Welcome to Anaesthesia!
Dr Basil Almahdi
Consultant Anaesthetist
History
Perioperative medicine
Preoperative assessment
Equipment
Procedures
Safety
Stone Age Traditional!
BC attempts
Spongia Somnifera
6 men and a surgeon technique!
PERIOPERATIVE MEDICINE
PRE-OP
INTRA-OP
POST-OP
Anaesthesia for medical
students
Pre-operative care
drugs, fluids, monitoring
care of the unconscious patient
post-operative care including analgesia,
intravenous fluid management, and
management of common complications
Practical procedures
PRE-OP
Aims of Pre-assessment
Screen for unknown conditions
Assess and optimise known medical
problems
Assess risk
Anticipate 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 plan
Airway – 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
Pt
Pt
Pt
has Fe def anaemia - Hb is 7.8
on diuretics - K is 2.7
on warfarin for AF – INR is 3.1
says they have worsening SOB on exertion for 3/12
– now housebound
ECG – heart rate is 135/min
ASA status
American Society of Anesthesiologists
1.
2.
3.
4.
5.
Normal healthy patient
Mild to mod. systemic disease. No functional
limitation
Severe systemic disease with limitation of normal
function
Severe systemic disease that is a constant threat to
life
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 lists
Lectures
Tutorials
Website (Google ‘UCL Anaesthesia students’)
Articles and Podcasts
student workbook
Assessment CBD
Anatomy
Physiology
Pharmacology
Physics
Equations
Intravenous (real time) medicine
Risks (balance of)
Clinical skills
Patient safety
Consent
Capacity
Communication
Patient safety (Risk)
Wrong site surgery
Drug error
Surgical site infection
Procedural complication
Human factors (technical/non-technical)
Equipment
Organisational/system issues
Personal safety
sharps practice /body fluids/ radiation/back injury
Anaesthesia
Local
Regional
Sedation
General
Pros v cons ??
General Anaesthesia
General Anaesthesia
Induction (inject vs inhale)
Maintenance (inject vs inhale)
Emergence
Recovery
Full stomach??  Rapid sequence
POST-OP
Post -op
Airway breathing circulation
Conscious level
Observations
Analgesia
Renal function (urine)
Antimicrobials
Haemoglobin/glucose
Types of complications
General state
•Immobility
•Sepsis
•Pressure sores
Medical
•Cardiac
•Respiratory
•Renal failure
Surgical
•Bleeding
•Wound problems
•Anastamotic leak
Enjoy the firm!