Chapter 01: Choosing Anesthesiology and Difficult Airway Management

Authors

• Carin Hagberg M.D., FASA, FACHE, The University of Texas MD Anderson Cancer Center
• Jose Javier Garza, The University of Texas MD Anderson Cancer Center

Files

Description

Dr. Carin Hagberg describes how her medical residency led her to specialize in neuroanesthesia and difficult airway management. She highlights the importance of deep physiological knowledge and precise real-time decision-making in managing complex surgical patients. A pivotal experience during her training shaped her focus on preparation, risk assessment, and teamwork.

Dr. Hagberg pursued education and clinical research to reduce variability among clinicians in high-stakes procedures and to improve patient safety in airway management. She views education as a powerful tool to amplify impact and has developed training programs to enhance consistency and preparedness in airway management.

Identifier

HagbergC_20260224_C01

Publication Date

2-24-2026

Interview Session

Carin Hagberg MD, FASA Oral History Interview, February 24, 2026

Topic Covered

Professional Path; The Clinician; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Professional Values, Ethics, Purpose; Portraits; Formative Experiences

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Jose Javier Garza

Okay, I’m Jose Javier Garza, and I am interviewing Dr. Carin Hagberg for the Historical Resources Center’s Making Cancer History Voices Oral History Project. This is the second interview with Dr. Hagberg following her 2024 interview with Alison Sines. Dr. Hagberg came to MD Anderson in 2016 to be the division head in the Department of Anesthesiology, Critical Care, and Pain Medicine. Currently, Dr. Hagberg is the institution’s Senior Vice President and Chief Academic Officer and serves as the Bud Johnson Clinical Distinguished Chair and professor with term tenure in the Department of Anesthesiology and Perioperative Medicine, and an adjunct professor in the Department of Anesthesiology at the UTHealth McGovern Medical School. This interview is being conducted over Zoom, and the time is 10:38 a.m. on February 24, 2026. Dr. Hagberg, thank you again for agreeing for another interview.

Carin A. Hagberg, M.D., FASA, FACHE

 Oh, thank you. I’m happy to be here, Javier. I have so much respect and admiration for the work of the Historical Resources Center. So, I’d say thank you for asking me back.

Jose Javier Garza

 Of course, thank you. It’s our—it’s our honor. So I kind of wanted to start with the interview with your specialty. So, what led you to specialize both in anesthesiology and in neuroanesthesia and difficult airway management in particular?

Carin A. Hagberg, M.D., FASA, FACHE

 Thanks for that question. I hope I don’t go too long with this answer, but my path to neuroanesthesia really began in my residency, where I had a lot of exposure to complex surgical care of neuro patients. I completed a two-month neuroanesthesia rotation at Parkland Hospital, and then I pursued an additional three-month elective during my CA-3 year at Zale Lipshy Hospital in Dallas. Both were tertiary referral centers caring for some of the most complex patients. So, we had large cerebral aneurysms we cared for, arterial venous malformations, and high-risk intracranial pathology. It was an exceptional hospital, really, to be honest, Zale Lipshy, but those experiences were truly formative for me. Neurosurgical anesthesia is uniquely demanding. It does require a deep understanding of physiology and precise real-time decision-making, and I would say a real unwavering attention to detail because the margin for error is extraordinarily small. But even subtle changes in blood pressure, ventilation, or intracranial dynamics can have irreversible consequences. But in addition, these patients often need to emerge from anesthesia immediately after surgery, so the neurosurgeon can perform a neurological assessment.

 I think that’s one of the more challenging things about this area of anesthesia—neuroanesthesia. But that means that the anesthetic must be meticulously tailored, providing enough depth to ensure safety and stability during the operation but really allowing the patient to awaken promptly. They must follow commands and speak clearly right after their surgery. I was very fortunate to train under exceptional mentors who modeled not only really the technical mastery of neurosurgical anesthesia, but also composure and leadership under pressure. So that kind of then led into when I joined UT Houston Medical School, now UTHealth. I was appointed the section chief of neuroanesthesia at Memorial Hermann Hospital. And the chair who had recruited me, Dr. Jeffrey Katz, had previously led that service himself, but when he became chair, he no longer had the bandwidth to continue in that role.

