Top 10 Questions for Anesthesia Attending Interview

1. What are the key components of a comprehensive pre-operative assessment for a patient undergoing major abdominal surgery?

A thorough pre-operative assessment is crucial to optimise patient outcomes. Key components include:

• Medical history: Review of current and past medical conditions, medications, allergies, and social habits.
• Physical examination: Evaluation of vital signs, airway, cardiovascular, respiratory, and abdominal systems.
• Laboratory tests: Comprehensive blood work, urinalysis, and coagulation studies to assess overall health and identify potential risk factors.
• Imaging studies: Chest X-ray, electrocardiogram, and other imaging modalities as indicated to evaluate organ function and rule out any underlying abnormalities.
• Anesthesia-specific assessment: Evaluation of airway anatomy, dental status, and any previous anesthesia experiences or complications.

2. Describe the pathophysiology, clinical manifestations, and management of malignant hyperthermia.

Pathophysiology

• Inheritable autosomal dominant trait characterised by an abnormal response to halogenated volatile anesthetics and depolarising muscle relaxants.
• Caused by mutations in the RYR1 gene, impairing calcium regulation in skeletal muscle.

Clinical Manifestations

• Hyperthermia, tachycardia, muscle rigidity
• Metabolic acidosis, hyperkalemia
• Arrhythmias

Management

• Immediate discontinuation of triggering agents
• Hyperventilation with 100% oxygen
• Administration of dantrolene
• Supportive care: cooling, antiarrhythmics, electrolyte management

3. Discuss the indications, contraindications, and potential complications of regional anesthesia techniques.

Indications

• Surgical procedures below the diaphragm (e.g., abdominal, pelvic, lower extremity)
• Pain management in the perioperative period
• Reduce intraoperative blood loss

Contraindications

• Infection at the injection site
• Coagulopathy or antiplatelet therapy
• Neurological deficits or disease involving the area to be anesthetised
• Patient refusal

Potential Complications

• Local anesthetic toxicity
• Hematoma or nerve injury
• Vascular puncture or arterial injection
• Hypotension

4. Explain the principles of balanced anesthesia and its advantages in maintaining intraoperative homeostasis.

Balanced anesthesia aims to achieve optimal anesthetic depth while minimising adverse effects on vital organ function. It involves combining different classes of anesthetic agents to achieve the desired level of sedation, analgesia, and muscle relaxation:

• Inhalational agents (e.g., sevoflurane, desflurane) for hypnosis and analgesia
• Intravenous opioids (e.g., fentanyl, remifentanil) for potent analgesia
• Neuromuscular blocking agents (e.g., rocuronium, vecuronium) for muscle relaxation

Advantages:

• Synergistic effects allow for lower doses of each agent
• Reduced risk of side effects associated with individual agents
• Improved hemodynamic stability, organ perfusion, and faster recovery

5. Discuss the management of a patient with acute airway obstruction.

Immediate airway management is crucial to prevent asphyxia:

• Basic Life Support: Position the patient, open the airway, and perform rescue breathing if unconscious.
• Advanced Airway Management: Use supraglottic airway devices or endotracheal intubation as appropriate to establish a definitive airway.
• Identify and Treat Underlying Cause: Determine the etiology of obstruction (e.g., foreign body, laryngeal edema, bronchospasm) and address accordingly.
• Monitoring and Supportive Care: Pulse oximetry, capnography, and hemodynamic monitoring are essential. Provide oxygen, bronchodilators, and other supportive measures as indicated.

6. Explain the concept of minimum alveolar concentration (MAC) and its clinical significance.

MAC is a measure of anesthetic potency, defined as the alveolar concentration of an inhalational anesthetic required to prevent purposeful movement in 50% of surgical patients exposed to a noxious stimulus. It varies among different agents and patient characteristics.

Clinical Significance:

• Helps determine appropriate anesthetic depth
• Guides dosage adjustments to achieve desired level of hypnosis
• Used in teaching and research settings to compare anesthetic potencies

7. Discuss the principles of closed-loop anesthesia and its potential benefits.

Closed-loop anesthesia involves using a feedback system to titrate anesthetic delivery based on real-time monitoring of physiological parameters (e.g., EEG, BIS). It aims to maintain a target anesthetic depth or specific physiological endpoint.

