Awake while intubated

Breathing through your nose would still involve using the intubation tube. As far as I'm aware when intubation takes place the tube has a cuff which is inflated to seal the trachea.

I would imagine being awake and aware would be most distressing.

Sometimes people are intubated awake if they have a potentially difficult airway to be intubated. They are lightly sedated, usually their mouth and trachea are anesthesized with local anesthetics and then a flexible fiberoptic scope can be introduced into their trachea and an endotracheal tube slide down over the scope into the trachea, resulting in intubation.

There are two videos that I know of on YouTube showing awake patients being intubated. Apparently anesthetic is used to stop the gagging reflex. It is definitely something I would not want to experience though the people undergoing it do not seem to have a problem with it:

http://www.youtube.com/watch?v=GWIvf8zvkN8

http://www.youtube.com/watch?v=E54bE8HBNVA

(this second one has no audio)

I came out of my lumbar fusion intubated. Not fun at all. Although it's bearable if you realize what's going on!

This sounds horrible! The worst procedure I've ever had done was insertion of an NG tube by a resident MD in 1978. It felt like he was jamming a spike up my nose, until the tube made the turn. Right behind that was catheter insertion while awake. An upper GI endoscopy awake was a piece of cake, thanks to lidocaine spray in the throat. Rigid Sig. was no big deal the first time, but the second time to examine my resection from the inside, it was lights out pain. And the Flex. Sig. actually felt good.

I'm sure that a panic response would be natural to awakening while intubated. I've seen several folks awake with the tubing in place, but never one waking up to it.

I have PTSD from an intubation that was handled very badly. I was awake.

My bypass surgery was much the same as the others. I had warned the PA that they were to restrain me because hospitals triggered my PTSD. She said they do that anyway because your first reaction was to pull the tube out of your throat.

In recovery when I became aware of what was going on the PA was standing over me yelling my name. I was in full restraint.

She told me later she had never seen someone react like I did. She was sure I was going to rip the rails off the bed. But once my eyes focused it all stopped.

PTSD is a pain sometimes and so is intubation

As a Critical Care Transport paramedic for WAY too many years I have intubated many people. Intubations are NOT something the average person wants to "play" with. People, this is DEADLY serious stuff. People DIE if intubations go wrong in the best of circumstances. It takes ALOT of instruction and practice to get to the point that a medical professional is allowed to perform this procedure. If the porcedure fails and the person cannot be intubated the alternative is a tracheostomy, getting their throat cut!

Let me walk you thru two "typical" Intubation scenarios. An endotracheal tube is placed to positively secure a patent airway. This insures that, the person can receive adequate ventilations with oxygen rich air and, even if the patient vomits nothing will get into the lungs.

1) Person is unconscious and unresponsive and not breathing or is not breathing well enough to perfuse the end organs (brain, heart, lungs, liver, kidneys). He/she has NO gag reflex, this is important. All equipment is assembled and checked for proper operation as the patient is ventilated with a bag/valve/mask (the baggie thingie they squeeze to breath for the patient). The patient is hyperventilated for 30 seconds to 1 minute (18-20 ventilations/minute). The patient is positioned in the "sniffing" position with the head tilted backwards. Towels or a pillow may be placed under the patient's shoulders to more easily facilitate this position. The mouth is opened and the laryngoscope blade is inserted into the space at or just above the epiglottis. The blade is manipulated to open the epiglottis (there are several types and sizes of blades to accomodate diffeences in the anatomy). The vocal chords are visualized and the appropriate size endotracheal tube is inserted into the trachea. In an adult the ET tube has a "cuff", an inflatable balloon near the distal end. The cuff is inflated to fully occupy the space inside the trachea, thus allowing the lungs to be inflated with the bag/valve. The ET tube is then secured to the person's mouth and the person is placed on a ventilator or is manually "bagged". Notice that the person is still unconscious. If the person regains consciousness, the hands and arms might be restrained so that the ET is not pulled out, which is a natural reaction to having a foreign object in the airway.

