Two nights ago, on call. Just got home (9pm) from finishing up late cases and a labor epidural. Just crawled into bed, chatting w/ wife, call from OR. 51 yr female with bilat ureteral obstruction for emergengy ureteral stent placement. Upon arrival and preop interview, female BMI 40+, s/p RouxY (over yr ago i think), GERD questionably controlled, IDDM, HTN, New onset AFIB, failed cardioversion, fully anticoagulated. Airway inspection revealed MP2, MO 3, TM 3, cervical FROM, upper dentures only.

Although tenitively short case, hx, regional not safe option, and small MO justified ETT w/ modified RSI.

Usually Miller 2 kinda guy

On table, healthy ramp, alignment looks good

Pre-o2, 150 Fent (agent orange already in), cricoid pressure, prop, sux...

DL #1, nothing but pink tissue everywhere, reposition, damn tongue flopping over blade... need to change to MAC blade... I'll fix that tongue...out

DL #2 MAC blade in, Awe sh*t, can't see sh*t from size of blade vs. small mouth opening...bad choice...however, tongue well secured..out

OP airway in, lets ventilate a bit and get this tube in. Sure am glad I pulled that Glidescope outside the room...so much for my RSI...

DL #3, Glide assisted, crap I have Glide w/ the sh*t moniter, gotta make it happen. Something resembling cords appear in the farthest north section of the screen...I'm taking it...swing and it's good.

The rest of the case proceedes pleasently uneventful. I finally make it home at 0300. Daughter up at 0600...and here we go..

So my personal take-away from this...

When working solo, ALWAYS ALWAYS, ALWAYS BE PREPARED

Prepare for the worst...be pleasantly disappointed.

God I love my job!
-M