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Anesthesia Addendum

    1. Preanesthetic Evaluation
      1. The student shall acquire an appreciation of the Anesthesiologist's considerations in preoperative evaluation of the patient. This is demonstrated by:
        1. Conducting several preanesthetic assessments, including
          1. Taking and recording a pertinent history
          2. Performing an appropriate physical examination, including assessment of:
            • airway
            • cardiovascular system
            • respiratory system
            • other systems as indicated
          3. Reviewing pertinent laboratory data
          4. Assigning appropriate ASA physical status
        2. Discussing how the following factors may influence the patient's course during the perioperative period:
          1. Age
          2. Nature of surgery, including minor versus major, peripheral versus central, and elective versus emergent
          3. Cardiovascular disorders, including but not limited to:
            • coronary insufficiency
            • hypertension
            • myocardial failure
            • dysrhythmias
          4. Respiratory disorders
            • known or suspected difficult intubation
            • upper and/or lower respiratory infection
            • asthma
            • chronic obstructive pulmonary disease
            • lab work-up
            • interpretation of blood gases
          5. Central nervous system disorders
            • increased intracranial pressure
          6. Hematologic disorders
            • anemias
          7. Personal or family history of unusual response to anesthesia
            • malignant hyperthermia susceptibility
            • abnormal succinylcholine metabolism
          8. Lifestyle factors
            • obesity
            • substance abuse - tobacco, alcohol, chemicals
        3. Discussing medication histories and the influence of chronic and current medications on the peri-anesthetic period, including:
          1. Which drugs should be discontinued and why
            (The rebound phenomena resulting from abrupt discontinuation of some classes of drugs, notably beta blockers and clonidine)
    2. Preoperative Medication
      1. The student shall demonstrate knowledge of the objectives of effective preanesthesia medication by naming and discussing drugs used for:
        1. Relief of anxiety
        2. Sedation
        3. Analgesia (acute and chronic pain patients)
        4. Reducing gastric acidity and volume
        5. Nausea and vomiting
    3. The Operating Room
      1. The student will demonstrate knowledge of procedures and observe the induction of anesthesia.
      2. The student will identify several agents used on induction of general anesthesia and give their advantages and disadvantages:
        1. Intravenous agents
        2. Inhalation agents
        3. Neuromuscular blocking agents
        4. Opioids
      3. The student will demonstrate proper airway and ventilatory management by:
        1. Observing and practicing airway management during several uncomplicated intravenous inductions
        2. Describing the indications, risks and benefits of airway management by mask versus intubation versus laryngeal mask airway (LMA)
        3. Describing and identifying basic oropharyngeal and laryngotracheal anatomy
        4. Identifying and overcoming upper airway obstruction with mask ventilation, using
          1. Various masks
          2. Jaw thrust
          3. Nasopharyngeal airway
          4. Oropharyngeal airway
      4. In order to demonstrate understanding of the principles and practice of routine intraoperative monitoring, the student will:
        1. Explain and demonstrate ECG lead placement and selection to optimize detection of dysrhythmias and ischemia
        2. Demonstrate results of arterial blood gas analysis in terms of
          1. Oxyhemoglobin dissociation curve
          2. Acid-base status
      5. Student will prescribe and conduct appropriate intraoperative fluid and electrolyte therapy with the guidance of his instructor by:
        1. Identifying the common sites for venous access and the contraindications and indications for each
        2. Demonstrating skill at establishing venous access by:
          1. Using sterile technique and universal precautions
          2. Successfully inserting several peripheral catheters of various calibers
          3. Protecting the venipuncture site and immobilizing the catheter
        3. Prescribing maintenance fluid and electrolytes
          1. Predicting how the following preoperative conditions will alter requirements for perioperative maintenance therapy:
            1. NPO
            2. Bowel prep
            3. NG suction
            4. Fever
          2. Discussing intraoperative considerations relating to maintenance fluid and electrolyte therapy including:
            1. Blood loss
            2. "Third space" loss
            3. Temperature
          3. Correctly interpreting data from the following monitors of volume status:
            1. Examination of the patient
            2. Pulse and blood pressure
            3. Urine output
            4. CVP
            5. PCWP
          4. Discussing indications, risks and benefits of crystalloid, colloid and blood product replacement therapies:
              1. Regarding the functions of:
                blood volume
                oxygen carrying capacity
                coagulation
              2. Regarding complications of each type of therapy
      6. The student shall identify several position-related injuries that patients may sustain while unconscious
    4. Regional Anesthesia
      1. The student will demonstrate knowledge of local anesthetic pharmacology appropriate to the practice of general medicine by:
        1. Classifying commonly used agents according to amide or ester linkage
        2. Listing commonly used local anesthetics for:
          1. Topical use
          2. Local infiltration
          3. Peripheral nerve blocks
        3. Listing acceptable doses of at least two agents used for topical and local infiltration anesthesia
        4. Describing and identifying signs of impending local anesthetic and/or vasopressor toxicity
        5. Describing therapeutic steps necessary to prevent or treat local anesthetic toxicity in the event of an accidental intravascular injection
        6. Discussing allergic reactions to local anesthetics
    5. Ambulatory anesthesia
      1. The student will demonstrate knowledge of the types of procedures and patients appropriate for ambulatory surgery
      2. The student will demonstrate knowledge of assessment of the ambulatory patient with respect to:
        1. ASA classification
        2. NPO status
        3. Appropriate lab work
        4. Nausea/vomiting prophylaxis
          1. Scopolamine
          2. Dexamethasone,
          3. 5HT3 receptor antagonists
          4. Phenergan
          5. Propofol
          6. Metoclopramide
        5. Discharge criteria
        6. Pain management
    6. Post operative pain management
      1. The student shall demonstrate knowledge of the basic pharmacology and pharmacokinetics of the following opioids, including dosage schedules and relative and absolute contraindications:
        1. Morphine
        2. Hydromorphone
        3. Fentanyl
      2. The student will demonstrate knowledge of the different types of pain management, including:
        1. IV PCA
        2. Epidural catheters
        3. PRN vs round-the clock dosing
        4. PO medications
          1. Narcotics
          2. Acetaminophen w/wo codeine
          3. N-SAIDS, COX-2
      3. The student will demonstrate knowledge of assessing post-op pain
        1. Pain scales
        2. Visual analog scales
      4. The student will demonstrate knowledge of how to convert patient from parenteral drugs to p.o. drugs