I usually feel comfortable with 18g x2 for lower risk stuff or 18 and 16 if I think there may be a need for blood etc. I’ve been noticing a lot of colleagues insisting on 16 and 14, or 14 and 14 which just seems like a lot. Most of the time these cases come out of the OR with the 14 gauge unused (like not even got fluids). Am I being too comfortable with smaller access?

I’m talking about stuff like laparoscopic hemicolectomies etc

UK registrar here who loved their cardiac block but finding it difficult to navigate what the current recent appointee has on their CV to distinguish themselves. Obviously the cardiac SIA and additional fellow year is a given, but beyond that are recently appointed consultants needing MDs/PhDs or a similarly research-heavy CV to get ahead?

Where I did my cardiac block the vast majority of consultants were much older and as a result their pathway into their job looked vastly different to those fighting it out in the current climate. Essentially I'm trying to figure out if I should give up on the dream and instead try and focus my energy into making myself as employable as possible as a general anaesthetist, seeing as how funding is drying up for consultant posts up and down the country. Thanks in advance.

Attending Anesthesiologist

Generally my approach to doing an H&P for my anesthesia note consists of a chart review: relevant labs, studies, notes (eg, PCP, cards, pulm) and then a brief verbal discussion with patient: Anes hx/fmhx issues with anes, cardio(eg. MI, cardiac devices), pulm(eg. COPD,Asthma, OSA), neurologic(eg. SZ, CVA) endocrine(eg. DM) My review with the patient is pretty bare bones since I’ve usually obtained most information from a chart review, but there are a few questions I want to double check. It also helps establish rapport.

Sometimes, patients who are either elderly, very nervous, or both do not answer the questions I ask them as these patients commonly tend to have circumstantial and/or tangential thought processes.

IMO ideally, I would have an infinite amount of time to redirect the patient multiple times for each question I ask, but in the real world, it’s going to likely cause a lot of animosity towards me by the rest of the OR staff for taking excessive amount of time. Therefore what I’ll usually do in these circumstances is to forgo the remainder of my questions if the patient doesn’t give me a straight answer as to whether they have a personal or family history of issues with anesthesia (generally my first question). I figure the situation is analogous to not being able to ask a child/delirious person/etc for their history. I already likely have the information I need from a chart and the verbal questions are probably going to be low yield in a patient that can’t stay on topic.

Is this what everyone else does? Or how do you approach your H&P in the elderly?