Many people have referred to anesthesia as 99% boredom and 1% sheer terror. While it’s not as black and white as the old saying goes, there is some truth in the matter. Problems can indeed occur and may have very devastating consequences. Physiological mechanisms of action of the anesthetic agents can lead to hypoventilation, hypotension, and bradycardia, which often are correctable if the anesthesia staff recognize the changes and reverse them in time. Human error is one of the biggest challenges to anesthesia. It is imperative for personnel in the operating room to monitor the patient during anesthesia. Transition periods, especially from induction to the maintenance phase of anesthesia or from maintenance to recovery, can be particularly prone to complications.
In the 1980s Dynamo Kiev, Ukraine’s most decorated soccer club, implemented a system of attack called аритмия (“arrhythmia”) during games. For long stretches at a time, the players would kick the ball on the their half of the pitch without any real conviction or urgency. However, seemingly lackadaisical back passes and slow group movement was a ploy! Not seeing any apparent threat, opposing teams were duped into playing down to the level at which Dynamo wanted them, and all of a sudden were caught completely off guard when Dynamo launched a full-blown attack. While this style of play was probably boring for athletes and spectators alike, to some degree it was successful. Like the players on other teams who were caught unawares, we can never know when complications will strike. While the majority of anesthesia situations can seem unremarkable and tempt us to avert concentration from the patient and to something more exciting going on in the operating room (if that is even possible), it is best practice to remain vigilant of aberrations from normal.