So, my depth of training in neuroanesthesia really did position me to step up into that leadership responsibility when I first started as an assistant professor in the Department of Anesthesiology.

I know that was a little long-winded, sorry about that. But my interest in difficult airway management really came from a defining moment during my CA-3 year of residency. So, both came out of residency, but I had an experience, Javier, that left a lifelong impression with me —I was providing general anesthesia for a case where I couldn’t secure the patient’s airway. And despite escalating it appropriately, I couldn’t intubate or adequately ventilate the patient. What we really refer to now as a “cannot intubate, cannot ventilate” situation. And the surgeon ultimately had to perform an emergent cricothyrotomy.

We were incredibly fortunate. The patient survived without neurological injury, but that experience stayed with me. And I replayed it over and over. In many ways, I was really what we now call a second victim. I had difficulty sleeping for months, reliving that experience, thinking about what I could have done differently. It was really a humbling and really a sobering experience for me. And that moment, Javier, fundamentally changed how I approach airway management. I made a commitment that I would never rely on someone else to rescue a situation that I could have better anticipated. And I became deeply focused, not just on the technical skill of intubation, but on the preparation, risk assessment, backup planning, equipment readiness, and then team communication. I think it’s just so important. In fact, I just gave a lecture on teamwork in airway management. I think this is why I got involved in guideline development because I thought if I had had a laryngeal mask airway, and that’s a device that actually sits above the glottis, not through the glottis, like an endotracheal tube, I could have prevented her from the need for a surgical airway.

So, I learned that success in airway management isn’t about heroics. In fact, you really need to leave your ego at the door, but it’s about preparation, judgment, and teamwork. I’ve always been drawn to areas where anticipation matters more than speed—I think that’s where really getting it right makes an immediate and more meaningful difference. And I think that early experience didn’t discourage me. It actually clarified my purpose and really ultimately shaped my career.

Jose Javier Garza

 Great, thank you. And thank you so much for sharing that. I think it’s really important to both for—both in terms of documenting your story, but, also, I guess, mentoring, or part of this project is for future anesthesiologists and physicians to kind of learn about these learning—these learning and teachable moments and how you both incorporated that into your career and how it’s, like, focused on that. I did want to ask, but how did you decide on a track that focuses both on education and clinical research?

Carin A. Hagberg, M.D., FASA, FACHE

 That’s a great question. And—you know—for me, Javier, education and clinical research were never about career ambition. They were really more about responsibility. And I think early in my career, I began to recognize how much variability existed in clinical practice and variability, especially in high stakes areas, like airway management, creates risk. It really does. Two equally well-trained clinicians might approach the same situation very differently. And that difference can really matter. And I have to say, this is just a very strong passion of mine, but after my difficult airway experience that I just described, I became especially sensitive to that. I realized that education is one of the most powerful ways to reduce variability. I didn’t want others to repeat the mistakes I had made, particularly around incomplete assessment or insufficient preparation. So clinical research really became a natural extension of that commitment.

My first study involved the laryngeal mask airway. At the time, it was a relatively new device. And I was really interested in some practical questions. Should it go into the difficult airway guidelines? Does this device improve patient safety? Will practitioners perform more flexible scope intubation procedures if used as an intubation conduit? And that’s what that first study was—using that device as an intubation conduit. And then, how does it compare really to existing techniques? So, I was never drawn to research for its own sake. I was drawn to research that answered questions—you know—the clinicians faced at the bedside. So education became the multiplier. If you train one clinician well, that person may improve care for thousands of patients over a career. And that ripple effect, I believe, is really incredibly powerful started a residency rotation in difficulty airway management at UTHealth. And then I started a fellowship in airway management here at MD Anderson for this very reason. I never saw education research as separate from clinical work. You know, I always say my lab is in the OR, and that is really how I honor the patients I care for, really by trying to make the system safer, more consistent and better prepared than it was the day before.

Recommended Citation

Hagberg, Carin M.D., FASA, FACHE and Garza, Jose Javier, "Chapter 01: Choosing Anesthesiology and Difficult Airway Management" (2026). Interview Chapters. 1613.
https://openworks.mdanderson.org/mchv_interviewchapters/1613

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