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Is sedation required for intubation?

Reviewed on 7/17/2020

What Is Intubation?

Intubation Sedation
Unless the patient is already unconscious or if there is a rare medical reason to avoid sedation, patients are typically sedated for intubation.

Intubation is a medical procedure used by doctors to keep the airway open or safe during a medical emergency or a surgical procedure. 

What is Intubation Used For?

Intubation is used:

How do Doctors Perform Intubation?

To perform intubation:

  • The patient is placed on cardiac and oxygen monitors lying on their back, face-up
  • Pre-oxygenation is done when possible 
  • High-flow oxygen is usually administered by mask or nasal cannula prior to the procedure
  • Medications are administered to sedate the patient and paralyze the muscles of the airway
  • The head is tilted slightly back
  • The mouth, throat, and pharynx are cleared of any debris or secretions
  • A scope with a light is inserted past the teeth and tongue into the back of the throat to locate the voice box (larynx) which is where the part of the airway that connects to the lungs begins
  • An endotracheal tube is guided along with the lighted scope and placed in between the vocal cords in the trachea
  • A small airway cuff (a small balloon at the end of the endotracheal tube) is inflated so the tube stays in place inside the trachea
  • The endotracheal tube is connected to oxygen via a ventilator
  • Once the tube is in place, the doctor will check that it’s in the right position and is assisting the patient in breathing correctly

Is Sedation Required for Intubation?

Unless the patient is already unconscious or if there is a rare medical reason to avoid sedation, patients are typically sedated for intubation. 

Intubating patients who are not sedated is difficult and can be dangerous. The patient’s gag reflex can cause movement of the airway and regurgitation of vomit or secretions into the airway causing complications. The vocal cords can also spasm during a non-sedated intubation causing damage to the cords and complicating the procedure. 

Medications used in tracheal intubation include:

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What are Risks and Complications of Intubation?

Complications of intubation include:

  • Dental damage such as chipped or broken teeth
  • Lip, gum, or inner cheek cuts 
  • Sore throat
  • Difficulty talking or breathing following the procedure
  • Pain in the lungs
  • Lung collapse
  • Pneumonia or another lung infection
  • Aspiration (inhalation of vomit, blood, or other secretions into the lungs)

In the extremely rare case, intubation is unsuccessful, the patient may need an emergency procedure called a cricothyroidotomy, in which a smaller airway tube is placed into the neck through the cricoid membrane (near the “Adam’s apple”).  

Risk factors for complications from intubation include:

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Reviewed on 7/17/2020
References
Source: https://emedicine.medscape.com/article/80222-overview
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