The Power of Preparation in Anesthesiology

by Rebecca Kreidstein

As a fourth-year medical student with aspirations in anesthesiology, I've come to realize that preparation is not just a step in the process, but is the very foundation upon which everything else in medicine is built. It informs our clinical decisions, safeguards our patients, and defines our professional competence. Through my clinical rotations, I’ve witnessed how preparation can determine the entire outcome of a case, especially in a field as dynamic and high-stakes as anesthesiology.

Preoperative Preparation: Laying the Groundwork

During one of my rotations, a morbidly obese, middle-aged patient presented for an emergency cholecystectomy. Due to the urgency of the case, no formal airway evaluation was documented, and anesthesia proceeded without a specific airway plan. Upon induction, multiple attempts at direct laryngoscopy failed, leading to an unanticipated difficult airway. Mask ventilation became increasingly difficult, with no supraglottic airway immediately available, and no fiberoptic scope nearby. Ultimately, a surgical airway had to be performed via emergency cricothyroidotomy.

That experience left a lasting impression. In emergencies, time may be limited, but our mindset should never be. This cricothyroidotomy could have been avoided had even a brief airway assessment or contingency plan been made. Preparation is about anticipating failure and being ready to act with clarity and confidence when the unexpected happens.

Key components of effective preoperative preparation include:
 - Conducting a thorough risk assessment, particularly in patients with comorbidities like obesity, cardiovascular disease, or pulmonary pathology
 - Ordering relevant labs and imaging to guide intraoperative decision-making
 - Performing detailed airway assessments to flag potential challenges
 - Optimizing the patient’s physiological status through medications, fluids, and other interventions
 - Developing contingency plans for intraoperative or postoperative complications

Inside the OR: The Art of Anticipation

The operating room is a space of constant change, where no two cases are alike. Every patient brings a unique set of challenges. This unpredictability requires not only technical skill, but also deliberate foresight. 

An example of this occurred during one thoracic case, where the attending asked me to talk through the anesthetic plan. I enthusiastically focused on induction agents and paralysis. He paused and said, “What about one-lung ventilation? What if they desaturate?” I truly hadn’t even thought that far ahead. From that moment on, I realized the importance of thinking in “what ifs.” What if the BP crashes after induction? What if the IV infiltrates mid-case? What if the epidural fails? To me, it’s no longer pessimism – it’s preparation.

Anticipatory preparation includes:
 - Ensuring all equipment is checked and functioning (anesthesia machines, airway devices, monitors, and backups)
 - Maintaining continuous vigilance through real-time monitoring of vitals, hemodynamics, and anesthetic depth
 - Engaging in clear, proactive communication with the surgical team to coordinate responses to intraoperative changes

Outside the OR: Postoperative Planning

Recovery doesn’t just start in the PACU, it begins with thoughtful planning well before the final suture. A smooth emergence from anesthesia and proactive management of complications not only speeds recovery but builds trust with patients and families alike.

Effective postoperative planning involves:
 - Coordinating early for a controlled emergence, minimizing risks like airway obstruction or hemodynamic instability
 - Personalizing pain management strategies to balance effective analgesia with safety and comfort
 - Anticipating common complications such as nausea, delirium, or respiratory depression
 - Collaborating closely with PACU and ICU teams to ensure seamless continuity of care

Beyond the OR: Learning and Growth

What makes anesthesiology such a dynamic and rewarding field isn't just technical proficiency, but the mindset behind it. The OR teaches precision, composure under pressure, and rapid decision-making. Beyond that, it’s constant evolution and the willingness to ask, “How can I improve?” even when things have gone well.

Beyond the OR, I have found immense value in mentorship and community. Involvement in the American Society of Anesthesiologists (ASA) conferences, engaging in seminars, pursuing continuing medical education, and participating in advanced simulations are vital components of that growth. These opportunities not only keep us current with advancing science and evolving standards of care but also connect us with a broader community of professionals equally committed to excellence.

The Takeaway: Success Favors the Prepared

Uncertainty is part of medicine, but being unprepared should not be. Emergencies test our training, but they also expose the strength of our foresight. The difficult airway case I witnessed reminded me that preparation is not a luxury reserved for elective cases, but a mindset that must persist even in the chaos of the unexpected. Whether it’s reviewing a patient’s chart during a brief pause or mentally rehearsing rare scenarios, every small act of preparation adds up. Success in anesthesiology rarely looks like perfection—it looks like resilience, foresight, and the ability to make clear decisions under pressure. In critical moments, it’s not just skill that makes the difference—it’s the readiness to act when it matters most.