2) A person is conscious, alert and has a gag reflex but for medical reason must be intubated to secure a positive airway. The person is prepared for a Rapid Sequence Induction (RSI) [rapid sequence is a misnomer since this procedure is not really rapid]. An IV is started and verified for patency. The RSI drugs are drawn up up according to the patient's weight and labeled. The patient is given a sedative, Versed, is the medication of choice here due to its amnesia effects. The procedure is explained a last time to the patient. A very small dose of one paralytic agent is given to eliminate fasiculations, painful muscle twitching similar to cramps. After this the patient is given pain medications. Even though the person is paralysed pain can still be present. Since the patient can't tell you about the pain it has to be managed proactively. Now the person is given a short acting paralytic and is paralyzed thus loosing the gag reflex. The intubation proceeds as in 1 above. If the in tubation is successful the patient is then given a long acting paralyitic and placed on a ventilator. If the intubation was unsuccessful the patient is "bagged" until the short acting paralytic is matabolized and the person is able to move and breath on their own.

Here, let's just stick to inserting tubes into somebody's butt. That's alot more fun.

Thank you for an informed and very sobering description.

Let's hope anyone considering trying any of these intricate and dangerous procedures takes careful note of your wise professional advice.

Hi Arbol10,

You DO NOT want to intubate anyone. Please read the post from bmatt9119 and follow his advise.

In the ER we have tons of equipment and frequently an anesthesiologist or nurse anesthetist intubates and they have problems. Please put this out of your play book, (just as those who want to do a cervical dilation). These are very dangerous procedures and can produce life threatening harm.

I have been following the development of this thread and as someone very familiar with RSI, intubation and ventilation I cannot understand the sheer irresponsibility and downright insanity of individuals wanting to perform such procedures in a play environment.

I have witness seasoned professional have great difficulties when attempting to intubation individuals in a clinical setting with all the emergency equipment readily available and on hand.

This procedure has life threatening consequences, would you know how to recognize and treat complications like injury to the person’s tongue, epiglottis or vocal cords, vomiting, aspiration, bronchospasm, intubation of the right main bronchus and pneumothorax.

This is one of many procedures that needs to remain out of a play setting unless you wanted to be responsible for the potential death of someone.

I had a minor operation when I was 17, I was put under with anastethic, I was told to count back from 10, and that I'd be asleep by I got to 5, I got to 5 and stopped counting, I then opened my eyes and a kind nurse gave me more anastethic, it wore off when I was in recovery but the tube was in my mouth. They pulled it out as soon as I rang the bell.

I agree with most of the people here: in real life, I have no doubt it would be horrible and terrifying.

But in an erotic fantasy, I can see how it really would be the ultimate loss of control. You would need a very trusting bond with someone.

I woke up during surgery and i could feel all the pressure form them operating on me.. when the doctor seen i was waking up he had them put me back out.

Thank you RN1993, As you say it`s pretty well a daily occurance on a ICU ward untill were sure they can breath on own, other than that its not recommended at all. I wont go into details but i will normally use just airway tubes if I wanna go that way of playing

Yes was awake was passed out till they gave me a parylitic drug. Then could not move. I recall everything was a most different experience. Could not move a eyelid anything. Like some kind of out of body experience. They had to deflate the bulb as was placed and was leaking. Felt like a fluttering but no trouble. Then they bagged me to go to the room. Nurse got distracted and forgot to pump the bag out of air and helpless. She did start pumping.

I think the subject has been well covered by RN1993 and the patients who awoke while intubated. I don't know but the idea is terrifying. In my practice in the ER I have intubated thousands of patients. Not once was it routine and not filled with anxiety and fear. For those who yearn for it--forget it. The complications can be life threatening or fatal. This is an example of something which must be kept to real life medicine.

For the longest time I had urges to vomit, cut myself or bash my head into a wall whenever I had flashbacks of my awake intubation. But I've been doing some slow and steady exposure therapy, consisting of watching intubation videos on youtube. Now, I'm doing much better. Yes, it was noxious. It was horrifying. But it saved my life. And I survived it.

