> Several years ago, I was involved in a case that illuminates the difficult position many doctors today find themselves in. The patient was pregnant, close to delivery, and experiencing dangerous declines in her baby’s heart rate. She had been on a blood thinner, which kept me, the anesthesiologist, from placing an epidural in her back. She also had strange airway anatomy, which would make it a struggle to put her to sleep quickly if an emergency cesarean section became necessary. I advised the obstetrician to perform an elective cesarean section now, in advance, while we had good working conditions, and not to wait for an emergency, where time is of the essence, and where the delay needed to induce general anesthesia might seriously injure the baby.

I am a doctor and that scenario scares me. This has a very high likelihood of stuff hitting the fan and you need to think about your plan when it does.

You want stuff to hit the fan during daytime when everyone is around. In this case, during the day surgery is around, ENT, around, other anesthesiologists all of these can rush in if needed to help you secure an airway. You also have the neonatologists around.

If it happens in the middle of the night, the staffing will be much reduced and you won’t have as many resources available.

One of the most important things to learn as a doctor is when algorithms and guidelines actually apply to the current situations.

“Life is short, the art long, opportunity fleeting, experiment treacherous, judgment difficult”

- Hippocrates