AS4.3-5 | Induction, Maintenance, Monitoring and Vital Organ Support During Anaesthesia — Summary & Reflection

KEY TAKEAWAYS

The conduct of general anaesthesia (AS4.3–AS4.5) covers: pre-induction (ASA grading, fasting confirmation, ABCDE machine check, drug preparation); induction (preoxygenation → opioid → induction agent → mask ventilation → NMBA → intubation → confirm with capnography); maintenance (balanced anaesthesia — volatile/TIVA + opioid + NMBA; ventilator settings 6–8 mL/kg; ETCO₂ 35–45 mmHg; cardiovascular support with fluids and vasopressors; temperature management; BIS 40–60); monitoring (minimum: SpO₂, capnography, ECG, NIBP, temperature, neuromuscular monitoring; capnography = gold standard for tube confirmation and ventilation); emergence and extubation (TOF ≥0.9 confirmed, adequate analgesia established, protective reflexes returned, extubation criteria met); PACU (supplemental O₂, monitoring, Aldrete score, PONV prophylaxis/treatment). Throughout: anticipate and prevent physiological derangements rather than react to crises.

REFLECT

After observing or participating in your first general anaesthetic, take 10 minutes to write answers to these questions: (1) At what point in the induction did the patient lose consciousness — what physical signs told you this? (2) How was tracheal tube position confirmed — did you see the capnography trace appear? (3) What was the highest priority monitoring alarm during the case and how was it managed? (4) When was the reversal agent given and how was adequacy of reversal confirmed before extubation? (5) What was the patient's blood pressure at induction compared to their pre-induction baseline — and what does this tell you about the cardiovascular effects of the induction agent used? These observations, connected to the physiological principles in this SDL, are the foundation of clinical competence in anaesthesia.