Prospective, randomized, single-blinded controlled study to compare the airway and respiratory complications of deep and awake tracheal extubations in adults.

Inclusion Criteria:

• ASA physical status classification system for assessing the fitness of patients before surgery 1-3
• Meeting American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting
• Adult patients age 18-64
• Favorable airway examinations (Mallampati 1 or 2, normal mouth opening, and intact neck extension)
• Scheduled cases in which tracheal intubation and general anesthesia are indicated

Exclusion Criteria:

• Patients with chronic obstructive pulmonary disease, pulmonary hypertension, interstitial lung disease, active respiratory infections, and/or uncontrolled asthma
• Unfavorable airway examinations (Mallampati 3 or 4, limited mouth opening, and/or inability to extend neck)
• Full stomach
• Known difficult intubation or mask ventilation
• Surgeries of the airway and intrathoracic surgeries
• Emergent surgeries
• Case duration >6 hours
• Pregnancy
• Patients scheduled to receive a protocolized anesthetic (Enhanced Recovery After Surgery aka ERAS)
• ASA Physical Status Classification 4 or 5
• Chronic diseases such as obstructive pulmonary disease, pulmonary hypertension, interstitial lung disease, active respiratory infections, and/or uncontrolled asthma
• Uncontrolled gastroesophageal reflux disease (heartburn) defined by presence of symptoms despite compliance with appropriate medication regimen
• Patient scheduled to receive a protocolized anesthetic ie Enhanced Recovery After Anesthesia (ERAS)
• Surgeries requiring prone positioning