Routine tracheal extubation location after anesthesia in adult patients: a nationwide French mixed-methods survey of...

Tracheal extubation (TE) is a commonplace procedure, but should not be trivialized; it remains a critical yet under-standardized step in anesthesia practice. Whether performed in the operating room (OR) or the post-anesthesia care unit (PACU), the TE location reflects a compromise between patient safety and operating room efficiency and remains a concern. This national survey aimed to describe TE practices among French anesthesia professionals and identify factors influencing the choice of routine TE site.

We conducted a national mixed-methods survey, combining quantitative and qualitative analyses, to assess TE practices among care-providing anesthesia professionals. An online questionnaire endorsed by the French Society of Anesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) was distributed from June to September 2025. It included demographic data and three standardized clinical scenarios of increasing anesthetic complexity. Respondents specified their optimal TE site, operator characteristics, oxygenation methods, and rationale for decision-making. Quantitative data were analyzed descriptively; qualitative responses underwent thematic analysis.

A total of 297 anesthesia professionals responded, including 194 (65.5 %) CRNAs and 102 (34.5 %) anesthesiologists. Most worked in university or general hospitals (72 %). The composition of PACU staff was heterogeneous, with nurses trained in the recovery room in 56.9 %, CRNAs in 47.5 %, and anesthesiologists in 10.8 %. TE location varied widely: 30% performed all routine TE in the OR, 23% mostly in the OR, 14% equally in both locations, 21% mostly in the PACU, and 12% exclusively in the PACU. Most operating room TE occurred after low-risk procedures (64%) and were performed by CRNAs under anesthesiologist supervision; anesthesiologist involvement increased with case severity. Most respondents reported to plan TE site before anesthesia induction. Determinants of TE site considered analgesia quality, staff competence, equipment reliability, and organizational constraints.

Routine TE practices in France exhibit significant variability, shaped by clinical and institutional factors rather than standardized protocols. The predominance of nurse-based PACUs and limited anesthesiologist presence highlight the need for structured, evidence-based guidelines to optimize postoperative airway safety, even during non-difficult airway management.