approach every general anesthetic so this can be quite straightforward the intraoperative goal it's
very simply i want the patient to get through this pretty you know horrendous journey potentially
around this training with minimal physiological and psychological alteration and the way i do that
is you know a whole bunch of things but medical knowledge combined with technical skills and
airway management bench support and circulatory support as well as a lot of very interesting
medications and very potent medications the way we do that is going through this whole process
a step-by-step sequence for the general anaesthetic which i've mentioned before
we've got all these before theater tasks and all the in theater tasks which we'll go through in a
second as well uh on pages six to eight i've got a whole bunch of anesthetic assessments
um and what so the thing about these assessments is they're very checklistable you know so if you
can fill this checklist out you can be at the level of a very good basic trainee simply by
following a pro forma um so you know this is really reassuring for you i care more about
your ability to be able to cover all the points superficially every single time and not about
the depth of knowledge necessarily the depth of knowledge will definitely come to you over time
but i want you to cover all these points without fail so this is a very busy you know performer
which i you know encourage you guys to use just so that you don't miss anything because that
means that i know that you're thorough and you know incompetent in following these processes
but really this is literally what i ask um and you'll be very familiar with this so you know
do you have any prior general anaesthetic issues postoperative nausea vomiting or pnv
or any family history of issues and then i specifically ask about medications analogies any
problems with cardiovascular respiratory as the most important systems and then any other systems
that they might mention and then i get an idea of overall function by asking the question can
you walk up two flights of stairs without stopping now really importantly if they if they don't have
stairs you know i don't really care i need to just know what their exercise tolerance is there
whether it's asking them specifically what the activities of day-to-day living that they can do
whether they can do some gardening or lawn mowing or walk four blocks to the shops or whatever it is
your you know your boss and your supervisor will be really really happy with the fact that you get
an idea of their global functioning specifically especially that that's that's a problem as i
mentioned medication list allergies and whatever those allergies cause whether the patient
has fasted if they have reflux and then do an examination which is really just the airway
exam and auscultating the chest and then a dental exam and then noting any relevant investigations
so again this is very checklistable i go through the previous pro forma if i was junior just to
make sure i don't miss anything and i've also given an obstetric pro form and a pediatric
profile and possessed slightly different and again just by filling out those i want you to be able to
really impress your consultant and also on a you know patient-centered approach if you take away
a lot of that you know i guess the um you know the checklist stuff from your consultant you
really offload a lot of the you know mental energy that they can then focus on other tasks as well so
it's really helpful for you for your supervisor on many levels to know that you're very thorough
so i just want you know anyone can do this use a checklist and ask this over and over
again from every patient but the real the real challenge is the application of this information
and that's what we'll focus on so again do this time and time again until it's absolutely boring
uh watch the youtube videos um which are on the channel and i've gone through it in a lot more
detail and what we'll go through now and in the future is about how to practically apply that
so what's most difficult is knowing when to proceed or postpone and we'll
go through this in the assessment of the cardiac patient for non-cardiac
surgery so again imagining you've got all of this history of this patient
we then want to go through whether this patient is ready for surgery or not thank you