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Medical Forum / General / General / March 2007conscious intubation procedure
I recently had a cancelled surgery and have rescheduled it in a different surgical center with supposedly better equipment. The reason is that I have arthritis and have several fused vertebra in my neck, and stiff jaw, so the anesthesiologist wasn't able to intubate me. Oh, I should also say that the surgery was to clean out my sinuses endoscopically. I did warn the anesth. about my neck and jaw beforehand, so he was aware that I might be difficult. From what I understand, the surgery center we were in didn't have the kind of intubation equipment with cameras, or something. He said that the problem wasn't the size of the tube, but that he couldn't see where he was putting it (couldn't see my glottis). So, we're going to try again at a bigger hospital. As I was coming back out of the anesthesia, he spoke to my husband and told him that they might have to intubate me while still conscious. I understand that they give you drugs that make you not panic and not remember it, but the whole idea has me freaked out. I did a quick google search and see that it's a common thing to do to people with apnea. Given that I don't have apnea and breath just fine when unconscious, is there really a need to intubate me while awake? I'm going to call my doctor and ask her because obviously she knows my case and situation. But until then I thought I'd ask here also for general opinions about the procedure itself. Why would conscious intubation be chosen over sedated intubation? If they insist on intubating me while conscious, is there anything I can do to not freak like crazy? - Sharon "Gravity... is a harsh mistress!" >I recently had a cancelled surgery and have rescheduled it in a different > surgical center with supposedly better equipment. The reason is that I [quoted text clipped - 37 lines] > like > crazy? First of all, "awake intubation" doesn't mean you'll be awake staring at the ceiling - you'll be sedated and amnestic..almost certainly would remember nothing afterward. However, that assumes that awake fiberoptic intubation is necessary. That's a technique that's used in difficult airway situations, but usually those that are far more complicated than yours - situations where there are other things beside fused cervical vertebrae, such as really big tonsils, morbid obesity, really short jaw etc. If none of those things are true and your only airway problem is lack of neck mobility and they are comfortable that they would be able to use a mask to ventilate you adequately, then the state-of-the-art would be video intubation - using a video laryngoscope. That would certainly be done with you under general anesthesia and paralysis. Normally, in order to intubate someone they induce general anesthesia and paralysis so that their reflexes are completely suppressed. HMc > First of all, "awake intubation" doesn't mean you'll be awake staring at the > ceiling - you'll be sedated and amnestic..almost certainly would remember [quoted text clipped - 10 lines] > general anesthesia and paralysis so that their reflexes are completely > suppressed. Ok. I'm hoping they can do the video laryngoscope with me out cold. Since the doctor is doing sinus surgery, working in my nose, I understand that I need to be ventilated orally and a mask won't work. Over the last few months of working with my ENT, I'm getting comfortable with having a laryngoscope inserted into my nose and peeking at my throat. She let me see on the monitor and it looks to me like they should be able to locate my airway and intubate me with a scope. Of course, I know I'm just the patient, but it looked to me like my throat is pretty open, so the only problem could be the neck/jaw immobility. I found a couple good training videos on the web so I understand what they're doing. The videos made reference to how the equipment they were demonstrating could be used on either conscious or sedated patients. So then I was curious why the anesth. would choose one technique over another. Thanks for the answer. I guess another issue altogether is that the anesth shouldn't have told me about the idea! Anticipation of something scary is always worse than the thing itself, right? - Sharon "Gravity... is a harsh mistress!" > Ok. I'm hoping they can do the video laryngoscope with me out cold. > Since the doctor is doing sinus surgery, working in my nose, I understand [quoted text clipped - 21 lines] > worse > than the thing itself, right? An awake fiberoptic intubation is a fairly extreme measure and used by competent anesthesiologists only in circumstances where they believe that mask ventilation won't be possible, such as elements of airway obstruction. Bear in mind that in ALL cases of general endotracheal intubation, the ability to provide mask ventilation has to be assured. No anesthesiologist wants to induce general anesthesia with paralysis so the patient can't breathe for themself and can't protect their own airway, and then find that they can't intubate AND that they can't adequately ventilate the patient by mask. *Now* we have an emergency. OTOH, if they can adequately mask ventilate the paralyzed patient, they have all the time in the world to use a video intubation without risk to the patient. HMc > An awake fiberoptic intubation is a fairly extreme measure and used by > competent anesthesiologists only in circumstances where they believe that [quoted text clipped - 9 lines] > > HMc Ahh, ok thanks for that. They can mask-ventilate me easily, just not while the ENT is probing inside my nose/sinuses. But then I assume they'll get me intubated first using the procedure you describe and then give her the high-sign. - Sharon "Gravity... is a harsh mistress!" >I recently had a cancelled surgery and have rescheduled it in a different > surgical center with supposedly better equipment. The reason is that I [quoted text clipped - 28 lines] > there > really a need to intubate me while awake? This increases the odds that you will have oxygen in your blood at all times. Your brain will thank you. > I'm going to call my doctor and ask > her because obviously she knows my case and situation. But until then I [quoted text clipped - 5 lines] > like > crazy? When you are unconscious, your brain is not keeping your airway from collapsing. Obviously, the anesthesiologist was not able to see well enough to get the endotrachial tube into your trachea. With the camera, he might be able to. If not, keeping you conscious will allow your airway to stay open so that he can put the tube in. As he said, even though you will be conscious, you will be sedated. It is not nearly as bad as it sounds. Plus the drugs they give you will make it so you don't remember it. Jeff > - Sharon > "Gravity... is a harsh mistress!" |
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