SECOND YEAR PROFESSOR :

MISS SAOUSSEN JILANI

ANESTHESIA
Higher Institute of
Second Semester
Health and Medical Academic Year: 2022/2023
Techniques of Monastir
 Professor : Miss Saoussen Jilani

1. Communicating with patients

❖ Patient education allows patients to play a bigger role in their own care. To be an effective
anesthetist, you need to be able to assess patient needs and communicate clearly.

The success of patient education depends largely on how well you assess your patient's:

• Needs

• Concerns

• Readiness to learn

• Preferences

• Support

• Barriers and limitations (such as physical and mental capacity, and low health literacy or numeracy)

❖ Often, the first step is to find out what the patient already knows. Use these guidelines to
do a thorough assessment before starting patient education:

• Gather clues. Talk to the health care team members and observe the patient. Be careful
not to make assumptions. Patient teaching based on incorrect assumptions may not be
very effective and may take more time. Find out what the patient wants to know or take
away from your meeting.
• Get to know your patient. Introduce yourself and explain your role in your patient's
care. Review their medical record and ask basic get-to-know-you questions.
• Establish a rapport. Make eye contact when appropriate and help your patient feel
comfortable with you. Pay attention to the patient's concerns. Sit down near the patient.
• Gain trust. Show respect and treat each patient with compassion and without judgment.
• Determine your patient's readiness to learn. Ask your patients about their outlooks,
attitudes, and motivations.
• Learn the patient's perspective. Talk to the patient about worries, fears, and possible
misconceptions. The information you receive can help guide your patient teaching.
• Ask the right questions. Ask if the patient has concerns, not just questions. Use open-
ended questions that require the patient to reveal more details. Listen carefully. The
patient's answers will help you learn the person's core beliefs. This will help you
understand the patient's motivation and let you plan the best ways to teach.
• Learn about the patient's skills. Find out what your patient already knows. You may
want to use the teach-back method (also called the show-me method or closing the loop)
to figure out what the patient may have learned from other providers. The teach-back
method is a way to confirm that you have explained the information in a way that the
patient they understand by asking them to act as if teaching it to you. Also, find out what
skills the patient may still need to develop.

1
 Professor : Miss Saoussen Jilani

• Involve others. Ask if the patient wants other people involved with the care process. It
is possible that the person who volunteers to be involved in your patient's care may not
be the person your patient prefers to be involved with. Learn about the support
available to your patient.
• Identify barriers and limitations. You may perceive barriers to education, and the
patient may confirm them. Some factors, such as low health literacy or numeracy may be
more subtle and harder to recognize.
• Take time to establish rapport. Do a comprehensive assessment. It is worth it because
your patient education efforts will be more effective.

Quick Quiz:
1. Patient’s assessment requires:
a. Readiness to learn
b. Readiness to teach
c. Readiness to share
2. Observing the patient is required to gather
a. Assumptions
b. Signs
c. Clues
d. Symptoms
3. Judging a patient can lead to
a. Gain sympathy
b. Gain pity
c. Gain trust
4. Asking the right question to a patient should be addressed by
a. Open-ended questions
b. Close-ended questions
c. Free-choice questions
5. The health care members whom involved within the patient’s care are
preferred by
a. The doctor
b. The patient
c. The family’s patient
d. The anesthetist

2
 Professor : Miss Saoussen Jilani

2. Light Anesthesia

Signs of Light Anesthesia Preventing Awareness

• Avoid or minimize muscle relaxants when
• Tearing
able
• Sympathetic activation: Dilated
• Consider different treatment for
pupils, sweating
hypotension other than decreasing
• Coughing or bucking
• Patient movement anesthetic consideration

Management• Monitor brain activity using BIS or

SedLine if using TIVA

If you suspect your patient may be aware:
• Consider different treatment for

• Immediately deepen the anesthetic with fast-acting agents

hypotension other than decreasing
• Talk to the patient, reassure them that everything is OK (hearing is the last
anesthetic concentration
sense to be lost)
Redose IV anesthetic when delivery of
• Talk to the patient after the case to assess if they had any awareness
inhalational agent is difficult (ie during long
• Set up counseling if necessary intubation or rigid bronchoscopy)

ITE TIPS

Procedures associated with awareness

• 1. Major trauma with significant blood loss
• 2. Cardiac surgery

Awareness facts:
• Awareness is twice as likely when neuromuscular blocking drugs are used.
• The amount of volatile anesthetic is what matters most.

