Endotracheal Intubation

    Endotracheal intubation (EI) is an emergency procedure most often performed in patients who are unconscious or who cannot breathe on their own. EI helps to prevent suffocation or obstruction of the passage of air.

    In a typical EI, a patient is first given a heavy anesthetic. Then, a flexible plastic tube is placed into the trachea (windpipe) through the mouth or sometimes the nose to help the patient with breathing.

    The trachea, also known as the windpipe, is a cylindrical tube that is about four inches long and one inch in diameter. It begins just under the voice box, descends behind the breastbone, and then divides into two smaller tubes. Each tube connects to one of your lungs.

    The windpipe is made from discs of tough cartilage, muscle, and connective tissue. Its lining is composed of smooth tissue. Each time you breathe in, the windpipe gets slightly longer and wider—then returns to its normal size as you breathe out.

    What EI Addresses

    You may need this procedure for one of the following reasons:

    • to remove an object that is blocking your air passage
    • to open your airways so that you can receive an anesthetic, medication, or oxygen
    • to enable your doctor to get a clear view of your upper airway
    • to protect your lungs
    • if you have stopped or are having difficulty breathing
    • you need a machine to help you breathe
    • you have a head injury

    The administration of EI will enable your airway to completely open. This allows oxygen to pass freely to and from your lungs as you breathe.

    Where and How Is the Procedure Administered?

    EI is typically performed in the hospital, where you will be given a strong sedative. In emergency situations, EI may be administered by a paramedic at the scene of the emergency. Studies have shown that paramedics can successfully perform this procedure. (Gray, Cartlidge, & Gavalas, 1992).

    In a standard EI surgery, you will receive an anesthetic before the procedure. Once you are sedated, an anesthesiologist will open your mouth and insert a small camera called a laryngoscope. This camera is used to examine the inside of the voice box. Once the vocal cords have been located, the flexible plastic EI tube will be placed into your mouth and lowered through the vocal cords.

    The tube may then be connected to a ventilator (breathing machine) or may be manipulated manually by attaching a bag to the tube, which the anesthesiologist will use to pump air into your lungs. The anesthesiologist will then listen to your breathing through a stethoscope to ensure that the tube is in the right place. Once you no longer need help breathing, the tube is removed.

    What are the Risks of the Procedure?

    Anesthesia Risks

    In most cases where EI must be performed, the patient will be under general anesthesia. Though most healthy people do not have any problems with general anesthesia, there is a small risk of long-term complications and, very rarely, death. These risks largely depend upon your general health and the type of procedure you are undergoing.

    Factors that may increase your risk of complications include:

    • medical conditions that involve your lungs, kidneys, or heart
    • family history of adverse reactions to anesthesia
    • sleep apnea
    • obesity
    • allergies to food or medications
    • alcohol use
    • smoking

    If you have any of these medical problems or are older, you may be more at risk of the following complications. However, these complications are still rare:

    • heart attack
    • lung infection
    • stroke
    • temporary mental confusion
    • death

    Waking Up While Under Anesthesia

    According to the Mayo Clinic, about one or two people in every 1,000 wake up briefly while under the effects of general anesthesia (Mayo, 2010). If this happens, usually you will be aware of your surroundings but will feel no pain. On rare occasions, people feel severe pain. This can lead to long-term psychological problems. Factors that may increase the risk of this happening include:

    • emergency surgery
    • heart or lung problems
    • long-term use of opiates, tranquilizers, or cocaine
    • daily alcohol use

    Intubation Risks

    There are some risks related to intubation. To prevent these from occurring, you will be evaluated by the anesthesiologist (or ambulance personnel in an emergency situation) before the procedure and will be monitored throughout for potential complications such as:

    • buildup of excess water in your tissues
    • bleeding
    • collapsed lung

    Preparation for the Procedure

    Intubation is an invasive procedure and can cause considerable discomfort. For this reason, general anesthesia and a muscle relaxing medication are usually administered so that you do not feel anything. However, if necessary, the procedure can be performed while the patient is awake, with local anesthesia or with no anesthesia at all.

    What to Expect After an EI

    You may have slight difficulty swallowing after an EI, but this should quickly pass.

    However, experiencing any of the following symptoms may indicate further issues with your airway. Seek medical advice immediately if you have:

    • swelling of the face
    • sore throat
    • chest pain
    • difficulty swallowing
    • neck pain