Question:
Intubation While Awake?

Hi. I have noticed that there has been a lot of talk lately about intubation while awake. I have been trying to determine why this would take place (I am waiting for my surgeon appt.) and have looked at profiles with BMI's from 39 to 58, so it certainly is not only based on weight. Small airways?? Any other reasons?    — Renee D. (posted on April 29, 2002)

April 29, 2002
I had a "wake intubation" 2 1/2 yrs ago for my lapBPD/DS. During pre-surgical testing it was not mentioned by the anesthesiologist and I had him check me 3 weeks after surgery and said it had been completely unnecessary. It was only mentioned to me a minute before surgery, when I was nervous and really didn't know what it meant. What it meant for me was the worst 45 minutes of my life and certainly worse than the surgery itself, or any of the numerous PSs that have followed! They strapped me down to the OR table and shoved something like a speculum down my throat while I gagged and struggled. They kept injecting my throat repeatedly w "something that would numb the throat". They did this repeatedly because it never did. It was like being orally raped, but rape would be preferrable since you could at least breath and not gag. I asked my surgeon at his first visit "Did you see what the anesthesiologist did to me (it took 3 of those beasts)?" He replied, that since hospital protocol would not allow him to interfer, he had to walk out of the OR as he could not watch! After telling ALL my comrads at this hospital to steer clear of this anesthesiologist, I never discuss this as it is disturbing to remember and doesn't seem to happen to people, so why scare them? I have come to the conclusion that this anesthesiologist wanted to give the 2 fellows who were assisting her a full "teaching experience" and chose me as the guinea pig for live or wake intubation. My BMI was only 51 and as I said the hospital anesthesiologist could find no reason why it should have been done. I have known many people of larger size, with breathing problems and comorbidities that were not treated to this method. It still makes me angry. My advice to anyone is to discuss the possibility at length, get a second opinion, and discuss the necessity and options to make the procedure less barbaric. I would never have agreed to this unless to was actually necessary and I would have found an anethesiologist who at least used valium or whatever they do for the endoscopy to make it palatable.
   — Jill L.

April 29, 2002
I don't think all experiences are similar to Jill's. The nurse anesthetist told me that I might be having a "fiber optic" intubation, which is done while the patient is still awake. The reason is my mouth doesn't open up very much (only about two and a half fingers worth)...and I have severe TMJ and other problems with my jaw. She said they would give me a drug called Versed which is a sedative and also an amnesiac type drug in that you don't remember what they did to you afterwards. She said there will be some discomfort. I would of course prefer to be intubated once I'm asleep but that may not be an option for me. A fiber optic intubation is still better than them saying I can't have surgery because of my jaw problems. It has nothing to do with BMI, it's how open your mouth can be, and if they have a straight visual line back to your airway in order to "see" enough to put the tube in. In my case, they don't have enough visibility to do it the regular way.
   — [Deactivated Member]

April 29, 2002
Hearing these horor stories is awful. I cannot imagine what it must be like. I have had 6 major surgeries and have never been intubated while awake. I have always been put under first. I cannot imagine that there would be a good reason to do that. Definitely discuss this with your anethesiologist. Good question, I learn something from this site every day.
   — Cheri M.

April 30, 2002
I'm shocked after reading of Jill's experience. I would have said that intubation while awake would never happen except in an emergency situation, but after reading Jill's story it shows you to "never say never." Jill, I am so sorry to hear that you had no advocate for you in the OR. As for the concerns of someone who wants to avoid this, there should be a pre-op discussion with someone from anesthesia as you are being prepped for surgery. I would recommend at that time that you very clearly state to the doctor: "I do NOT consent to an intubation while awake and would like you to note that in your chart." The magic words to use in medical situations (if you are able to speak) is: "I withdraw my consent for this procedure."
   — BethVBG