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Mhm. You should be able to hear me. Um I've changed my microphone so that should be ok. Let me know if that's working or it's not. Yeah, perfect. Alright. Um cool. I'll start this now. So welcome to this tutorial. We're gonna focus on anesthetics and pro of care. Um If you've never been to teaching things before, we're a group of medical students from UCL that do weekly tutorials every Thursday. Um usually at six PMU K time. I do apologize that this one is a bit later and we try and just focus on of things from the clinical perspective that will come up in both your exams and placement to just try and help you become a medical students and we have doctors reviewing every tutorial that we do. We're coming to the end of our tutorials now. But if you do, you want to have a look at our older ones. Um we've got them all uploaded on our middle page and I think it'd be really good revision if you want to start revising for your exams because I know those are sort of around the corner for you guys. Also, I do apologize for my voice. It's about 5 a.m. where I am. So voice is a bit, is a bit rusty right now. Um You can also follow us a medal if you wanna come to our tutors that we have, we have about four left for the year. Um And that will again be focusing more on like the ethics, ethics side of things and some gastro stuff, I think and some osk stuff like how to document things, which I think it would be worth going to. Ok. So today we can split broadly into three different parts, the pre op assessment. Um So what we do, we put a patient into the theaters and then I just cover the basics of anesthesia, which is more of a placement thing. It won't come up huge amounts in your exams, but anesthetic is something most people don't really get um when they're in placement and they don't get too much exposure. So I thought I just focus on that today and then POSTOP prescribing. So we've got a pain relief and then fluids as well. Um Those can come up not only in the F one ear, but uh in your oscopies or CP SAS or whatever you guys call them, you know, universities, they are, they are very common stations. So it's good to good to get, good to get to Christmas with them. Um So why is pre op care and anesthetics important? But essentially most patients are gonna have a surgery and as an F one F to doctor or wherever hospital you're working in, you will have to be, you will have to write on the notes, you will have to consult them for surgery. That's the surgeon's job, but you will have to do everything else more or less. Uh, and that will include examining the patient, taking histories, giving them medication and stopping the relevant medication. And just so, you know, peri op just means before surgery, during surgery and after surgery, it's just you just mean surrounding surgery. So just a quick poll just to assess how much you guys confident in terms of what you know, so far. Um Yeah, just, just drop an answer in the chat, but there's no worries if you don't feel confident in this at all. Hopefully by the end of it, you will be feeling a little bit better. Ok. So most of you aren't too sure that that's fine come today and hopefully we can, we can learn a couple of things. So if, if that's we changed fine. All right. So in terms of w what do you guys think we would do if we have a patient in the hospital who we need to get ready for surgery? Um I'm not gonna give you a specific type of patient specific history or anything. I just want some general points that you might have to do if you've got a patient and they need to go into theaters. Just give me some random basic stuff that you think might be important. It can be as simple as you want. It can be as complicated as you want. Yeah, perfect. So, no, by mouth, stopping relevant medication check about signs, BP, blood glucose cathe isn't exactly all on the right track. So we wanna optimize the patients for surgery. We wanna make sure they're safe to have a surgery. So again, just try and split your answers in two categories. And that just makes sure you're answering a little bit better. Something I struggle with as well because medical school doesn't teach you this properly. But when you get asked a question, you want to try and split it up into groups and then, but then those groups give little answers. So at the bedside, like you said, for four set of S, you can do an E CG, you can do relevant examinations and then you can think about blood. Are they diabetic? Do we need to check their blood glucose? The HBA one C full blood counts using these, of course, we want to check their liver function as well. Um And then Gina will cross match if you're, if they're going that it is very important. Something else you can consider is, is C testing, which we won't go into. But that just helps measure a patient's oxygen capacity um to see if they're fit enough for surgery and every patient gets a, a test for MRSA. So this is something that's used quite a lot in anesthetics. It's called the A SA classification. Essentially, it's a way of classifying every single patient who comes into theaters on a scale of 1 to 6. The average patient is an A SA one, but there are a lot of A SA, twos, threes and fours that are coming into, coming into play now and those are quite difficult to manage. So it's, it's important to be aware of this sort of classification system. Essentially. The more ill you are the lower down you are in the classification system. Someone with a SA one is healthy, someone with a SA two, someone that has something like a well controlled asthma or their BMI is between 3040. They have well controlled diabetes and that's quite a lot of people in today's world and then the A SA three is severe systemic disease. So poorly controlled diabetes, poorly controlled CO PD. Um Alcohol is a history of, of uh cardiovascular compromise. So myocardial infarctions, cerebrovascular accidents. Um Ti A s that sort of stuff and you'll see this being read out um by the anesthetist most of the time when they're prepping a patient. So just to just to educate you guys in this and to explain why it's important, it does help strategize, it does help stratify risk. So a higher assay grade indicates a greater risk of, of perative complications. So you'll need more input from see, involvement and consult anesthetists. Um It may lead to things like more careful positioning and longer preoxygenation, changing your, the medication that you use, um and monitoring more things in surgery. And we'll talk about some of those terms later on. So, don't worry about it too much. Um It also predicts the outcome of the surgery lower down. So one is in a sa the more complications there are likely to be and that can predict the outcome. Um, and it just gives a common sort of communication tool between specialties, um, which is, which is helpful in surgery in a A two. How many of the criteria listed do you need to be in that category? I just wanna go back and open that up. So it's a bit slow here, but it would just be one of those criteria. So, yeah, if you're a current smoker, if you're a social drinker, if you're pregnant or if you're obese with bmi 30 to 40 you'll be, you'll be in the A SA two bracket. So it's actually quite harsh. Like a lot of moderately healthy people will be in the A SA, uh, two bracket. But yeah, moving on. Um, you, if you guys do have questions, yeah, just drop it in the chat and I'll get around to. So, in terms of modifying medication, this is something that's important in the surgical setting. Um, there are certain can that patients have when going into surgeries. But there are patients, there are some medications that we need to remove. Um, and it's important to know which ones you need to remove when prepping a patient for surgery. So it's much, much easier to remember the ones that you need to remove rather than learning all the medications and all the rules for every medication. So I would recommend just learning the ones you need to stop. Um, and if you can learn why you need to stop them, well, we'll just focus on what you need to stop today. So, this is a good list. I found, I think from mind the bleep, if you guys haven't done your prescribing assessments yet, when you're in your final year of medical school, you'll have to do an exam that sort of covers this stuff. Um, this is just sort of a taster to give a more holistic picture about the surgical, surgical background. Um, but you wanna stop, you know, your ace inhibitors angiotensin receptor blockers, you wanna stop diuretics, you wanna stop anti anticoagulants and antiplatelets. Usually for about a week. Um, you wanna stop, hit in the combined pill.