Positive-Pressure Extubation Improves Early Oxygenation but Not Desaturation After Cesarean Delivery Under General...

Background/Objectives: Extubation technique, postoperative oxygenation, and hypoxemia are critical determinants of respiratory outcomes after general anesthesia. This study evaluated whether positive-pressure extubation improves early postoperative oxygenation and reduces desaturation in patients undergoing cesarean delivery. Methods: In this prospective randomized controlled trial, 120 participants were randomly assigned to positive-pressure or suction extubation. The primary outcome was postoperative desaturation (SpO₂ < 92%) within 60 min after extubation. Secondary outcomes included early post-extubation oxygenation and hemodynamic parameters. Multivariable logistic regression was used to identify independent predictors of desaturation. The trial was registered at ClinicalTrials.gov (NCT07251686. Results: Postoperative desaturation occurred in 13.3% of patients in the positive-pressure group and 20% in the suction group (p = 0.327). Mean SpO₂ values were significantly higher in the positive-pressure group at 0, 5, and 10 min after extubation (p < 0.01), but were similar at later time points. Extubation technique was not independently associated with desaturation (OR 0.69, 95% CI 0.24-1.98; p = 0.491). Conclusions: Positive-pressure extubation improves early postoperative oxygenation but does not reduce clinically relevant desaturation compared with suction extubation. Overall postoperative respiratory outcomes were comparable between the two techniques in this low-risk obstetric population.