Useful information about working in Anaesthesia Services

Anaesthesia and the Perioperative Period

• Starship, Auckland City and Greenlane Hospitals have 4 completely separate Anaesthetic Departments that provide services to acute and elective patients.

• They are Starship, Level 4 (Cardiac/ENT), Level 9 (O&G), Level 8 (everything else + GSU).

• During the daytime, there is a Specialist Anaesthesia Consultant (SMO) holding the ‘Coordinator’ phone. Afterhours, this is usually held by a Registrar. They are your first port of call for any anaesthesia related questions.

Calling anaesthesia services

Why do you need to call us?

• It is important that all elective and acute patients arrive in the operating rooms ready to be anaesthetised (fasted, co-morbidities optimised as best as possible).

• You need to call us about every acute patient that is booked, so we can help you figure out if the patient is ready for theatre, or if there are issues that need optimising, or if DCCM/CVICU/PICU needs to be involved. Some of these issues can be optimised by you and your surgical team, e.g. referral to haematology for help with warfarin bridging.

• Most acute patients are able to be seen and assessed by the anaesthetist in the pre-op area. If they are medically or surgically complex, they may need a face to face anaesthesia review on the ward prior to being formally booked for surgery.

• All adult elective patients are seen or phoned by the Pre-Assessment Clinic, the list of people to contact can be found here

When should you call Anaesthesia?

• When you need to book ANY acute case. Overnight, if the case is straightforward and the patient is well, there is no need to call the overnight Registrar – you or the morning team can call after 0700.

• When you have a patient who may need surgery, but needs an anaesthesia review first (high risk patients or high risk surgery – or complex decision making MDT needed).

• When you need advice about medications or investigations outside of what is available in this chapter.

• When you need help with IV access and you have already escalated this through your team, i.e. a Registrar has made an unsuccessful attempt or the patient is known to have difficult IV access. See IV access requests, below.

What do you need to know before you call?

• The proposed procedure – open/laparoscopic/endoluminal

• Likely time of surgery – today/tomorrow/future elective list

• Fasting status, COVID/RAT status

• Co-morbidities (see section 5 for further information)

• List of current medications and allergies, especially anticoagulants

• Results of relevant recent investigations, e.g. echo/spirometry

• Outcomes of any recent anaesthetics/surgeries (e.g. difficult airway)

• List of specific questions you would like answered

How do you book a patient acutely?

• If the procedure is to be done in Starship or Level 8 Theatres (or would require anaesthesia assistance from either of these departments) – book using scOPe. This includes haemodialysis line insertion for the Renal Service and acute radiology and gastroenterology procedures requiring anaesthesia assistance. Make sure to select correct Facility and Specialty for your personal login in scOPe at the start of each rotation.

• If your service does not use scOPe (those services using GSU, Level 4 and Level 9 Theatres for their acute cases), then complete an acute booking form (CR2789) and fax or take to the appropriate operating rooms reception.

• Ensure the following details are legible:

  • Patients Name and NHI

  • Responsible Consultant surgeon’s details

  • Your name and contact number

  • Date and time of form completion

  • Call the relevant Anaesthesia Coordinator AND the relevant Nursing ‘Floor’ Coordinator.

Contact Details

IV access requests

• For adult PICC lines, call the Adult radiology PICC line service. Make a referral via ROERS under angio/Interventional. If PICC service unavailable, call Anaesthesia; Level 4 for Cardiology and CTSU patients, Level 8 for other patients.

• Anaesthesia may be able to help with difficult IV lines (where appropriate attempts by RMOs have been unsuccessful), CVLs or PICCs. These need to be discussed with the relevant Anaesthesia Coordinator and booked as for an acute surgical case. Due to other acute work, we are not always available to assist, but we try hard to help.

• Patients needing IV access for radiological procedures, e.g. angiograms can have these done by the Radiology team. If needed for investigations (CT/MRI), then Anaesthesia may assist if needed.

Fasting information for planned (acute or elective) surgery

Clear fluids (i.e. water, black tea, black coffee) until 2 hours pre-anaesthesia for all patients.

AM or All Day list

• No food from: 6 hours before expected arrival time to hospital. This includes milk, lollies and chewing gum.

• Water: should have a glass of water before leaving the house on the day of operation and then nothing else (unless instructed) after that.

• Pre-op carbohydrate drink available when list order confirmed and patient waits longer than 2 hours.

PM list

• Light breakfast (e.g. cereal, toast) with tea/coffee/milk prior to 0700h. Should have a glass of water when leaving home and can have water until leaving to go to hospital.

• A small drink of water with medication does not contravene the NBM guideline.

Special notes

Unless a patient is to be exposed to a significant dose of contrast during surgery, they do not require IV fluids overnight prior to surgery. It is better for patients to remain orally hydrated by sipping water for thirst throughout the night. Small sips of water (<100 mL in an hour) until they are called for surgery is safe with regards to proceeding with anaesthesia.

Fasting for Anaesthesia or Sedation policy found here

Other useful information: