Morbidly obese parturient, BMI over 60. Urgent D+C for retained POC. I had the dubious honor of taking care of the same patient less than a year ago for her primary c/s. At that time she refused neuraxial up and down - we told her she could die, or worse, and ended up doing a GA with Glide and it went fine. So now she's oozing after her second baby, weighs a little less than a year ago, but unsurprisingly, adamantly refusing neuraxial again. Foolishly, I felt reassured because of her relatively straightforward airway I managed a year ago for her c-section. We did an RSI with Glide and passed the tube through. No end tidal. Double checked the tube, circuit and machine. Still no end tidal. Patient starts desaturating. Suspecting an esophageal intubation, I took another look but at this point was not able to identify any recognizable anatomy. Shoved an LMA in and we were able to squeak some air in and out but not ideal. Woke the patient up and told her she almost died, and that she was getting a spinal for the procedure - I didn't care anymore that she didn't want a needle in her back. Did a CSE (not easy either) but the spinal was good and we didn't have to use the epidural. She did ok.
Another patient - crash c/s - induced GA, couldn't positively identify the glottic opening, couldn't pass the tube with the Glide. Patient desaturates. Shove an LMA in with marginal results. Meanwhile my colleague sneaks in behind me with a 6.0 MLT loaded on a fiberoptic. Slams that tube in through the LMA (no Aintree). The tube is barely long enough to stick far enough out of the iGel LMA so that the circuit can attach. I spend the entire case with my hand on the tube to keep it from moving. He later told me he couldn't really identify anything through the fiber optic either. He saw a hole, guided the fiber in, and shoved the tube in. Patient did ok too.
All of my sphincter tightening airways have always been on ****ing L&D. The stress is even higher because these typically happen at ass-o'clock in the morning, with no other experienced personnel around. OB/GYN is useless and so are the OR nurses (they are just repurposed L&D nurses). ENT is a mile away and if I'm lucky I get a pediatric CRNA from downstairs.