Do Patients Get Intubated During Surgery? Understanding Anesthesia and Medications

October 10, 2025 •

4 min read

While not all surgical procedures require a breathing tube, do patients get intubated during surgery? Yes, it is a routine and critical part of airway management for many major or lengthy operations performed under general anesthesia.

Quick Summary

Intubation during surgery is a controlled procedure managed by an anesthesiologist, necessary for certain operations, particularly those requiring general anesthesia. Medications are used to relax the patient and ensure a clear, protected airway for the duration of the procedure.

Key Points

Intubation is Common in General Anesthesia: Due to the effects of general anesthesia on the respiratory system, intubation is often necessary for major or lengthy surgeries.
Anesthesiologists Use Specific Medications: Drugs like propofol for sedation and muscle relaxants like rocuronium are used to facilitate the placement of the breathing tube.
Protection Against Aspiration: Intubation protects the lungs from the risk of aspiration (inhaling foreign material) when a patient's reflexes are suppressed.
Type of Surgery Dictates Need: Procedures involving the chest, abdomen, head, and neck most often require intubation for airway control.
Extubation is Safe and Controlled: At the end of the surgery, the anesthesiologist reverses the medications and removes the tube once the patient can breathe independently.

For many patients, the thought of receiving a breathing tube during surgery can be a source of anxiety. Understanding the conditions that require this procedure, the medications involved, and the safety measures in place can help alleviate these concerns. Intubation is not an automatic part of every surgery but is a standard protocol for specific types of anesthesia and surgical procedures.

The Role of Anesthesia and Pharmacology in Intubation

The need for intubation is directly linked to the type of anesthesia administered. General anesthesia is the primary reason intubation is performed in a surgical setting. It induces a state of unconsciousness and muscle relaxation that necessitates controlled breathing assistance.

General Anesthesia's Effect on the Airway

General anesthetic medications cause significant changes to the body's respiratory system. The effects include:

Muscle Relaxation: Anesthetic agents relax all muscles in the body, including the tongue and throat muscles that normally keep the airway open. This can cause the airway to collapse and become blocked.
Suppressed Breathing Drive: The medications also depress the central nervous system's control over breathing. A patient under general anesthesia may stop breathing naturally or their breathing may become too shallow to be effective.
Loss of Reflexes: General anesthesia suppresses protective reflexes like coughing and gagging, which prevents the patient from protecting their airway against aspiration (inhaling stomach contents or secretions into the lungs).

To counteract these effects and maintain a secure airway, the anesthesiologist places an endotracheal tube (ETT) into the trachea after the patient is unconscious. The ETT is then connected to a mechanical ventilator that breathes for the patient throughout the surgery.

Key Medications Facilitating Intubation

Pharmacology plays a critical role in ensuring the safe and smooth placement of the breathing tube. Two main classes of medication are typically used:

Induction Agents: These drugs induce unconsciousness and include medications like propofol, etomidate, or ketamine. Propofol, a common choice, is a potent sedative that induces sleep very quickly.
Neuromuscular Blocking Agents (NMBAs): Also known as muscle relaxants or paralytics, these powerful medications cause temporary paralysis of skeletal muscles, including those in the larynx. This provides optimal conditions for the anesthesiologist to insert the ETT without resistance. Common NMBAs include succinylcholine (for short action) and rocuronium (for longer procedures).

When Intubation is Necessary for Surgery

Several factors determine if a patient will need to be intubated during a surgical procedure.

Type and Location of Surgery: Procedures involving the chest, abdomen, or airway (head, neck, or throat) almost always require a breathing tube to ensure proper ventilation and protect the airway from the surgical site.
Length of Surgery: Longer procedures are more likely to require general anesthesia and therefore intubation, to provide stable and continuous breathing support.
Patient Positioning: If the patient needs to be in a position other than lying on their back (supine), such as on their stomach, intubation is often required for secure airway management.
High Risk of Aspiration: Patients at risk of aspiration, such as those with gastrointestinal issues or those undergoing emergency surgery after recently eating, are intubated to protect their lungs from stomach contents.

