Weekly outline
Course Guide
The Department of Anesthesiology welcomes Learning Unit VI students to Anesth 251: Integrated Clinical Clerkship in Anesthesiology II. This course will provide an introduction to the perioperative anesthestic management of surgical patients under close supervision by faculty members, fellows, and residents. Clinical clerks will have an opportunity to learn and apply anesthetic management principles before, during, and after surgery. Moreover, students will also have an opportunity to learn and practice technical skills, including but not limited to airway management and lumbar tap, that may be valuable in a variety of clinical specialties and situations.
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The Anesth 251 Course Pack gives you the learning outcomes, teaching-learning activities, assessment, and evaluation tools for the entire course. Use this as a general guide for your daily activities in the first and second semesters of the academic year.
UPCM Honor Code
As a student of the University of the Philippines College of Medicine, I uphold honesty and truth. I will not lie, cheat, or steal someone else's work. As a future doctor, the welfare of my patients will always come first.
Bilang mag-aaral ng Kolehiyo ng Medisina ng Unibersidad ng Pilipinas, paninindigan ko ang katapatan at katotohanan. Hindi ako magsisinungaling, manlilinlang, o magnanakaw ng Gawain ng iba. Bilang manggagamot sa kinabukasan, uunahin ko ang kapakanan ng aking mga pasyente.
General Guidelines for Lectures via Zoom
1. The resident monitor will provide the link to your Zoom meeting through the block's Liaison Officer.
2. Please be punctual for your lectures via Zoom.
3. Attire during lectures via Zoom may either be your school uniform, scrubs, or anything decent. Incidentally, you may be asked to turn on your video for a short time to document student attendance in the Zoom meeting.
4. Keep yourselves muted at all times.
5. If you have questions or comments, raise your digital hand by clicking on the Participants icon, and wait to be acknowledged. You may unmute yourself once you have been recognized by the faculty staff.
6. Please do not record the Zoom lecture. A separate annotated video lecture on the topic will be made available for your future reference after the session.
- Learn more: Video - How Anesthesia Works File 3.4MB Video file (MP4)
Below are your textbooks for the course.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
The Student Evaluation for Teaching Effectiveness (SET) is a useful source of information for assisting faculty in improving how they teach their courses. It describes teaching behaviors from the point of view of students. Your sincere and honest feedback is very much appreciated. Your responses will be anonymous and will not be linked to you as an individual. This will be done and is required for each of the lecturers/consultants, for a total of 6 SETs for this course in your 1st week and 3 SETs in your second week in Anesthesiology 251. You may access the form in the link below.
http://forms.gle/Wh7uQWckTNi52rDE7
The UPCM Course Evaluation by Students (CEBS) allows the course faculty to evaluate the delivery of instruction and enhance teaching-learning methodologies and assessments to achieve student learning outcomes. This will be accomplished after your 2nd week with us in Anesthesiology 251. You may access the form in the link below.
http://forms.gle/Fwe8WrJhy9pMsjNv5
Day 1 Module A - Preoperative Evaluation and Management
Preoperative evaluation of the patient is a cornerstone of perioperative anesthestic management.
At the end of this module, the clinical clerk should be able to:
- Define preoperative evaluation.
- Describe the components of preoperative evaluation.
- Stratify the risks of patients before anesthesia
- Determine if a patient requires preoperative laboratory testing.
- Discuss the preparation of a patient for anesthesia.
- Appraise effectively a patient’s requirement for preoperative medication.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Holt NF. (2015). Preoperative Evaluation and Management. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
- Lecture on Preoperative Evaluation File
In this video, one of the faculty members of the UPCM Department of Anesthesiology, Dr Bandola discusses the concepts and principles of Preoperative Evaluation and Management.
- Learn more: ASA Practice Advisory for Preanesthesia Evaluation File 182.2KB PDF document Uploaded 2/08/19, 15:31
Based on what you have learned on preanesthesia evaluation, classify the following patients according to the ASA-PS classification system.
- ASSIGNMENT: Cardiopulmonary Risk Assessment and Pre-Anesthesia Evaluation
Download the UP-PGH Anesthesiology Cardiopulmonary Risk Assessment and Pre-Anesthesia Evaluation form. Identify an individual, whether a family member, a classmate, or a friend who will serve as your mock patient for preanesthesia evaluation. Try to come up with a hypothetical pre-operative diagnosis and proposed surgical plan for your patient. Perform a preanesthesia evaluation and fill out the form as completely and correctly as possible. Submit your accomplished form using your surname as the file name (eg, Reyes).
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 1 Module B - Airway Management
Management of the airway is paramount to safe perioperative care.
