Outpatient Surgery Magazine

Special Outpatient Surgery Edition - Anesthesia - July 2019

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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This memorable case ended with the patient receiving a difficult air- way letter that would warn future anesthesia providers about the potential of facing a challenging intubation. Jonathan E. Charnin, MD, foresaw that the patient's congenital issues would lead to problems in adulthood that would likely require several surgeries. Establishing the patient's airway proved challenging, but Dr. Charnin was ready to manage it. "So, after the successful surgery, I sent the patient home with a difficult airway letter," says Dr. Charnin, an anesthesiologist at the Mayo Clinic in Rochester, Minn. That letter came in handy for both the patient, who, as expected, wound up having several additional surgeries, and the patient's anes- thesia providers. "The patient could show up with the difficult airway letter and let future providers know that this was an obstacle that they had to address and manage," says Dr. Charnin. Planning for failure Dr. Hagberg says the mistakes providers commonly make generally fall into 3 categories: • failure, delay or difficulty in securing the airway; • aspiration of gastric contents; and • extubation-related complications. But it's human factors that ultimately lead to these mistakes. "It comes down to poor assessment of the airway, poor planning, and a lack of personal and institutional preparedness for managing difficult airways," says Dr. Hagberg. Her close call occurred back in 1992 and, as she now notes, "We were not as equipped with intubation aids and devices as we are today. 5 4 • 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

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