Human intubation

[Guest guest]

Hi All

With human intubation, aspiration is a very big concern. There is a

risk when the tube enters and when it is removed. Any decrease in

consciousness will also increase the risk of aspiration. That is why

you are not supposed to eat or drink after midnight the night before

(4-6 hours for an infant). A patient is put out, then a paralytic

agent (similar to curare) is almost always used in the operating

room. This paralyzes all skeletal muscles. Keeps spasm down, blocks

cough, etc. The patient is given an anti-emetic and something to

decrease secretions. The patient is " bagged " (breathed for with a bag

and a mask). The paralytic makes it harder to throw up, because even

though your stomach may reverse direction, you cannot generate the

retch which gives it power. Your stomach will also be empty, so there

is less to vomit and less stimulus to do so.

Obviously, it is not always possible to avoid eating (emergency

surgery). In that case, a " crash induction " is done. The breathing

tube (trachea) is in front of the food tube (esopahgus). While one

person gets ready to put the artificial airway tube (ET tube) in,

another person puts pressure on part of the trachea (the crycoid

cartilage) to use it to pinch off the esophagus, and increase the tone

of the sphincter between the stomach and the esophagus, making it

harder for stomach contents to go up and past that barrier.

Once the ET tube is in place below your vocal cords, an inflatable

balloon is blown up to stabilize its placement and help prevent any

later stomach contents from getting in. In little kids, their airways

will not allow this balloon, so the tube itself blocks the trachea,

sort of by being wedged in place (this is too forceful a term).

One of the biggest aspiration risks is that the metal blade used to

hold the tongue out of the way (the laryngoscope) in inexperienced

hands can break the teeth, and the fragments can be aspirated.

A naso-gastric tube will also be placed to keep the stomach deflated.

To remove tube, after the balloon is deflated, patients are asked to

cough while it is being pulled, which helps distract and cut down gag,

and helps eject the tube.

If a procedure was necessary on someone with a hypersensitive gag,

there is an anesthetic that cuts it down--cetacaine, that can be

sprayed in the back of the throat. Until it wears off, the patient's

airway is at risk, because they cannot protect it.

Patients on some medications (like lithium) have reduced gags

For patients with hypersensitive gags, an osteopath that can do

cranial can help.

[Guest guest]

,Thanks for your post. I hope your surgery comes out OK. Are you all right?To: aspires-relationships Sent: Wednesday, August 19, 2009 2:40:38 AMSubject: Re: Human intubation

You would not only be asleep, you would be paralyzed.

It is still possible for your nervous system to "learn" even asleep.

Learning can take place in utero. So it may not be possible to

determine whether your aversion to airway block is learned. Maybe

there was a pillow in your crib? Or you did not like the feel of your

mother's bladder on your face?

If you ever need surgery, the thing to do is talk to the

anesthesiologist and tell him/her your special concerns. That is the

purpose of the pre-surgery interview with the anesthesiologist or

nurse-anesthetist.

There are many possible complications of short term and long term

intubation. Changes in blood pressure, changes in heart rhythm,

puncture (especially if a stylet is used) but the most common

complication is placing the tube in the wrong place, usually so far

down the trachea that you only are ventilating one lung (usually the

right one). Complications are rare, but not to be dismissed lightly.

The question is, is the risk work it? Is the operation so important

that the risk of not having it is greater than the combined risk of

the intubation, medication and surgery? That is the bottom line.

That is why I do not understand recreational surgeries.

When there is an intubation done, there is always risks to the cords.

Hurting them is rare. Making them a little sore temporarily is

common. When a person is intubated, the laryngoscope is used not only

to hold the tongue out of the way, it is used to move things out of

the way so that the cords can be seen. The ET tube is slipped between

them while looking and watching the whole thing. In fact, it is

called "visualizing the cords". The patient is paralyzed first, then

breathed for with 100% oxygen. When the doc is ready to "do it" the

doc takes a deep breath and uses the laryngoscope to see the cords,

the space between and insert the ET tube into same. The reason the

doc takes a deep breath is because she is holding her breath. If she

runs outta air, so has the patient, and it is time to stop, breathe

for the patient a bit before trying again. It is a good way to make

really darn sure the doc doesn't try "just a bit longer" at the

expense of the patient. You need to breathe? So does your patient.

It does not take long to get smooth at this and be quick and accurate.

I remember a surgery I had when I was a child. They gave me mask

anesthesia (ether), and I felt like I was suffocating and fought for

my life. I was a skinny runty 8 year old, but it took five nurses to

hold me down even though I was already strapped to the table. Five

years ago I had general anesthesia for abdominal surgery, and I am

sure I was intubated. No memory of it, no discomfort, no struggle.

Start the IV, count backward from 100, nite-nite. Next thing I know,

I was in recovery. Not even a sore throat. I am having surgery again

next week.

My definitely spectrum son has almost no gag reflex. In fact, when he

swallowed something he shouldn't have, I *tried* to induce vomiting on

him with *no* success. But he was on lithium at the time, and that

may have been why. Now that he is off the lithium, I must admit I

have not checked.