At the end of this module, the clinical clerk should be able to:
- Apply airway anatomy in the clinical setting.
- Perform a thorough assessment of the airway.
- Discuss various techniques in the clinical management of the airway.
- Recognize difficult airway and possible interventions.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Abrons RO and WH Rosenblatt. (2015). Airway Management. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
- Lecture on Airway Management File
In this video, one of the vice chairs of the UPCM Department of Anesthesiology, Dr Chiong-Perez discusses the principles of Airway Management.
- Video - Airway Examination File 111.8MB
In this video, staff of the UPCM Department of Anesthesiology demonstrates the assessment and examination of a patient's airway.
- Video - Steps in Intubation Using Direct Laryngoscopy File 37.5MB Video file (MP4)
In this video, the staff of the UPCM Department of Anesthesiology demonstrates the steps in intubation with direct laryngoscopy.
- Learn More: ASA Practice Guidelines for Management of the Difficult Airway File 603.8KB PDF document Uploaded 2/08/19, 15:44
Based on what you have learned, assess the following airways according to the Mallampati classification.
- ASSIGNMENT: Airway Assessment of a Simulated Patient
Record a video of you performing the airway evaluation on your selected patient in the preoperative evaluation module. Annotate what you are doing and describe your findings.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 2 Module A - The Anesthesia Workstation
The anesthesia workstation includes the anesthesia machine, physiologic monitors and accessories such as suction equipment and adjunctive bag-valve-mask device. It is vital in ensuring patient safety.
At the end of this module, the clinical should be able to:
- Describe the functional anatomy of the anesthesia workstation.
- Discuss the delivery of gases in the anesthesia workstation.
- Describe the anesthesia breathing systems and relevant considerations.
- Define the scavenging system.
- Perform an anesthesia workstation check to ensure preparedness to administer anesthesia.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Nathan N and TC Krejcie. (2015). The Anesthesia Workstation. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
In this video, the staff of the UPCM Department of Anesthesiology gives you a virtual meeting with an anesthesia workstation at the Philippine General Hospital.
After completing the activities for this module, try to correctly identify the parts of the anesthesia machine. You are allowed two attempts to complete this quiz. Fifteen (15) minutes will be allotted for each attempt. Remember to submit you responses in order for them to be recorded.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 2 Module B - Monitoring
Vigilance in patient monitoring is an essential management principle in the field of anesthesia.
At the end of this module, the clinical clerk should be able to:
- Define monitoring and its importance in anesthesia practice.
- Present the ASA standards for basic monitoring.
- Discuss the basic mechanisms, usefulness, and limitations behind basic anesthesia monitors.
- Interpret intra-operative monitors accurately.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Fink RJ and JB Mark. (2015). Standard Anesthesia Monitoring Techniques and Instruments. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
- Lecture on Basic Anesthesia Monitoring File
In this video, one of the consultants of the UPCM Department of Anesthesiology, Dr Espejo introduces the concepts of Basic Anesthesia Monitoring.
- UPCM-PGH Anesthesia Intraoperative Record for Clinical Clerks File 360.6KB PDF document
This is the form to be used by clinical clerks when they do intraoperative monitoring for patients under anesthesia. It is best to familiarize oneself on how to accomplish the Anesthesia Intraoperative Record.
- Learn More: ASA Standards for Basic Anesthetic Monitoring File 205.2KB PDF document Uploaded 2/08/19, 15:37
- Opened: Tuesday, 12 January 2021, 6:00 PM
After completing the activities for this modules, try to interpret the rhythms that one may see on the cardiac monitor. You are allowed two attempts to complete this quiz. Fifteen (15) minutes will be allotted for each attempt. Remember to submit you responses in order for them to be recorded.
After completing the activities for this modules, try to interpret the waveforms that one may see on capnography. You are allowed two attempts to complete this quiz. Fifteen (15) minutes will be allotted for each attempt. Remember to submit you responses in order for them to be recorded.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 3 Module A - Fluid and Electrolytes
Perioperative fluid management involves maintenance of sufficient intravascular volume to support organ perfusion and physiologic homeostasis.
At the end of this module, the clinical clerk should be able to:
- Summarize acid-base balance and its disturbances.
- Interpret an arterial blood gas analysis systematically.
- Discuss the physiology of fluid management.
- Outline the fluid management of the patient in the perioperative period.
- Enumerate the presentation of common electrolyte disturbances.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Hankinson EE and AM Joffe. (2015). Fluids and Electrolytes. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
- Lecture on Perioperative Fluid Management File
In this video, one of the faculty members of the UPCM Department of Anesthesiology, Dr Espina-Bertoso talks about the basics of Perioperative Fluid Management.
