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Wednesday, July 30, 2014
Awake during intubation
I had dental surgery a year ago with general anesthesia. I was told that I was very difficult to intubate and was given a letter concerning this. I am scheduled for a double mastectomy with reconstruction in a week. I am petrified because the anesthesiologist has informed me that I will have to be awake (semiconscious) during the intubation.
Will I feel the tube placement and be aware of its insertion/removal?
"Awake intubation" is an important safety measure used when a person needing general anesthesia is known to be difficult to intubate. One can understand why you would not be looking forward to this!
The good news however is that in the hands of a competent anesthesiologist you are likely to have no more discomfort (and possibly quite a bit less) than the average person scheduled for an endoscopic examination of the stomach - a gastroscopy. This is a very common procedure done in doctor's offices and outpatient centers. Although intubation is not exactly the same as an upper gastrointestinal endoscopy, what this tells you is that hundreds of thousands of people undergo this type of procedure every year without a huge amount of discomfort.
A variety of drugs may be used to keep you comfortable during the intubation, but breathing adequately (the breathing part is the key). Also, local anesthetic is applied to your airway (throat and lower airway) to make the passage of the tube easier to handle, suppressing the gag reflex.
Once the tube has been inserted, you will immediately be given additional anesthesia so that you become unconscious, as with any other general anesthetic. At the end of the procedure, the anesthetic is lightened and as soon as you are awake enough and strong enough to breath on your own and keep your airway open, the tube will be removed. Most people have no recollection of this part of the procedure.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University