Anaesthetics is a decidedly variable speciality. The day-to-day life of an SpR can differ greatly and no two weeks are the same. Currently, anaesthetists work in operating theatres, both elective and emergency, intensive care units, pain management services, peri-operative medicine clinics, obstetric wards… the list goes on. Each area covered by an anaesthetist has its own nuances. I will describe a day in an elective list then a day working on-call.
For an elective day, the day will start at 7.30-8.00AM. You will be assigned to an operating list for the morning and for the afternoon, appropriate for your level of training.
For the majority of patients requiring surgery, they can be seen by an anaesthetist on the day of surgery (although being seen earlier then this has been shown to reduce cancellation rates and improve the results of surgery, for the more complicated surgeries and patients). When I review a patient I am looking for a few specific things, so I don’t need to take a full medical history. I check recent blood results and discuss the anaesthetic plan with the patient, so they know what to expect, as this is probably what they will remember most from their day of surgery.
Lots of patients expect to be put to sleep for even minor surgery, so often an explanation of regional blockade is required. Often patients are anxious or have lots of questions, so I try to do our best to answer them all, so they are calm and understand everything that is about to happen to them. I can only offer anaesthetic techniques that I can perform myself, which is why being assigned to an appropriate list is important. For example, there is little to be gained by assigning me to a list where every patient needs a wrist replacement under regional blockade, as this is not a technique I can accurately perform. If I am working with a consultant or a supervisor or I am on a training list, then I can also offer the techniques of my consultant as part of the anaesthetic (if I know what they are).
Drugs: A Note
Anaesthetic drugs are incredibly dangerous, as they have almost instant profound effects on the patient’s physiology. Before I can give any of the drugs, I must be able to manage all eventualities of the situation. For example, if the patient needs to be paralysed for their surgery, as the anaesthetist I must be able to ventilate the patient, as they will no be able to breathe for themselves anymore. Ventilation frequently required intubation. If I cannot intubate the patient, and cannot oxygenate the patient through other means, then I must gain access to their airway through the front of their neck. An anaesthetist must be willing to do this every time they use a paralysing agent.
Having seen the patients for the morning, I then attend the WHO morning meeting. Here I discuss each patient, and then my anaesthetic plan for the patient. I also start preparing my anaesthetic and checking that all my equipment is functioning. I normally also check where the emergency airway trolley is, as well as who is in charge of the theatre that day so that if I have either an emergency or I need a break, I know who to contact.
End of the Day
If the day goes to plan, then I go see each patient after their operation and make sure it all went as expected as well as give them advice about pain relief. I normally leave work at around 5.30 – 6 PM.
On an on-call day, I will either be assigned to covering operating theatres or ITU. For a theatre day, I must work out how best to prioritise the theatre time. Often, which patient is coming to theatre next is decided very last minute. The anaesthetic will often have to be adjusted if they are septic, or if the patient has had a traumatic injury.
For a day on call in ITU, your day will involve seeing patients on the ward for escalation of treatment, admitting new patients to the ITU and setting up interventions required for their treatment. As well as an extended ward round where each part of the treatment for the patient is examined and questioned to try and make sure the patient will recover the fastest. The day will often involve managing the airway for cardiac arrests or sometimes running the arrest itself. These days will be highly variable depending on what sort of ITU you are covering and what other services your hospital can offer. If your hospital cannot offer the treatment required by the patient, you might need to transport them to one that can.