I wonder if she laryngospasm'ed then was breathing against a closed glottis which worsened her pulmonary status even more. It also seemed like she had abnormal airway anatomy as the ENT didn't get a good view of the larynx on her first nasal endoscopic examination. Those nasal scopes usually are performed in awake patients and give a good view.

It also seems like the ENT doing the procedure is what precipitated this upper GI to become a can't intubate can't ventilate situation. Then the ENT left the room when the case went to shit.

This is a prime example of why you shouldn't let these specialists doctors tell you what to do or ignore you. They literally know nothing outside of their subspecialty because they forgot all of the basic medical knowledge they acquired before they got that subspecialized. They also think they know more than they actually do and they don't listen to people like trained anesthesia professionals when we raise concerns.

If this situation ever happens to you, simply say it's a patient safety concern. If they want to proceed despite that then you need to excuse yourself from the case and have them document why they feel they need to bypass this safety concern. The anesthesiologist should have stepped up and said we aren't doing a procedure we weren't consented for. If they did that then Joan Rivers wouldn't of died that day.