Chapter 03: Specialty The Importance of Anesthesiology and Airway Management in Oncology

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. Hagberg explains the critical role of anesthesiology and airway management, particularly in cancer care. Airway management is especially challenging due to tumors, prior surgeries, and radiation, which can distort anatomy and complicate care. She emphasizes that the most perilous moment in surgery occurs when patients lose consciousness, requiring anesthesiologists to protect brain function, ensure oxygen delivery, and maintain stability.

She describes anesthesiologists as essential partners in oncology, contributing to not only the operating room but also critical care and pain management, leading to safer surgeries and improved recoveries.

As the field has evolved, her research has expanded from devices to broader areas such as systems, human factors, and guideline development. She has also made key educational contributions by establishing training rotations and fellowships that shape clinician preparation and teamwork.

She highlights the growing role of advanced visualization tools and artificial intelligence in identifying high-risk airways and supporting decision-making, while stressing that technology cannot replace strong clinical judgment.

Identifier

HagbergC_20260224_C03

Publication Date

2-24-2026

Interview Session

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

Topic Covered

Character, Values, Beliefs, Talents; The Clinician; Career and Accomplishments; Education; On Education; Research

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

So, one thing I wanted to ask is, how would you explain kind of the importance of neuroanesthesia and difficult airway management, particularly in cancer care to a general audience?

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

Well, good question. You know, when most people think about surgery, they think about the surgeon. That’s okay, but I think the most dangerous moment of surgery or an invasive procedure requiring anesthesia is often the moment they lose consciousness. So that’s where the anesthesiologist comes in. And our job is to keep patients safe when they are at their most vulnerable time, when they can’t breathe for themselves, speak for themselves, or protect themselves. You know, we protect brain function. We ensure oxygen delivery. We maintain blood pressure and stability during the most physiologically stressful moments of care. Now, you mentioned neuroanesthesia and highlighted earlier why I went into this area, but neuroanesthesiology is especially delicate because the brain has almost no tolerance for instability. And even small changes in oxygen levels or blood pressure can have lasting consequences. Now, difficult airway management is equally critical.

Before any surgery can begin, we must secure the airway—you know—ensuring that the patient can be safely ventilated and oxygenated. And if that step goes wrong, nothing else matters. In cancer patients, these challenges are just even magnified. Tumors, prior surgeries, prior radiation, scarring can distort normal anatomy. And many patients that we see here at MD Anderson are frail or have limited physiologic reserve. So, the margin for error is very small, Javier. At its core, my field is—as I think about this—making the most dangerous part of a patient’s day, okay, the moment they lose consciousness as safe as humanly possible. So that responsibility is both technical and deeply human. And it requires preparation, anticipation, and teamwork. You know, Javier, I always say when it’s done well, it’s invisible, which is exactly how it should be.

Jose Javier Garza

So, from your perspective, how has anesthesiology, critical care, and pain medicine contributed uniquely to oncology? And how has that division evolved over time?

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

Well, these three areas—anesthesiology, critical care, and pain medicine—really do contribute to oncology, and I think in ways that are often invisible, as I just mentioned. But they’re absolutely foundational. You know, first, we enable cancer care. We have such complex tumor resections here at MD Anderson that can last ten to twelve hours, even longer. And we often perform multi-organ or other complex surgeries or procedures here. None of these would be possible without the team that can maintain that physiologic stability minute by minute. But we also ensure oxygen delivery and protect vital organs, including the brain. We manage massive fluid shifts and guide patients safely through operations or procedures that would otherwise be unsurvivable.

So that’s the first thing, but secondly, I think we extend care beyond the operating room. A lot of people think we are only in the operating room. That is not true. We actually spend even more time out of the operating room, providing services, but in critical care, we support patients through life-threatening complications, sepsis, respiratory failure, organ dysfunction. And in pain medicine, we treat both acute surgical pain and chronic cancer-related pain, allowing patients to tolerate therapy, recover faster, and really maintain dignity and quality of life through their cancer journey. So, I think our role has evolved significantly over time. And historically, I think anesthesiology was sometimes viewed as just a support service. Today, I think we’re a strategic partner in oncology care. We’re involved in preoperative risk assessment, optimization before surgery, enhanced recovery pathways, ICU management, as I mentioned, and long-term pain strategies. So, we’ve really shifted from reactive to proactive, from responding to complications to preventing them.

And I would say, in many ways, modern oncology depends on modern perioperative medicine. And as cancer therapies become more complex, and you know they are, our specialty has grown right alongside them, so enabling safer surgeries, smoother recoveries, really better overall outcomes. And when we do our job well, having—often patients don’t remember us at all, which—you know—as I mentioned, it means everything went exactly as it should. It’s often like airline pilots. And actually, we do compare our specialty often to the airline industry with all their checklists and—for anesthesia, takeoff and landing and so forth. But it’s very similar, right? Anesthetic induction is like takeoff and extubation is like landing. Complications are rare. You don’t notice the pilot unless something goes wrong. And then you pay attention, right? But it’s so funny as I—when I depart from a plane, I always stick my head into the cockpit and say, “Thank you”.

