Anaesthetists Handbook - MEDICAL EDUCATION at University ...

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Awareness during anaesthesiaAwareness during anaesthesia[Dr Keith Clayton, January 2010]You must report all instances of anaesthesia awareness on a clinicaladverse event form.There have been at least three recent instances of awareness duringanaesthesia. The points below will help in prevention andmanagement of this major complication.Pre-operative visit• Talk to your patient.• Allay anxiety.• Build up rapport.Explanation• Describe the anaesthetic technique.• Explain invasive monitoring and intravenous access.• If using muscle relaxants tell the patient.• Answer all questions truthfully.Forewarn susceptible groups• Cardiovascular instability requiring light anaesthesia.• Open-heart surgery.• Caesarean section.• Trauma surgery.• Obesity.• Alcoholism.148 Anaesthetists Handbook January 2010
Awareness during anaesthesiaPrevention• Check equipment, be familiar with the ventilator.• If prolonged intubation attempts, maintain anaesthesia.• Avoid mismatch of inexperienced anaesthetist with sick patient.Professionalism• When the patient is anaesthetised avoid derogatory remarks.• Avoid personal comments.• Maintain vigilance in monitoring physiological parameters.Damage limitation• If awareness is suspected during the operation talk to the patientimmediately.• Reassure them and apologise.• Maintain reassurance in recovery and on the ward.Debriefing• Visit the patient with another senior anaesthetist.• Believe the patient.• Be frank, be open and apologise.• Try and explain the cause of the awareness.• Listen to the patient’s account of events.• Validate every aspect of the account putting the events intocontext.• Get the patient to write down their experience before the nextvisit.Anaesthetists Handbook January 2010 149
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Department of AnaesthesiaAnaestheti
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Document control for approved clini
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ContentsTrauma list anaesthetist (t
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ContentsStudy leave 81Junior doctor
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ContentsIndications for investigati
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ContentsRenal patients - clinical g
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Introduction and scope of guideline
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Introduction and scope of guideline
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Airway assessmentManaging difficult
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Managing difficult airways• Flexi
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Managing difficult airways• Manuj
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Resuscitation - advanced life suppo
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Resuscitation - advanced life suppo
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Duties of the on call anaesthetists
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Getting senior helpGetting senior h
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On call casesGetting senior helpYou
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Supervision for sick patientsGettin
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Calling the senior resident anaesth
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Perianaesthesia Care Unit (PACU)PAC
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PACUThe surgical team responsible f
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PACU6. Oxygen and intravenous thera
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Integration with the critical care
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Inter-hospital transfersInter-hospi
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Inter-hospital transfersConsultant
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Signing onAdministrative issuesYour
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Administrative issuesMobile phones
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Administrative issuesobstetrics, we
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Administrative issuesMain theatre r
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CLWrota processes• To complete ca
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Security rules:• Do not put confi
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Education and trainingthe Royal Col
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Education and trainingthe necessary
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Education and trainingarrive in the
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Education and traininginformation c
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Education and trainingexamination i
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Education and trainingAll consultan
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Presenting at seminars• Bring har
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Presenting at seminarsDOI advise yo
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Clinical adverse event reportingCli
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Clinical auditClinical audit[Apprai
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Clinical auditYour presentation sho
Page 97 and 98: Pain management and postoperative c
Page 121 and 122: Signs and symptomsAgitation, anxiet
Page 123 and 124: Epidural anaesthesia and analgesiaP
Page 125 and 126: Epidural anaesthesia and analgesiai
Page 127 and 128: Epidural anaesthesia and analgesiaS
Page 129 and 130: IndicationsEpidural anaesthesia and
Page 131 and 132: Epidural anaesthesia and analgesiaH
Page 133 and 134: Assessment and treatment optionsEpi
Page 135 and 136: Epidural anaesthesia and analgesia3
Page 137 and 138: Epidural anaesthesia and analgesia
Page 139 and 140: Epidural anaesthesia and analgesiaA
Page 141 and 142: Epidural anaesthesia and analgesiaG
Page 143 and 144: Allergies and adverse drug reaction
Page 145 and 146: Allergies and adverse drug reaction
Page 147: Allergies and adverse drug reaction
Page 151 and 152: Fractured neck of femur:management
Page 153 and 154: Fractured neck of femurGuidelines f
Page 155 and 156: Management of patients with diabete
Page 157 and 158: Patients who take insulinManagement
Page 163 and 164: Preoperative assessment and investi
Page 167 and 168: Indications for investigationsFull
Page 171 and 172: SevofluraneSevoflurane[Dr Mark Port
Page 173 and 174: Sevofluranemust be considered on it
Page 175 and 176: Gabapentin in acute painSide-effect
Page 177 and 178: Blood and blood productsBlood and b
Page 179 and 180: Blood and blood productsWhen the un
Page 181 and 182: Blood and blood productsCross match
Page 183 and 184: Blood and blood productsBlood Cool
Page 185 and 186: Blood and blood productsHaematology
Page 187 and 188: Blood and blood products25322 so th
Page 189 and 190: Blood and blood productsfactors, ha
Page 191 and 192: Day case anaesthesia6. Social crite
Page 193 and 194: ENT anaesthesiaENT anaesthesia{Dr C
Page 195 and 196: ENT anaesthesiaIntraoperative• In
Page 197 and 198: Miscellaneous issuesMiscellaneous i
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Miscellaneous issuesideally be cont
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Miscellaneous issuesinstruction man
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Miscellaneous issuesRemifentanilRem
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Miscellaneous issuesCentral neuraxi
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Miscellaneous issuesAnalgesia Fenta
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Miscellaneous issues• Diclofenac
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Miscellaneous issues• Associated
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Miscellaneous issues• Everyone wi
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Miscellaneous issues• If fasting
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Miscellaneous issueslabour ward ana
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Miscellaneous issuesThere is no cli
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Patient monitoring in and out of th
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Miscellaneous issuessuch as Hartman
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Miscellaneous issues• Abdominal a
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Miscellaneous issuesPrevention of p
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Miscellaneous issuesDifferent clini
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Recovery and patient handoverMiscel
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For afternoon list (pm)Diabetic Pat
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Miscellaneous issuestake part in th
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Miscellaneous issuesSee page 37 for
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Waiting list initiatives[Appraised
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Major Incident ProcedureStaff assem
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Major Incident Procedure• In coop
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Finding your way round theUniversit
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• Coffee room.• Quiet room (fiv
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Anaesthesia department lead clinici
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Trust organisational structureTrust
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Telephone numbersLabour ward……
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IndexIndexAabsence, 68adenotonsille
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Indexemergency department, 222emerg
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Indexmortality review, 93MRI scansa
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Indexstudy leave, 81applications, 6
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NotesAnaesthetists Handbook January
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NotesAnaesthetists Handbook January
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