All Systems Go

Systems. Habits. Ways of doing things, lining things up, preparing vials of drugs or positioning the ultrasound just-so.

Everyone has one.

Everyone is a bit different; all built from advice from different mentors or in response to different previous disaster-pants moments – a product of the necessary learning curve in anaesthestic training.

As a junior trainee, or a prospective doctor on a taster week, or maybe even an experienced doctor making a move to a new department, watching how other established anaesthetists set themselves, their kit, their drugs and their team up before launching into mission mode is an informative experience.

Today I learned about one anaesthetist’s technique of putting opioids into 5ml syringes, muscle relaxants into a 10ml syringe, and propofol into a 20ml syringe – a system learned in the time-critical arena of pre-hospital care, where differing syringe sizes to identify which drug is which provide tactile information in addition to the visual reminder of a coloured drug label sticker – an extra layer of redundancy to ensure safety during an RSI in a dark corner at 3 in the morning, and a great tip for a junior.

Sometimes, however, watching this preparation and comparing it to our own system (or lack of system) can be intimidating; Is my system not good enough? Which system is best? Which to choose? Will this make or break my anaesthesia delivery?

Maybe there is one single anaesthetic preparation set up that will rule them all.

On the other hand, we might be liberated by the existence of a wide breadth and individuality of the systems employed by individuals; That there are so many systems, yet many safe and effective anaesthetics given, means that there are no major differences between the outcomes of different systems.

So, maybe there is no ‘optimal’ set up!?

The excellent principles of rigour, organisation and checklists to enable safe practice are seen throughout anaesthetic practice, and there are many circumstances where the consequences of poor systems are so disastrous that it should take much to contemplate whether an off-piste route should be taken e.g. CICO scenarios.

But, with regard to the large and multi-faceted task of delivering an anaesthetic, the smaller, personal details might not matter so much (as in they probably won’t help another practitioner). Whether you protocolise your pre-gas checks by lining everything up, drawing some drugs up and but leaving others in their vials, or use specific syringe sizes to mark out opioid, hypnotic and muscle relaxants is by-the-by; its success for you probably won’t translate into success for another practitioner with different experiences, habits or foibles. Our systems just play around the edges of a greater whole i.e. the principles of anaesthesia.

In summary, take comfort that no system is best, but the best one is the one that you choose and works for you (safely and consistently).

Dr Rory Heath

Clinical Fellow in Emergency Medicine