A typical day as a novice
Getting started – a typical day as a novice
The day before...
If this is a Sunday or a non-working day, then don’t worry so much. If you are in work, find out how your theatre lists are scheduled and if you need electronic access. Many theatre receptions have paper copies printed for the following day. Your supervisor for tomorrow's list might be in work today, if so you can discuss the cases with them and what learning opportunities may arise. Crucially, find out where patients get admitted to the morning of surgery, or if you are doing an emergency list, where the surgical inpatient ward or ambulatory care area is.
Many patients arrive to hospital the morning of their surgery, and there is competition for time with them between the nursing, surgical and anaesthesia teams. If the first patient isn’t free, try seeing the others and circling back later. If you haven’t taken an anaesthetic preassessment history, then chat with your supervisor about observing them for the first few patients. As in all of medicine, there are many ways of taking an anaesthetic history and it takes time to develop a way you prefer.
Preparations in theatre
This might be in an anaesthetic room but some newer theatres no longer have dedicated anaesthetic rooms.
The anaesthetic assistant on your list may be either an Operating Department Practitioner or an Anaesthetic Nurse. They may be familiar with the surgeon and supervising anaesthetist so may have already done some preparation.
If you know what drugs need to be drawn up then you can start getting some things ready but if you are uncertain, it is absolutely fine to wait.
Checking the machines is a vital skill to practice and now is the perfect time before the team brief.
Part of the 5 steps to safer surgery, and a mandatory exercise outside of a truly time critical lifesaving surgery.
Each member of the team in theatre that day should introduce themselves by their first name and role. The person leading the brief will then run through the patients in the list, confirming the anaesthetic and surgical plans, as well as checking on bed status and equipment availability.
There is always a pressure to “send” for a patient to be brought to theatre. When they arrive they will need to be checked in, where crucial identity and safety checks are confirmed with the patient such as nature and site of surgery. This may be in theatre reception or in the anaesthetic area of your theatre.
Being new to any specialty it’s hard not to link your mood to the most recent success or failure at a practical skill – and in anaesthesia this is likely to be the cannula or the intubation. Both of these take time to master, particularly when you have an audience in the form of an experienced anaesthetic assistant and medical supervisor.
The patient may already be on the operating table or you may have to transfer them anaesthetised into theatre, the WHO “time out” takes place before knife to skin.
Anaesthesia is famous in specialty training for the amount of one-on-one supervisor time you get. It’s a great opportunity to discuss and reflect on the cases so far as well as anything that has come up in your first few weeks. Catching up on logbook and SLEs if time allows is helpful, but getting a feel for the rhythm of theatres is also important, including any critical steps or moments in a given surgery. Your supervisor may offer you a break, there is rarely a good reason to refuse this offer. An appropriate amount of time is how ever long it takes to make and drink a cup of coffee whilst chatting to colleagues in the coffee room.
Waking the patient up…
This can be a stressful moment and it will take a little time before you get a feel for when the best time to extubate someone is. In general, if you are in doubt, wait a bit longer for your chosen anaesthetic to subside. Your supervisor should always be there or available should you need them.
Lists should end with a team debrief but this can sometimes be hard if there have been time pressures. It’s a chance to talk about the achievements of the team and anything that could be addressed next time.
The novice period is one of continuous feedback from supervisors and it can get a little overwhelming, particularly if they give contradicting advice! There is always more than one way of giving a safe anaesthetic, and the beauty of anaesthesia as a specialty is that you get to see such diversity between your supervisors. It might seem frustrating to begin with, but it allows you to build up an arsenal of anaesthetic methods.