Extubation is a very common practice for anesthesiologists as part of their daily clinical practice. It is therefore imperative to generate evidence on good clinical practice during anesthetic emergence in order to potentially identify an effective extubation strategy to reduce postoperative pulmonary complications. conditions: Intra-abdominal Surgery conditions: Anesthesia conditions: Lung Injury conditions: Ventilator-Induced Lung Injury conditions: Atelectasis studyType: INTERVENTIONAL phases: NA allocation: RANDOMIZED interventionModel: PARALLEL interventionModelDescription: During surgical closure, the definitive ARISCAT score and exclusion criteria will be assessed. Patients will be randomized equally (1:1) using web-based allocation-concealed methods, with stratification by center and ARISCAT risk category. An unblinded research assistant will reveal group allocation to the anesthesiologist and monitor the emergence procedure. primaryPurpose: TREATMENT masking: DOUBLE maskingDescription: Until surgical closure, all will be blinded to treatment allocation. Only specific healthcare professionals (anesthesiologist, respiratory therapist, operating room nurses, unblinded research assistant) will be present during emergence to maintain blinding. Other healthcare team members will remain blinded. Outcome adjudicators, Executive and Steering committee members, and the data analyst will also be blinded. No mechanism for unblinding is planned, as both interventions follow the same diagnostic and treatment algorithms for adverse effects. whoMasked: PARTICIPANT whoMasked: OUTCOMES_ASSESSOR count: 216 type: ESTIMATED name: Protective "open-lung" extubation name: Conventional extubation measure: Average weekly patient recruitment rate measure: Protocol adherence rate measure: Postoperative pulmonary complications outcome completion rate measure: Accuracy of self-reported protocol adherence compared to directly observed protocol adherence measure: Postoperative pulmonary complications measure: Amount of supplemental oxygen administered following discharge from the post-anesthesia care unit measure: Quality of recovery measure: Discharge disposition measure: Days alive and out of hospital measure: Health-related quality of life measure: Lowest oxygen saturation post-extubation in the operating room measure: Time in minutes with oxygen saturation < 85% post-extubation in the operating room measure: Re-intubation rate in the operating room and in the post-anesthesia care unit sex: ALL minimumAge: 18 Years stdAges: ADULT stdAges: OLDER_ADULT facility: The Ottawa Hospital city: Ottawa state: Ontario zip: K1H 8L6 country: Canada name: Daniel I. McIsaac, MD role: CONTACT phone: 613-761-4940 email: dmcisaac@toh.ca name: Manoj Lalu, MD role: CONTACT email: mlalu@toh.ca name: Daniel I. McIsaac, MD role: PRINCIPAL_INVESTIGATOR name: Manoj Lalu, MD role: SUB_INVESTIGATOR lat: 45.41117 lon: -75.69812 facility: Unity Health Network city: Toronto state: Ontario zip: M5B 1W8 country: Canada name: Michael C. Sklar, MD role: CONTACT phone: 416-864-5071 email: michael.sklar@mail.utoronto.ca name: Ashwin Sankar, MD role: CONTACT email: ashwin.sankar@mail.utoronto.ca name: Michael C. Sklar, MD role: PRINCIPAL_INVESTIGATOR name: Ashwin Sankar, MD role: SUB_INVESTIGATOR lat: 43.70011 lon: -79.4163 facility: Centre Hospitalier de l'Université de Montréal (CHUM) city: Montréal state: Quebec zip: H2X 0C1 country: Canada name: Martin Girard, MD role: CONTACT phone: 514-890-8000 email: martin.girard@umontreal.ca name: Eva Amzallag, MSC role: CONTACT phone: 514-890-8000 email: eva.amzallag.chum@ssss.gouv.qc.ca name: Michael Chassé, MD role: SUB_INVESTIGATOR name: François Martin Carrier, MD role: SUB_INVESTIGATOR lat: 45.50884 lon: -73.58781 facility: CHU de Québec - Université Laval city: Québec zip: G1V 4G2 country: Canada name: Alexis F. Turgeon, MD role: CONTACT phone: 418-525-4444 phoneExt: 66058 email: alexis.turgeon@fmed.ulaval.ca name: Michael Verret, MD role: CONTACT phone: 418-525-4444 phoneExt: 66847 email: michael.verret.med@ssss.gouv.qc.ca name: Alexis F. Turgeon, MD role: PRINCIPAL_INVESTIGATOR name: Michael Verret, MD role: SUB_INVESTIGATOR lat: 46.81228 lon: -71.21454 hasResults: False