Suctioning the breathing tube versus skipping suctioning when waking from general anesthesia

Comparison of Endotracheal Tube Suctioning Versus No Suctioning During Emergence From General Anesthesia With Endotracheal Intubation: A Randomized, Single-Blind Study

This tests whether skipping suctioning of the breathing tube right before removal is as safe for adults (18–90) having elective surgery under general anesthesia.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 408 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Mahidol University (other)
• Locations: 1 site (Samut Sakhon)
• Trial ID: NCT07287293 on ClinicalTrials.gov

What this trial studies

Adults undergoing elective surgery with endotracheal intubation are randomly assigned 1:1 to routine tracheal suctioning or omission of suctioning immediately before extubation. The primary non-inferiority outcome is postoperative desaturation (SpO2 <92% within 60 minutes after extubation) with a predefined 10 percentage-point margin. Secondary outcomes compare postoperative cough severity, sore throat, and extubation-related adverse events between groups. Key exclusions include obstructive sleep apnea, chronic pulmonary disease, BMI >35, pregnancy, airway or head/neck surgery, high aspiration risk, and anticipated difficult airway.

Who should consider this trial

Good fit: Adults 18–90 years old with ASA physical status I–III scheduled for elective surgery under general anesthesia with planned tracheal extubation who can provide informed consent and do not have significant lung disease or high aspiration risk.

Not a fit: Patients with obstructive sleep apnea, chronic pulmonary disease, BMI >35 kg/m², pregnancy, increased aspiration risk, airway/head-and-neck surgery, or an anticipated difficult airway are unlikely to be eligible or to benefit from skipping suctioning.

Why it matters

Potential benefit: If successful, omitting suctioning could reduce coughing and sore throat and avoid the discomfort of suctioning while keeping early oxygen levels safe after extubation.

How similar studies have performed: Smaller observational studies and physiological reports suggest suctioning can provoke cough and sore throat and may not improve oxygenation, but randomized non-inferiority data are limited.

Eligibility criteria

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.

Where this trial is running

Samut Sakhon

• Somdetphraphutthaloetla hospital — Samut Sakhon, Thailand (RECRUITING)

Study contacts

• Study coordinator: Saowaluk Sotananan, Doctor of Medicine

Conditions: Hypoxia, Airway Obstruction, Postoperative, Sore Throat, Cough, Postoperative, Airway Management, Suctioning, Emergence from Anesthesia, Endotracheal Intubation