Overview

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.

Eligibility

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.