What Is an Awake Intubation?

An awake intubation is performed on a surgical patient who is not yet sedated. During surgery, a tube inserted down the throat and into the trachea lets the patient breathe. Awake intubation is generally suggested for patients who may not tolerate being put under general anesthesia before the tube is placed. The awake procedure is considered safer than the sedated procedure due to maintenance of laryngeal and pharyngeal muscle tone. While the awake method is safer, it may need to be abandoned if the patient is uncooperative.

Several reasons exist to choose an awake intubation attempt. Patients who have abnormally structured airways are often candidates for this procedure. Such patients are not typically good candidates for general anesthesia intubation. Once they are sedated, it can be too difficult to get the tube down the abnormally structured throat and into the trachea.

Patients who have broken jaws or other issues making it difficult to open the mouth are also candidates for awake intubation. Swelling of mouth and throat tissue also create problems with a general anesthesia inubation. An awake intubation is easier to perform, as the patient is typically alert and able to follow directions, such as opening the mouth and breathing regularly.

Awake intubations are performed through either the mouth or the nose to the trachea. Patients are usually given a mild sedative to help them relax and cooperate with the procedure. A small camera is used to guide the tube properly.

A numbing agent is used on the lips or nose before the tube is inserted. The numbing agent makes it more comfortable for the patient to endure the procedure. The body's natural gag reflex may still cause the patient to fight against the tube. In extreme cases, the procedure is abandoned and a sedated intubation is attempted.

The decision to use an awake intubation is made by an anesthesiologist during pre-surgery discussions. He or she discusses the patient's neck shape, mouth structure, or other issues with the patient and explains the desire to try the awake procedure first. Once the tube is placed, general anesthesia is administered and surgery proceeds normally.

An awake procedure is also considered when the patient has a full stomach. Patients with food in their stomachs run a risk of vomiting the stomach contents up and inhaling them into the lungs. An awake intubation allows the patient to feel when he or she is about to vomit and cough or turn over to prevent choking and inhalation.