Why do they put a tube down your throat during surgery?

September 21, 2025 •

4 min read

Over 50 million surgical procedures are performed under general anesthesia annually in the United States, during which the majority of patients undergo intubation. This crucial procedure is performed to control a patient's breathing and protect their airway while under general anesthesia. It is a fundamental element of modern surgical safety.

Quick Summary

A breathing tube is inserted during general anesthesia to ensure proper oxygen delivery and lung protection while a patient's natural reflexes are suppressed. This process, known as intubation, is a standard safety measure performed by an anesthesiologist to manage breathing and prevent aspiration during surgery.

Key Points

Airway Control: General anesthesia paralyzes breathing muscles, making the endotracheal tube and ventilator essential for managing a patient's breathing during surgery.
Aspiration Prevention: A cuff on the breathing tube seals the windpipe, preventing fluids and stomach contents from entering the lungs, a serious risk during anesthesia.
Surgical Access: Intubation provides a stable airway, which is crucial for surgical procedures involving the chest, head, or neck, and prevents complications from patient movement.
Professional Procedure: A skilled anesthesiologist performs the intubation after the patient is unconscious, using specialized tools to ensure safe and correct placement.
Varied Methods: Depending on the surgery, different types of intubation or airway devices, such as a laryngeal mask airway, may be used for less invasive procedures.
Post-Procedure Effects: A sore throat or hoarseness is a common, temporary side effect after intubation and typically resolves within a few days.

The purpose of intubation

Intubation is the process of placing a flexible, plastic tube (known as an endotracheal tube or ET tube) into the windpipe (trachea) of a patient. This procedure is a critical component of general anesthesia for several key reasons, ensuring patient safety throughout the surgical process.

Controlling ventilation

When a patient is under general anesthesia, the medications cause the muscles throughout the body to relax completely. This includes the muscles responsible for breathing, such as the diaphragm. The patient's natural breathing reflex is temporarily paralyzed, and without intervention, they would stop breathing. The ET tube is connected to a ventilator, a machine that takes over the work of breathing, mechanically moving air in and out of the lungs to ensure a continuous and controlled supply of oxygen.

Protecting the airway from aspiration

One of the most significant risks during anesthesia is aspiration, which is when stomach contents or other secretions from the mouth and throat are accidentally inhaled into the lungs. Anesthesia suppresses the body’s protective reflexes, including the gag reflex that prevents this from happening. The ET tube has a small, inflatable cuff at the end that creates a seal inside the trachea. This seal acts as a barrier, protecting the lungs from any fluids that might otherwise be breathed in.

Facilitating surgical procedures

For some types of surgery, especially those involving the chest, abdomen, or head and neck, a stable and unobstructed airway is essential. The ET tube provides a direct pathway for air, ensuring that the surgeon's work is not complicated by patient movement or breathing issues. It also allows for precise control over the patient's breathing, which is necessary for certain advanced surgical techniques.

The intubation process

The process of intubation is carefully planned and executed by a trained anesthesiologist or certified registered nurse anesthetist (CRNA). The procedure is usually performed after the patient is already unconscious from the initial anesthetic medication. This is what you need to know about the intubation procedure:

Preparation: The anesthesiologist reviews the patient's medical history and discusses the procedure with the patient beforehand. They gather the necessary equipment, including the ET tube, a laryngoscope, and a ventilator.
Sedation: The patient receives medication through an IV line to induce unconsciousness and muscle relaxation. The throat may also be numbed to prevent any gagging response during the insertion.
Tube insertion: Using a laryngoscope, the medical professional gently guides the ET tube through the mouth, past the vocal cords, and into the trachea. The laryngoscope has a light and a blade to help them visualize the airway clearly.
Verification: Once the tube is in place, the anesthesiologist verifies its correct position. This is typically done by listening to the lungs with a stethoscope and monitoring the exhaled carbon dioxide levels. A small balloon on the cuff of the tube is then inflated to secure it and prevent leaks.
Monitoring: Throughout the surgery, the patient's breathing, heart rate, blood pressure, and oxygen levels are continuously monitored to ensure the equipment is functioning properly and the patient is stable.

Types of intubation

While the endotracheal tube is the most common, there are other airway management devices used in different situations. The choice depends on the specific surgical needs and the patient's condition.


Type of Intubation	Description	Common Use Cases
Endotracheal (ET) Intubation	Placement of a flexible tube through the mouth and into the trachea.	General surgery, emergency situations, severe trauma.
Nasotracheal Intubation	Insertion of a tube through the nose, into the pharynx, and down the trachea.	Surgeries involving the mouth, or facial and dental procedures.
Laryngeal Mask Airway (LMA)	A tube with an inflatable cuff that forms a seal around the larynx (voice box), rather than going into the trachea.	Short, less invasive surgical procedures where less airway control is needed.
Tracheostomy	A surgical procedure to create an opening directly into the trachea through the neck.	Long-term ventilation needs, bypassing an upper airway obstruction.

Potential complications and post-operative recovery

Though intubation is a routine and safe procedure, there are some potential side effects and complications. Post-operatively, many patients experience a sore throat or hoarseness, which is caused by the temporary irritation of the throat during tube placement. Other, less common risks, include damage to teeth, vocal cord injuries, or sinus infections from nasal intubation.

The soreness typically subsides within a few days and can be managed with pain relief medication or lozenges. Your medical team will monitor you closely during recovery to ensure a smooth and comfortable experience. For more in-depth information about the intubation process and its clinical applications, you can consult a trusted medical resource such as the National Center for Biotechnology Information.

Conclusion

Ultimately, putting a tube down your throat during surgery is a highly specialized medical procedure performed to guarantee your safety and well-being. By taking control of your breathing and protecting your lungs, the anesthesiologist ensures that the surgical procedure can be completed safely while minimizing serious risks. Understanding the reasons behind this step can help demystify the process and provide reassurance to those preparing for surgery.

Frequently Asked Questions

No, you will not feel any pain because the intubation is performed only after you have received general anesthesia and are completely unconscious. Your medical team ensures you are sedated and relaxed before the procedure begins.

For most procedures, the breathing tube is removed by the anesthesiologist in the operating or recovery room as you begin to wake up. They will only remove it once they are certain you can breathe effectively on your own.

A sore throat or mild hoarseness is a very common side effect and usually lasts for a day or two. The irritation is a temporary result of the tube being in place, and it can be soothed with pain medication or lozenges.

Intubation is the process of inserting the tube that secures the airway. A ventilator is the machine that the tube is connected to, which does the actual work of breathing. The tube is the physical connection to the breathing machine.

If you require general anesthesia for a major surgery, intubation is a critical safety measure and typically not optional. However, you can discuss your concerns with your medical team beforehand to understand the necessity and alternatives, if any.

While rare, minor trauma to the vocal cords is a possible risk. Anesthesiologists are highly trained to perform the procedure gently and safely, and any hoarseness or irritation that occurs is usually temporary.

Not every patient needs an endotracheal tube. For shorter, less complex procedures, a less invasive airway device like a laryngeal mask airway (LMA) may be used instead.