Welcome to Anaesthesia!

Dr Basil AlmahdiConsultant Anaesthetist

HistoryPerioperative medicinePreoperative assessmentEquipmentProceduresSafety

Stone Age Traditional!

BC attempts

Spongia Somnifera

6 men and a surgeon technique!

PRE-OP

INTRA-OP

POST-OP

PERIOPERATIVE MEDICINE

Anaesthesia for medical students

Pre-operative caredrugs, fluids, monitoringcare of the unconscious patientpost-operative care including analgesia, intravenous fluid management, and management of common complicationsPractical procedures

PRE-OP

Aims of Pre-assessment

Screen for unknown conditionsAssess and optimise known medical

problemsAssess riskAnticipate complications

Reduce risks of anaesthetic and surgery to a minimum

Where?By whom?How urgent is the surgery?Anaesthetic clinical assessment – what questions??History examination investigations consent planAirway – assessment and plan

Mallampati

Who does it??

Why is it important?Consider:You are clerking a patient evening

before THR (on waiting list 6/12)

Pt has Fe def anaemia - Hb is 7.8 Pt on diuretics - K is 2.7Pt on warfarin for AF – INR is 3.1Pt says they have worsening SOB on exertion for 3/12 – now houseboundECG – heart rate is 135/min

ASA statusAmerican Society of Anesthesiologists

1. Normal healthy patient2. Mild to mod. systemic disease. No functional

limitation3. Severe systemic disease with limitation of

normal function4. Severe systemic disease that is a constant

threat to life5. Moribund patient unlikely to survive 24 hours

with or without operation

INTRA-OP

“The most important monitor employed by the anaesthetist during anaesthesia is his/her own vigilence.”

Not just observation..

... A very practical specialty!

Anaesthesia = Airway!!

(anywhere anytime, no if’s no but’s!)

Anaesthesia for medical students

Theatre listsLecturesTutorialsWebsite (Google ‘UCL Anaesthesia students’)

Articles and Podcasts

student workbookAssessment CBD

AnatomyPhysiologyPharmacologyPhysics EquationsIntravenous (real time) medicine Risks (balance of)Clinical skillsPatient safetyConsentCapacityCommunication

Patient safety (Risk)Wrong site surgeryDrug errorSurgical site infectionProcedural complicationHuman factors (technical/non-technical)Equipment Organisational/system issuesPersonal safetysharps practice /body fluids/ radiation/back injury

AnaesthesiaLocalRegionalSedationGeneral

Pros v cons ??

General Anaesthesia

General Anaesthesia

Induction (inject vs inhale)Maintenance (inject vs inhale)EmergenceRecovery

Full stomach?? Rapid sequence

POST-OP

Post -opAirway breathing circulationConscious levelObservationsAnalgesiaRenal function (urine)AntimicrobialsHaemoglobin/glucose

Types of complications

Surgical•Bleeding•Wound problems•Anastamotic leak

Medical•Cardiac•Respiratory•Renal failure

General state•Immobility•Sepsis•Pressure sores

Enjoy the firm!