After 21 years of practice, I've had my share of anesthesia issues. Not to play the blame game, but when stuff like this happens, it increases my Maalox Index for the day.

• The precarious airway. Nothing gives me more gastric acid than what I term "the precarious airway." Your patient is under anesthesia and for whatever reason the anesthesiologist chooses a laryngeal mask airway, which is a fancy term for anesthesia administered without an endotracheal tube. Now I know the merits of avoiding a tube: less tracheal irritation, no worries about intubation and less aspiration. But let's face it, when you hear the patient gurgling in the middle of a case, it doesn't exactly evoke a lot of confidence.

Last month, midway through an arthroscopy, I kept hearing persistent wheezing from a patient with an LMA. I finally turned to the 'ologist and declared, "Sounds like he needs a tube!" To which he replied, "Well, he has a short neck, a history of sleep apnea and that will be very difficult." He paused to consider what he'd just said, and then quickly followed with: "How much longer do you have, Kel?"

Short neck, sleep apnea, difficult intubation. Has the doc ever heard of a spinal? Pass the Maalox.

• The elusive spinal. You are between cases and the anesthesiologist has now spent what seems like an eternity trying to introduce the spinal needle into your patient's spine. The back table is growing cobwebs and all the doc keeps uttering is, "I think I will get it this time."

At this point I kindly remind the 'ologist that the patient is 350 pounds, has had 3 back surgeries and is allergic to needles. To which the anesthesiologist responds: "Well, I guess spinal was a poor choice." Ya think?! Pass the Pepcid.

• The (un)teachable moment. I work at a teaching hospital where anesthesia residents get to practice on patients. It's not always pleasant, like when you're waiting for your fourth case and the resident has now spent nearly 40 minutes trying to get the epidural. You watch in awe (and agony) as your patient squirms and flinches with each passing, errant stab. Rather than show the young resident how it's done, the teacher continues to let the young resident struggle. We all then witness the poor young doc's confidence wither away.

At long last, I tactfully interject, "Doc, why don't you help out?" At which point the attending grabs the needle and commences to prod and poke the now swollen tissues to no avail.

An hour later, the patient is intubated. Pass the Rolaids, please!

• Block blues. After repeated assurances by the anesthesiologist that the femoral nerve block was "superb," you greet your post-op patient in the recovery room, only to find him hysterical, writhing in pain, throwing objects at the nurses and using expletives you haven't even heard at the gym. "You said it wouldn't hurt much!" At that point I am reminded of the Southwest Airlines commercial, "Wanna get away?" Thankfully enough morphine kicks in to at least partially compensate for the unblocked nerves. Pepto-Bismol will suffice.

God bless anesthesiologists. They have a very difficult job. But sometimes, they, like surgeons, can make it a little tougher than it needs to be.

Now, if you will excuse me, I am late for my own upper GI endoscopy.

Hope they use enough sedation.