Scenario Analysis: This scenario is professionally challenging because it involves a patient with a significant pre-existing condition that directly impacts anaesthetic management and carries increased perioperative risks. The anaesthetist must balance the need for effective pain relief and surgical access with the potential for exacerbating the patient’s underlying pathology. This requires a thorough understanding of the disease’s pathophysiology, its interaction with anaesthetic agents, and the availability of appropriate monitoring and resuscitation resources. The decision-making process must be guided by patient safety, evidence-based practice, and professional ethical obligations. Correct Approach Analysis: The best professional approach involves a comprehensive pre-anaesthetic assessment specifically tailored to the patient’s severe COPD. This includes a detailed history of exacerbations, current medication regimen, functional capacity, and recent investigations (e.g., spirometry, arterial blood gases). The anaesthetist should then formulate a tailored anaesthetic plan, considering the use of bronchodilators, appropriate ventilatory strategies (e.g., lung-protective ventilation, avoiding high PEEP if contraindicated), judicious use of opioids and sedatives to minimise respiratory depression, and potentially regional anaesthetic techniques to reduce systemic opioid requirements. Close intraoperative monitoring of oxygenation, ventilation, and haemodynamics is paramount, with readily available resources for managing bronchospasm and hypoxaemia. This approach aligns with the fundamental ethical principle of beneficence and non-maleficence, ensuring the patient receives care that maximises benefit and minimises harm, as well as adhering to professional standards of practice that mandate thorough patient assessment and individualised care plans. Incorrect Approaches Analysis: An approach that proceeds with a standard general anaesthetic without specific consideration for the severe COPD would be professionally unacceptable. This fails to acknowledge the increased risks associated with anaesthetising such a patient, potentially leading to severe bronchospasm, hypoxaemia, and prolonged recovery. It neglects the anaesthetist’s duty to assess and mitigate risks specific to the patient’s condition. Choosing an anaesthetic technique solely based on surgeon preference without adequately considering the patient’s severe COPD and its implications for anaesthetic management is also professionally unsound. While surgeon collaboration is important, the anaesthetist retains ultimate responsibility for the patient’s anaesthetic care and must prioritise patient safety and physiological stability. Administering anaesthetic agents known to cause significant respiratory depression or bronchoconstriction without a clear plan to manage these effects would be a failure to uphold professional standards. This demonstrates a lack of foresight and preparedness for potential complications, contravening the principle of providing safe and effective anaesthesia. Professional Reasoning: Professionals should employ a systematic approach to patient assessment, focusing on identifying and quantifying risks associated with pre-existing conditions. This involves a thorough review of the patient’s medical history, current medications, and functional status. Following this, a risk-benefit analysis should be conducted for all proposed anaesthetic and surgical interventions. The anaesthetist must then develop an individualised anaesthetic plan that mitigates identified risks, utilising appropriate pharmacological agents, monitoring techniques, and contingency plans. Open communication with the patient, surgical team, and other relevant healthcare professionals is crucial throughout this process.

