I Preanesthetic Evaluation
A The student shall acquire an appreciation of the Anesthesiologist's considerations in preoperative evaluation of the patient. This is demonstrated by:
1 Conduction several preanesthetic assessments, including
a Taking and recording a pertinent history
i Must turn in 2 Case Planning reports
b Performing an appropriate physical examination, including assessment of:
i airway – Miller Ch. 12
ii cardiovascular system – Bates Ch. 8
iii respiratory system – Bates Ch. 9
iv other systems as indicated
c Reviewing pertinent laboratory data
d Assigning appropriate ASA physical status – Miller Ch. 9
2 Discussing how the following factors may influence the patient's course during the perioperative period:
(Sample case discussions in OR)
a Age
b Nature of surgery, including minor versus major, peripheral versus central, and elective versus emergent
c Cardiovascular disorders, including but not limited to:
coronary insufficiency
hypertension
myocardial failure
dysrhythmias
d Respiratory disorders
known or suspected difficult intubation
upper and/or lower respiratory infection
asthma
chronic obstructive pulmonary disease
lab work-up
e Central nervous system disorders
increased intracranial pressure
convulsive disorders
cerebrovascular insufficiency
quadriplegia or paraplegia
f Gastrointestinal disorders
pulmonary aspiration risks
hiatal hernia/gastro-esophageal reflux/full stomach
functional or mechanical bowel obstructions
hepatitis, hepatic insufficiency, portal hypertension
g Renal insufficiency and electrolyte abnormalities
h Hematologic disorders
anemias
coagulopathies
hemoglobinopathies
i Personal or family history of unusual response to anesthesia
malignant hyperthermia susceptibility
abnormal succinylcholine metabolism
j Lifestyle factors
obesity
substance abuse - tobacco, alcohol, chemicals
k Pregnancy
concomitant surgery
pre-eclampsia and eclampsia
3 Discussing medication histories and the influence of chronic and current medications on the perianesthtic period, including:
a Which drugs should be discontinued and why
Do monoamine oxidase inhibitors pose a potential danger?
The rebound phenomena resulting from abrupt discontinuation of some classes of drugs, notably beta blockers, and clonidine
b Approaches to perioperative management of patients taking insulin or anticoagulants
c Do they affect MAC?
II Preoperative Medication (Fill out Drug Chart)
A 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 Amnesia
4 Analgesia
5 Drying secretions
6 Reducing gastric acidity and volume
B The student shall demonstrate knowledge of the basic pharmacology and pharmacokinetics of the following premedication agents, including dosage schedules and relative and absolute contraindications:
1 Narcotics
a Morphine
b Meperidine
c Others
2 Sedatives
a Benzodiazepines: Midazolam
b Antihistamines: Benadryl
c Barbiturates: Thiopental
d alpha-2 agonists: Dexmedetomidine
3 Anticholinergics
a Atropine
4 Drugs used to reduce the incidence or consequences of pulmonary aspiration
a H2 antagonists
b Antacids
C NPO guidelines:
1 Fasting periods (assuming no risk for increased gastric emptying time)
a Adults
2 hours clear liquids
6 hours for solids
b Pediatrics
2 hours clear liquids
4 hours breast milk
6 hours formula, non human milk, solids
8 hours or more for full meal
2 Definition of clear liquids
Water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee
III The Operating Room
A The student will demonstrate knowledge of procedures and observe induction of
Anesthesia:
1 Identify several agents used on induction of general anesthesia and give their advantages and disadvantages: (fill out drug chart)
a Intravenous agents
b Inhalation agents
c Neuromuscular blocking agents
2 Discuss emergency intubations, indications, techniques, and complications; concentrate on aspiration prophylaxis
3 Observe and practice airway management during several uncomplicated intravenous inductions
B The student will demonstrate proper airway and ventilatory management by:
(see articles on airway management and chapter in Miller)
1 Describing the indications, risks and benefits of airway management by mask versus intubation versus laryngeal mask airway (LMA)
2 Describing and identifying basic oropharyngeal and laryngotracheal anatomy
3 Identifying and overcoming upper airway obstruction with mask ventilation, using
a Various masks
b Jaw thrust
c Nasopharyngeal airway
d Oropharyngeal airway
4 Naming several techniques of intubation and practicing direct laryngoscopy
5 Understanding principles of airway complications and difficult airway management.
C In order to demonstrate understanding of the principles and practice of routine intraoperative monitoring, the student will: (Questions for OR discussions)
1 Explain and demonstrate ECG lead placement and selection to optimize detection of dysrhythmias and ischemia
2 Indications and risks for invasive methods for monitoring blood pressure
3 Demonstrate results of arterial blood gas analysis in terms of: (acid-base article)
a Oxyhemoglobin dissociation curve
b Acid-base status
D Student will prescribe and conduct appropriate intraoperative electrolyte and fluid therapy with the guidance of his instructor by:
1 Explaining the rationales for establishing both central and peripheral venous access
2 Identifying the common sites for venous access and the contraindications and indications for each
3 Demonstrating skill at establishing venous access by:
a Using sterile technique and universal precautions
b Successfully inserting several peripheral catheters of various calibers
c Protecting the venipuncture site and immobilizing the catheter
4 Prescribing maintenance fluid and blood transfusion:
a Predicting how the following preoperative conditions will alter requirements for perioperative maintenance therapy:
1 NPO (adults and children)
2 Bowel prep
3 NG suction
4 Fever
b Discussing intraoperative considerations which after maintenance fluid and electrolyte therapy including:
1 Blood loss
2 "Third space" loss
3 Temperature
c 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
d 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
E The student shall identify several position-related injuries that patients may sustain while unconscious
F The student will discuss methods of recognizing and treating various perioperative problems, including: (see Questions/Scenarios)
1 Dysrhythmias
2 Ventricular dysfunction
3 Hypertension
4 Myocardial ischemia
5 Low oxygen saturation
6 Hypercarbia
7 Endobronchial intubation
8 Esophageal intubation
IV Neuraxial/Regional Anesthesia
A 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: (Miller Ch. 7)
a Topical use
b Local infiltration
c 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 vs. "allergic reaction"
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
7 Contrasting allergic reactions to systemic and/or toxic reactions in local anesthetics
8 Have a basic understanding of neuraxial/regional techniques and rationale for use (Miller Ch 13-14)
V Post operative pain management
A The student will demonstrate knowledge of the different types of pain management, including:
1 PCA
2 Epidural catheters
3 Prn vs round-the clock dosing
4 PO medications
a Narcotics
b Acetaminophen w/wo codeine
c Ketorolac
d N-SAIDS
B The student will demonstrate knowledge of assessing post-op pain
1 Pain scales
2 Visual analog scales VI Post Operative nausea and vomiting (PONV)
A The student will demonstrate knowledge of current PONV management. VII The student should successfully complete basic CPR and ACLS training during medical school. | 