In June of 2013 I had open heart surgery to repair my mitral valve. When I woke up from the anesthesia I was still intubated. The tube was in for another few hours. It didn't hurt, it was more uncomfortable than anything.

Many patients may intubated and awake or at least sedated. This is common in the CCU and ICU unrelated to anesthesia or surgery. Being intubated means you are unable to breathe adequately on your own because of trauma or disease. Getting intubated "awake" doesn't mean a painful experience with modern techniques, sedation and topical anesthetics. Rarely a patient can be "aware" under major surgery, sometimes because the patient is in such poor shape, shock for example, that any real aesthetic would kill them. Even then, it is even more unlikely for the patient to have pain associated with awareness. But it can happen. With more and more lower reimbursement, the person delivering the anesthesia may not be adequately trained. MD anesthesiologists will become rare.

I had a VERY strange awakening while under intubation. For lack of a better term I would have to call the incident "psychedelic." It all started just before I became comatose with sudden, severe sepsis. A good friend answered my call for help and had me whisked to the hospital via helicopter. An unknown length of time later, as I very gradually regained consciousness, I became aware at some level that I could not control my own breathing. It felt like I imagine waterboarding might feel. I experienced the loss of control, panic, and anger that a prisoner under torture must feel.

What happened next seemed almost spiritual at the time, though looking back at it now, PTSD comes to mind. I can recall the entire chain of events with the vividness of the mythical LSD flashback.

In my hallucinatory state the intubation machine spoke to me, telling me in no uncertain terms that it would kill me if I did not follow its instructions carefully. It told me that the room I was in would cycle through a specific sequence of colors (even though my eyes were closed). It told me about other sights and sounds that would occur. It defined a spot in the sequence at which I was to reach up and pull the tubes out of my throat...or suffer fatal consequences!

I waited in addled, dreamy wonderment as events unfolded exactly as the machine had described. When the sequence reached the state I had been ordered to watch for, I did as the machine had commanded. The tubes (it seemed like a whole bundle of tubes with different colors and lengths to me at the time) were much longer than I had anticipated. I had to pull and pull and pull. The restraints on my wrists were no obstacle -- either I had the strength of a champion weight lifter or there was enough slack to allow me to save myself from certain doom.

When the end of the longest tube finally slid free I was instantly able to breath again. I gasped air with the joy of freedom won through super-human tenacity. I still have a clear vision of the machine floating in the air in front of me, somehow humbled yet oddly glowing with pride. As I lay basking in my victory over the reaper my bed was suddenly surrounded by hospital staff. For some reason they interpreted my success very, very differently, and they did not mince words. I expect some of them will remember me for a good while, but not nearly as long as I will remember that strange struggle. And I suspect some of my friends think I'm a little "off," as I spent the next couple days describing the incident as only a wide-eyed true believer could.

After one of my many surgeries I woke up with the tube still in my throat. It was a very unpleasant experience. I was trying to breathe but the breathing apparatus was in control. This lasted for close to an hour. I'm not sure but I think they over anestethised me. When the tube was finally pulled out I had an extremely sore throat for days. I made sure that my surgeon was well informed about my displeasure.

I had a severe back injury. I also have narcolepsy. I had been passing out from the pain. Because of not being able to get into my primary care Dr I had to return to work. Busy restaurant Friday night I was the manager passed out and threw up at same time. Woke up in emergency room. Had been given a parylitic drug. Also they had none of my records from my recent care. They thought I was a overdosed junkie. So they also put in Narcan. After so many years on the medicine, I was on it was very painful. I could hear everything but not move. Very hard to deal with. I remember everything taking my contacts out. The conversations the staff had. Being transferred to ICU. But I arrived with a 56 blood oxygen and was ashen grey. So mostly dead. I was grateful for being alive. When the parylitic wore off. My hands were tied down. But I made motion to write on paper. I did manage to write out pain. After that I got something for pain it was not to bad. They removed the tube the next night. Could deal with it just did not like the parylitic drug. But there was my two cents to the tag line.