Bare Bones Anaesthesia: A guide for medical students

By Adam Arshad, Pooja Devani, Sonika Sethi and Arjuna Thakker

A one-stop full-colour resource which provides tailored, guideline-specific information to prepare you for your medical school examinations.

Bare Bones Anaesthesia is an exciting new text appropriate for the level of a medical student to excel in their medical school examinations. It contains all the core information you need to know and includes important MCQ and OSCE tips for those tricky situations that examiners attempt to catch medical students out on. These are highlighted throughout the textbook to emphasize their importance for your learning and to focus your understanding.

Written by a team of junior doctors, who have recently been through medical schools, the book gives you the essential information in an easy-to-use format.

• Language: English
• Publisher: Scion Publishing
• Release date: Mar 3, 2024
• ISBN: 9781914961458

Book preview

Cover: Bare Bones Anaesthesia, A Guide For Medical Students by Adam Arshad, Pooja Devani, Sonika Sethi, Arjuna Thakker, Nicholas Marsden and Simran Minhas

Anaesthesia

A GUIDE FOR MEDICAL STUDENTS

Adam Arshad, BSc (Hons), MBChB (Hons), PgCert (MedEd), MRCSEd, FHEA

ST2 Trauma and Orthopaedics Academic Clinical Fellow – University Hospitals Coventry and Warwickshire

Pooja Devani, iBsc (Hons), MBChB

ST3 Paediatrics Academic Clinical Fellow – University Hospitals Leicester

Sonika Sethi, iBsc (Hons), MBBS, MRCP

ST3 Gastroenterology Academic Clinical Fellow – Chelsea and Westminster Hospital

Arjuna Thakker, BSc, MBChB, MRCSEd, PgCert (MedEd)

CT1 Plastic Surgery – The James Cook University Hospital

Nicholas Marsden, BSc, MBBS, PgCert (MedEd), FRCA, MSc

ST7 Anaesthetic Trainee, West Midlands Deanery

Simran Minhas, MBBS, FRCA, PgCert Keele (Clinical Leadership)

Consultant Anaesthetist, Royal Orthopaedic Hospital Birmingham

Logo: Scion Publishing Ltd

© Scion Publishing Ltd, 2024

First published 2024

All rights reserved. No part of this book may be reproduced or transmitted, in any form or by any means, without permission.

A CIP catalogue record for this book is available from the British Library.

ISBN 9781911510987

Scion Publishing Limited

The Old Hayloft, Vantage Business Park, Bloxham Road, Banbury OX16 9UX, UK

www.scionpublishing.com

Important Note from the Publisher

The information contained within this book was obtained by Scion Publishing Ltd from sources believed by us to be reliable. However, while every effort has been made to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the authors or publishers.

Readers are reminded that medicine is a constantly evolving science and while the authors and publishers have ensured that all dosages, applications and practices are based on current indications, there may be specific practices which differ between communities. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practising.

Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention.

Registered names, trademarks, etc. used in this book, even when not marked as such, are not to be considered unprotected by law.

Cover design by Andrew Magee Design

Typeset by Evolution Design & Digital Ltd (Kent)