Potential Benefits:

• Improved stability of anesthetic depth
• Reduced awareness and postoperative nausea and vomiting
• Faster recovery times
• Potential for resource optimisation (e.g., reduced anesthetic consumption)

8. Explain the pathophysiology and management of postoperative shivering.

Pathophysiology

• Triggered by a drop in core body temperature during anesthesia
• Involves a complex interaction of thermoregulatory mechanisms and neurotransmitter systems

Management

• Prevention: Maintaining normothermia during and after surgery
• Active Rewarming: External warming blankets, warm fluids
• Pharmacological Agents: Meperidine, clonidine, dexmedetomidine
• Non-Pharmacological Interventions: Shivering blankets, heat packs

9. Discuss the role of regional anesthesia in the management of chronic pain.

Regional anesthesia techniques (e.g., nerve blocks, spinal cord stimulation) play a significant role in chronic pain management by providing targeted and long-lasting pain relief.

• They block pain signals at the source, reducing the need for systemic opioids and their associated side effects.
• Can improve quality of life, reduce disability, and facilitate rehabilitation.
• May be used as a diagnostic tool to identify the source of pain.

10. Explain the principles of multimodal analgesia and its benefits in the postoperative period.

Multimodal analgesia involves combining different classes of pain medications and non-pharmacological techniques to achieve optimal pain control while minimising side effects.

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Opioids
• Regional anesthesia
• Physical therapy

Benefits:

• Improved pain control
• Reduced opioid consumption and side effects
• Faster recovery and rehabilitation
• Enhanced patient satisfaction

An Anesthesia Attending plays a critical role in providing safe and effective anesthesia to patients undergoing surgical procedures. Their key responsibilities include:

1. Preoperative Assessment and Planning

Assessing patients’ medical history, physical condition, and surgical plans to determine the appropriate anesthesia type and develop an individualized anesthesia plan.

2. Anesthesia Administration

Administering anesthesia using various techniques, such as general, regional, and sedation, to ensure patient safety and comfort during surgery.

3. Intraoperative Monitoring and Management

Continuously monitoring patients’ vital signs, adjusting anesthesia as needed, and managing complications or emergencies that may arise during surgery.

4. Postoperative Care and Recovery

Providing immediate postoperative care, managing pain, and monitoring patients’ recovery from anesthesia.

5. Collaboration and Communication

Collaborating with surgeons, nurses, and other healthcare professionals to ensure optimal patient care and seamless coordination of the surgical process.

6. Education and Training

Educating patients and healthcare staff about anesthesia techniques, risks, and benefits, and providing training to junior anesthesia providers.

7. Quality Improvement and Research

Participating in quality improvement initiatives, conducting research, and staying up-to-date with advancements in anesthesia practices.

Preparing thoroughly for an Anesthesia Attending interview is crucial. Here are some tips to help you ace it:

1. Research the Hospital and Position

Familiarize yourself with the hospital’s reputation, surgical case mix, and the specific requirements of the position. Research the hospital website and LinkedIn profiles of current staff to gather insights.

2. Practice Behavioral Interview Questions

Behavioral interview questions focus on your past experiences and behaviors. Prepare examples that demonstrate your skills in teamwork, problem-solving, patient care, and handling stress.

3. Showcase Your Expertise

Highlight your anesthesia knowledge, experience, and certifications. Mention specific cases or research projects where you have demonstrated exceptional skills. If possible, quantify your accomplishments using data.

4. Ask Thoughtful Questions

Prepare thoughtful questions to ask the interviewers about the hospital’s philosophy on patient care, their approach to anesthesia management, and opportunities for professional development.

5. Be Professional and Enthusiastic

Dress professionally, arrive on time, and maintain a positive attitude throughout the interview. Show enthusiasm for the opportunity and demonstrate your passion for anesthesia.

6. Follow Up

After the interview, send a thank-you note to the interviewers, reiterating your interest in the position and highlighting any key points discussed.