Endotracheal intubation (EI) is an emergency procedure that’s often performed on people who are unconscious or who can’t breathe on their own. EI maintains an open airway and helps prevent suffocation.
In a typical EI, you’re first given a heavy anesthetic. Then, a flexible plastic tube is placed into your trachea, or windpipe, through your mouth or nose to help you breathe.
The trachea, also known as the windpipe, is a tube that carries air to your lungs. It’s about 4 inches long and 1 inch wide. It begins just under your larynx, or voice box, and extends down behind the breastbone, or sternum. Your trachea then divides into two smaller tubes called bronchi. Each tube connects to one of your lungs.
Your trachea is made up of tough cartilage, muscle, and connective tissue. Its lining is composed of smooth tissue. Each time you breathe in, your windpipe gets slightly longer and wider. It returns to its normal size as you breathe out.
You can have difficulty breathing or may not be able to breathe at all if your trachea is blocked or damaged. This is when EI is necessary.
You may need this procedure for one of the following reasons:
- to open your airways so that you can receive an anesthetic, medication, or oxygen
- to protect your lungs
- you’ve stopped breathing or you’re having difficulty breathing
- you need a machine to help you breathe
- you have a head injury
EI makes your airway open completely. This allows oxygen to pass freely to and from your lungs as you breathe.
In most cases, you’ll be under general anesthesia during the procedure. This means that you’ll be asleep as the tube is inserted. Healthy individuals usually don’t have any problems with general anesthesia, but there’s a small risk of long-term complications. These risks largely depend on your general health and the type of procedure you’re undergoing.
Factors that may increase your risk of complications include:
- problems with your lungs, kidneys, or heart
- a family history of adverse, or bad, reactions to anesthesia
- sleep apnea
- allergies to food or medications
- alcohol use
More serious complications may occur in older adults who have serious medical problems. These complications are rare but may include:
- heart attack
- lung infection
- temporary mental confusion
Waking up While Under Anesthesia
Approximately one or two people in every 1,000 wake up briefly while under general anesthesia. If this happens, people are usually aware of their surroundings but won’t feel any pain. On rare occasions, they can feel severe pain. This may lead to long-term psychological problems, such as post-traumatic stress disorder (PTSD). Certain factors can make this situation more likely:
- emergency surgery
- heart or lung problems
- long-term use of opiates, tranquilizers, or cocaine
- daily alcohol use
There are some risks related to intubation, such as:
- a buildup of too much water in your tissues
- a collapsed lung
A doctor who administers anesthesia called an anesthesiologist or ambulance personnel will evaluate you before the procedure to help prevent these complications from occurring. You’ll also be monitored carefully throughout the procedure.
Intubation is an invasive procedure and can cause considerable discomfort. However, you’ll likely be given general anesthesia and a muscle relaxing medication so that you don’t feel any pain. In some rare cases, the procedure may be performed while you’re awake. A local anesthesia can be used to numb the area, but sometimes no anesthesia will be used at all.
EI is usually done in the hospital, where you’ll be given a strong sedative. In emergency situations, a paramedic at the scene of the emergency may perform EI.
In a typical EI procedure, you’ll first receive an anesthetic. Once you’re sedated, your anesthesiologist will open your mouth and insert a small instrument with a light called a laryngoscope. This instrument is used to examine the inside of your larynx, or voice box. Once your vocal cords have been located, a flexible plastic tube will be placed into your mouth and lowered through your vocal cords.
The tube may then be connected to a ventilator, or breathing machine. In some cases, the tube may be manually attached to a bag, which your anesthesiologist will use to pump air into your lungs. Your anesthesiologist will then listen to your breathing through a stethoscope to make sure that the tube is in the right place. Once you no longer need help breathing, the tube is removed.
You may have some difficulty swallowing after the procedure, but this should go away quickly.
There’s also a slight risk that you’ll experience complications from the procedure. Make sure you call your doctor right away if you’re showing any of the following symptoms:
- swelling of your face
- a sore throat
- chest pain
- difficulty swallowing
- neck pain
These symptoms may be a sign of other issues with your airway.