Site of Tracheal Extubation and Operating Room Efficiency During Robot-assisted Surgery

Peking University

Status: Enrolling

Conditions: Postoperative Complications; Airway Extubation; Operating Rooms; Anesthesia Recovery Period; Robotic Surgical Procedures

Treatments: Procedure: Extubation in post-anesthesia care unit (PACU); Procedure: Extubation in operating room (OR)

Study type: Interventional

Funder types: Other

Identifiers

NCT07332806

2025R0568

Details and patient eligibility

About

This study aims to evaluate the impact of different extubation strategy on the occupancy time of operating room (OR) and the incidence of adverse events and quality of recovery after robotic-assisted surgery. The investigators hypothesize that extubation in the post-anesthesia care unit (PACU) may reduce OR occupancy time without increasing adverse events or worsening quality of recovery early after robotic-assisted surgery. This strategy may enhance perioperative efficiency while maintaining clinical safety.

Full description

Major surgeries are generally performed under general anesthesia with endotracheal tube. Intubation during anesthesia induction and extubation during anesthesia emergence are two high-risk periods associated with anesthesia-related complications. In clinical practice, extubation is performed either in the OR or in the PACU, according to local routine.

Robotic-assisted surgery offers potential clinical benefits but involves high costs and limited resource availability, making operating room (OR) efficiency a critical priority. While extubation in the post-anesthesia care unit (PACU) has been suggested to improve OR turnover, evidence regarding its impact on perioperative efficiency and safety compared to standard OR extubation in robotic surgery is limited.

The investigators hypothesize that extubation in the post-anesthesia care unit (PACU) may reduce OR occupancy time without increasing adverse events or worsening quality of recovery early after robotic-assisted surgery. This study aims to evaluate the impact of different extubation strategy on the occupancy time of operating room (OR) and the incidence of adverse events and quality of recovery after robotic-assisted surgery.

Enrollment: 218 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Aged ≥18 years;
2. Scheduled to undergo elective robot-assisted laparoscopic surgery under general anesthesia;
3. Expected tracheal extubation during daytime working hours (before 4:00 PM).

Exclusion criteria

1. Refuse to participate in the study;
2. Morbid obesity (body mass index ≥35 kg/m²);
3. Preoperatively diagnosed obstructive sleep apnea, or patients with a STOP-Bang score ≥3 in combination with serum bicarbonate (HCO₃-) ≥28 mmol/L;
4. Patients at high risk of difficult airway (anticipated difficult intubation and/or extubation during preoperative assessment);
5. Preexisting sick sinus syndrome, severe sinus bradycardia (heart rate < 50 beats/min), or second-degree or higher atrioventricular block without pacemaker implantation; congenital heart disease with any type of arrhythmia; or other severe cardiovascular diseases with New York Heart Association (NYHA) functional class ≥III;
6. Significant pulmonary function impairment (FEV₁/FVC ratio < 70%, and total lung capacity [TLC] and vital capacity [VC] < 80% of predicted values);
7. Severe hepatic dysfunction (Child-Pugh class C); severe renal dysfunction (estimated glomerular filtration rate < 30 mL/min/1.73 m²); or American Society of Anesthesiologists (ASA) physical status classification ≥IV;
8. Preoperative diagnoses of schizophrenia, epilepsy, Parkinson's disease, or myasthenia gravis;
9. Inability to communicate due to coma, severe dementia, or language impairment;
10. Planned postoperative admission to the intensive care unit;
11. Any other conditions that are deemed for study participation.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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218 participants in 2 patient groups

Extubation in post-anesthesia care unit (PACU)

Experimental group

Description:

At the end of surgery, patients will be transferred from operating room (OR) to PACU with endotracheal intubation and then extubated in PACU.

Treatment:

Procedure: Extubation in post-anesthesia care unit (PACU)

Extubation in operating room (OR)

Active Comparator group

Description:

At the end of surgery, patients will be extubated in operating room (OR) and then transfered to PACU.

Treatment:

Procedure: Extubation in operating room (OR)