Dr. Anshul, an anaesthesiologist with a decade of high-acuity practice, outlines a structured, equipment-free screening protocol that identifies difficult airways before induction and can be applied by any clinical team regardless of resource constraints.
Airway-related complications remain one of the most preventable contributors to surgical mortality. Yet the systems designed to catch them before induction are failing consistently. A study published in Anesthesiology found that nearly 78% of healthcare facilities reported anesthesia staffing shortages. That figure is more than double the 35% recorded before the COVID-19 pandemic. Together, these trends are narrowing the margin for error in ways that make preventable escalation increasingly costly, clinically, operationally, and financially. Understanding what that margin looks like from inside a high-acuity surgical environment requires a perspective that goes beyond workforce data.
To understand where current screening methods fall short, we spoke with Dr. Anshul, a specialist anaesthesiologist practicing in high-acuity surgical and critical care environments. Surgical systems assume that airway problems become visible at induction. She has spent her career in the environments where that assumption fails most visibly and most expensively. Her caseload at one of Haryana’s largest public teaching hospitals includes high-risk obstetric patients, frail elderly patients under regional anaesthesia, complex comorbidity cases, and procedures as demanding as cadaveric organ retrieval and kidney transplantation. Across every case type, the pattern is the same: the risk was present before the patient reached the table. The question is whether the system was built to catch it.
That question is what drives her most recent research. It examines whether a simple, equipment-free screening tool can reliably identify high-risk airway patients before induction. The focus is specifically on settings where advanced imaging and specialist backup are not guaranteed. It is the kind of research question that only comes from years of operating where those resources are not available as a fallback.
Where the Failure Happens
Surgical workflows assume that airway difficulty becomes apparent at induction. In practice, the failure point is earlier. By the time it becomes visible in the operating room, the window for controlled management has already narrowed significantly.
This dynamic is clearest in high-volume public surgical environments. At Pt. Bhagwat Dayal Sharma Medical College and Hospital in Rohtak, where Dr. Anshul practices, the same pattern recurs across every case type. When airway risk goes undetected before induction, the clinical team is forced into reactive management at precisely the moment when preparation matters most.
“These cases don’t just surprise you in the OR. The warning signs are almost always there beforehand, in the patient’s anatomy, their history, and their comorbidities. By the time it becomes a crisis on the table, you’ve already missed the window where you had real options. That’s the problem. Not the crisis itself, the missed window before it,” Dr. Anshul explains.
The Screener That Works Without Specialist Support
Addressing the failure point before it reaches the operating room requires a structured, prevention-focused approach. It must be built into the preoperative pathway, and followable by any clinical team regardless of resource constraints. Dr. Anshul’s assessment process combines anatomical examination, patient history review, comorbidity evaluation, and validated scoring frameworks. All of this is applied before anaesthesia begins. The goal is consistent: identify risk while options for planned management still exist.
Central to her recent research is the STOP-BANG questionnaire. It is a screener built around eight measurable clinical indicators: Snoring, Tiredness, Observed apnea, high blood Pressure, BMI over 35, Age over 50, Neck circumference over 40cm, and male Gender. Each indicator is associated with obstructive sleep apnea and difficult airway anatomy. A higher cumulative score flags patients who warrant closer preoperative evaluation. Her January 2026 study, published in the Journal of Emergency Medicine, Trauma and Acute Care, tested whether this tool could reliably identify high-risk patients before induction, particularly in settings that lack the resources for more intensive workup.
The practical question driving the research is straightforward. Can a simple, low-resource screener that any team member can administer extend structured risk assessment to environments where specialist support is least available?
“What separates a controlled case from a difficult one is almost always what happened before induction, not during it. If you catch the risk early, you have choices. You can plan around it, prepare your team, and have the right equipment ready. Wait until you’re already in the procedure, and those choices disappear one by one,” Dr. Anshul notes.
Building the Protocol Into the System
A screening tool is only as effective as the system built around it. What scales is protocol? Dr. Anshul’s approach centers on three elements that any surgical team can embed into standard workflow without additional staffing. The first is standardized airway assessment documentation applied to every patient, regardless of apparent complexity. The second is structured pre-induction briefings for flagged cases. The third is proactive preparation of alternative airway equipment before the procedure begins, not after the first sign of difficulty.
This is also what she brings into training. As a faculty member at airway management workshops, trauma bootcamp sessions, and ultrasound-guided regional anaesthesia programs, including at AIIMS and PGIMS Rohtak, Dr. Anshul works with residents and junior anaesthesiologists. Her focus is on building these habits before they become independent practitioners.
That same framework extends into her broader body of work. She has contributed to national and international peer-reviewed journals and presented award-winning research at four consecutive conference cycles, including a first-prize paper at the 7th International Airway Congress of the Airway Management Foundation in 2024 and a prize paper at ICACON 2025 in Jodhpur. Her 25 peer-reviewed publications reflect the same orientation: how do you make safe airway practice reproducible across operators and settings, not just in experienced hands? She is a member of five anaesthesiology societies, including the Indian Society of Anaesthesia, the Airway Management Foundation, and ICACON. The last of these admits members based on demonstrated clinical and academic contributions.
“People think anaesthesia safety is about what you do when something goes wrong. But the real work happens before the patient is even sedated. Did someone ask the right questions? Did anyone flag the risk? Did the team know going in? Those three things, done consistently, every single time, are what keep cases from becoming emergencies,” Dr. Anshul says.
The tools for structured preoperative airway screening exist. The evidence supporting their use is established. What surgical systems are still missing is the institutional decision to apply them consistently, not selectively, not only in flagged cases, but as a standard step before every induction. With staffing shortages continuing to reduce the margin for managing complications that should never have occurred, that decision has become as much an operational imperative as a clinical one.