Jose Javier Garza

Yeah, same. I always thank the pilot and everything, but you are right about memory—like not—

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

Yeah, most often we don’t even think about them.

Jose Javier Garza

Yeah, exactly. If it goes smoothly, then you don’t think about all of the work, but thank you so much for sharing that. One thing I wanted to ask is, how has your research evolved over the course of your career, and what studies or projects stand out to you as particularly meaningful?

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

I would say that my research has really evolved in parallel with my own growth as a clinician. Early in my career, my focus was very technical. After that difficult airway case I experienced, on my last night on call as a resident, I was determined to understand airway management at the deepest level. As I said, I really had second victim syndrome, but my early research examined airway devices, techniques, and very practical bedside solutions, including some of the early work with supraglottic devices. I really wanted to know what works, when, and why. But then, over time, my perspective broadened. I began to realize that airway crises are really just technical failures, like the one I experienced. They’re often failures of anticipation, communication, or decision-making under stress. So, my work evolved from focusing purely on techniques to thinking about systems, human factors, cognitive load, escalation strategies, and then guideline development, which is where I do spend quite a bit of time now. But that shift was incredibly meaningful to me because I really became less interested in inventing a new device, which I often helped companies—improve their devices, and even did invent a device, but I became more interested in how—in changing how clinicians think. I would say some of the most—some of the projects I’m most proud of are really educational in nature.

As a residency director at UTHealth, I established both a regional anesthesia rotation and an advanced airway management rotation, which I directed for many years. But those programs shaped generations of anesthesiologists. And as division head at MD Anderson, I developed an airway fellowship that continues today. And in fact, I still teach invasive airway management. And I continue to serve as an adjunct professor at UTHealth. I’m deeply involved in national and international work through organizations such as the American Society of Anesthesiology, the Texas Society of Anesthesiologists, the Society of Airway Management, the Project for Universal Management of Airways. But the work that stands out most to me isn’t just about what people do differently. It’s about what they think differently. And you can shift the mindset toward preparation, anticipation, and teamwork. And I think—you know—that way you change outcomes at a scale. And in many ways, Javier, everything traces back to that one case as a resident. It shaped not only what I studied, but why.

Jose Javier Garza

Wow! So, are there any emerging technologies or future breakthroughs you anticipate will significantly impact anesthesiology and airway management?

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

Oh, very much so. I think we’re entering a very exciting era in anesthesia and airway management. On the technology side, advanced visualization tools are really prominent now, including newer optical stylets and video-assisted devices. They are continuing to improve our ability to see anatomy very clearly and intervene even earlier than before, but better visualization reduces guesswork. And in airway management, guesswork is the enemy of safety. But technology alone isn’t the breakthrough. Simulation has become extraordinarily sophisticated. We can now train clinicians in rare, high-risk scenarios. Again, similar to pilot training, in ways that just weren’t possible earlier in my career. I didn’t train that way. And when you combine simulation with data, tracking performance, identifying patterns, refining decision-making, training becomes far more precise and intentional. And now, artificial intelligence will also play a role. I see AI evolving as a decision support tool and actually as a risk stratification partner. You know, it may help identify high-risk airways earlier, flag subtle physiologic deterioration better than we could, or guide clinicians toward evidence-based pathways in real time.

That said, technology will never replace clinical judgment, but what it will do is expose weak judgment faster. The clinician of the future, they’ll need to integrate advanced tools with critical thinking, communication, institutional awareness, but the fundamentals, Javier, which is what I really focus on when teaching, that preparation, anticipation, and teamwork, that’s not going to change. But the tools available to support those fundamentals will become increasingly powerful. And I would say if we use them wisely, they will make the most vulnerable moments in a patient’s life even safer.

Jose Javier Garza

Well, thank you so much. So, when I was researching for the interview, I came across a foreword you wrote for Anesthesiology for Oncological Surgery. And you described an often overlooked but crucial aspect of cancer care is anesthesia. So, thank you so much for—you know—taking the time to kind of help—help me and I guess the people listening to this interview kind of understand why that’s so important.

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

Oh, you’re welcome.

Recommended Citation

Hagberg, Carin M.D., FASA, FACHE and Garza, Jose Javier, "Chapter 03: Specialty The Importance of Anesthesiology and Airway Management in Oncology" (2026). Interview Chapters. 1615.
https://openworks.mdanderson.org/mchv_interviewchapters/1615

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Open