Judge the gravity of the situation quickly and make alterations to techniques or medications quickly

In spite of all instructions and information one is likely to come across patients whose records do not reflect the conditions suddenly detected on operating table. One has to be very cautious about these patients and one might have to change strategy suddenly.
-Patients orthopnoeic
-Patients having difficulty in breathing
-Inability to open jaw
-Tonsil
-Tooth septic with spreading infection
-Patient in CCF or LVF
-Patient in shock state
-Ectopic beats
-Duodenal perforation, bowel perforation, leaking anastomosis
-Abdominal catastrophe
-Oedema face or legs
-Patients very pale due to sudden massive haemorrhage like burst ectopic pregnancy.
All these and many others can change the plan and new strategy will have to be adopted. All the pros and cons must be rapidly thought and may well delay the procedure, than putting ones foot into it.
In a really difficult situation where the decision is likely to end in fatality one should not hesitate to take a second opinion from a senior anaesthetist. There is no need to have feeling of inferiority and shame while seeking the help of a senior.