Many unanswered questions here. Please include the pre-operative anesthesia assessment and anesthesia record if at all possible in future anesthesia cases - administered drugs, doses and timing are paramount in anesthesia. What were the characteristics of the patient’s airway that earned a Mallampati 4 score in the preop assessment?? Were extubation criteria of head lift >5 seconds and following commands documented on the record? Were they really followed?? That would be required for a patient with appendicitis and a presumed ileus/full stomach at risk for aspiration. Snoring? Not likely if the patient meets these criteria. The usual cause of difficult ventilation immediately post-extubation is laryngospasm from extubating too early. Was an appropriate dose of Succinylcholine given? This would have broken laryngospasm and facilitated re-intubation. Was the anesthesiologist, who did not speak English particularly well, board certified and if not, why? Neither ‘expert’ impressed me

Thank you for posting these cases. They are great to learn from. Could you expand more on this analysis point: "I suspect they intentionally avoided labeling a diagnosis, and criticized more tangible parts of the record to avoid their own opinion being called speculative." What would constitute an opinion being speculative? The defendents seemed to think at least the initial issue was a bronchospasm.

I also don't understand the plaintiff's expert criticizing that monitoring of SpO2. It was either monitored or it was not during extubation. The defendent's expert states "breathing and saturation were properly appreciated." These assertions seem mutually exclusive.