Other risk factors for awareness:

• Chronic pain patients
• Clinical pearl (medical information obtained from clinical experience and
observation)

3
Professor : Miss Saoussen Jilani

3. Phrasal Verbs
Natural English conversation includes many phrasal verbs. These are verbs made up of two
words: a verb and a preposition. For example: 'I get up at eight o'clock'. Complete the
sentences below using the phrasal verbs in the box. You will have to change the forms of some
of the verbs to make the grammar of the sentence correct. The first one has been done for
you as an example.

1. He got over his cold. Phrasal verbs

2. The nurses are _______________her very well. break down = to start to cry and
become upset
3. He must have _______________ the disease when he was
bring up = to cough up material such
travelling in Africa.
as mucus from the lungs or throat

4. She often _______________ in front of the TV. cough up = to cough hard to expel a

substance from the trachea drop off

5. When we told her that her father was ill, she
_______________. = to fall asleep get around = to move

about
6. She _______________ and cried as she described the
symptoms to the doctor. get over = to become better after an
illness or a shock

7. He _______________ his father. give up = not to do something any

more go down = to become smaller
8. The doctor asked him to _______________ his shirt.
knock out = to hit someone so hard
9. He was _______________ mucus. that he or she is no longer conscious

look after = to take care of a

10. Since she had the accident she _______________ using person and attend to his or her
crutches.
needs pass out = to faint pick up
11. I was advised to _______________ smoking. = to catch a disease

12. He was _______________ by a blow to the head. prop up = to support a person, e.g.
with pillows

13. The nurse _______________ the patient with pillows. take after = to be like one or other
parent
14. The swelling has started to _______________.
take off = to remove something,
especially clothes
15. She became worried when the girl started
_______________ blood.

4
Professor : Miss Saoussen Jilani

4. Anesthesia Scenarios for Anesthesia Students

❖ Case 1: You look for the consent and you cannot find it. Still, the surgeon
affirms that he signed it. Do you proceed with the case?

Answer:
………………………………………………………………………………………………………
…………………………………………………………………………………………….. .

❖ Case 2: A routine case: You induce the usual doses of drugs, but the blood
pressure drops to 80. How to deal with this drop pressure in relation to
the drugs induction?

Answer:
………………………………………………………………………………………………………
…………………………………………………………………………………………….. .

❖ Case 3: What special considerations do you have when running

anesthetic on a renal failure patient?

Answer:
………………………………………………………………………………………………………
…………………………………………………………………………………………….. .

❖ Case 4: Right in the middle of the surgery, a patient is suffering from

severe injuries. Large amounts of blood are lost. How do you manage the
fluids in such a case?

Answer:
………………………………………………………………………………………………………
…………………………………………………………………………………………….. .

5
Professor : Miss Saoussen Jilani

5. Offering a Good Advice

These sentences all give very good advice, but they have been divided into separate halves.
Match the half-sentences in Column A with the half-sentences in Column B to make 14
sentences which are correct, complete and true.

Column A Column B

1. a) ... burn easily in the sun.

Regular exercise is ...

2. b) ... cause back pain.

A balanced diet should ...

c) ... be inoculated against diphtheria.
3.

Medicines should ...

... be kept out of the reach of children.
4. d)
A patient in shock should ... ... about 2.5 litres of fluid each day.
5.
e)
Not taking any exercise is ... ... five minutes' exercise every
6. morning.

Reading in bad light can ... f)

7. ... be sterilised before use.

