Is a person intubated for general anesthesia?

Tracheal Intubation in General Anesthesia

Yes, tracheal intubation is typically performed for general anesthesia to secure the airway and provide controlled ventilation during the procedure. 1

Rationale for Intubation During General Anesthesia

General anesthesia commonly involves endotracheal intubation for several important reasons:

• Airway Protection: General anesthesia suppresses protective airway reflexes, increasing the risk of aspiration
• Ventilation Control: Anesthetic medications decrease respiratory drive and can cause respiratory depression
• Surgical Access: Many procedures require a secured airway to prevent airway compromise during surgery
• Oxygenation: Ensures adequate oxygen delivery and carbon dioxide elimination

Airway Management Options During General Anesthesia

While tracheal intubation is common, several airway management techniques may be employed depending on clinical circumstances:

1. Endotracheal Intubation (ETT):

   • Most commonly used technique for securing the airway
   • Can be performed via oral or nasal route
   • Provides definitive airway protection against aspiration
   • Allows for positive pressure ventilation

2. Supraglottic Airway Devices (SADs):

   • Laryngeal mask airways (LMAs) may be used for selected cases
   • Less invasive than endotracheal intubation
   • May be suitable for shorter procedures with lower aspiration risk
   • Associated with fewer side effects such as throat discomfort and hoarseness 2

3. Spontaneous Ventilation:

   • Rarely used alone for general anesthesia
   • May be combined with pressure support ventilation (PSV) in select cases
   • Associated with atelectasis formation and decreased functional residual capacity 3

Factors Influencing Airway Management Choice

The decision between ETT and other airway management techniques depends on:

• Surgical Factors: Location, duration, and position required
• Patient Factors: Aspiration risk, difficult airway predictors, comorbidities
• Anesthesia Factors: Depth and type of anesthesia planned

Special Considerations for Difficult Airways

For patients with anticipated difficult airways, guidelines recommend:

• Awake Tracheal Intubation (ATI): Securing the airway before induction of general anesthesia when difficulties are anticipated 1
• Videolaryngoscopy: Often preferred for intubation after induction in patients with predicted difficult airways 1
• Avoiding Persistent Laryngoscopy: Multiple attempts at direct laryngoscopy increase the risk of patient injury 1

Common Pitfalls and Caveats

• Disregarding Airway Assessments: Evidence shows anesthetists sometimes proceed with general anesthesia despite anticipating difficult intubation 1
• Inadequate Preparation: Failure to have difficult airway equipment immediately available
• Persistent Attempts: Continuing with repeated laryngoscopy attempts rather than moving to alternative techniques
• Extubation Risks: Extubation after difficult intubation requires special precautions and planning 1

In summary, while tracheal intubation is the standard approach for airway management during general anesthesia, the specific technique should be determined based on patient factors, surgical requirements, and the anesthesiologist's expertise. For anticipated difficult airways, securing the airway before induction of general anesthesia is often the safest approach.