Welcome to Anaesthesia!

1. Dr Basil Almahdi Consultant Anaesthetist Welcome to Anaesthesia!

2. History • Perioperative medicine • Preoperative assessment • Equipment • Procedures • Safety

3. Stone Age Traditional!

4. BC attempts

5. Spongia Somnifera

7. 6 men and a surgeon technique!

13. PERIOPERATIVE MEDICINE PRE-OP INTRA-OP POST-OP

14. 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

15. PRE-OP

16. 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

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

18. Mallampati

19. Who does it??

20. 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

21. ASA status American Society of Anesthesiologists • 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

23. INTRA-OP

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

26. Not just observation.. • ... A very practical specialty!

27. Anaesthesia = Airway!! (anywhere anytime, no if’s no but’s!)

39. Anaesthesia for medical students • Theatre lists • Lectures • Tutorials • Website (Google ‘UCL Anaesthesia students’) • Articles and Podcasts • student workbook • Assessment CBD

45. Anatomy Physiology Pharmacology Physics Equations Intravenous (real time) medicine Risks (balance of) Clinical skills Patient safety Consent Capacity Communication

46. 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

47. Anaesthesia • Local • Regional • Sedation • General • Pros v cons ??

48. General Anaesthesia

49. General Anaesthesia • Induction (inject vs inhale) • Maintenance (inject vs inhale) • Emergence • Recovery • Full stomach??  Rapid sequence

50. POST-OP