Intubation vs. Other Anesthetic Techniques


Feature	General Anesthesia with Intubation	Laryngeal Mask Airway (LMA)	Regional or Local Anesthesia
Airway Control	Complete, highly secure airway control.	Less secure airway control compared to ETT; uses a cuff that seals around the larynx.	No airway device needed; patient remains conscious and breathes spontaneously.
Indication	Major, lengthy, chest, or abdominal surgery.	Shorter, less invasive procedures where deep airway protection isn't crucial.	Procedures on a specific body part, such as a limb, where sedation can be used if desired.
Ventilation	Patient's breathing is fully controlled by a mechanical ventilator.	Can support spontaneous breathing or be connected to a ventilator for assisted ventilation.	Patient breathes entirely on their own.
Medications	Induction agents (propofol) and muscle relaxants (rocuronium).	Sedatives or light general anesthesia, usually without full paralysis.	Local anesthetics are injected to block nerve signals.
Risk of Aspiration	Minimal risk once tube is securely placed.	Slightly higher risk if patient is prone to vomiting, not used for high aspiration risk.	Minimal, as patient remains awake and their airway reflexes are intact.

The Anesthesiologist's Role and Extubation

An anesthesiologist is a medical expert who is responsible for managing a patient's airway throughout the entire process. Before surgery, they conduct a thorough assessment to predict any potential difficulties with intubation. Techniques like fiberoptic intubation may be used for patients with anticipated difficult airways.

After the surgery is complete, the anesthesiologist carefully reverses the medications, allowing the patient to regain consciousness and start breathing on their own. Once they confirm the patient has a strong breathing reflex, they remove the breathing tube. This process is called extubation. For most people, the experience is routine and they may only notice a mild sore throat afterwards.

Conclusion

For many major surgeries, a patient will indeed be intubated. This is a deliberate, carefully managed medical procedure, not an arbitrary action. It is performed under the strict supervision of an anesthesiologist using specific medications to temporarily relax the muscles and ensure the airway remains open and protected. This allows the surgical team to perform the procedure safely while the patient is unconscious. While associated with some minor risks like a sore throat, intubation is a cornerstone of modern anesthesia that enables complex surgical interventions while safeguarding the patient's breathing and overall well-being. More information on anesthesia and intubation can be found from trusted sources like the American Medical Association.

Frequently Asked Questions

You will not feel anything during intubation for surgery. The procedure is performed after you have been put to sleep with general anesthesia. You will be unconscious, and the anesthesiologist will ensure you are comfortable throughout.

No, intubation is not always required. Some general anesthesia procedures, particularly shorter or less invasive ones, may use a laryngeal mask airway (LMA) instead, which is a less invasive device placed over the voice box.

Intubation involves placing a tube directly into the windpipe (trachea), offering the most secure airway control. An LMA is a mask-like device placed in the back of the throat, providing a seal over the larynx. The LMA is less invasive and used for shorter procedures.

The main medications used for surgical intubation are an induction agent, such as propofol, to cause unconsciousness, and a neuromuscular blocking agent (paralytic), like rocuronium, to relax the muscles and allow for the safe placement of the tube.

During a pre-operative evaluation, the anesthesiologist assesses your airway anatomy. They use tools like the Mallampati score and consider factors like facial structure, neck mobility, and medical history to anticipate potential difficulties and prepare an appropriate airway management plan.

A mild sore throat and some hoarseness are common side effects after the removal of the breathing tube and typically resolve quickly. While rare, more serious injuries to the larynx can occur, and patients should report persistent or severe symptoms.

Anesthesiologists are trained to handle a 'difficult airway' scenario. If intubation fails, they have alternative techniques and backup equipment, such as an LMA or fiberoptic scopes, to secure the airway. In extremely rare, emergent situations, a surgical airway may be necessary.

The breathing tube is only in place for the duration of the surgery. It is removed once the procedure is finished, the anesthetic medications have worn off sufficiently, and the anesthesiologist confirms you can breathe on your own.

For some procedures, alternatives to full general anesthesia with intubation may be used. These can include regional anesthesia (blocking nerves to a specific body area) or a laryngeal mask airway (LMA) for lighter, shorter general anesthesia.