Positive-Pressure vs Suction Extubation in Cesarean Patients

Extubation represents a vulnerable phase of general anesthesia, during which airway secretions, reduced functional residual capacity, and diminished upper airway tone may contribute to hypoxemia and other respiratory complications. Pregnant women are particularly susceptible due to decreased lung volumes, increased oxygen consumption, and airway edema associated with pregnancy.

The Positive-Pressure Extubation Technique (PPET) has been proposed as a strategy to reduce the migration of secretions toward the distal airways during cuff deflation, potentially improving lung aeration and gas exchange. Unlike conventional suction-based methods, PPET uses continuous positive pressure to maintain airflow direction, theoretically minimizing micro-aspiration and early atelectasis formation.

Although PPET has demonstrated benefits in pediatric and mixed surgical populations, evidence regarding its application in obstetric anesthesia remains scarce. This study aims to evaluate whether positive-pressure extubation provides physiological advantages over conventional negative-pressure extubation in adult patients undergoing cesarean delivery under general anesthesia. By examining postoperative respiratory stability and hemodynamic responses, the study is expected to clarify the clinical importance of tailored extubation strategies in populations with reduced pulmonary reserve.

Inclusion criteria

• Adult female patients aged 18 to 45 years.
• Scheduled for elective cesarean delivery under general anesthesia.
• Ability to provide written informed consent

Exclusion criteria

• Exclusion criteria included patients participating in another study,
• Patients refusing to participate,
• Uncooperative patients,
• Patients undergoing emergency surgery,
• American Society of Anesthesiologists (ASA) Physical Status Classification > 3,
• Patients with chronic respiratory failure, obstructive sleep apnea, and patients with anticipated difficult airways.