Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issues• Pressure points should be protected.• For GA preoxygenation is almost always indicated and is moreeffective in the reverse Trendelenburg position.• Difficult intubation equipment should be at hand andanaesthetist should be familiar and skilled with their use.• Patients with predicted difficult airway should be anaesthetisedin the University Hospital.• For super-obese (BMI >50) patients a second anaesthetistshould assist.• Regional technique should be preferred whenever possible toavoid postoperative respiratory complications.Recovery and the postoperative period• If possible, all patients should be recovered in the semirecumbentor sitting-up position.• Postoperative oxygen therapy should be continued as long asneeded and pulse oximetry may be advised for 24 hours.• It is advisable to avoid opioids and use non-opioid analgesics,nerve or regional block and local infiltration for painmanagement.Obstetric anaesthesia – new registrars and locums[Appraised by Dr John Elton, January 2008]All non-consultant anaesthetists must spend at least one supervisedsession in the labour ward with a consultant anaesthetist or a postfellowshiptrainee before working without direct supervision as the oncall labour ward anaesthetist. Service lists may be cancelled to allowthis introduction to working facilities, practices and duties.Locum anaesthetists are not normally employed in obstetricanaesthesia. If employed, they should not commence work as the216 Anaesthetists Handbook January 2010