to sedate or not to sedate...

[dfk]

at my facility, anesthesia does not sedate during intubation.. the patient is fully awake, writhing, looks uncomfortable and probably in pain through the whole process.. when i ask them why not some propofol or whatever, they say it's better/safer for the patient, i.e. aspiration or the like. at this point, i say, what's the difference, they end up on sedation as soon as the tube is in. i shake my head in disgust. if there's one thing that bothers me the most at my job, is this. your thoughts?

[subee, MSN, CRNA]

I was intubated while I was awake. To the nurse who questioned if discomfort is equal to pain, a few words, try being tubed awake. Do you have any idea what it is like to have a garden hose (that is what it felt like, jammed down your trachea? It is more then discomfort. There is an overwhelming sensation of not being able to breath and an unenviable sensation of pure panic. And I knew why I had to be intubated. If at all possible a patient should receive some sedation, if for no other reason then ensuring a smooth intubation.

Grannynurse

A well sedated patient is good insurance against aspiration when adequate cricoid pressure is applied. As for the hypotensive patients - NOTHING raises the BP like intubation. If no sedation is necessary for intubation then hire a chimpanzee to do it - they're stronger than I am. What we in anesthesia are supposed to do is PROVIDE ANESTHESIA - even if it makes up a little nervous and uncomfortable. Even in the OR when we do a fiberoptic intubation on someone we know is going to be difficult, the patient is sedated during the procedure. ANYONE who has ever been intubated awake finds it traumatizing.