunately, there is little information about the impact of wearing medical masks on patients in PACU. In this report, we aim to share our experience by reporting the perioperative characteristics and impact on oxygen saturation of medical masks worn by adult surgical patients following general anesthesia in PACU during the COVID-19 epidemic. Methods Research design We conducted a retrospective database review at the First Affiliated Hospital of Chongqing Medical University from January 1 to January 27 in 2020 (patients wearing no medical masks after extubation, group A) and from March 1 to March 18 in 2020 (patients wearing medical masks after extubation, group B) in PACU. This study was approved by the Institutional Ethics Committee of our hospital on April 15, 2020 (approval number: 20201601). And the study was registered prior to patient enrolment at http://www.chictr.org.cn (registration number: ChiCTR2000032213). Informed consent have been obtained from all participants. Inclusion criteria 8 Patients aged over 18 undergoing elective non-cardiac surgery in general anaesthesia within 3 h, who were enrolled in after extubation in PACU. Exclusion criteria Patients in thoracic surgery with emergency anesthesia, operation time over 3 hours, and direct intubation to intensive care unit (ICU) after anesthesia in our hospital are excluded, with preoperative hypoxemia as acute respiratory pathology, and patients who had no complete arterial blood gas data in PACU were also excluded from the study. Data collection The following pre-existing conditions already existed in the data base: (1) age, (2) sex, (3) body mass index (BMI), (4) smoking status,（5）difficult airway history,（6）comorbidities,（7） American Society of Anesthesiology (ASA) classification,（8）chest CT scans, （9）throat swab testing for COVID-19,（10）type of surgery,（11）laparoscopic surgery. After extubation, pulse oxygen saturation, heart rate (HR), noninvasive mean blood pressure（MBP）were compared for all patients at
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