{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:28:28Z","timestamp":1787228908347,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Tracheal extubation is a vulnerable phase of general anaesthesia. Smooth extubation strategies aim to reduce cough, bucking, and the sympathetic surge. This trial compared deep extubation with no-touch awake extubation in adults undergoing elective laparotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective, randomised, partially outcome-assessor-blinded trial enroled American Society of Anesthesiologists (ASA) physical status I\u2013II adults scheduled for elective laparotomy, allocated to deep extubation (Group D) or no-touch awake extubation (Group N). The primary outcome was cough (grade \u22651) within five minutes of extubation. Secondary outcomes were cough severity, airway adverse events, airway support, haemodynamics, and recovery characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Seventy patients (35 per group) were analysed. Cough occurred in 3 (8.6%) patients in Group D and 8 (22.9%) in Group N (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.18). Deep extubation was associated with more desaturation below 95% (11 vs 2;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.009), more breath-holding (8 vs 1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.028), greater need for airway support, and four re-intubations versus none. Recovery times were shorter in Group D. The heart rate and blood pressure were higher in Group N during early recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Deep extubation did not significantly reduce cough and was associated with more airway-related adverse events and airway support needs, including reintubation. Shorter recovery times and less moderate-to-severe cough in Group D did not reduce these risks. The findings do not support routine use of deep extubation and need confirmation in a larger, adequately powered trial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_607_26","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:00:49Z","timestamp":1787227249000},"page":"890-897","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Deep extubation versus no-touch awake extubation in adults undergoing elective laparotomy: A randomised controlled trial"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9348-7190","authenticated-orcid":false,"given":"K. Sathya","family":"Narayanan","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9924-301X","authenticated-orcid":false,"given":"R.","family":"Praveen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6343-607X","authenticated-orcid":false,"given":"D.","family":"Premkumar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3028-9848","authenticated-orcid":false,"given":"Navya","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, AIIMS Bhubaneshwar, Bhubaneshwar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0169-3563","authenticated-orcid":false,"given":"Jethroben","family":"Kevin","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Kauvery Hospital, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5814-1314","authenticated-orcid":false,"given":"Sundaram","family":"Loganathan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"R1-20260820","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1186\/s12871-020-01191-8","article-title":"Incidence of airway complications associated with deep extubation in adults","volume":"20","author":"Juang","year":"2020","journal-title":"BMC Anesthesiol"},{"key":"R2-20260820","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.4103\/neuroindia.NI_674_17","article-title":"The art of waking up a neurosurgical patient: It is time to hone our skills","volume":"65","author":"Bhagat","year":"2017","journal-title":"Neurol India"},{"key":"R3-20260820","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1213\/ane.0b013e31817f9476","article-title":"Planning for early emergence in neurosurgical patients: A randomised prospective trial of low-dose anaesthetics","volume":"107","author":"Bhagat","year":"2008","journal-title":"Anesth Analg"},{"key":"R4-20260820","doi-asserted-by":"crossref","first-page":"528","DOI":"10.4103\/neurol-india.Neurol-India-D-23-00528","article-title":"Comparison of response-first technique with reversal-first technique for quality of extubation in patients undergoing transsphenoidal pituitary surgery: A randomised clinical trial","volume":"72","author":"Kapil","year":"2024","journal-title":"Neurol India"},{"key":"R5-20260820","first-page":"8883257","article-title":"Smooth extubation and smooth emergence techniques: A narrative review","author":"Wong","year":"2021","journal-title":"Anesthesiol Res Pract 2021"},{"key":"R6-20260820","doi-asserted-by":"crossref","first-page":"e192","DOI":"10.1016\/j.bja.2020.03.016","article-title":"Extubation of patients with COVID-19","volume":"125","author":"D\u2019Silva","year":"2020","journal-title":"Br J Anaesth"},{"key":"R7-20260820","doi-asserted-by":"crossref","first-page":"125","DOI":"10.4103\/1658-354X.82778","article-title":"Evaluation of no-touch extubation technique on airway-related complications during emergence from general anaesthesia","volume":"5","author":"Sheta","year":"2011","journal-title":"Saudi J Anaesth"},{"key":"R8-20260820","doi-asserted-by":"crossref","first-page":"810366","DOI":"10.3389\/fmed.2022.810366","article-title":"Tracheal extubation under deep anaesthesia using transnasal humidified rapid insufflation ventilatory exchange versus awake extubation: An open-labelled randomised controlled trial","volume":"9","author":"Qiu","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"R9-20260820","first-page":"331","article-title":"A comparison of deep versus awake tracheal extubation in adults: A randomised controlled trial","volume":"25","author":"Ciaramella","year":"2025","journal-title":"BMC Anesthesiol"},{"key":"R10-20260820","doi-asserted-by":"crossref","first-page":"34406","DOI":"10.1038\/s41598-025-17380-9","article-title":"Early extubation effects on postoperative outcomes in high-risk abdominal surgery based on propensity score matching","volume":"15","author":"Gong","year":"2025","journal-title":"Sci Rep"},{"key":"R11-20260820","doi-asserted-by":"crossref","first-page":"1288978","DOI":"10.3389\/fmed.2024.1288978","article-title":"Multimodal prevention of emergence cough following nasal endoscopic surgery under general anaesthesia: A double-blind randomised trial","volume":"11","author":"Xu","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"R12-20260820","first-page":"e941920","article-title":"The effect of head elevation on emergence cough during anaesthetic emergence in male patients undergoing laparoscopic cholecystectomy: A randomised controlled trial","volume":"29","author":"Lim","year":"2023","journal-title":"Med Sci Monit"},{"key":"R13-20260820","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s44158-023-00088-5","article-title":"BIS-guided sedation prevents the cough reaction of patients under general anaesthesia caused by extubation: A randomised controlled trial","volume":"3","author":"Zhang","year":"2023","journal-title":"J Anesth Analg Crit Care"},{"key":"R14-20260820","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jclinane.2008.04.006","article-title":"Esmolol blunts postoperative haemodynamic changes after propofol-remifentanil total intravenous fast-track neuroanaesthesia for intracranial surgery","volume":"20","author":"Bilotta","year":"2008","journal-title":"J Clin Anesth"},{"key":"R15-20260820","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/ALN.0000000000004002","article-title":"2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway","volume":"136","author":"Apfelbaum","year":"2022","journal-title":"Anesthesiology"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_607_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:00:51Z","timestamp":1787227251000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_607_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":15,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_607_26","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-04-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}