The risks of tracheal intubation

Various lesions have been described as post-intubation complications: injuries, of usually minor degree, of the pharynx and larynx, oedema of the larynx, ulcerations of the pharynx and larynx with pseudomembranes and bleeding, chondromalacy of the larynx, granulomata, oesophago-tracheal fistula, stenosis of the larynx or trachea, paralysis and synechia of the vocal cords, paralysis of the tongue. Etiologic factors of these complications are mainly chemical, in relation with the material of the tube and with the sterilization agents, or mechanical due to pressure on neighbouring tissues. Post-intubation sore throat seems independent from traumatic laryngoscopy. Although intubation is meant to provide safer ventilation, interference with respiration may occur by compression of the tube or accidental obstruction from various causes. It should not be forgotten that in anesthesia cases, for which intubation is not really required, it may be advantageous to administer the anesthetic by mask.