If the patient is not breathing adequately at this stage, gentle assisted ventilation on the reservoir bag may be employed. A little patience may be required.

A Guedel oral airway is often inserted at this time. It helps prevent the patient from biting down on the tracheal tube. When the patient is extubated, this device will also help to prevent obstruction caused by the tongue or collapse of the pharynx. Additionally, it provides useful access for a suction catheter.

When the patient is breathing spontaneously, an adequate tidal volume and respiratory rate (>8 breaths/min in an adult) should be observed on the reservoir bag. The patient will be waking up during this process, and the presence of a tube in the trachea may cause coughing, straining and breath holding. This needs to be kept to a minimum, because it raises arterial, intracranial and intraocular pressure.