The time out is a valuable opportunity to discuss the critical portions of a case. These are moments where patient physiology may shift rapidly and where anesthesia vigilance is essential. Communication between surgery and anesthesia around these moments is essential, and you should act proactively to initiate them.

Reading ahead about your cases and discussing anticipated critical portions with your attending is essential. Not only does this prepare you clinically, but it also serves as a helpful prompt to your attending that your involvement and their supervision may be needed during those key moments.

During these times, the expectation from the surgical team is that your attention is fully on the patient and the surgical field, with all routine tasks paused and your focus primed for sudden changes in clinical status. These are not moments for catching up on the EMR. Your alert and engaged presence can make all the difference.

There’s no rigid definition of what constitutes a critical portion, but here are some examples:

• Induction
  
• Surgical time out
  
• Abdominal insufflation
  
• Airway manipulation (e.g., ETT retraction, surgical airway placement, rigid bronchoscopy, placement of endoscopy probe, or bronchoscopy)
  
• Orthopedic nailing or cementation
  
• Gastric tube placement or removal during cases with shared anatomy: gastrectomy, gastric sleeve, or Roux-en-Y
  
• Opening the dura in a case with elevated intracranial pressure
  
• Clamping or unclamping of major vessels
  
• Administration of heparin or protamine in cardiovascular surgery
  
• Emergence and extubation

These events represent turning points in a case: physiologically, surgically, or both. By identifying them in advance and staying present when they occur, you can prevent complications, respond faster when issues arise, and gain the trust of your surgical colleagues.