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