Printed in the UK

Last digit is the print number: 10 9 8 7 6 5 4 3 2 1

Contents

Preface

About the authors

Abbreviations

Chapter 1 – Principles of anaesthesia

1.1 General anaesthesia – the basics

1.2 Induction agents

1.2.1 Intravenous and intramuscular induction agents

1.2.2 Inhaled induction agents

1.3 Analgesics

1.4 Neuromuscular blockers

1.4.1 Depolarising agents

1.4.2 Non-depolarising agents

Chapter 2 – Preoperative assessment and planning

2.1 A– theAnaesthetic history

2.2 A–Airway planning

2.3 B–Bloods and investigations

2.3.1 Patient fitness

2.3.2 Surgical grade

2.3.3 Other investigations

2.4 C–Comorbidities: medication management

2.4.1 Diabetic medications

2.4.2 Steroids

2.4.3 Anticoagulation and antiplatelet medications

2.4.4Oral contraceptive pill

2.4.5Anti-epileptic and Parkinson’s medications

2.5 D–Drugs to provide

2.5.1 Analgesia

2.5.2 Antacids

2.5.3 Anxiolytics

2.6 D–DVT/VTE prophylaxis

2.6.1 Risk assessment

2.6.2 Methods of providing VTE prophylaxis

2.7 E–Entering surgical recovery

2.8 F–Fasting

2.9Safety – conducting the WHO surgical checklist

2.9.1 Prior to induction – sign-in

2.9.2 Before skin incision – time out

2.9.3 Before the patient leaves the operating room – sign-out

Chapter 3 – Conducting anaesthesia

3.1 Induction of anaesthesia

3.1.1 Rapid sequence induction

3.2 Maintenance anaesthesia

3.3 End of anaesthesia

3.3.1 Enhanced recovery after surgery

Chapter 4 – Airway management

4.1 Airway adjuncts

4.1.1 Oropharyngeal airway

4.1.2 Nasopharyngeal airway

4.2 Supraglottic airway devices

4.2.1 Laryngeal mask airway

4.2.2 i-gel airway device

4.3 Subglottic airway devices

4.3.1 Endotracheal tube

4.3.2Tracheostomy and cricothyroidotomy

Chapter 5 – Complications in anaesthesia

5.1 Anaphylaxis

5.2 Aspiration of gastric contents during anaesthesia

5.3 Atelectasis

5.4 Awareness during general anaesthesia

5.5 Bronchospasm

5.6 Laryngospasm

5.7 Malignant hyperthermia

5.8 Suxamethonium apnoea (pseudocholinesterase deficiency)

5.9 Shivering ± hypothermia

Chapter 6 – Local anaesthesia

6.1 What is local anaesthesia?

6.2 Types of local anaesthesia

6.3 Complications of local anaesthesia

Chapter 7 – Regional anaesthesia

7.1 Peripheral nerve blocks

7.1.1 Types of peripheral nerve block

7.2 Neuraxial anaesthesia

7.3 Epidural anaesthesia

7.3.1 Clinical uses of epidural anaesthesia

7.3.2 Complications of epidural anaesthesia

7.4 Spinal anaesthesia

7.4.1 Complications of spinal anaesthesia

Chapter 8 – Postoperative complications

8.1 Postoperative nausea and vomiting

8.1.1 Prevention of PONV

8.2 Other postoperative complications

8.2.1 Postoperative haemorrhage

8.2.2 Postoperative urinary retention

8.3 Postoperative pyrexia

8.3.1 Postoperative pneumonia

8.3.2Pulmonary atelectasis

8.3.3Surgical site infection

8.3.4Anastomotic leak

8.3.5Deep vein thrombosis and venous thromboembolism

8.3.6Postoperative pulmonary embolism

Chapter 9 – MCQs and OSCE scenarios

9.1 MCQs

9.2 OSCE scenarios

9.3 Case-based discussions

9.3.1 Left-sided primary total hip replacement

9.3.2Left inguinal hernia repair

9.3.3Total hysterectomy: open procedure

9.4 Answers to MCQs

9.5 Answers to OSCE scenarios

References

Figure acknowledgements

Index

Preface

What should I use to learn this medical specialty… I don’t really know what I’m required to learn and to what depth I should learn the content as a medical student?

The above question is one that as medical students, we have all faced at medical school. The same challenge occurred each year: we had fifteen new and tricky specialties to learn for our examinations, an essay due in a week and we were required to attend placement daily to practise for those dreaded OSCEs. On top of this, we had to maintain some degree of a social life to prevent us from going insane from all this work and stress!

As medical students, we authors decided that this must change. Specifically, we realised that the current resources for medical students to efficiently and effectively learn medical and surgical specialties were not appropriate. This was especially true in the field of anaesthetics. We were tired of wasting our time in the search for appropriate resources to learn the required content. Therefore, we needed a one-stop resource that provided tailored, guideline-specific information to prepare us for our medical school examinations.

By putting our revision notes together, we formed this textbook – Bare Bones Anaesthesia. We believe it achieves this goal, in providing knowledge of anaesthetics based on guidelines and evidence, appropriate for the level of a medical student to excel in their medical school examinations. Furthermore, we have incorporated our own experience of tricky MCQ and OSCE scenarios that examiners attempt to catch medical students out on. We have highlighted these specifically throughout the book to emphasise their importance for your learning and to focus your understanding.

We hope that this book stimulates your interest in anaesthetics, such that if you are interested in learning more about the specialty, it has provided you with the basic understanding to carry your learning forward. Alternatively, if you have little interest in the field of anaesthetics, and just want to pass your examinations, this textbook is the perfect aid for you to surpass your medical school requirements and comfortably conduct your career as a foundation doctor. Overall revising does not need to be challenging, especially when you have the right resources by your side.

Adam Arshad

Pooja Devani

Sonika Sethi

Arjuna Thakker

About the authors

Adam Arshad is an ST2 Academic Clinical Fellow in Trauma and Orthopaedics. He has a personal interest in medical education, having completed his PgCert in Medical Education at Newcastle University and published his final coursework on Virtual Reality in Orthopaedics. He is passionate about improving the resources available for medical students to learn specialties, and hopes this book can be a valuable resource for individuals at any stage of their training.

Pooja Devani is a Paediatric Specialist Trainee and Academic Clinical Fellow at the University of Leicester. Pooja has a vast range of teaching experiences from organising local teaching in her hospital, to academic skills courses nationally as part of her company Step2Med. Most popularly, she runs Step2SFP and Step2ACF annually for all applicants to the academic training programmes. She is passionate about improving training for medical students and junior doctors, and piloted the first teaching programme formalised by the University of Leicester in an attempt to equip final year students with clinical insights that may have been missed due to the pandemic. In addition, she is a keen researcher in childhood asthma and is leading several projects looking into uncontrolled asthma and diagnosis of this in childhood.

Nick Marsden is an ST7 in Anaesthetics in the West Midlands Deanery. His interests include paediatric anaesthesia, human factors and ergonomics. He has been involved in medical education for over ten years, during which time he has developed several award-winning simulation courses. He is keen for medical students to have greater exposure and understanding of Anaesthesia before becoming doctors, as it is the best specialty you could ask for, and we want more people to love it too!

Simran Minhas is a Consultant Anaesthetist and Senior Academy Tutor for undergraduate perioperative medicine at the Royal Orthopaedic Hospital in Birmingham. The ROH is a single specialty surgical hospital, which is uniquely placed to provide a vantage point for anaesthesia and perioperative medicine, given the complex operations it provides on all patients without specialty physicians on site.

Simran qualified in London from King’s College School of Medicine and has pursued a career in anaesthesia across several regions in the UK and Sydney, Australia. She is passionate about the integrity of clinical leadership and hence believes that undergraduate students are the key to leading change and innovation.

As a