What anaesthetists actually do

The anaesthetist’s core job (in one line)

• Keep patients safe and comfortable around procedures by managing: unconsciousness/sedation, pain relief, breathing/oxygenation, circulation (blood pressure/heart), and recovery.
• Anticipate problems early, prevent harm, and respond quickly when things change.

Where anaesthetists work

• Operating theatres: general anaesthesia, regional anaesthesia (e.g., spinal/epidural/nerve blocks), sedation, and perioperative medicine.
• Labour ward: epidurals, spinal for caesarean section, managing obstetric emergencies (e.g., major haemorrhage, high blood pressure complications).
• Critical care (ICU): organ support (ventilation, vasoactive drugs), procedures (lines, airway), and complex physiology.
• Emergency department / resus: airway management, trauma, rapid sequence induction (RSI), analgesia, procedural sedation support.
• Pain services: acute pain rounds (post-op analgesia, PCA), chronic pain clinics (selected units).

Before the procedure: assessment and planning

• Meet the patient, confirm identity, procedure, and consent status; check allergies and previous anaesthetic problems.
• Assess airway (how easy it might be to ventilate/intubate), breathing, heart/circulation, and key comorbidities (e.g., asthma/COPD, ischaemic heart disease, diabetes).
• Review fasting status and aspiration risk; plan anaesthetic technique (general vs regional vs sedation) and backup plans.
• Medication review: what to continue/withhold (follow local guidance; ask seniors if unsure).
• Explain the plan in simple terms: what they will feel, pain relief options, common side effects (nausea, sore throat), and safety steps.
• Optimise basics: analgesia, antiemetic plan, antibiotics timing (if relevant), blood availability if bleeding risk, and VTE prophylaxis plan (team-based).

In theatre: preparing for safe anaesthesia

• Do the anaesthetic machine and airway checks (per local checklist) before starting a list.
• Prepare drugs and label syringes clearly; keep high-risk drugs separate; double-check concentrations.
• Standard monitoring for most cases: ECG, pulse oximetry (SpO2), non-invasive blood pressure, capnography (ETCO2), temperature (as appropriate).
• Positioning and pressure area care: protect eyes, nerves, and skin; ensure safe access to the patient once draped.
• Team communication: join the WHO surgical safety checklist (sign-in/time-out/sign-out) and speak up if concerns.

During anaesthesia: what you actively manage

• Airway and breathing: oxygen delivery, ventilation, airway devices (mask, supraglottic airway, tracheal tube), and capnography interpretation.
• Circulation: maintain blood pressure and heart rate with fluids, vasopressors/inotropes as needed, and treat bleeding early.
• Depth of anaesthesia/sedation: ensure unconsciousness or appropriate sedation level; prevent awareness; avoid over-sedation.
• Analgesia: multimodal pain relief (e.g., paracetamol, NSAIDs if suitable, opioids, regional blocks) tailored to patient and surgery.
• Temperature and fluids: prevent hypothermia; manage IV fluids and electrolytes appropriately.
• Anticipation: plan for key moments (induction, positioning, incision, tourniquet, cement, emergence, extubation).

After the procedure: recovery and handover

• Safe emergence: ensure airway reflexes and breathing are adequate; treat pain and nausea early.
• Handover to recovery (PACU) using a structured approach: procedure, anaesthetic, airway, analgesia plan, fluids/blood loss, complications, and ongoing concerns.
• Review patients with issues: pain, nausea/vomiting, hypotension, hypoxia, delirium, urinary retention, shivering.
• Escalate early if deterioration: persistent oxygen requirement, hypotension, reduced consciousness, bleeding, severe pain, or concerns about airway.

Common “first-time” scenarios for new starters

• Pre-op: being asked to assess a patient quickly—focus on airway, major comorbidities, fasting/aspiration risk, and a clear plan; ask for senior help early if unsure.
• Theatre start: machine check, drawing up drugs, and setting up monitoring—use a consistent routine and avoid rushing.
• Induction: assisting with pre-oxygenation, cricoid pressure (if used locally), passing equipment, and documenting observations.
• Airway support: bag-mask ventilation help, preparing a supraglottic airway, suction, and having a clear ‘plan B’ ready.
• Spinal/epidural assistance: positioning, asepsis support, monitoring blood pressure closely, and treating hypotension promptly (with senior direction).
• Recovery calls: managing pain/nausea/hypotension—do an ABC approach, check observations/trends, and escalate if not rapidly improving.

How to be useful and safe as a new starter

• Be predictable: arrive early, check equipment, and keep a tidy workspace; know where emergency airway equipment and drugs are kept.
• Communicate clearly: say what you see (e.g., “SpO2 falling to 90%”), what you’ve done, and what you need.
• Use an ABC approach for any deterioration: Airway, Breathing, Circulation—then Disability (consciousness), Exposure (bleeding/temperature).
• If you are worried, call for help early; anaesthesia is team-based and escalation is good practice.
• Document key events and drugs accurately; if you didn’t write it down, it can be hard to reconstruct later.

Key definitions (plain English)

• General anaesthesia: controlled unconsciousness with pain relief and support of breathing/circulation as needed.
• Sedation: reduced awareness/anxiety; can unintentionally deepen—needs the same respect for airway risk and monitoring.
• Regional anaesthesia: numbing part of the body (e.g., spinal, epidural, nerve block) to reduce pain and sometimes avoid general anaesthesia.
• Analgesia: pain relief (not the same as anaesthesia).
• Capnography (ETCO2): a continuous trace of exhaled CO2; helps confirm ventilation and detect airway problems early.