- ASSIGNMENT: Fluids
Download the assignment provided and answer the questions on the theoretical patient's perioperative fluid requirements. Cite your sources correctly. Submit your answers as a pdf file using your surname as the file name (eg, Reyes).
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 3 Module B - Intravenous Anesthetics
There are several commonly used intravenous agents in the practice of anesthesia: barbiturates, propofol, benzodiazepines, etomidate, ketamine, and dexmedetomedine.
At the end of this module, the clinical clerk should be able to:
- Discuss the pharmacology of intravenous anesthetics.
- Describe the effects of intravenous anesthetic on the different organ systems.
- Select the appropriate intravenous anesthetics and sedatives for clinical use.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Connor CW, B Sadighi and J Black. (2015). Intravenous Anesthetics and Sedatives. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
In this video, we learn more about two intravenous anesthetics, midazolam and propofol.
- QUIZ: Intravenous Anesthetics
After completing the activities for this module, try the following quiz on intravenous anesthetic agents. You are allowed two attempts to complete this quiz. Ten (10) minutes will be allotted for each attempt. Remember to submit you responses in order for them to be recorded.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 4 Module A - General Anesthesia
General anesthesia renders a patient for surgery, unconscious in a reversible and controlled manner.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Norris MC and R Saffary. (2015). General Anesthesia. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
- Lecture on Introduction to General Anesthesia File
In this video, one of the Anesth 251 Course Coordinators of the UPCM Department of Anesthesiology, Dr Sy Su discuss the planning and conduct of General Anesthesia.
In this video, staff of the UPCM Department of Anesthesiology show the basic setup before the administration of general anesthesia.
Guedel's classification is a means of assessing the dept of general anesthesia that was introduced by Arthur Ernest Guedel in 1937. Since general anesthesia became first became widely used in 1846, John Snow and Francis Plomley attempted to describe various stages of general anesthesia in 1936, but Guedel's detailed system was generally accepted. Read the article to learn more.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 4 Module B - Inhalational Anesthetic Agents
Inhaled gases and volatile anesthetics can be effective in providing analgesia and sedation or producing general anesthesia.
At the end of this module, the clinical clerk should be able to:
- Discuss the pharmacology of inhalational anesthetic agents.
- Describe the effects of inhalational anesthetic agents on the different organ systems.
- Select the appropriate volatile and nonvolatile anesthetics for clinical use.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Ramaiah R and SM Bhananker. (2015). Inhalational Anesthetic Agents. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
In this video, we learn more about one of the inhalational volatile agents, sevoflurane.
- QUIZ: Inhalational Anesthetics Agents
After completing the activities for this module, try the following quiz on inhalational anesthetic agents. You are allowed two attempts to complete this quiz. Ten (10) minutes will be allotted for each attempt. Remember to submit you responses in order for them to be recorded.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 4 Module C - Neuromuscular Blocking Agents
Neuromuscular blocking agents (NMBAs) produce muscle relaxation either by directly depolarizing acetylcholine (ACh) receptors or competing with ACh for the recognition sites to prevent normal receptor function.
At the end of this module, the clinical clerk should be able to:
- Discuss the physiology and pharmacology of neuromuscular blocking agents.
- Differentiate between non-depolarizing and depolarizing neuromuscular block agents.
- Describe monitoring neuromuscular blockade.
- Discuss reversal for neuromuscular blockade.
- Select the appropriate neuromuscular blocking and reversal agents for clinical use.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Brull SJ and C Claudius. (2015). Neuromuscular Blocking Agents. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
In this video, we learn more about three neuromuscular blocking agents, succinylcholine, atracurium, and rocuronium.
- QUIZ: Neuromuscular Blocking Agents
After completing the activities for this module, try the following quiz on neuromuscular blocking agents. You are allowed two attempts to complete this quiz. Ten (10) minutes will be allotted for each attempt. Remember to submit you responses in order for them to be recorded.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 5 Module A - Regional Anesthesia
Regional anesthesia (spinal or epidural anesthesia) is a useful anesthetic technique during surgery and even into the postoperative period.
At the end of this module, the clinical clerk should be able to:
- Discuss the anatomy of the spinal cord and epidural space.
- Discuss the techniques used for neuraxial blocks.
- Discuss the pharmacology of the commonly used local anesthetics.
- Discuss the physiological consequences of neuraxial blockade.
