Typical Viva Questions
Last modified: 28 October 2022, 1:52:36 PM AEDT
How will/would you ASSESS this patient?1 / 8
- The word "assess" MEANS = Hx, Ex, Ix, Consultations
- "In addition to my usual anaesthetic assessment, I would take a focused Hx / Ex along with relevant Ix and Cx"
- I would assess the severity and stability of his ____
- by taking a focused Hx and Ex
- along with relevant Ix and consultations
- I would extend this to his other co-morbidities
- "In addition to my standard anaesthetic assessment".....
- Medical Hx and Ex, Anaes Hx, Airway Ax
- In addition to my usual assessment, I would specifically want to know about.....
- In addition to my usual anaesthetic assessment, I would...
- "In addition to my routine anaesthetic assessment, I would focus on..."
- Assess Severity
- Degree of _____ (eg. respiratory) compromise
- MODIFICATIONS
- In addition to my usual assessment....
- I would take a focused Hx and Ex along with relevant Ix and Cx
- In the Hx and Ex, FOR THIS PATIENT, I am looking for symptoms and signs of...
- In the EXAMINATION, use "Look, Listen, Feel" as a prompt
- Big 4 questions
- ISSUES = what are the issues of this patient having this surgery
- GOALS = what the aims of anaesthesia?
- PLAN = How to achieve these goals?
- PROBLEMS = anticipated problems / complications
How will you prepare?2 / 8
- Logistics
- Inform OT
- "Skilled assistant"
- "Second anaesthetist", eg. for difficult AW
How would you ______? (eg. extubate this patient)3 / 8
- I would go through my usual assessment for .... extubation
- My primary plan would be to...
How will you anaesthetise this patient?4 / 8
-
One example
- I will plan for a general anaesthetic
- Before induction
- At induction
- I would maintain the anaesthetic with
- Postoperatively, I would transfer the patient to ICU
-
I will prepare for a general anaesthetic
-
After assessment and optimisation, I would prepare for a general anaesthetic
- (Think: BAY)
- IV access
- "Standard ANZCA monitoring"
- (Think: OT)
- Drugs = Fentanyl 1 mcg/kg, Propofol 2 mg/kg, Rocuronium 1 mg/kg
- Videolaryngoscope
- Size 7.5 ETT
-
MODIFICATIONS
- My usual technique is....
- But IN THIS PATIENT...
-
"This patient needs a GA"
-
The issues are...
-
"My goals are..."
-
"So, preoperatively, intraoperatively
-
"The choice of anaesthetic technique (GA vs. MAC) should be INDIVIDUALIZED on the basis of the patient’s neurological status and the risk of infection to health care personnel"
-
These are my concerns...
- This is what I'm going to do = my primary plan
- This is why...
- There are other options
-
Given that this patient has AS, my haemodynamic goals are....
-
And I will achieve this by intubating and ventilating the patient
What are the indications / contraindications?5 / 8
- STRUCTURE = Patient / Surgical / Anaesthetic
What are the differentials / causes?6 / 8
- STRUCTURE = Patient / Surgical / Anaesthetic
- And then the SYSTEM
- If you say "hypoglycaemia", you won't think of other causes
- If you say "metabolic" and then "hypoglycaemia", you may be prompted to think of other metabolic causes, eg. electrolyte disturbances etc
How would you manage this crisis?7 / 8
- Attend immediately
- Scan the room and monitoring
- Receive a handover
- Call for help
- Concurrently assess and treat
- Identify and anticipate the most LIKELY causes, esp for THIS PATIENT
- "Re-assess after these initial measures"
- Actual crises
- Need to know these algorithms very well
Why this dose of propofol?8 / 8
- An ADEQUATE dose to facilitate laryngoscopy