ing bradycardic and turning cyanotic. Her stats were dropping. I'll
never forget that sound."
The situation was becoming dire and the surgeon requested to per-
form a surgical airway using a scalpel, finger and tube technique. It
worked.
The patient fully recovered. Dr. Hagberg, however, was forever
changed by the experience. She says, "That case is the reason I
became involved in difficult airway management and decided to mas-
ter as many airway skills and techniques as possible."
2. Expected airway trouble,
with an unexpected result
Even in cases where anesthesiologists anticipate a difficult airway
and have a plan in place to react, things can easily go sideways.
Such was the case with Leon Chang, MD, associate clinical direc-
tor and clinical professor in the department of anesthesiology at
UC San Diego (Calif.) Health. Dr. Chang was working with a resi-
dent to anesthetize a patient with dwarfism, a condition known to
cause potentially difficult intubation, so he expected to en-counter
some difficulties. When 2 laryngoscopies (one by the resident and
one by Dr. Chang himself) proved unsuccessful — as he'd suspect-
ed they would — Dr. Chang switched to his plan B.
He proceeded with an intubating laryngeal mask airway (LMA), with
the intention of intubating fiberoptically through the LMA and using it
as a direct conduit for the endotracheal tube, a technique he had a lot
of experience with and one that typically has a very high success rate.
Unfortunately, even with the fiberoptic scope being easily passed, the
patient's anatomy made it impossible for Dr. Chang to advance the
tube into the trachea.
"With the prior laryngoscopies and minor trauma associated with
5 2 • 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
