Comparison of Deep Versus Awake Tracheal Extubation 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