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SurgSpace

07 / Anaesthesia

The head of the bed

Surgery is two teams working on one patient, and students almost never get taught the other one. This is the whole department, in the order of an anaesthetic: assess, prepare, induce, maintain, wake, recover, and what to do the moment the screen stops looking like this.

Theatre 4 · sevoflurane at 1.0 MAC · 40 minutes in

HR
68
SpO2
99%
NIBP
118/72
EtCO2
4.9 kPa
RR
12
Temp
36.4°

A quiet anaesthetic looks like this. Every room below is about keeping the screen looking like it, and knowing what to do in the first minute when it does not.

Start here

Give an anaesthetic yourself

6 whole cases with live vitals and the record filling itself in: a full stomach, an asthmatic who wheezes at the tube, a spinal for a caesarean, a child who spasms on extubation. Wrong answers explain their consequence and the case goes on.

Induce

Then the crisis drills: 13 algorithms, one hidden step at a time, because reading one is not the same as being able to run one.

An anaesthesiologist in scrubs and mask watches the monitor above the head of the bed during an operation aboard a hospital ship.
The seat at the head of the bed: the surgeons work at one end, the anaesthetist watches the screen at the other.

Photograph: Navy Medicine, Public domain, via Wikimedia Commons.

The department

Every room, in the order of an anaesthetic

  1. 01AssessASA, fasting, risk, the patient's drugs10 patients to grade · 18 drugs to decide
  2. 02AirwayViews, sizes, the four plans, the rapid sequence9 bedside tests · 4 plans
  3. 03Drug cartEvery drug, drawn up for the patient you set35 drugs · 4 trays to prepare
  4. 04Machine checkEvery line, with the failure behind it15 lines
  5. 05VentilationThe capnograph, the ventilator, the nerve stimulator10 traces to read
  6. 06PhysiologyMAC, fluids, bloodMAC by age, the fluid and blood sums
  7. 07RegionalLocal anaesthetic sums, dermatomes, the needle5 local anaesthetics · 10 blocks
  8. 08SimulationWhole anaesthetics, decision by decision6 whole anaesthetics
  9. 09RecoveryThe first hour, and going home12 calls from recovery
  10. 10CrisesThe algorithms, one hidden step at a time13 algorithms
  11. 11TeachingOne anaesthetic, start to finish8 modules

The label language

Know your syringes

Every anaesthetic syringe wears its class as a colour (ISO 26825). Learn the palette here, then prove it in the drill.

Induction agent: Yellow
Benzodiazepine: Orange
Opioid: Blue
Other: White with black text
Muscle relaxant: Fluorescent red
Vasopressor: Violet
Anticholinergic: Green
Local anaesthetic: Grey
+1
9 ISO label colours
Label drillName the class from the colour0/0

Every dose, range and score in this department is a teaching value, printed the way a textbook prints it so the reasoning and the arithmetic can be practised. It is not a prescribing reference. Real anaesthesia follows your formulary, your department’s guidelines, your seniors, and the patient in front of you.