Endotracheal Tube Suctioning Versus No Suctioning During Emergence From General Anesthesia

NCT ID: NCT07287293

Last Updated: 2026-01-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

408 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-05

Study Completion Date

2027-03-31

Brief Summary

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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.

Detailed Description

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Conditions

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Hypoxia Airway Obstruction, Postoperative Sore Throat Cough, Postoperative

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

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.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors
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.

Study Groups

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Routine Endotracheal Suctioning (SUC)

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.

Group Type ACTIVE_COMPARATOR

Routine Endotracheal Suctioning

Intervention Type PROCEDURE

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

Omission of Endotracheal Suctioning (NON-SUC)

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.

Group Type EXPERIMENTAL

Omission of Endotracheal Suctioning

Intervention Type PROCEDURE

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

Interventions

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Routine 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.

Intervention Type PROCEDURE

Omission of Endotracheal Suctioning

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

Intervention Type PROCEDURE

Other Intervention Names

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SUC NON-SUC

Eligibility Criteria

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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.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mahidol University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Somdetphraphutthaloetla hospital

Samut Sakhon, , Thailand

Site Status RECRUITING

Countries

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Thailand

Central Contacts

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Saowaluk Sotananan, Doctor of Medicine

Role: CONTACT

+66894549111

References

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Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011 May;106(5):617-31. doi: 10.1093/bja/aer058. Epub 2011 Mar 29.

Reference Type RESULT
PMID: 21447488 (View on PubMed)

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.

Reference Type RESULT
PMID: 34840816 (View on PubMed)

Young CC, Harris EM, Vacchiano C, Bodnar S, Bukowy B, Elliott RRD, Migliarese J, Ragains C, Trethewey B, Woodward A, Gama de Abreu M, Girard M, Futier E, Mulier JP, Pelosi P, Sprung J. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. Br J Anaesth. 2019 Dec;123(6):898-913. doi: 10.1016/j.bja.2019.08.017. Epub 2019 Oct 3.

Reference Type RESULT
PMID: 31587835 (View on PubMed)

Blackwelder WC. "Proving the null hypothesis" in clinical trials. Control Clin Trials. 1982 Dec;3(4):345-53. doi: 10.1016/0197-2456(82)90024-1.

Reference Type RESULT
PMID: 7160191 (View on PubMed)

Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, Riou B. Prediction of difficult mask ventilation. Anesthesiology. 2000 May;92(5):1229-36. doi: 10.1097/00000542-200005000-00009.

Reference Type RESULT
PMID: 10781266 (View on PubMed)

Farrington CP, Manning G. Test statistics and sample size formulae for comparative binomial trials with null hypothesis of non-zero risk difference or non-unity relative risk. Stat Med. 1990 Dec;9(12):1447-54. doi: 10.1002/sim.4780091208.

Reference Type RESULT
PMID: 2281232 (View on PubMed)

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.

Reference Type RESULT
PMID: 30678727 (View on PubMed)

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.

Reference Type RESULT
PMID: 15385385 (View on PubMed)

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.

Reference Type RESULT
PMID: 28882741 (View on PubMed)

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.

Reference Type RESULT
PMID: 40241288 (View on PubMed)

Hartley M, Vaughan RS. Problems associated with tracheal extubation. Br J Anaesth. 1993 Oct;71(4):561-8. doi: 10.1093/bja/71.4.561. No abstract available.

Reference Type RESULT
PMID: 8260307 (View on PubMed)

Difficult Airway Society Extubation Guidelines Group; Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012 Mar;67(3):318-40. doi: 10.1111/j.1365-2044.2012.07075.x.

Reference Type RESULT
PMID: 22321104 (View on PubMed)

Other Identifiers

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Suction

Identifier Type: -

Identifier Source: org_study_id

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