Sarra Wang

As an Anaesthetic Registrar, I’m with patients at every step of their surgery journey. I’m involved in perioperative care, spending time in the pre-assessment clinic seeing them before their surgery. I’m in theatre with them during their procedure, managing their anaesthetic. And I work on the Critical Care Unit (CCU) as a Critical Care Registrar, managing them after their operations.

Anaesthetic registrars at The Royal Marsden usually work with a consultant anaesthetist.  A typical day in theatres would start at around 7.15am. I check the patient operating list the night before surgery so I can carry out any preparation. If the procedure is complex and not routinely performed elsewhere – such as an oesophagectomy – we need extra time to plan. Depending on the complexity of the surgery, we might have two or three patients on our lists for the day.

Pre-op planning

Once I’ve changed into scrubs, I head to the Day Surgery Unit to see the patients I’ll be looking after in theatre. I then discuss their cases with our consultants, and we plan what sort of anaesthetic is most appropriate for them. At around 8am, I’m back in theatres for a briefing with the whole theatre team to discuss the surgical and anaesthetic plan for each patient on the operating list. We’ll call our first patient in for their procedure during this time.

The most important aspect of our role in theatres is to administer the anaesthetic, which is tailored to the patient and the type of surgery they’re having. This often involves tasks like providing spinal injections or epidurals, and inserting catheters for additional monitoring and administering medications, fluids and blood products. We’ll administer the medications required for a general anaesthetic, and also intubate patients so they can be put on a ventilator. For major surgery, all this can take a significant time before the procedure can start.

We’re with our patients for the duration of their surgery, constantly monitoring them and treating the effects of the anaesthetic drugs or the operation as necessary. The length of surgery varies hugely – it can sometimes take 10-12 hours.

Managing pain

As part of anaesthetic care, we also manage a patient’s pain relief during and after their operation. This varies depending on each patient and what type of procedure they’re having. We monitor how a patient responds to pain relief during surgery and adjust our plan accordingly.

When appropriate, we’ll wake up our patient in theatre at the end of surgery, take them to the recovery ward or CCU and hand them over to the clinical team. But sometimes, if a surgery is particularly complex, we plan for the patient to be woken up in CCU.

No two days are the same as an anaesthetic registrar. Some days, I’m ‘on call’ for theatres or CCU. These are 13-hour shifts and can be night shifts. But I love my job; it’s exciting and varied, with patient wellbeing at the heart of what we do.