You should do ...

g) ... make the eyes ache.
8.

A normal adult should drink ... h) ... provide all the nutrients needed, in
9. the correct proportions.
HIV can be transmitted ...
... an unhealthy way of living.
10. i)

Bad posture can ...

j)
11. ... be kept warm and lying down.

People with fair complexions ... k)

12.

Surgical instruments must ... ... be by pressure and elevation.

13. l)
... by using non-sterile needles.
Babies should ... m)
14.
... good for the heart.
Haemorrhage control routinely should ... n)

6
Professor : Miss Saoussen Jilani

6. Word Stress in Medical Conversations

One of the keys to English pronunciation is stress - emphasis. There are three possible patterns
for three-syllable words:
A: hos-pi-tal
B: pre-scrip-tion
C: rec-om-mend

Read these five conversations. Find all the three-syllable words and classify them by their
pronunciation. There are 27 in total. Put them in the correct sections of the table on the right.
The first one has been done for you as an example.

Dialogue 1
- When was she admitted to hospital?
- At about four o'clock.
- Has there been any improvement?
- No, her condition is stable. We're waiting to see how things develop.

Dialogue 2
- What do you recommend?
- Well, first of all: cut down on fatty foods.
- And what else?
- Take regular exercise, don't smoke and keep alcohol down to a minimum.

Dialogue 3
- What's the problem?
- I went to give him his injection and I saw that he'd started to hemorrhage.
- We'll have to operate. Make sure all the equipment is prepared.
- I'll go down to the theatre and check.

Dialogue 4
- So, is it serious?
- Don't worry. It's probably just an allergic reaction.
- Are you just saying that to reassure me?
- You're fine. Look, I'm going to give you a prescription for some painkillers…

Dialogue 5
- Have you got the test results yet?
- Well, they're still incomplete, but it's clear that it's positive.
- Any idea when infection took place?

7
Professor : Miss Saoussen Jilani

- I'd say five or six weeks ago, but that's just an opinion. Do you want to see her
medical history?

Group A: Group B:
1 1 admitted

2 2

3 3

4 4

5 5

6 6

7 7

8
8
9
9
10
10
11
11
Group C:
12
1
13
2

8
Professor : Miss Saoussen Jilani

7. Word Stress in Medical Terminologies

One of the keys to English pronunciation is stress - emphasis. There are three normal patterns
for four-syllable words:

A: vac-ci-na-ted B: pneu-mo-ni-a C: in-flu-en-za

Complete the sentences below using the four-syllable words in the table. The first question has been done
for you as an example.

1. She appeared to be improving, but a complication set in and she died a few hours later.

2. Bells Palcy causes facial ______________.

3. Come right now: it's an ______________!

4. The patient was having difficulties breathing so we put him on a ___________.

5. She had an ______________ to replace the cornea.

6. He was given a general _____________ before the surgeons began work.

7. As a precaution against AIDS we use ___________ needles.

8. He can't take aspirin: he has an ______________ to it.

9. Rub your hands together to get the ______________ going.

10. He couldn't ______________ the movements of his arms and legs.

11. An ______________ was organized to test the drug on a small group of people.

12. Tests confirmed the _____________ of the growth.

13. This is the allergen which was _____________ for the patient's reaction.

14. ______________ showed that the food contained bacteria.

15. The surgeons are trying to find a ______________ donor.

16. A diet high in _____________ fats increases the risk of heart disease.

17. The surgeon ___________ to the students how to make the incision.

18. As many as 60-70% of diarrheal deaths are caused by______________.

19. Autistic children do not ______________ with anyone.

20. _____________ is a common antibiotic produced from a fungus.

9
 A B C

Professor : Miss Saoussen Jilani

anaesthetic

analysis

circulation

communicate

compatible

complication

coordinate

dehydration

demonstrated

disposable

emergency

experiment

intolerance

malignancy

operation

paralysis

penicillin

respirator

responsible

saturated

10