1. The career-
defining sur-
prise
It was the very last
night on call for Carin
Hagberg, MD, as chief
anesthesiology resi-
dent when a Spanish-
speaking woman in
her late 50s was about
to receive general
anesthesia for a dou-
ble mastectomy. Dr. Hagberg didn't anticipate any issues with the
patient's airway. For good reason. The pre-op exam didn't reveal obvi-
ous issues, and there were no problems noted when the patient was
wheeled into the OR. Dr. Hagberg performed a cursory airway exam
and proceeded with the induction.
When Dr. Hagberg performed direct laryngoscopy, she visualized a
grade 3 airway and knew she faced a difficult case. She informed the
attending physician that there was limited neck movement and that
visualization of the glottis was also limited. She attempted to mask
ventilate the patient — to no avail. Then, the attending physician tried
a direct laryngoscopy and couldn't see anything. Dr. Hagberg and the
attending attempted a 2-person mask ventilation that was unsuccess-
ful.
"Airway trauma resulted and there was now blood in the
oropharnyx," says Dr. Hagberg, who today is the Helen Shaffer Fly
Distinguished Professor of Anesthesiology and division head of anes-
thesiology, critical care and pain medicine at the University of Texas
MD Anderson Cancer Center in Houston. "The patient started becom-
5 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 9
• ON CALL If an anesthesia provider is unable to step away and gather materials
from the emergency cart without disrupting the case, any member of the OR team
should be prepared to do so.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
