Anaesthesia for the ageing patients

Time is flying and never stops, therefore we are now facing the bigger patient group, the ageing population. The better healthcare technology together with better care management make our people live longer, and they are presenting themselves to us later in their lives. The anaesthetics for this group of patient requires some concerns such as:

1. Underlying diseases: the aged are more likely to have more problems than the younger counterparts, it is the thing that cannot be avoidable since the organ functions are declining since the age is more than 30. We should evaluate every organ system, so that we can make a further plan what we should proceed later. The more problems they have, the more prescriptions for them are increasing, and increase the risk of drug interactions.

2. Declining organ function : the metabolism and excretion of the drug given are more likely to have more effects, since the GFR is lower when the age is going up and up. Postoperative cognitive dysfunction should be evaluated in the perioperative period.

3. The skin is more likely to lose its temperature control, the longer operative time means that they would have a lower core temperature, therefore, temperature monitoring and interventions needed to control the worse outcome should be implemented.

It seems that we are doing the same things to the ageing patients like what we would do to the neonates and paediatric patients.

Simulated patient and learner for consultant workshop

Today the department organised a meeting for consultants, they joined together for a review for teaching methods, from an inspiration from another colleague, how to give a good feedback to the trainees, how to supervise your trainees during a procedure and finally what a good reflection from our learners should be.

The sample of what happened during the day is available in the following link, it started with a volunteer to supervise a simulated doctor trainee to perform a simple procedure, but it went out a nightmare because of a simulated patient. Enjoy the show.

Supervision

What would you do if the ventilator you are applying to your patient shouts "TV cannot be delivered"?

After the ventilator alarm "Desired TV cannot be delivered"....

1. back to patient clinical conditions, does he/she have hypoxia
2. recheck the tube position either end-tidal COtwo or auscultation
3. recheck the previous IPPV setting whether or not, it is appropriate
4. look at Paw whether there is any air leakage
5. change a new ventilator machine
6. if it cannot be solved, postpone the surgical procedure, support patient ventilation
7. ask for help/advice about IPPV setting or checking
8. if the ventilator is truely malfunctioned, turn down the alarm volume, so that it would not disturb others

What should you look for?

In a situation that makes you confused, do not know what to perform next, calm down a bit and concentrate on your patient again. Some occasion you cannot perform a useful investigation, because it is not possible to palpate your patient's arms or legs because of an obstructed C-arm fluoroscope, because the CVP is not the up-to-date monitoring in this world and it just tells you whether or not your patient has a right heart failure, because PPV cannot be interpreted since your patient's cardiac rhythm is not sinus.

So, what you could possibly do are listed in the attached foto....

Simulation Class Atmosphere on Christmas day :(

Learning atmosphere on simulation class in cardiovascular and respiratory crisis in perioperative patients for 5th year medical students.

We began with short introduction about the way we would proceed, how the learners should perform, and we told them we can let go the patient death because it was a simulated event, it would not the real world. So, we ended up just one patient survived, one with complications from the medical treatment, and unfortunately all the remaining four were discharged with mortality.

Finally, the learners' feedback about what they have to acquire for more knowledge and more reading, that is the most important ideas for the day.

Medical schoold director addressed his closing remark

Professor Prasit Watanapa, the Medical School Director, made a closing remark to the consultants of the Faculty of Medicine Siriraj Hospital on the workshop of Curriculum Change.

Unfortunately, the language of the video is not English, however, if you would like to get the atmosphere, please click the link below.

New curriculum

Excuse me, does he....?

A kind good looking surgeon was surprised, and reluctantly quietly asked his anaesthetist counterpart whether or not the patient needs any kind of airway intervention.

Then he was questioned by his anaesthetist what went wrong, everything was fine and business is usual.

So, have you found whether or not there is something Right!!!