In addition to the very severe cases of Covid-19, intubation is used when performing very complex operations. Here is what happens to the patient at the end of the intervention
COVID-19. The good news is that the numbers of people hospitalized in intensive care continue to decline, therefore they need respiratory assistance. To allow them to maintain the activity of the lungs, obviously in an artificial way, intubation is carried out. But how do you do it? And how can we return to normal?
It is important to block the muscles
There are precise strategies to make possible the intubation of the trachea, the duct that then bifurcates into gradually smaller and smaller bronchi up to the pulmonary alveoli, where the exchanges between air and blood take place. But it is often essential to have drugs that somehow allow to block the reaction of nerves and muscles, obviously led to "expel" the foreign element connected to the machine.
Thanks to these medicines it is possible to simplify the insertion of the tube into the trachea and therefore improve the situation even in case of complex operations, as well as being able to assist mechanical ventilation in patients who have reduced the functioning of the respiratory tract, as happens in case Covid-19 very serious. There are neuromuscular blocking agents in two forms and it is up to the specialist to choose the type of treatment based on the patient's factors, the type of procedure to be performed and the clinical indication.
Thanks to intubation, the airways can be protected, controlled ventilation with high airways is allowed, the respiratory tract is cleared of any secretions and the lung is "isolated". This approach, used for very serious Sars-CoV-2 infections, is however indicated for large surgical operations, when there is a need for controlled ventilation or lung isolation, for cases with unusual positioning where the intervention is long duration, when access to the airways is required. In addition, intubation is used to protect against aspiration in patients at high risk for resuscitation, when gas exchange is likely to be compromised, when it is possible to use high pressures for ventilation in patients who require prolonged post-operative intubation.
How to do it at the end of the intervention
At the end of the surgery, because apart from the Covid-19 emergency, intubation is used especially when complex operations are to be performed, the anesthesiologist gradually stops the administration of the anesthetic and the patient slowly wakes up.
The awakening is achieved through the progressive elimination from the body of the residues of the anesthetic drugs used. Anesthesia can be disposed of through spontaneous recovery and therefore just wait for the time necessary for the drugs to be disposed of or use antagonist drugs of the anesthetic itself.
With regard to neuromuscular blockade, after stopping the administration of the drugs, the patient's muscles, including the muscles involved in breathing, gradually come out of the state of paralysis previously induced by neuromuscular blockers, allowing the resumption of spontaneous breathing.
To accelerate the recovery time of the muscles and above all to eliminate any trace of anesthetic in the circulation, which could again determine the paralysis of the respiratory muscles and create complications, innovative drugs can be used that selectively antagonize neuromuscular blocking drugs. The antagonist drugs "capture" those used for muscle paralysis and "sweep them away" by removing them from the patient's body who, in a few minutes, returns to breathing independently. Thanks to these drugs you can have a complete recovery of the muscles in a few minutes and therefore a rapid and predictable recovery of spontaneous breathing. Then the patient, going through a minimal state of consciousness, awakens.