Standard operating procedure for the Dept.
of Anaesthesia
SDAMC – Bangalore.
Section1- Minimum Mandatory Standards in Operation Room
(ISA)
The speciality of anaesthesiology requires a lot of vigil on part of anaesthesiologists. It
includes presence of anaesthesiologist as well as lot of monitoring equipment. The Goal of
these minimum monitoring standards is to improve safety of patient undergoing anaesthesia.
The surgeon, anaesthesiologist, other physician and ancillary staff work as team to improve
outcome of the procedure. The Goals includes
1. Presence of Anaesthesiologist- The operating surgeon & hospital must ensure presence of a
qualified and registered Anaesthesiologist in the Operating Room where a patient is
undergoing a procedure under anaesthesia.
2. Pre Anaesthetic Check-up(PAC) & Investigations – The surgeon should request the PAC of
the patient from the anaesthesiologist before listing the patient for OR. The necessary
investigations, references and optimisation of patient should be done in consultation with
anaesthesiologist. The ISA recommend a patient questionnaire, PAC chart to be used by all
anaesthesiologist.
3. Presence of Anaesthesia Machine/Workstation and Monitoring equipment- The OR should
have a functioning anaesthesia machine/workstation, defibrillator, monitoring equipment in
working condition, essential medicine and airway equipment.
4. Safety Checklist- The anaesthesiologist should ensure availability of checklist in the OR
and perform it before giving anaesthesia to patient 5. Adequate facility to manage emergency
& To transfer patient if required.
Section 2- Functioning of department
1. Regular monthly meetings is a must, even over a cup of tea is ok, Clinical
topics, Difficulties in practice, setups, black sheep etc should always be
discussed.
2. Public awareness is woefully lacking about our specialty & every member
should take it on himself to promote this activity. Some suggestions are
A. Starting your own Pre Anaesthesia Clinic in each hospital, visiting the
patient preoperatively & in postoperative period.
B. Anesthesia specific consent forms with a preoperative questioner to be
handed over to the patient once he has been posted for surgery (in local
language)
C. Designing & pasting posters imparting knowledge about Anaesthesia
with pictorial demonstration of modes & techniques of Anaesthesia.
D. Organise conferences/ Workshops not only for Anaesthesia but also on
Pain, Labour Analgesia bringing all specialists to a common platform.
E. 7. Frequent meetings & interactions help in a cohesive stress free
atmosphere.
F. 9. A Grievance cell should be setup in each hospital as also a rescue team
to help members in times of distress in OT/ ICU.
G. We should be well focused in O.T. hours & should never feel insecure.
H. We should strike a balance between family &profession life and shouldbe
eager to work unitedly.
I. We should be full of energy & have command on our professional skills.
Section 3- Ethical Conduct of Anaesthesiologist
The ISA advises and expects thorough ethical conduct from its members at all
times. The professional conduct helps in avoiding landing in unwanted
situations, helps in overcoming adverse circumstances and also helps in case of
litigations. The ISA recommends following to its members.
1) Perform a Pre Anaesthetic Check-up(PAC) of the patient before taking
the patient for surgery. Ask all your surgeons to send all patients of
elective surgery for PAC. Use the ISA recommended Questionnaire &
PAC format for documentation of PAC. Performing PAC helps in
establishing a rapport with the patients and their family. Do not forget to
Communicate, Document, Communication of documentation, &
Documentation of Communication as this is the key to success in
medicolegal cases.
2) Always optimise the patient before taking up for surgery. Get proper
investigations & references done for the type of surgery & patient, and
document it.
3) Consent- Always obtain a separate consent for anaesthesia from patient
after explaining him the technique, alternatives and answering his
queries.
Pre Anaesthetic Check-up:
This needs to be done by a qualified anaesthesiologist.
History: write here whatever is significant. It is duty of the anaesthetic to ask
for all related medical history irrespective of whether it was answered as
negative in the questionnaire. For medical history written in adequate details
by the patient, the anaesthesiologist may only mention that it was noted.
Examination: To be done in details and all the positive findings to be entered
in details. Anaesthesia Plan & Alerts: Write here the plan of anaesthesia best
suited as per your judgement and patient counselling and also if there are any
anticipated difficulties or special preparations to be done. Example: GA with
TAP Block, Low Hb will need to arrange blood. After the patient is seen and
counselled by the anaesthesiologist, the anaesthetist will sign the form and
give it back to the patient. The patient will read it at his leisure and if willing
for surgery, sign it and come for admission on appointed time. The consent
will be signed by the patient, if he is adult and capable of giving consent. In
cases of minors and people not fit to give consent, the consent will be signed
by guardians/parents. If the patient is not fit to sign consent, in cases of
emergency where no known relative is present, it will be signed by
competent hospital authority as prescribed by law.
4) The ISA recommends that members should always perform the pre
anaesthetic evaluation before inducing the patient, and document.
GUIDELINES TO USE ANAESTHESIA RECORD
• Demographic details to be filled by anaesthesiologist or anaesthesia
technician after the patient is taken in OT. To be verified by anaesthesiologist
if filled by anyone else.
• PAC Findings: Fill here any alerting point noted during PAC. E.g. HT/DM/
anticipated difficult airway/ allergy to penicillin etc. All findings noted in
PAC to be rechecked here. Significant Investigations: write here only those
investigations which are significant to present anaesthetic, e.g. Hb 6 g%, EF
30%, HIV positive, etc.
• Mark all the monitors used. It is highly recommended to use all monitors
available in OT and as per minimum standards prescribed.
• Anaesthesia Checklist: It is to be performed before each anaesthetic and
marked here after completion of each check.
• Position of patient: enter the position of patient to be given during surgery.
• Regional/ Block: write here the name of the regional (epidural/
subarachnoid) or block used. Enter the concentration and volume of local
anaesthetic agent along with any adjuvant used. Induction agent: write here
the name and dose of induction agents used along with muscle relaxants if
any. • Airway management: if any airway device is used write here, e.g.
endotracheal tube no7.0, LMA No.4, I gel, etc.
• Maintenance of anaesthesia: write here the names and concentration of
agents used to maintain anaesthesia, e.g. N2O 60%, O2 40%, Iso 1%
• Ventilation: write here the mode of ventilation used during the anaesthetic
along with tidal volume and respiratory rate if applicable
• Intraoperative monitoring chart: Symbol for various hemodyanamic&
respiratory parameters are given. It is to be entered in a line form to show the
vitals value during the anaesthetic. Different colours can be used for
differentiation. The timeline has been left empty so that the anaesthesiologist
can enter as per the duration of surgery and according to the changes in
vitals. IV Fluids, here the Fluids given can be written along the time line.
Drugs given during the conduct of anaesthetic can also be entered along the
timeline. Remarks column here is to make any additional note as may be felt
necessary.
. Post op Condition of patient and orders are selfexplanatory and need to be
filled. Here whether patient was shifted to ward/ Recovery Room and the
monitoring required there has to be clearly mentioned.
• Inform SOS: it is strongly advised to enter the mobile phone of
anaesthesiologist here so that he can be reached with ease in event of any
incident.
5) The anaesthesiologist is guardian of patient during anaesthesia. The
anaesthesiologist should be present throughout the surgical procedure, and
be vigilant. The vitals should be recorded in intraoperative chart every 5
minutes. Complication/adverse event, if any should also be documented in
the chart.
The Anaesthesiologist should ensure safe transport of patient from
Operation Room to Post Anaesthesia Care Unit/ICU/Ward etc. He
should communicate with patient & his attendants at the end of surgery.
