Novice Guide

Published: 15/08/2019

Pre-assessment

A thorough anaesthetic pre-assessment should be performed on all patients prior to surgery. The aim of pre-assessment is to:

  • establish a good rapport with the patient
  • make sure the patient is fit and optimally prepared for surgery
  • formulate an anaesthetic plan.

You may be expected to assess patients on your list from the start of your training. Initially you will be directly supervised by your consultant. However you will progress to performing uncomplicated preoperative visits by yourself. The following will guide you through the process and direct you to the appropriate educational resources.

Preparation is the key

Try to locate the theatre list early and contact your supervising consultant before any preoperative visits. This allows you to:

  • discuss the patients in detail
  • perform the preoperative visit with more confidence
  • read up on the cases beforehand to take advantage of any learning opportunities.

The preoperative visit

Allow plenty of time to see your patients. It can take longer than you think:

  • take a history, assess the airway and examine the cardiorespiratory system as indicated
  • review any investigations
  • review the notes and any old anaesthetic charts which may contain information about previous anaesthetics
  • make a problem list if you identify any issues
  • formulate an anaesthetic plan.

As a trainee, you should not cancel a patient by yourself. You should discuss any issues with your supervising consultant.

You need to consider:

  • the severity of the problem
  • whether the patient can be improved or optimised prior to surgery
  • whether it is in the patient’s best interest to go ahead or delay the procedure.

The final decision is made by the consultant anaesthetist after discussion with the surgical team.

Associated e-Learning resources:

The anaesthetic plan

An anaesthetic plan is made for each patient undergoing a particular procedure. It depends on specific patient, anaesthetic and surgical factors and involves all aspects of the perioperative period.  

It includes the:

  • type of anaesthetic
  • monitoring required
  • plan for intraoperative and postoperative analgesia
  • prevention of nausea and vomiting
  • fluid management including blood products that may be required
  • methods of temperature control during the procedure
  • postoperative care e.g. high dependency unit or intensive care.

You should try and formulate an anaesthetic plan for each patient you see and discuss it with your supervising consultant. With experience, you will be given increasing responsibility and autonomy to formulate and then put your anaesthetic plan into practice.

Once the plan has been finalised, you must:

  • discuss the options and associated risks with the patient in language they will understand
  • obtain informed consent
  • communicate your plans to the anaesthetic assistant before the start of the list so that they can prepare the required equipment
  • make sure your anaesthetic chart is complete and includes details of your assessment, management plans and risks discussed.
  • prepare the anaesthetic room and theatre.

Associated e-Learning resources: