This book is a structured, clinically grounded guide for final‑year medical students at the Umanand Prasad School of Medicine (UPSM) who are rotating through anaesthesia and critical care. It is designed as a hybrid resource: a pocket survival manual for the operating theatre and ICU, and a high‑yield companion for MCQ and OSCE preparation. The narrative follows the patient’s perioperative journey and the student’s parallel transformation from passive observer to active, safe team member.
At its core, the manual is organised into twelve integrated modules that mirror the temporal flow of anaesthetic care, beginning with pre‑operative assessment on the ward, progressing through theatre preparation, airway management, pharmacology, and regional techniques, and culminating in ICU, resuscitation, perioperative crises, and exam strategy. Throughout, the content is explicitly contextualised to Fiji’s health system, with emphasis on Rheumatic Heart Disease, non‑communicable diseases, diabetic sepsis, limited resources, and the realities of divisional and regional hospitals.
Pedagogically, the manual adopts a highly structured page architecture. Each module is built around three zones: a “Top Bar” that summarizes immediate actions, key doses, or safety checks; a “Clinical Core” that provides stepwise instructions and concise theory; and a “Sidebar” that employs recurring cognitive cues. These cues include targeted MCQ notes, Fiji‑specific clinical warnings related to equipment constraints or epidemiology, and short OSCE scripts that model the exact phrasing and structure expected in a station. This tripartite design anchors rapid bedside use while covertly reinforcing examinable principles.
The opening modules establish the conceptual and practical foundations for safe anaesthetic practice. The initial pre‑operative assessment chapter presents a focused, high‑yield approach anchored in functional capacity, comorbidity profiling, and structured airway evaluation. Students are taught to integrate exercise tolerance, the “Fiji Big Three” comorbidities, and previous anaesthetic history into a coherent risk stratification strategy. Bedside airway assessment is operationalised through a simple algorithm that combines visual inspection, the 3‑3‑2 rule, Mallampati classification, and neck mobility, enabling students to anticipate difficulty rather than merely react to it. This is immediately followed by a module on investigations and risk, which distills the “minimal lab set” appropriate to Fiji’s resource constraints and aligns ordering behaviour with the principle of only requesting tests that change management.
The subsequent theatre‑focused modules demystify the anaesthetic machine, monitoring, airway maneuvers, and basic physiological support. The hardware chapter guides students through an actionable checklist of machine safety, with particular emphasis on oxygen supply verification, suction readiness, and the MS‑MAID mnemonic as a pre‑induction ritual. High‑pressure gas systems, circle circuits, soda lime function, and leak testing are explained not as abstract mechanics but as safety‑critical behaviors. Mandatory monitoring is presented as the “Big Five” that must be in place before induction: pulse oximetry, capnography, non‑invasive blood pressure, ECG, and inspired oxygen concentration. Within this frame, capnography is highlighted as the single most reliable indicator of endotracheal tube placement, and the book devotes concise but practical guidance to troubleshooting sudden waveform loss.
The airway management module then synthesizes theoretical prediction and hands‑on technique. It trains students to view airway care as a hierarchy: from positioning and bag‑mask ventilation, through supraglottic devices, to endotracheal intubation and finally front‑of‑neck access in “Can’t Intubate, Can’t Oxygenate” crises. The narrative emphasizes core psychomotor skills, including the sniffing position, effective mask seal with the E‑C clamp, left‑hand laryngoscopy with tongue displacement, and prompt confirmation of tube placement through visualization and capnography. The book repeatedly reinforces a central safety maxim: oxygenation is paramount, and learners must feel permitted to abandon unsuccessful intubation attempts and return to bag‑mask ventilation rather than perseverating into hypoxia.
Once basic theatre competence is established, the manual turns to the two domains that most commonly unsettle students: fluid therapy with acid–base interpretation, and regional anaesthesia. The fluids and acid–base module frames intravenous therapy as a pharmacological intervention in its own right, with potential for harm at both extremes. It walks the student through rational choice of crystalloid versus colloid in the Fijian context, using intra‑operative urine output, heart rate, and dynamic indicators such as pulse pressure variation as pragmatic surrogates of volume status. A streamlined three‑step approach to arterial blood gas interpretation is provided, grounded in pattern recognition of respiratory and metabolic derangements commonly encountered in sepsis and diabetic ketoacidosis. This analytical discipline is paired with Fiji‑specific caution regarding fluid administration in Rheumatic Heart Disease, where preload dependence and risk of pulmonary edema make slow, titrated infusions essential.
Regional anaesthesia, particularly spinal block, is treated as a pivotal rite of passage for UPSM students. The spinal module integrates surface anatomy, needle trajectory, and sensory level titration into a procedural “cookbook” that is both reproducible and exam‑ready. Landmarking with Tuffier’s line, recognition of tissue planes, the tactile cues of ligamentum flavum and dura, and the critical importance of positioning are articulated in a stepwise narrative. Common technical difficulties such as bone contact and radicular pain are reframed as manageable cues rather than failures, and clear contraindications are set out to cultivate the judgment to decline spinal anaesthesia when risk is unacceptably high. By foregrounding how to say “no,” the manual subtly inducts students into the ethical dimension of anaesthetic decision‑making.
Building on this spinal foundation, the obstetric anaesthesia chapter addresses the physiologic and logistical complexity of Caesarean section in a setting where Category‑1 emergencies are frequent. Here, the manual contrasts spinal anaesthesia as the gold standard with general anaesthesia and rapid sequence induction as time‑critical alternatives when neuraxial techniques are not feasible. It unpacks the implications of reduced functional residual capacity, increased oxygen consumption, and heightened aspiration risk in pregnancy, reinforcing routine pre‑oxygenation, left uterine displacement, and aspiration prophylaxis. Both neuraxial and general techniques are contextualised within the realities of postpartum hemorrhage and high‑parity obstetric practice in Fiji, highlighting the need for early recognition and aggressive management of uterine atony.
Paediatric anaesthesia and pharmacology are similarly approached through pragmatic rules that ease cognitive load: weight‑based dosing schemes, the 4‑2‑1 rule for maintenance fluids, and age‑appropriate airway considerations. While avoiding oversimplification, the manual equips students with enough structure to safely assist while recognizing their own limitations. This emphasis on “safe participation” rather than independent practice is a recurring theme across chapters, consistent with the professional expectations of a final‑year student rather than a specialist trainee.
The book’s later modules relocate the student from the operating theatre into the ICU and emergency response domain, aligning with the modern reality that anaesthetists often lead resuscitation and critical care. The ICU and resuscitation chapter is anchored in the ABCDE assessment framework and is particularly concerned with the first sixty minutes of management of the deteriorating patient. It guides learners through pattern recognition of the four canonical shock types and introduces mechanical ventilation in an accessible manner, focusing on a few fundamental parameters: mode, FiO₂, positive end‑expiratory pressure, and tidal volume. The advanced life support section integrates reversible cause analysis via the 4Hs and 4Ts heuristic, enabling students to move beyond rote algorithm recitation to explanatory reasoning about cardiac arrest.
The perioperative emergencies module then synthesizes crisis management across a small number of high‑impact scenarios: anaphylaxis, local anaesthetic systemic toxicity, laryngospasm, bronchospasm, malignant hyperthermia, and massive haemorrhage. Here, the book models explicit declaration of emergencies, early escalation, and leadership behaviours in resource‑constrained settings. Each condition is presented with a minimalist syndrome definition, key triggers, immediate actions, and drug regimens, with particular attention to adrenaline dosing in anaphylaxis and intralipid protocols in toxicity. Fiji‑specific infection risks, consumables reuse, and blood product scarcity are acknowledged openly, preparing students to practice safely within systemic constraints rather than in an idealized environment.
Crucially, the manual concludes with two “exam mastery” chapters that transpose clinical knowledge into the language of assessments. The MCQ “buzzwords” module catalogues recurrent stem‑answer associations that students must recognise rapidly, such as classic links between specific agents and characteristic toxicities or complications. However, each association is accompanied by a brief mechanistic explanation, reinforcing conceptual understanding rather than pure memorization. The final OSCE script chapter abstracts a universal communication and action scaffold for emergency stations: a rehearsed opening sequence that establishes safety, calls for help, and initiates oxygen therapy; a structured ABCDE assessment with sample verbalizations; and a closing handover focusing on documentation and family communication. By providing scripted wording rather than loose advice, the book converts performance anxiety into a series of predictable, practised routines.
Collectively, these elements position the manual as more than a compendium of facts. It functions as a cognitive apprenticeship model for anaesthesia and critical care in Fiji, guiding the UPSM student from shadowing to meaningful participation. The repeated integration of action checklists, physiological rationale, and exam cues reflects a dual commitment: to immediate patient safety in divisional theatres and ICUs, and to the long‑term professional development of students as they prepare for finals and the responsibilities of internship.
