A patient arrives for surgery after weeks of waiting. They have fasted, taken time off work, arranged transport, and prepared themselves mentally for the operation. Then the anesthesiologist says, “I think we should wait.”
For the patient, this can be frustrating. “I feel fine.” “Why can’t we just go ahead?” These are understandable questions. But one of the less visible parts of an anesthesiologist’s job is deciding not only how to provide anesthesia safely, but also whether today is the right day to proceed.
Anesthesia is more than simply putting someone to sleep. Anesthetic medicines can affect breathing, blood pressure, heart function, and the way the body responds to surgical stress. A health problem that seems minor in everyday life may become more important during an operation.
That is why we ask so many questions before surgery. Has there been recent chest pain? A new cough or fever? Shortness of breath? Changes in medication? Problems with blood sugar? Blood thinners? Previous difficulties with anesthesia?
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Sometimes the answers reveal something that deserves attention before an elective operation. A patient may have developed a significant respiratory infection. Another may report new chest discomfort. Blood pressure or blood sugar may be severely uncontrolled. A medication may need to be adjusted before a particular procedure.
This does not mean every new medical issue leads to cancellation. The decision depends on the patient, the operation, how urgent it is, and the potential risks of proceeding versus waiting. That distinction is important.
In an emergency, delaying surgery may itself be dangerous. The anesthesia and surgical teams may need to proceed while taking additional precautions. Elective surgery is different. It often gives us something valuable: time. If a medical problem can be investigated or improved first, using that time may make surgery safer.
Patients sometimes ask whether they have been “cleared” for surgery. I prefer to think of preoperative assessment differently. There is no test or medical letter that can make surgery completely risk-free. The goal is to understand the patient’s health, identify problems that can reasonably be improved, and make the safest possible plan.
Most patients go ahead as scheduled. Sometimes we change the anesthetic technique or arrange additional monitoring. And occasionally, we recommend postponing.
Clinicians also need to remember what a postponement means to the patient. It may mean another day away from work, another period of fasting, another hospital visit, and more anxiety. So if surgery must be delayed, patients deserve a clear explanation. They should know what concern has been identified, what needs to happen next, and why waiting may make the operation safer.
Many patients meet their anesthesiologist only shortly before surgery and understandably think our main role begins inside the operating room. In reality, some of our most important decisions happen before any anesthetic drug is given. We are asking: Is it safe and sensible for this patient to have this operation today?
Most of the time, the answer is yes. Occasionally, the answer is: not yet.
And sometimes, the safest surgery is the one we choose to postpone.
Girishkumar Modi is a senior specialist anesthesiologist at Sheikh Tahnoon Bin Mohammed Medical City and Tawam Hospital (SEHA) in the United Arab Emirates. His clinical practice includes regional anesthesia, trauma and orthopedic anesthesia, neuroanesthesia and spine anesthesia, obstetric anesthesia, pediatric anesthesia, perioperative medicine, and the management of complex surgical patients. He serves as faculty in an anesthesiology residency program accredited by the Accreditation Council for Graduate Medical Education International, where he contributes to resident teaching, clinical supervision, assessment, and mentorship. He also contributes to trauma-service development and multidisciplinary perioperative care.
His academic interests include perioperative physiology and pharmacology, regional anesthesia, total intravenous anesthesia, acute pain management, point-of-care coagulation and hemostasis, medical education, health care economics, and perioperative patient safety. He is active in clinical research, medical writing, and peer review, with publications spanning anesthesiology, pharmacology, perioperative medicine, regional anesthesia, point-of-care coagulation and rotational thromboelastometry, and medical education. His work has appeared in the Mathews Journal of Anesthesia, the Journal of Anesthesia & Pain Medicine, and Anaesthesia, with abstracts presented at the Association of Anaesthetists Winter Scientific Meeting in London and the Integrated Anesthesia and Comprehensive Care Conference in Abu Dhabi.
He also writes commentary on clinical judgment, artificial intelligence, and patient readiness for surgery, including rapid responses in The BMJ such as “Medicine is not a 64-square board: Human oversight requires independent judgment” and “AI systems need a tested exit plan.”
