Welcome to Anaesthesia! Dr Basil Almahdi Consultant Anaesthetist

History Perioperative medicine Preoperative assessment Equipment Procedures Safety

PRE-OP INTRA-OP POST-OP PERIOPERATIVE MEDICINE

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 has Fe def anaemia - Hb is 7.8 Pt on diuretics - K is 2.7 Pt on warfarin for AF – INR is 3.1 Pt 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. Normal healthy patient 2. Mild to mod. systemic disease. No functional limitation 3. Severe systemic disease with limitation of normal function 4. Severe systemic disease that is a constant threat to life 5. 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 + 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

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 Surgical Bleeding Wound problems Anastamotic leak Medical Cardiac Respiratory Renal failure General state Immobility Sepsis Pressure sores

Enjoy the firm!