1. Given a patient about to undergo surgery, the student will demonstrate an understanding of the anesthetic considerations for a variety of medical conditions and perform the appropriate/necessary preoperative assessment/preparation of the patient.

• obtain and record pertinent medical history

• perform a focused physical examination including assessment of the airway, the respiratory and cardiovascular system, and other systems as indicated by the clinical situation.

• interpret basic laboratory data and investigations relevant to the perioperative assessment

• develop and problem list and assign appropriate physical status.

• recommend appropriate pre-medication (eg. aspiration prophylaxis) and recognize which medications to hold preoperatively (eg.  anticoagulants)

• state recommended preoperative fasting guidelines, list risk factors for perioperative aspiration and describe risk reduction strategies

2. Given a perioperative patient, the student will assess their volume status and describe appropriate fluid and blood component therapy.

• recognize and describe the physiologic and pathologic routes of fluid losses and be able to estimate these losses

• assess a patient’s volume status using history, physical exam and lab investigations

• demonstrate an understanding of the composition of commonly available intravenous fluids by selecting appropriate perioperative fluid and electrolyte replacement, while taking into account the patient’s deficits, maintenance requirements and ongoing losses

• insert a peripheral intravenous catheter

• state the indications and complications of the various blood products and describe the factors influencing decision making/thresholds to administer blood product therapy

3. The student will recognize and describe the main drug classes frequently used in peroperative period.

• describe the main therapeutic effects, side effects and contraindications of the following classes of medications:

  • • Benzodiazepines - midazolam, lorazepam
    • Anticholinesterase and anticholinergics - neostigmine, glycopyrrolate, atropine sulfate
    • Opioids agonists & antiagonists - fentanyl, morphine, hydromorphone, naloxone
    • Induction agents - propofol, ketamine
    • Inhalational agents - desflurane, sevoflurane, isoflurane, nitrous oxide
    • Local anesthetics (lidocaine, bupivacaine - including maximum recommended dosage)
    • Muscle relaxants - succinylcholine, rocuronium
    • NSAIDS - ibuprofen, naproxen
    • Vasoactive medications - ephedrine, epinephrine, phenlyephrine, norepinephrine
    • Antiemetics - dimenhydrinate, ondansetron, metoclopramide, diphenhydramine

  • recognize the signs and symptoms of local anesthetic toxicity and outline initial management

4. Given a patient presenting with acute pain the student will review and describe the principles of acute pain management.

• identify and describe a variety of modalities commonly used for pain control

• explain the concept of multimodal analgesia

5. Given an unconscious patient, student will demonstrate the ability to manage the airway and vetilation of an unconscious patient.

• label the basic structures of the oropharyngeal and laryngo-tracheal anatomy

• state the indications and complications of airway management by laryngeal masks, face mask and intubation

• identify the appropriate sizes of laryngeal masks, face masks, oral and nasal airways, laryngoscope blades and endotracheal tubes

• independently demonstrate bag-mask ventilation of an unconscious patient

• recognize upper airway obstruction and independently demonstrate appropriate use of face mask, oral and nasal airways, head positioning, jaw thrust and chin lift maneuvers

• successfully prepare appropriate equipment for intubation

• position and intubate a patient with minimal supervisory intervention

• correctly identify (within 15 seconds) those patients in whom endotracheal intubation was not successful

• recognize need for intubation/controlled ventilation using a combination of clinical circumstances, physical signs, and lab results

1. Demonstrate a commitment to patient care that emphasizes the best interests of the patient.
2. Recognize a patient’s right to confidentiality, privacy, and autonomy, and treats patients and families with compassion and respect.
3. Seek assistance appropriate to the needs of the clinical situation while taking into consideration one’s own experience and knowledge.
4. Address ethical issues relevant to entry level rotations with direct supervision
5. Accept constructive feedback, but occasionally demonstrate resistance to feedback

1. Share health care information about the anesthesia encounter orally with other members of the health care team to optimize further care, patient safety and privacy

• communicate patient status to supervisors and other providers effectively, including hand offs and transitions in care.

• present preoperative assessment in a clear, concise and complete format in a timely manner

1. Work effectively with physicians and other health care professionals.

• understand the high level of collaboration (anesthesia, surgery, nursing, pharmacy, anesthesia assistants, and respiratory therapists) required for the effective management of the patient in the perioperative period

1. Identify and take action where possible on the determinants of health that pose barriers to achieving the best possible health outcomes.

• understand the risk factors that lead to increased perioperative risk and how anesthesiologists can assist in modifying these risks in the perioperative period