Post Graduate Intern Protocols

Department of Anesthesia
Dr. John Philip Pestano

Duty Schedule for Post Graduate Interns:

1. Daily Work Schedule:

a. Hospital Time In: 8:00am Hospital Time Out : 5:00pm
b. 24 Hour Duty Time In: 8:00am 24 Hour Duty Time Out : 10:00pm
c. Post Duty Interns to return for scheduled conferences or hospital activities where their
attendance is expected.

2. Holiday and Weekend Work Schedule:

a. Only Duty Interns are expected to be within the operating room complexes on
weekends and holidays.
b. Postduty and Preduty Interns are on off-duty or on-call status as OR conditions merit.

3. Daily Time Recording

a. Interns are expected to sign in and out of the allocated logbook for Post Graduate
Interns and Junior Interns found at the Anesthesia Office with their full names, times in
and out, countersigned at the end of each day by the anesthesia resident in charge of
the Interns.

Curriculum for Post Graduate Interns:

1. General Objectives:
a. To create an appropriate exposure program in the Department of Anesthesia that will equip a
Post Graduate Intern with the basic skills and knowledge in airway management necessary to be
able to function as a future resident in a tertiary care center or as a physician in an emergent
airway situation.
b. To instill an appreciation for the science and art of anesthesia through exposure of the different
anesthetic procedures that may be encountered in a 15 day period in a tertiary government
hospital, prioritizing knowledge and skills development in basic airway management.

2. Specific Objectives:
a. At the end of a 15 day program, the Junior Intern is expected to be able to perform the following:

i. Perioperative Evaluation
1. Assess a patient’s airway, breathing, and circulatory status upon arrival at the
operating theatre.
2. Properly utilize commonly available operating room monitoring equipment and
documentation to evaluate a patient’s vital signs and perioperative status.
3. Evaluate and estimate fluid and hydration requirements, basic intravenous fluid
management, monitoring and estimation of blood and fluid losses
perioperatively.

ii. Airway Management (Bag Mask Ventilation, Direct Laryngoscopy, Intubation)

1. Identify anatomic and physiologic considerations critical to airway care and
management, including critical structures and planes of interest.
 2. Be able to describe the use, benefits, and limitations of the commonly found
airway support equipment in the operating theater such as the nasal cannula,
oral airway, facemask, supraglottic airway or laryngeal mask airway, and
endotracheal tube.
3. Describe the benefits of preoxygenation, and how it can be performed in the
pre-intubated patient.
4. Be able to control and operate a laryngoscope as well as identify and
differentiate its most common blades.
5. Prepare the necessary equipment and tools for intubation of a patient inclusive
of appropriate endotracheal tube sizes
6. Properly prepare and position a patient for intubation
7. Properly ventilate a patient for intubation.
8. Describe and execute proper visualization of critical airway structures in
intubation during direct laryngoscopy.
9. Perform a smooth, properly placed intubation of a patient, and be able to
describe the signs of a successful endotracheal intubation.
10. Perform proper airway evaluation to confirm proper siting and placement of
the endotracheal airway.
11. Properly secure the endotracheal airway.
12. Describe the observable criteria for extubation in an anesthetized patient
postoperatively.

iii. Pharmacology
1. Describe the basic mechanism of action, routes of administration, role in
anesthesia, and possible adverse effects of the following drugs:
a. Bupivacaine, inclusive of differentiating between the hyperbaric and
isobaric preparations as well as the benefits or uses of each.
b. Lidocaine
c. Morphine
d. Fentanyl
e. Propofol
f. Atracurium, succinylcholine
g. Sevoflurane, isoflurane
h. Midazolam
i. Ephedrine, Phenylephrine, Atropine, epinephrine

3. Time Frame: 120 to 136 hours

4. Inputs: Didactics with 1 consultant and 1 resident each inclusive of Research work and
prepared presentation lectures, supervised exposure, observation of procedures of
residents and consultants, guided performance of procedures of interest. (Didactics –
Endotracheal intubation, both inclusive of tools, technique, drugs as outlined above)

5. Outputs: 2 quizzes, 1 exit exam, execution of 2 intubations supported by copies of the relevant
signed anesthesia records as assists noted by the attending resident physician or
consultant, graded with rating tools.
Airway Management (Bag Mask Ventilation, Direct Laryngoscopy, Intubation)

1. Anatomic and physiologic considerations critical to airway care and management, including critical
structures and planes of interest.
2. Use, benefits, and limitations of nasal cannula, oral airway, facemask, supraglottic airway or laryngeal
mask airway, and endotracheal tube.
3. Benefits of preoxygenation, and how it can be performed in the pre-intubated patient.
4. Necessary equipment and tools for intubation of a patient inclusive of appropriate endotracheal tube
sizes
5. Preparing and positioning a patient for intubation
6. Proper ventilation for intubation.
7. Mallampati Scoring and Cormack Lehane Laryngeal Grading System
8. Signs of a successful endotracheal intubation.
9. Proper airway evaluation to confirm proper siting and placement of the endotracheal airway.
10. The properly secured endotracheal airway.
11. Observable criteria for extubation in an anesthetized patient.

Pharmacology Topic list

Basic mechanism of action, routes of administration, role in anesthesia, and possible adverse effects of the
following drugs:
a. Bupivacaine, hyperbaric and isobaric
b. Lidocaine
c. Morphine
d. Fentanyl
e. Propofol
f. Atracurium vs succinylcholine
g. Sevoflurane vs isoflurane
h. Midazolam
i. Ephedrine vs Phenylephrine,
j. Atropine
k. Epinephrine