I just had outpatient surgery and was told afterwards they had a difficult time intubating me. I feel as though there is a loose piece of tissue in my throat which gags me. Will this heal on its own or should I be examined by an ENT? My throat is very red and swollen. 

You must see your doctor. The following are general comments only. 

Difficult intubation can result in significant injury to soft tissues in the airway. A tear in the lining of the pharynx (throat) can in rare cases extend through the wall of the pharynx and into the mediastinum. The mediastinum is the space around the heart and the large blood vessels going into and out of the heart. Because the pharynx has many resident bacteria, a severe, even life-threatening infection can result. 

Iﾠam not suggesting that you have this type of injury, aﾠ"worst-case" scenario, only that is is foolhardy under these circumstances to seek advice from a consumer health information site. The only way to determine whether you have a potentially serious injury is to immediately call your doctor and have this attended to, possibly including an examination by an ENT specialist. 

A superficial pharyngeal tear or bruising should heal on its own. Antibiotic cover could be considered - again medical advice is needed to make this determination. Be sure to get as complete a description of what happened during your intubation, from the anesthesiologist. You need this information in order to avoid a repetition of this experience the next time you have a general anesthetic. 

Your anesthesiologist should be asked to document in writing whether the difficult intubation was expected or unexpected, whether mask ventilation (breathing for you through a mask rather than a tube) was difficult or easy, and what equipment was used. He or she might also be asked to suggest the best method of doing your intubation next time around. Try to get contact information which you can use for any future surgery - ask the next anesthesiologist to talk to the person who has just taken care of you. 

During an intubation my voicebox was injured. It is now 10 weeks and my voice is very hoarse and it takes alot of energy to speak. I went to a throat specialist and he prescribed a seven day dose of steroids and an anti acid. That did not work. I then took another dose of steroids. For a couple of days after the medication, my voice was a little stronger, but it did not last. I am scheduled to see another throat specialist at the end of April, but was wondering what your opinion is. How long does it usually take to heal this type of injury. When should I start to worry (I`m already worried). What are the chances of my voice not coming back? 

There is no doubt that intubation can injure the voicebox (larynx). In fact minor injuries that occur during routine, careful, apprarently uncomplicated intubation are surprisingly common, based on evidence from studies where the larynx is examined with endoscopes after intubation. The larynx appears bruised, with small areas of swelling (edema). So I routinely inform my patients that they may have a sore throat after intubation and often some hoarseness with it. 

Fortunately only a small number of injuries occur in which the function of the larynx is impaired for longer than a few days. In these cases the small cartilages which make up the structure of the voicebox can be dislocated or fractured. The diagnosis and treatment of these injuries is best undertaken by ENT doctors with special expertise. 

Ten weeks is certainly long enough to expect healing of minor injuries to have occurred. Steroids can help reduce swelling and inflammation, and antacids are useful for patients whose hoarseness is caused or exacerbated by acid reflux disease. 

A careful history, direct examination, and special studies are needed to assess your laryngeal function and anatomy. The prognosis depends on what is found. It is also important to make certain that you don't have some other disorder that a minor injury from intubation has unmasked. 

Can this tube damage your throat when its down your throat and then taken out? Will it cause your throat to be scratched for a couple of months after surgery? 

Yes it can. The procedure is known as endotracheal, or tracheal, intubation. It's usually done when you are already under anesthesia. The tube is normally taken out at the end of the procedure as you awaken. The tracheal tube is usually put into the mouth and passes through the throat, then through the voicebox (larynx) and into the windpipe (trachea). 

The larynx is quite a delicate structure. About 20-40% of people who have a tracheal tube experience a sore throat afterwards. Usually it's mild and goes away without special treatment over a few days. 

Recently there have been studies in which the voicebox of patients who have had routine anesthesia and intubation, without any problems, have been looked at. What has been found is that a surprisingly high number of people have bruising of the voicebox and sometimes noticeable damage to the small cartilages that form part of the voicebox. 

It is also possible to scratch the throat (pharynx) during passage of the tube or its removal. A small tear in the lining of the throat or an injury to the larynx might be enough to make your throat feel scratchy for a couple of months. If your symptoms persist, become severe, and are accompanied by a fever, chest pain, or general unwellness it would be wise to see your doctor. Very rarely, a tear in the lining (mucos) of the throat can go right through the wall of the throat and cause a very sever infection. 

Of course there are many other causes of sore throat, including common viral infections that can occur after surgery and anesthesia, without having anything at all to do with either of those factors! 

My mother, 85, with severe Alzheimer was operated on for a broken bone above the knee and was given general anesthesia. As a result of the intubation procedure her esophagus (or trachea) was torn. I would like to know if this sometimes happens during intubation (especially to a woman of 85). Is it rare? Could there have been negligence involved? The doctors here claim that "it happens" sometimes. Your reply is very important to me. PS As a result of the tear, my mother is now on life-support. She also developed pneumonia. 

I am sorry that your mother has had this complication and has become so ill. A tear in the lining of the throat can occur as a result of intubation. Unfortunately this is a known, although rare, complication of intubation. It is more likely to occur in the elderly because the lining of the throat - the mucosa - is more fragile, just as the skin in elderly persons is more delicate. It is also more common in women, perhaps for the same reason. Another risk factor is steroid medication. Had your mother been taking steroids for some reason? Finally, in patients whose anatomy makes it more difficult to see the larynx during intubation, the intubation can be correspondingly more difficult and the throat can be damaged accidentally during this process. Sometimes a difficult intubation can be predicted, but on other occasions it is a complete surprise. In some cases, the tear in the throat will heal by itself, over a period of days or weeks. But sometimes a severe infection occurs - this is known as mediastinitis, and is very difficult to treat. I hope your mother recovers. 

I have heard that sometimes the patient feels the tube being inserted down the throat when being given an anesthestic. Does this happen frequently? 

ﾠDuring general anesthesia most patients are `unaware`, that is they are unconscious and therefore unable to recall any of the events of the surgery, such as insertion of the breathing tube, cutting of the skin, conversation in the operating room, and so on. Awareness with recall of events occurs infrequently - recent studies suggest this happens perhaps 0.2 - 0.5% of the time. Often this is during surgery where, intentionally, very little anesthesia is given. Examples are cesarean sections (to avoid putting the baby at risk) and emergency surgery for major trauma (because anesthetic drugs cause depression of the heart and circulation which might be very dangerous in an already sick patient). 

In certain special circumstances the breathing tube may be inserted while the patient is still awake. This is not as nasty as its sounds, provided that the mouth and throat are `numbed up` with local anesthetic and some sedative drugs are given. 

Newer brain monitors might assist in preventing unintentional awareness during general anesthesia in healthy persons undergoing routine surgery but their routine use is controversial and they are not universally accepted to prevent awareness.