Anaesthetists Handbook - MEDICAL EDUCATION at University ...

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Preoperative assessment and investigationsRespiratory function test pathway for pre-screeningPatients answerpositively torespiratoryquestions or anycardiothoracicpatient.Patients who have hadprevious RFT in previous 2years with no change insymptoms do not routinelyrequire testing. Note on formreason for previous referral.Direct referralPatient has basic spirometry.FEV 1 / FVC < 70%without inhalers.Patient referred to stage two preoperativeassessment for anaesthetic opinion, priorto ordering full RFT testing.170 Anaesthetists Handbook January 2010
SevofluraneSevoflurane[Dr Mark Porter, October 2005; appraised by Dr John Elton, January 2008]Sevoflurane is twenty-one times more expensive than isoflurane.Think before using it and use it on low flow – less than 500 mL perminute. (Desflurane costs twenty-five times as much as isofluraneand should be used with similar attention to economy.)Clinical pharmacologyThe advantage of sevoflurane may be lost if using opiates ormidazolam, as these and other agents may cause postoperativesedation. Using a good regional block for analgesia instead ofsedative drugs will enable faster recovery.Where the duration of anaesthesia will exceed two hours, sevofluranewill not give a different recovery profile to isoflurane.While rapidity of recovery can be proven when comparingsevoflurane with isoflurane in shorter cases, it rarely has anysignificant effect on clinical outcomes, length of stay or list turnover.Do you really have to use it?Sevoflurane inhalational induction is about the same cost as anampoule of propofol, especially where nitrous oxide is used toincrease potency, and cardiorespiratory parameters may be bettermaintained. However, consider whether inhalational induction isnecessary in each case.Clinical indicationsAnaesthetists should consider the clinical indications for usingsevoflurane in every case. Where a specific indication is notapparent, anaesthetists should use isoflurane or another agent.1. Inhalational induction of anaesthesia.2. Maintenance of anaesthesia.Anaesthetists Handbook January 2010 171
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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
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Pain management and postoperative c
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Page 119 and 120: 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
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Page 129 and 130: IndicationsEpidural anaesthesia and
Page 131 and 132: Epidural anaesthesia and analgesiaH
Page 133 and 134: Assessment and treatment optionsEpi
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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 149 and 150: Awareness during anaesthesiaPrevent
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 165 and 166: Preoperative assessment and investi
Page 167 and 168: Indications for investigationsFull
Page 169: Preoperative assessment and investi
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
Page 199 and 200: Miscellaneous issuesideally be cont
Page 201 and 202: Miscellaneous issuesinstruction man
Page 203 and 204: Miscellaneous issuesRemifentanilRem
Page 205 and 206: Miscellaneous issuesCentral neuraxi
Page 207 and 208: Miscellaneous issuesAnalgesia Fenta
Page 209 and 210: Miscellaneous issues• Diclofenac
Page 211 and 212: Miscellaneous issues• Associated
Page 213 and 214: Miscellaneous issues• Everyone wi
Page 215 and 216: Miscellaneous issues• If fasting
Page 217 and 218: Miscellaneous issueslabour ward ana
Page 219 and 220: 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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