Airway Obstruction, Postoperative, Cough, Postoperative, Hypoxia, Sore Throat
Conditions
Keywords
Airway Management, Suctioning, Emergence from Anesthesia, Hypoxia, Endotracheal Intubation, Postoperative Complications
Brief summary
The goal of this study is to determine whether omitting tracheal suctioning immediately prior to extubation is non-inferior to routine tracheal suctioning with respect to early postoperative oxygenation among adult surgical patients (aged 18-90 years, American Society of Anesthesiologists \[ASA\] physical status I-III) undergoing elective surgery under general anesthesia with endotracheal intubation. The study addresses the following questions: * Primary outcome (non-inferiority): * Is the risk of postoperative desaturation (oxygen saturation \[SpO₂\] \<92% within 60 minutes after extubation) in the no-suction group not worse than in the routine-suction group by more than 10 percentage points? * Secondary outcomes (superiority): * Does omitting tracheal suctioning reduce postoperative cough severity and sore throat? * Does omitting tracheal suctioning avoid increasing extubation-related adverse events? Participants will be randomly assigned (1:1) to one of two groups: * Routine suctioning (SUC): Endotracheal suctioning plus oropharyngeal suctioning immediately before extubation * No suctioning (NON-SUC): Oropharyngeal suctioning only, without endotracheal suctioning All participants will receive standard anesthetic care and postoperative monitoring in the post-anesthesia care unit (PACU) for 60 minutes. Follow-up for airway symptoms and patient satisfaction will be conducted at 24 hours after surgery.
Interventions
PROCEDURERoutine Endotracheal Suctioning
Endotracheal suctioning performed immediately prior to extubation using standard suction pressure and technique. Oropharyngeal suctioning was also performed according to routine clinical practice.
PROCEDUREOmission of Endotracheal Suctioning
Oropharyngeal suctioning only was performed prior to extubation. No suction catheter was inserted into the trachea.
Sponsors
Mahidol University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
The anesthesiologist performing the intervention, the participants, and the investigators involved in intraoperative care and data collection were not masked because the suctioning procedures could not be concealed. The outcomes assessor, responsible for recording postoperative oxygen saturation, airway symptoms, and patient-reported outcomes, was blinded to the group assignment.
Intervention model description
Interventions Routine Suctioning Group (SUC): Participants received both endotracheal suctioning and oropharyngeal suctioning immediately prior to extubation, performed using standard suction pressure and technique. No Suctioning Group (NON-SUC): Participants received oropharyngeal suctioning only. No suction catheter was inserted into the trachea prior to extubation. If the anesthesiologist identified copious airway secretions requiring clearance for patient safety, endotracheal suctioning was performed. These participants were subsequently excluded from the analysis as per the predefined protocol.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18-90 years with American Society of Anesthesiologists (ASA) physical status I-III. * Scheduled for elective surgery under general anesthesia requiring endotracheal intubation. * Planned tracheal extubation in the operating room at the end of surgery.
Exclusion criteria
* Inability to provide informed consent or the presence of a significant language barrier that prevents effective communication with the clinical team. * Known diagnosis of obstructive sleep apnea (OSA), active pneumonia, or chronic pulmonary disease (e.g., chronic obstructive pulmonary disease, restrictive lung disease). * Body mass index (BMI) \>35 kg/m². * Pregnancy or increased aspiration risk (e.g., full stomach). * Scheduled for maxillofacial, head and neck, or airway surgery. * Anticipated surgical duration \>3.5 hours. * Anticipated difficult airway, defined as the presence of ≥2 predictors of difficult mask ventilation (DMV) based on Langeron et al., or a documented history of difficult intubation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of postoperative desaturation after extubation | First 60 minutes after extubation | Proportion of participants who develop desaturation, defined as peripheral oxygen saturation (SpO₂) \<92% at any time within the first 60 minutes after extubation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence and severity of postoperative coughing | First 60 minutes after extubation | Incidence and severity of postoperative coughing within the first 60 minutes after extubation, assessed using the modified Minogue scale. Severity is recorded as the highest coughing score observed during the assessment period. |
| Severity of sore throat during swallowing | First 60 minutes after extubation | Severity of sore throat during swallowing within the first 60 minutes after extubation, assessed using a 0-10 numerical rating scale (NRS). The outcome is recorded as the highest score reported during the assessment period. |
| Requirement and level of oxygen therapy | First 60 minutes after extubation | Requirement for oxygen therapy and the highest level of escalation within the first 60 minutes after extubation, including nasal cannula, simple face mask, reservoir mask, or more advanced oxygen delivery devices as clinically indicated. |
| Patient satisfaction | At 24 hours after surgery (± 2 hours) | Patient satisfaction with anesthetic care at 24 hours after surgery, assessed using a 0-10 numerical rating scale (NRS), where 0 indicates complete dissatisfaction and 10 indicates complete satisfaction. The recorded value represents the patient's reported score at the 24-hour assessment. |
| Incidence of extubation-related adverse events | From arrival in the PACU until discharge from the PACU, assessed up to 6 hours after PACU arrival. | Incidence of extubation-related adverse events during the post-anesthesia care unit (PACU) stay, including bronchospasm, laryngospasm, reintubation, and post-obstructive pulmonary edema. Events are recorded as present or absent throughout the PACU monitoring period. The PACU stay typically lasts 2-3 hours depending on discharge criteria. |
| Incidence of postoperative nausea and vomiting | First 60 minutes after extubation | Incidence of postoperative nausea and vomiting occurring within the first 60 minutes after extubation. Nausea and vomiting are recorded as present or absent during the assessment period. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Duration of stay in the post-anesthesia care unit (PACU) | From arrival in the PACU until discharge from the PACU, assessed up to 6 hours after PACU arrival. | Total duration of stay in the post-anesthesia care unit (PACU), recorded in minutes from arrival in PACU until discharge based on standard discharge criteria. The PACU stay typically lasts 2-3 hours depending on discharge criteria. |
Countries
Thailand
Contacts
Primary ContactSaowaluk Sotananan, Doctor of Medicine
Outcome results
None listed