welcome to anaesthesia! dr basil almahdi consultant anaesthetist
TRANSCRIPT
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!