Education

Fear of Intubation: Are the Worries Justified?

Many patients tell us they would avoid general anesthesia because of the breathing tube. The fear has some basis, and some of it is out of proportion.

What intubation is

During general anesthesia, a breathing tube may be passed through the mouth into the windpipe so the anesthesiologist can control breathing. Some operations use a softer airway device that sits above the vocal cords instead.

What is justified

  • Minor injury is common. A review of upper airway complications notes that trauma to the upper airway is a common event in adults undergoing intubation. Sore throat and hoarseness are the typical examples, usually settling in days.
  • Dental injury and voice problems can happen, and rarely persist.
  • A difficult airway exists. Some patients are harder to intubate. National guidance, such as the Canadian Airway Focus Group recommendations, exists precisely because anesthesiologists plan for this.

What is out of proportion

  • Serious airway problems are uncommon, and anesthesiologists are trained to anticipate and manage them, with backup devices and algorithms.
  • Most sore throats and hoarseness resolve without treatment.
  • Avoiding intubation does not mean avoiding all airway risk. Deeper sedation can also cause airway obstruction.

Where awake surgery fits

For suitable operations, local anesthesia with light to moderate sedation can avoid the need for a breathing tube. But we cannot promise you will never need airway help. If your anesthesiologist judges that general anesthesia is safer for you, we will go that way, and explain why.

If this fear is a major concern for you, tell us. It is a valid part of choosing your anesthetic plan.

Explore your options at a consultation

References

  1. Tikka T, Hilmi OJ. Upper airway tract complications of endotracheal intubation. Br J Hosp Med (Lond). 2019;80(8):441-447. PMID 31437047
  2. Law JA, Duggan LV, Asselin M, et al; Canadian Airway Focus Group. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth. 2021;68(9):1373-1404. PMID 34143394