This study aims to evaluate the impact of different extubation strategy on the occupancy time of operating room (OR) and the incidence of adverse events and quality of recovery after robotic-assisted surgery. The investigators hypothesize that extubation in the post-anesthesia care unit (PACU) may reduce OR occupancy time without increasing adverse events or worsening quality of recovery early after robotic-assisted surgery. This strategy may enhance perioperative efficiency while maintaining clinical safety.
Aged ≥18 years;
Scheduled to undergo elective robot-assisted laparoscopic surgery under general anesthesia;
Expected tracheal extubation during daytime working hours (before 4:00 PM).
Refuse to participate in the study;
Morbid obesity (body mass index ≥35 kg/m²);
Preoperatively diagnosed obstructive sleep apnea, or patients with a STOP-Bang score ≥3 in combination with serum bicarbonate (HCO₃-) ≥28 mmol/L;
Patients at high risk of difficult airway (anticipated difficult intubation and/or extubation during preoperative assessment);
Parallel
Extubation in post-anesthesia care unit (PACU)
Procedure/SurgeryAt the end of surgery, patients will be transfered from OR to PACU with endotracheal intubation and then extubated in PACU.
Extubation in operating room (OR)
Procedure/SurgeryAt the end of surgery, patients will be extubated in OR and then transfered from OR to PACU.
Operating room (OR) occupancy time
Time interval from end of surgery to leaving OR for PACU.
Incidence of emergence delirium
Emergence delirium will be assessed with the confusion assessment method for the intensive care unit (CAM-ICU).
Incidence of adverse events before leaving PACU
An adverse event indicates any unpredictable, unfavourable medical event that is associated with any medical intervention and occurs from end of surgery to the timepoint of leaving PACU.
Time interval from end of surgery to modified Aldrete score of ≥9
Modified Aldrete Score is used to assess post-anesthesia recovery in five aspects (activity, respiration, circulation, consciousness, and oxygenation); scores range from 0 to 10, with higher scores indicating better recovery. A score of ≥9 indicates that patients can be safely transferred from PACU to general wards.
Time interval from end of surgery to PACU discharge
Time interval from end of surgery to PACU discharge.
Time interval from end of surgery to extubation
Time interval from end of surgery to extubation.
Turnover time in the operating room
Time interval between leaving OR of the last patient and entering OR of the next patient.
Ready for surgery time in the operating room
Time interval between end of surgry of the last patient and ready for surgery of the next patient.
Quality of recovery on postoperative day 1
Quality of recovery (QoR) will be assessed using the QoR-15. QoR-15 is a 15-item scale that assesses quality of postoperative recovery in 5 domains including pain, physical comfort, physiological independence, psychological state, and support and communication. Scores range from 0 to 150, with higher scores indicating better recovery.
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