07 / Anaesthesia · Simulation

Give the anaesthetic yourself

Each case is one whole anaesthetic in real order. The monitor moves with your patient, the anaesthetic record fills itself in the way the paper chart does, v for systolic, ^ for diastolic, a dot for the heart rate, drugs annotated the minute they go in, and at the decision points the case waits for you: which drug, what dose philosophy, what next. Wrong answers explain their consequence and the case continues, because this room is for reps.

Photograph: Pöllö, CC BY 3.0, via Wikimedia Commons.

• Emergency laparotomy for perforated viscus

  The full stomach

  A rapid sequence induction for an emergency laparotomy: preoxygenation that has to count, drugs in fixed order, the pressure drop that follows, and a stimulated middle.

  54 y · 80 kg · ASA 3E

  Induce

• Elective laparoscopic cholecystectomy

  A routine list, until it is not

  An elective laparoscopic cholecystectomy: a standard induction, the physiology of blowing gas into an abdomen, and the airway's favourite ambush on waking.

  38 y · 70 kg · ASA 1

  Induce

• Hip fracture fixation (dynamic hip screw)

  The 84-year-old with a hip

  Anaesthesia for a fragility fracture: doses that respect an old circulation, the pressure line that must not sag, heat that must not leak, and a wake-up judged in whispers.

  84 y · 52 kg · ASA 3

  Induce

• Laparoscopic cholecystectomy

  The wheeze at induction

  An asthmatic who missed her inhalers, a tube through a light larynx, and the shark fin on the capnograph: bronchospasm found, treated in order, and the extubation planned so it does not happen twice.

  31 y · 65 kg · ASA 2

  Induce

• Elective caesarean section for breech presentation at 39 weeks

  The spinal for a caesarean

  An elective caesarean under spinal: the dose, the pressor that runs before the pressure falls, the block tested to T4, the oxytocin given slowly, and the uterus that would not contract.

  32 y · 74 kg · ASA 2

  Induce

• Tonsillectomy and adenoidectomy

  The tonsils

  A five-year-old for a tonsillectomy: a gas induction with a parent, the tube sized by the formula, opioid with care for a child who snores, and the laryngospasm at the end that every anaesthetist meets sooner or later.

  5 y · 20 kg · ASA 2

  Induce

Every dose is a teaching value for the printed patient, stated the way a textbook states it. This is not a prescribing reference; real anaesthesia follows your formulary, your seniors, and the patient in front of you.