Intended for healthcare professionals

Career Focus

Anaesthetics

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.334.7592.s86 (Published 10 March 2007) Cite this as: BMJ 2007;334:s86
  1. Henrik Reschreiter, specialist registrar in anaesthetics
  1. Royal Berkshire Hospital, Reading, henrik.reschreiter{at}web.de

Abstract

Henrik reschreiter raves about his specialty

Welcome to this great specialty. Whichever specialty you have been working in so far, you might find this new start challenging, simply because your everyday routine is completely different.

This article is meant to be a guide with some general tips and suggestions to get you through the first few days or weeks. It is not meant to replace reading textbooks or following the local guidelines.

General

  • Anaesthetics is fun

  • Most anaesthetists are quite nice people, so don't be afraid to approach them

  • You will see your consultants more often than in many other specialties

  • Safety is of paramount importance; this cannot be stressed often enough

  • If you are in doubt, always discuss matters with your seniors, even at night. They expect that.

Theatre

You will start and stay in theatre for the first six to twelve months.

Visit patients yourself

Visit the patients preoperatively yourself; don't rely on your seniors to do so.

  • It will get you in their good books and hence make it more likely that they will teach you

  • It might help to ask your senior how he or she does certain cases beforehand so that you can answer patients' questions and don't have to consent them for a spinal, epidural, general anaesthetic, and regional technique all at once

  • It will help you to understand why a particular anaesthetic technique was chosen

  • Things that are easily forgotten include:

    • — Last food intake

    • — Weight of children

    • — Anticoagulation status if spinal or epidural is planned

    • — Checking all available blood results

  • Always assess the airway preoperatively to avoid unpleasant surprises.

Figure1

Credit: SPACELABS HEALTHCARE/BLEASE MEDICAL

Perioperative care

  • Your anaesthetic nurse (or operating department assistant or practitioner) is your best friend; help them, so that they will help you (for example, clear your own sharps away, tell them what is happening or which technique will be used next, and so on)

  • You will be closely supervised for some time. This is not meant to be patronising; it is for everyone's safety until you are fit to fly solo

  • Become obsessed with attention to detail

  • Check all your equipment before the patient arrives; nothing can be checked too often. So even if the operating department practitioner has already checked the anaesthetic machine, do it again yourself. This is not lack of trust; everyone can miss something and four eyes see more than two. (You will be tested in your primary exam for fellowship of the Royal College of Anaesthetists in this, so if the carrot is not enough, the stick is there as well)

  • Draw up and label drugs before the patient arrives

  • Learn and practise emergency drills early—for example, failed intubation

  • Find out where the resuscitation equipment, defibrillator, and drugs are

  • Keep a logbook of your cases and the procedures from the first day onwards.

Teaching

You have a senior person to yourself all day who can teach you. Which other specialty has that? Use this to a maximum.

  • Don't expect to be spoon fed; show initiative

  • Always ask questions as you go along.

    Not only will it show interest, but the amount of information you soak up is enormous; it will improve your daily practice and help you with exam preparation.

    Tap on their wealth of experience and get the information no book can give you—people say anaesthetics is half art and half science.

  • For more formal teaching, agree on something to talk about in advance and read about it at home so that discussion is more fruitful.

Intensive care

This is usually after six to nine months. Routine day to day practice

  • There are no white rabbits out of hats, just careful medical practice

  • Admissions are usually via the consultant only

  • Consultants expect to be called frequently, even at night; never be afraid to ring them.

  • Ask a lot of questions (see above)

  • Don't be scared of the equipment; ask someone to explain it to you

  • The nurses are an immense source of information and advice. They have done it for much longer than you have, so don't hesitate to ask them what to do sometimes; it is not asking that will make them suspicious of you

  • You are not expected to know everything, so don't pretend you do or be embarrassed to admit you don't

  • Get to know local guidelines.

Cardiac arrest team

  • Although usually asked because of airway management, you often become the team leader as well; try to do an advanced life support course beforehand.

Outreach

  • A lot of patients can be improved with oxygen and fluids alone

  • If you have a dedicated outreach service, spend some time with them

  • Always discuss the case with your consultant after reviewing a patient (even at 4 am).

Nothing can be checked too often. So even if the operating department practitioner has already checked the anaesthetic machine, do it again yourself

Labour ward

This is usually in your second year of training.

General

  • You are often quite isolated from other anaesthetists. Ask for help early on; here, more than ever, it's better to be safe than sorry

  • Many things are done to improve the birthing experience of the mother, but it should never impinge on medical safety

  • If things don't go as planned (for example, insufficient block, dural tap), always be honest with the patient

  • Obstetrics is an area with a high litigation rate; meticulous note keeping is essential.

  • Look up the local guidelines early on

  • Develop a good rapport with the obstetric registrar. He or she is your best source of information about what is going on

  • Good communication and a good working relationship with the midwives are essential.

Epidural troubleshooting

  • If an epidural does not work properly, it needs a review and assessment. If repositioning the catheter slightly or a different strength top-up does not improve analgesia, it is better to admit failure and re-site it than to fiddle for hours; don't forget, the idea is to give the mother adequate analgesia

  • When taking over a shift, find out which epidurals are working and which are troublesome; plan what to do if a section suddenly becomes necessary.

Emergencies

  • True emergencies happen (for example, “crash sections”), but many things are labelled “emergency” when there is more time available (for example, “emergency section” for failure to progress). Always find out the details on what is really happening

  • Try to keep calm (at least on the surface); if the anaesthetist falls apart, the entire team gets a step closer to panic

  • Consider putting the mother on her side if the baby is in distress or the mother is hypotensive (aorto-caval compression is not just something in the books)

  • Never underestimate the chance of encountering a difficult airway; if in doubt, get senior support in time for a section under general anaesthetic

  • Sometimes staff and patients have already agreed what the anaesthetic plan for a patient is without actually consulting anaesthetists or knowing the implications. Assess for yourself and get senior help if you are in doubt; it is your responsibility. Finally, have a great time.

Footnotes

  • Competing interests: None declared.

View Abstract