The Airway I

The "A" in the anesthesia ABC's stands for airway, which is what most physicians think about when they think about anesthesia. (Some jokingly say B stands for book and C for chair). Anesthesiologists are the airway experts in the hospital, and we are often the ones to secure an airway during an emergency situation. For most surgeries, we need to intubate a patient - that is, place a breathing tube into the trachea (windpipe) to help a patient breathe. Our ability to do this under pressure in the most difficult patients makes our skill set different. While I am beginning to learn all the other things anesthesiologists do, the airway is a central focus.

Intubating a patient is a skill that has an incredibly steep learning curve but eventually plateaus once it clicks. It took me all of my first week of residency, trying different tricks, having different attendings, and learning the mechanical dexterity to be able to consistently see the vocal cords to place the breathing tube. At first, I was worried because it was so hard, but as I worked on it - studying the anatomy, practicing with models, and trying different suggestions, I finally got it - and now it's not that hard at all. I think this is the case for many hands-on interventions in medicine; unfortunately, we have to surmount the steep learning curve to reach the plateau where we can reliably and safely protect the patient.

Image from Gray's Anatomy is in the public domain, from Wikipedia