the home of anaesthesia in western australia

A FRAMEWORK FOR THE ANAESTHETIST’S KEY CONCERNS

A comprehensive framework for organising your key anaesthetic concerns for a given clinical scenario

PATIENT

Implications of medical comorbidities

  • Assessment of severity, scope for optimisation and perioperative risk
  • Implications of specific comorbidities for specific clinical scenario

Perioperative management of medication

Presence of special population groups

  • e.g. paediatric, obstetric, geriatric, obesity, opioid tolerance, substance abuse

PATHOLOGY

Implications of current pathological process 

  • e.g. shock states, traumatic brain injury, acute airway pathology

PROCEDURE

Implications of planned primary anaesthetic/analgesic technique

  • Requirement for general anaesthesia, possibility of regional anaesthesia
  • Appropriate airway selection e.g. difficult airway, fasting, shared airway, ventilatory control

Implications of surgery on patient risk

  • Physiological effects of surgery e.g. intubation, pneumoperitoneum, airway oedema, positioning
  • Anticipated blood loss, intraoperative crises

Implications of intraoperative surgical requirements

  • e.g. controlled hypotension, immobility

PERSPECTIVE

Implications of location & available resources

  • Limitations of care provision at facility
  • Availability of postoperative specialist support
  • Division of limited resources¬†
  • Outside areas

Day-case anaesthesia

  • Appropriate case selection
  • Appropriate patient selection

Implications of timeframe

  • Adequacy of time to facilitate medical optimisation
  • After hours
  • Order of list

PROFESSIONALISM

Consent issues

  • Cognitive capacity e.g. dementia, adolescent, trauma, trauma, labour

Appropriateness of surgery

  • Futile surgery
  • Advanced care directives

Competencies

  • Own scope of practice
  • Surgical competency/seniority
  • Competency of anaesthetic assistant

Training issues

  • Implications of presence of trainee staff
  • Signs of the trainee in difficulty

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