Welcome to the Department of Anaesthesia & Intensive care: And our two week final year course in Anaesthesia

People (CUHK) Professor Tony Gin Professor Lester AH Critchley (Chairman & Head of Department) Professor Lester AH Critchley (Coarse coordinator 2005/6) Connie (Secretary – Medical Student Affairs)

Places (PWH): 5/F Offices (secretaries) / Tea room, 3/F OT reception (Operating theatre) 2/F OT discussion room (Lectures / Tutorials) 2/F Simulator Room (beside the OT discussion room) 2/F Entrance to the changing room

Objectives of the course (1): To know what happens during anaesthesia to the patient: A knowledge sufficient to give a general explanation (in lay-mans terms) to a patient, such as would be expected of a family doctor.

Objectives of the course (2): To provide a background in perioperative management: appropriate for a 1st year MO. Pre-operative preparation for anaesthesia Post-operative care: (Pain, nausea & vomiting) Resuscitations skills: Airway skills, Oxygen therapy & intravenous fluid management Safe use of local anaesthetics & i.v. sedatives.

Time Table: Mon to Fri for 2 weeks 8:00-10:45h Morning clinical attachments (OT / EME / Pain / OBS) 11:00-12:30h Lecture / Tutorial (OT discussion room) 12:30-14:00h Lunch 14:00-17:00h Informal sessions: See patients preoperatively (± anaesthetist) Prepare your case reports SSM (two afternoons per week) Case presentations (one afternoon)

Morning assignments: Student no. Week 1 Week 2 Mon Tue Wed Thu Fri 1 Intro EME OBS Pain 2 4 3 5 6 7 8 9 10 OBS = Obstetrics 0800 5th floor Common room Pain = Acute Pain Service 0800 5th floor Common room EME = Emergency theatres 0800 5th floor Common room 1,4, etc = Elective operating theatres 0815 designated theatre

Practical Skills: Focus on airway management & i.v. infusions (a) Afternoon tutorial & workshop (b) Skills to be practiced in OT Airway management I.V. equipment Checking & giving antibiotics & blood

Practical Skills List: (i). Airway management: Bag & mask ventilation; Insertion of oral airway; Laryngoscopy & recognize anatomy and; Intubation & check placement (ii) Familiarity with i.v giving sets and equipment: common I.V solutions, I.V giving sets, CVP manometer set & syringe pumps

Patient Assessment: This is partly covered by the Anaesthesia case reports. However, there are a number of topics you also need to review:

Patient Assessment Topics: The basic history, examination & investigations required for a healthy patient. ASA status I – IV (American Society of Anesthesiologist’s) Assessment of the airway for intubation, including: Jaw opening, Mallampati grade, Neck mobility & recognizing anatomical problems. (Please review material on website under patient assessment)

Basic Anaesthetic History: Presenting condition for surgery: History: Past medical history & anaesthetic history Medications & allergies Last oral intake Examination: General appearance, Heart & Lungs Airway assessment Investigations: Ward tests / CBC / RFT / CXR / ECG

ASA Physical Status Classification System ASA 1 A normal healthy patient   ASA 2 A patient with mild systemic disease    ASA 3 A patient with severe systemic disease    ASA 4 A patient with severe systemic disease that is a constant threat to life    ASA 5 A moribund patient who is not expected to survive without the operation    ASA 6 A declared brain-dead patient whose organs are being removed for donor purposes As of June 2005

Mallampati Classification Class I = visualization of the soft palate, fauces, uvula, anterior and posterior pillars. Class II = visualization of the soft palate, fauces and uvula. Class III = visualization of the soft palate and the base of the uvula. Class IV = soft palate is not visible at all.

Chronic pain teaching: Chronic pain is not taught during the anaesthesia module. However, we do provide a year 5 SSM based on chronic back pain, which is integrated into our teaching. Students doing chronic pain attend the clinic on Tuesdays at Tai Po Nethersole Hospital. We do plan to provide a series of three lectures to the year as a whole.

Assessment: The Surgical Module: 50% - Anaesthesia Case Reports [60% written / 40% presentation & discussion] 50% - MCQs [end of surgical module exam] Final Year Surgery Exam: OSCE station(s) / written paper / MCQs

Anaesthesia Case Reports: Purpose: To help you develop a more “focused appraisal” of the patient’s anaesthetic care by: Thinking about how the type of operation and the patient’s medical condition influences anaesthesia and post operative care. To develop your skills in writing and presenting short reports.

What you have to do: See patients on the surgical ward before and after anaesthesia. Ideally you should observe the anaesthetist during a number of preoperative visits and discuss with them the cases that they have assessed. Select three interesting cases: Write a one page summary of the anaesthetic history. Write a one page “appraisal” of the anaesthetic care, under five headings A to E. Give a short presentation of one of these cases (limited to five slides).

The five headings A to E: A: How did the patients operation influence the choice of anaesthetic technique? B: How did the patient’s medical condition influence the anaesthetic? C: What was the patient told about his anaesthetic? D: Did the anaesthetist prescribe any preoperative medications and if so, why? E: What post operative care did the patient receive & why?

Guidance: Details of how these cases should be written and presented are provide on the web site. There will be a briefing session on writing & presenting the cases during the first week.

Attendance: You are expected to attend all fixed sessions, unless you have a good reason to be absent. No attendance registrar will be kept.

Time tabling difficulties: Occasionally sessions may need to be rescheduled because a tutor is not available. Public holidays can be problem because of loss of teaching time. Unforeseen changes may be necessary because of the New Curriculum. Please keep an eye on the master time table outside the Anaesthesia Office.

Course material: This has been post on: (i) the medical faculty website and (ii) the Department of Anaesthesia & Intensive Care website.