Intubation is a medical procedure in which a tube is inserted into the trachea to maintain an open airway, assist with breathing, and potentially deliver anesthesia. While it is a common procedure performed in emergency rooms, operating theaters, and intensive care units, many patients may have questions about the process, including whether they will be conscious during intubation.

Intubation is typically done in situations where a patient requires respiratory support, such as during surgery under general anesthesia, in critical care situations, or in cases of severe respiratory distress. The procedure involves inserting an endotracheal tube into the trachea through the mouth or nose, providing a secure airway that allows the delivery of oxygen or anesthetic gases and mechanical ventilation of the lungs ¹.

Whether a person is conscious during intubation largely depends on the type of anesthesia or sedation administered beforehand. In most cases, patients undergoing intubation will be either under general anesthesia or deeply sedated to ensure comfort and prevent distress.

In surgical settings, when general anesthesia is used, the patient is typically unconscious throughout the procedure. Common agents include intravenous drugs like propofol or inhalational agents like sevoflurane or isoflurane. Under general anesthesia, patients do not feel or remember the procedure. The anesthesiologist closely monitors the patient’s vital signs, including breathing, blood pressure, and heart rate, to ensure the patient remains stable ^2,3.

In certain emergency or non-surgical situations, a patient may receive sedation or local anesthesia instead of general anesthesia due to time constraints or other factors. The patient may be less deeply sedated, and it is possible that they could remain somewhat conscious or semi-conscious during intubation. However, the goal is still to make the procedure as comfortable as possible by dulling the sensations of pain or discomfort. In emergency situations, sedatives like benzodiazepines or opioids may be administered, and while they might keep the patient drowsy and relaxed, there remains a possibility of partial awareness. In some cases, patients may not remember the procedure due to the amnesic effects of certain drugs ^3–5.

For patients who do remain conscious during intubation, their experience may vary. Some people report feeling a sensation of pressure in the throat or chest as the tube is inserted, because the endotracheal tube is placed through the vocal cords and into the trachea, which can cause discomfort or the urge to cough. However, it is important to note that the anesthesiologist or medical team typically works quickly to minimize any discomfort, and patients who are awake are often given sedatives or pain relievers to ease the experience ^6–8.

Though rare, some patients may experience awareness during intubation, especially if the sedation or anesthesia is not administered adequately. This situation can be distressing for patients, leading to anxiety, fear, or memories of the procedure. However, with modern anesthesia techniques and equipment, the risk of awareness during intubation is very low ^9,10. In most cases, patients are not conscious during intubation, as they are under general anesthesia or sedation. The goal is always to ensure that the patient is comfortable and free from distress.

References

1.         Intubation: Purpose, Procedure and Potential Risks. Cleveland Clinic https://my.clevelandclinic.org/health/articles/22160-intubation.

2.         Xue, F.-S. & Liu, Q.-J. Tracheal Intubation Awake or Under Anesthesia for Potential Difficult Airway: Look Before You Leap. Chinese Medical Journal 131, 753 (2018). doi: 10.4103/0366-6999.226891

3.         Sequera-Ramos, L. et al. Sedation versus General Anesthesia for Tracheal Intubation in Children with Difficult Airways: A Cohort Study from the Pediatric Difficult Intubation Registry. Anesthesiology 137, 418–433 (2022). doi: 10.1097/ALN.0000000000004353.

4.         Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults – Ahmad – 2020 – Anaesthesia – Wiley Online Library. https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14904.

5.         Operater. Regional and Topical Anesthesia for Awake Endotracheal Intubation. NYSORA https://www.nysora.com/techniques/head-and-neck-blocks/airway/regional-topical-anesthesia-awake-endotracheal-intubation/ (2018).

6.         Mistry, V. et al. Comparison of patients’ experience following awake and asleep fibreoptic intubation: A prospective observational study. Trends in Anaesthesia and Critical Care 42, 20–25 (2022). doi: 10.1016/j.tacc.2021.11.005

7.         Gostelow, N. & Yeow, D. Awake tracheal intubation: a narrative review. Journal of Oral and Maxillofacial Anesthesia 2, (2023). doi: 10.21037/joma-23-17

8.         Knudsen, K., Nilsson, U., Högman, M. & Pöder, U. Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study. BMC Anesthesiol 16, 71 (2016). doi: 10.1186/s12871-016-0240-z.

9.         Bullard, T. L., Cobb, K. & Flynn, D. N. Intraoperative and Anesthesia Awareness. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2024).

10.         Parate, L. H. et al. The Study of Intraoperative Consciousness after Tracheal Intubation. Anesth Essays Res 12, 843–847 (2018). doi: 10.4103/aer.AER_139_18