Endotracheal intubation (EI) is often an emergency procedure that’s 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 given anesthesia. Then, a flexible plastic tube is placed into your trachea through your mouth to help you breathe.
The trachea, also known as the windpipe, is a tube that carries oxygen to your lungs. The size of the breathing tube is matched to your age and throat size. The tube is kept in place by a small cuff of air that inflates around the tube after it is inserted.
Your trachea begins just below your larynx, or voice box, and extends down behind the breastbone, or sternum. Your trachea then divides and becomes two smaller tubes: the right and left main bronchi. Each tube connects to one of your lungs. The bronchi then continue to divide into smaller and smaller air passages within the lung.
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 relaxed size as you breathe out.
You can have difficulty breathing or may not be able to breathe at all if any path along the airway is blocked or damaged. This is when EI can be necessary.
You may need this procedure for any of the following reasons:
- to open your airways so that you can receive anesthesia, 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 and cannot breathe on your own
- you need to be sedated for a period of time in order to recover from a serious injury or illness
EI keeps your airway open. This allows oxygen to pass freely to and from your lungs as you breathe.
Typically, you’ll be under general anesthesia during the procedure. This means that you won’t feel anything as the tube is inserted. Healthy people 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 with anesthesia include:
- chronic problems with your lungs, kidneys, or heart
- history of seizures
- a family history of adverse reactions to anesthesia
- sleep apnea
- allergies to food or medications
- alcohol use
More serious complications may occur in older adults who have significant medical problems. These complications are rare but may include:
Approximately one or two people in every 1,000 may become partially awake 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 complications, 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:
- injury to teeth or dental work
- injury to the throat or trachea
- a buildup of too much fluid in organs or tissues
- lung complications or injury
- aspiration (stomach contents and acids that end up in the lungs)
An anesthesiologist or ambulance EMT will evaluate you before the procedure to help decrease the risk of 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 typically be given general anesthesia and a muscle relaxing medication so that you don’t feel any pain. With certain medical conditions, the procedure may need to be performed while a person is still awake. A local anesthetic is used to numb the airway in order to lessen the discomfort. Your anesthesiologist will let you know prior to intubation if this situation applies to you.
EI is usually done in the hospital, where you’ll be given anesthesia. 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 see 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 passed beyond your vocal cords into the lower portion of your trachea. In difficult situations, a video camera laryngoscope may be used to give a more detailed view of the airway.
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. During surgical procedures and in the intensive care unit, the tube is connected to a ventilator, or breathing machine, once it’s in the proper place. In some situations, the tube may need to be temporarily attached to a bag. Your anesthesiologist will use the bag to pump oxygen into your lungs.
You may have a mild sore throat or 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 severe sore throat
- chest pain
- difficulty swallowing
- difficulty speaking
- neck pain
- shortness of breath
These symptoms may be a sign of other issues with your airway.