- Discuss the complications associated with neuraxial blockade.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Epidural and Spinal Anesthesia (2013). In Barash PG et al (Ed). Handbook of Clinical Anesthesia (7th ed). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
- Lecture on Introduction to Neuraxial Anesthesia File
In this video, one of the vice chairs of the UPCM Department of Anesthesiology, Dr MC Cruz gives an Introduction to Neuraxial Anesthesia.
In this video, staff of the UPCM Department of Anesthesiology demonstrates the performance of a lumbar tap for patient who is to receive spinal anesthesia.
- Learn More: ASRA Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: File 1.2MB PDF document Uploaded 2/08/19, 15:55
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 5 Module B - Local Anesthetics
Local anesthetics temporarily and reversibly inhibit the conduction of sensory, motor, and autonomic neural impulses to provide preoperative anesthesia or analgesia.
At the end of this module, the clinical clerk should be able to:
- Discuss the pharmacology of local anesthetics.
- Select the appropriate local anesthetics for clinical use.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Salinas FV. (2015). Local Anesthetics. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
- QUIZ: Local Anesthetics
After completing the activities for this module, try the following quiz on local anesthetics. You are allowed two attempts to complete this quiz. Ten (10) minutes will be allotted for each attempt. Remember to submit you responses in order for them to be recorded.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Day 5 Module C - Analgesics
All patients who undergo surgical procedure will experience acute pain perioperatively, hence pain management is a cornerstone of the practice of anesthesiology. Many pre-operative, intra-operative, and post-operative interventions and management strategies are available for our disposal in reducing and managing pain.
At the end of this module, the clinical clerk should be able to:
- Discuss the pharmacology of nonopioid and opioid analgesics.
- Describe the effects of opioid analgesics on the different organ systems.
- Select the appropriate nonopioid and opioid analgesics for clinical use.
For a more comprehensive understanding of the topic, it is recommended to read the following chapter on your reference book:
Thackeray EM and ED Egan. (2015). Analgesics. In Barash PG et al (Ed). Clinical Anesthesia Fundamentals. Philadelphia, PA: Wolters Kluwer Health.
In this video, we learn more about the synthetic opioid, fentanyl.
- Learn More: ANZCA Acute Pain Management: Scientific Evidence File 8.3MB PDF document
This is a comprehensive and exhaustive guide developed by the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine on acute pain management that may be used in your planning for individual patients.
- QUIZ: Analgesics
After completing the activities for this module, try the following quiz on analgesics. You are allowed two attempts to complete this quiz. Twenty (20) minutes will be allotted for each attempt. Remember to submit you responses in order for them to be recorded.
Please post your questions here. Posted questions can be answered by staff and other students. Be sure that your question relates to the materials in this module.
You can read through other questions and post a response, or ask a question of your own. But remember, please limit your questions and responses to 100 words or less.
If you have a question about specific content (videos or quiz questions) please be specific in your questions! If members of the faculty can't find the video or question, they will not be able to answer your question.
Submissions Portal
- Opened: Thursday, 9 June 2022, 10:00 AMClosed: Thursday, 9 June 2022, 12:00 PM
Hello and good morning! This is your final exam for Anesthesiology 251, and a culmination of your clerkship year in anesthesia.
For this exam, you will be given 120 mins to answer a total of 60 questions of multiple choice type. Please choose the BEST answer.
Clicking "Attempt quiz now" will start the timer. You may go back to questions during, but make sure to click "Finish attempt" at the last question, review that all your choices were entered, and click "Submit all and Finish" to finalize the exam. All unanswered questions will be marked wrong at the end of time limit.
If you have any questions during the exam, you may contact Dr. Mark Velasco via telegram or SMS (09429782022) or Dr Kevin Verona (09054920448). You will not be given extra time from time spent inquiring, so please use your best judgment.
Good luck and see you on your internship year!
- ASSIGNMENT: Case Discussion (General Anesthesia)
Submission portal for your case discussions on a case done under general anesthesia.
- ASSIGNMENT: Case Discussion (Regional Anesthesia)Opened: Tuesday, 29 November 2022, 9:53 AM
Submission portal for your case discussions on a case done under regional anesthesia.
- ASSIGNMENT: Reaction paper (Wednesday Conference)Opened: Tuesday, 29 November 2022, 9:54 AM
Upload your reaction paper based on a Wednesday Conference in this section
- ASSIGNMENT: Reflection paperOpened: Sunday, 29 May 2022, 11:14 AMDue: Tuesday, 7 June 2022, 11:14 AM
Upload your reflection paper for the whole rotation in this section.
- Opened: Monday, 10 January 2022, 12:00 AMDue: Saturday, 4 June 2022, 12:00 AM
Please upload a photo of your FTF attendance/ case log sheet here.