What Is Endotracheal Intubation?

If you're scheduled for an operation, intubation is probably the part nobody mentioned — and the part patients most often ask about afterwards, usually because of a sore throat they weren't expecting. So let's walk through the questions people actually ask, in roughly the order they ask them.

Endotracheal intubation is the placement of a soft, flexible breathing tube through the mouth (occasionally the nose) and into the trachea — the windpipe. Once it's in place and connected to a ventilator or anaesthesia machine, the team can deliver oxygen and anaesthetic gases directly to your lungs and be confident the airway stays open and protected while you can't manage it yourself.

The animation at the top of this page, "Endotracheal Intubation Sample Animation", runs just under five minutes and shows the whole sequence in teaching form. Its own description puts it plainly: the animation demonstrates the procedure in which a breathing tube is passed into the trachea to secure a patient's airway, and animations like it are used to teach the sequence of steps before hands-on clinical practice. Watching it first makes the answers below much easier to follow.

"Why would I need a tube at all?"

The commonest setting is a general anaesthetic. The medicines that keep you asleep also relax the muscles that hold your airway open and switch off the reflexes that protect your lungs, so the team takes over your breathing for you — our overview of what anaesthesia involves covers that side of the picture. With a tube in the trachea, your breathing can be controlled precisely for as long as the operation lasts, and stomach contents are far less likely to reach the lungs.

The other setting is an emergency or intensive care. Someone who can't breathe adequately on their own, whose airway is threatened by swelling, injury or reduced consciousness, or who needs prolonged support from a ventilator will usually be intubated so that breathing can be supported safely. It's also a step in resuscitation, which is why it appears in our guide to how CPR works. The reasons differ, but the goal is the same in each case: a secure airway the team can rely on.

"What actually happens while the tube goes in?"

For a planned operation, you won't be aware of any of it. You're given oxygen through a mask first, then the anaesthetic medicines, and only once you're fully asleep does the anaesthetist begin. Using an instrument called a laryngoscope — a handled blade with a light — they gently lift the tongue and look down to the opening of the windpipe, then slide the tube through the vocal cords into the trachea. A small soft cuff near the tube's end is inflated to seal it in place.

Placement is then checked carefully, because the tube has to sit in the windpipe and not the food pipe. The team listens to both sides of the chest, watches the chest rise, and uses a monitor that detects the carbon dioxide in your breath — a continuous reading is the clearest confirmation the tube is where it should be. Only then is it secured and connected up. A second animation on this site, "Intubation during General Anaesthesia 3D Animation", shows the same moment from inside the airway, which many people find makes the geometry click.

In an emergency the order is compressed — the patient may already be unconscious, and speed matters more — but the checks afterwards are the same, because confirming position is the step that makes everything else safe.

"Will I feel it, and what about afterwards?"

During a planned intubation, no — it happens entirely while you're asleep, and the tube is usually removed in the operating theatre or recovery area as you wake up, once you're breathing well on your own and your protective reflexes are back. Most people have no memory of it at all.

Afterwards, a sore or hoarse throat is common for a day or two, and so is a slightly dry or scratchy feeling when you swallow. Lips or teeth can occasionally be bruised by the laryngoscope, which is one reason anaesthetists ask about loose teeth, crowns and dentures beforehand. These effects usually settle on their own; a sore throat that worsens rather than improves, or difficulty breathing after any procedure, is always worth reporting promptly.

If a breathing tube is needed for longer — days rather than hours — the conversation changes. A tube through the mouth isn't comfortable or practical indefinitely, and teams may discuss a tracheostomy, a tube placed through the front of the neck instead; our article on what a tracheotomy is and how it works explains that procedure and how the two differ.

References & further reading

MedlinePlus — Endotracheal intubation (Medical Encyclopedia): https://medlineplus.gov/ency/article/003449.htm

NHS — Tracheostomy: https://www.nhs.uk/tests-and-treatments/tracheostomy/

Johns Hopkins Medicine — Tracheostomy: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tracheostomy

Frequently Asked Questions

Is intubation the same as being on a ventilator?

Not quite. Intubation is the placement of the tube; the ventilator is the machine the tube connects to. You can be intubated and breathe with support from a ventilator, or — during a short operation — have your breathing assisted through the tube by the anaesthesia machine. The tube is the connection; the machine does the work.

Can a breathing tube go in through the nose instead?

Yes, in some situations a tube is passed through the nose into the trachea — for example when surgery in the mouth needs the mouth kept completely clear, or when the mouth can't open normally. The mouth route is the usual one because it's quicker and more direct for most patients.

Why do people get a sore throat after intubation?

The tube rests against the lining of the throat and windpipe, and the laryngoscope passes through the mouth, so mild irritation and hoarseness afterwards are common. They typically ease over a day or two. Worsening pain, or any difficulty breathing, should be reported to the care team rather than waited out.

What happens if the tube is difficult to place?

Anaesthetists assess the airway before every anaesthetic and have a range of backup tools and techniques — different blades, camera-equipped scopes, and alternative airway devices — precisely for the small number of cases where the view is difficult. Planning for that possibility is a routine part of the job, not an afterthought.

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Educational only — this article is general information about endotracheal intubation, not medical advice and not a diagnosis. Whether this procedure, or any treatment, is right for you is a matter for your own care team, who know your results and your history.