Endotracheal Tube Suctioning Versus No Suctioning During Emergence From General Anesthesia

NCT07287293 | Recruiting DMC

• 1 other identifier: Suction
• Study Type: interventional
• Target: 408
• Locations: 1 country
• Sites: 1

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.

Conditions

Hypoxia; Airway Obstruction, Postoperative; Sore Throat; Cough, Postoperative

Keywords

Airway Management; Suctioning; Emergence from Anesthesia; Hypoxia; Endotracheal Intubation; Postoperative Complications

Outcome Measures

Primary Outcomes (1)

• Incidence of postoperative desaturation 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.

  First 60 minutes after extubation

Secondary Outcomes (6)

• Incidence and severity of postoperative coughing

  First 60 minutes after extubation

• Severity of sore throat during swallowing

  First 60 minutes after extubation

• Requirement and level of oxygen therapy

  First 60 minutes after extubation

• Incidence of postoperative nausea and vomiting

  First 60 minutes after extubation

• Patient satisfaction

  At 24 hours after surgery (± 2 hours)

Other Outcomes (1)

• 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.

Study Arms (2)

Routine Endotracheal Suctioning (SUC)

ACTIVE COMPARATOR

Participants in this arm received routine endotracheal suctioning immediately prior to extubation, performed using standard suction pressure and technique. Oropharyngeal suctioning was also performed according to usual clinical practice.

Procedure: Routine Endotracheal Suctioning

Omission of Endotracheal Suctioning (NON-SUC)

EXPERIMENTAL

Participants in this arm received oropharyngeal suctioning only prior to extubation. No suction catheter was inserted into the trachea. Standard anesthetic care and monitoring were provided as per routine practice.

Procedure: Omission of Endotracheal Suctioning

Interventions

Routine Endotracheal Suctioning PROCEDURE

Endotracheal suctioning performed immediately prior to extubation using standard suction pressure and technique. Oropharyngeal suctioning was also performed according to routine clinical practice.

Also known as: SUC

Routine Endotracheal Suctioning (SUC)

Omission of Endotracheal Suctioning PROCEDURE

Oropharyngeal suctioning only was performed prior to extubation. No suction catheter was inserted into the trachea.

Also known as: NON-SUC

Omission of Endotracheal Suctioning (NON-SUC)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Mahidol University: lead

Study Sites (1)

Somdetphraphutthaloetla hospital

Samut Sakhon, 75000, Thailand

RECRUITING

Related Publications (12)

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  PMID: 10781266 RESULT

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  PMID: 2281232 RESULT

• Tung A, Fergusson NA, Ng N, Hu V, Dormuth C, Griesdale DGE. Pharmacological methods for reducing coughing on emergence from elective surgery after general anesthesia with endotracheal intubation: protocol for a systematic review of common medications and network meta-analysis. Syst Rev. 2019 Jan 24;8(1):32. doi: 10.1186/s13643-019-0947-2.

  PMID: 30678727 RESULT

• Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg. 2004 Oct;99(4):1253-1257. doi: 10.1213/01.ANE.0000132779.27085.52.

  PMID: 15385385 RESULT

• L'Hermite J, Wira O, Castelli C, de La Coussaye JE, Ripart J, Cuvillon P. Tracheal extubation with suction vs. positive pressure during emergence from general anaesthesia in adults: A randomised controlled trial. Anaesth Crit Care Pain Med. 2018 Apr;37(2):147-153. doi: 10.1016/j.accpm.2017.07.005. Epub 2017 Sep 4.

  PMID: 28882741 RESULT

• Radkowski P, Oniszczuk H, Opolska J, Pawluczuk M, Samiec M, Mieszkowski M. A Review of Non-Cardiac Complications of General Anesthesia: The Current State of Knowledge. Med Sci Monit. 2025 Apr 17;31:e947561. doi: 10.12659/MSM.947561.

  PMID: 40241288 RESULT

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  PMID: 22321104 RESULT

• Benham-Hermetz J, Mitchell V. Safe tracheal extubation after general anaesthesia. BJA Educ. 2021 Dec;21(12):446-454. doi: 10.1016/j.bjae.2021.07.003. Epub 2021 Aug 25. No abstract available.

  PMID: 34840816 RESULT

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  PMID: 21447488 RESULT

MeSH Terms

Conditions

Hypoxia; Airway Obstruction; Pharyngitis; Cough; Postoperative Complications

Condition Hierarchy (Ancestors)

Signs and Symptoms, Respiratory; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Respiratory Insufficiency; Respiration Disorders; Respiratory Tract Diseases; Respiratory Tract Infections; Infections; Pharyngeal Diseases; Stomatognathic Diseases; Otorhinolaryngologic Diseases; Pathologic Processes

Central Study Contacts

Saowaluk Sotananan, Doctor of Medicine

CONTACT

+66894549111; pum.sotananan@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: 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.
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: 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.

Study Record Dates

• First Submitted: November 15, 2025
• First Posted: December 17, 2025
• Study Start: January 5, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): March 31, 2027
• Last Updated: January 12, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

TH (1)