Scenario Analysis: This scenario presents a professional challenge due to the inherent risks associated with administering anaesthetic agents, particularly in a patient with a complex medical history. The anaesthetist must balance the need for effective anaesthesia with the potential for adverse drug interactions and patient-specific vulnerabilities. Ensuring patient safety requires a thorough understanding of pharmacology, adherence to best practice guidelines, and a commitment to continuous professional development. The challenge lies in applying theoretical knowledge to a dynamic clinical situation, making informed decisions under pressure, and communicating effectively with the patient and other healthcare professionals. Correct Approach Analysis: The best professional practice involves a comprehensive pre-anaesthetic assessment that includes a detailed review of the patient’s current medications, allergies, and past medical history. This assessment should inform the selection of anaesthetic agents, considering their pharmacokinetic and pharmacodynamic profiles in the context of the patient’s specific physiology and comorbidities. The anaesthetist should consult relevant clinical guidelines and evidence-based literature to identify potential drug interactions and contraindications. This approach prioritises patient safety by proactively identifying and mitigating risks, ensuring that the anaesthetic plan is tailored to the individual patient’s needs and circumstances. This aligns with the ethical principles of beneficence and non-maleficence, as well as professional standards for anaesthetic practice in Australia, which emphasize thorough patient evaluation and risk assessment. Incorrect Approaches Analysis: One incorrect approach involves proceeding with anaesthesia without a thorough review of the patient’s current medications, assuming standard protocols are sufficient. This fails to account for potential synergistic or antagonistic effects of the patient’s existing drugs with anaesthetic agents, increasing the risk of unexpected and potentially dangerous physiological responses. This approach disregards the fundamental principle of individualised patient care and contravenes professional obligations to conduct a comprehensive pre-anaesthetic assessment. Another unacceptable approach is to rely solely on memory or anecdotal experience when selecting anaesthetic agents, without consulting up-to-date clinical guidelines or pharmacological resources. Anaesthetic pharmacology is a constantly evolving field, and outdated knowledge can lead to suboptimal drug choices or failure to recognise emerging risks. This approach demonstrates a lack of commitment to evidence-based practice and professional accountability, potentially compromising patient safety. A further incorrect approach is to administer anaesthetic agents without considering the patient’s specific comorbidities, such as renal or hepatic impairment, which can significantly alter drug metabolism and excretion. This oversight can lead to prolonged drug effects, increased toxicity, or inadequate anaesthesia. It represents a failure to apply fundamental pharmacokinetic principles and a disregard for the impact of systemic disease on drug response, which is a critical aspect of safe anaesthetic practice. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a comprehensive patient assessment. This includes gathering information on medical history, current medications, allergies, and previous anaesthetic experiences. Following this, they should consult current, evidence-based guidelines and pharmacological resources to inform drug selection, considering the patient’s specific physiological status and comorbidities. Risk assessment and mitigation should be an integral part of the planning process. Finally, clear communication with the patient and the anaesthetic team is essential throughout the perioperative period.

This scenario presents a professionally challenging situation due to the inherent risks associated with airway management in a patient with a potentially compromised airway. The anaesthetist must balance the immediate need for airway control with the potential for exacerbating the patient’s condition or causing iatrogenic injury. Careful judgment is required to select the safest and most effective method of airway management, considering the patient’s specific anatomy and the available resources. The correct approach involves a thorough pre-anaesthetic assessment of the airway, including a detailed history and physical examination, with particular attention to factors that might indicate difficult intubation. This assessment should inform the selection of appropriate equipment and techniques, and the development of a clear plan for airway management, including contingency strategies. This aligns with the fundamental ethical principles of beneficence and non-maleficence, ensuring that the patient receives the best possible care while minimising harm. Professional guidelines, such as those from the Australian and New Zealand College of Anaesthetists (ANZCA), strongly advocate for comprehensive pre-anaesthetic assessment and planning to optimise patient safety. An incorrect approach would be to proceed with anaesthesia without a detailed airway assessment, relying solely on assumptions or past experience with similar cases. This fails to acknowledge the individual variability in patient anatomy and the potential for unexpected difficulties, thereby breaching the duty of care and potentially leading to adverse outcomes. Another incorrect approach would be to select a single, rigid plan for airway management without considering alternative strategies or the possibility of failure of the primary method. This demonstrates a lack of preparedness and foresight, which is contrary to professional standards and the principles of patient safety. Finally, choosing an invasive airway technique as the first-line approach without a clear indication or a less invasive option being demonstrably unsuitable would also be professionally unacceptable, as it unnecessarily increases the risk of complications. Professionals should employ a systematic decision-making process that begins with a comprehensive assessment, followed by risk stratification, and the development of a multi-modal management plan. This plan should include primary, secondary, and tertiary strategies for airway management, ensuring that the anaesthetist is prepared for a range of eventualities. Open communication with the patient (where appropriate) and the anaesthetic team is also crucial.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the anaesthetist’s clinical judgment regarding the safety and efficacy of a proposed anaesthetic technique. The anaesthetist must navigate the ethical principles of patient autonomy, beneficence, and non-maleficence, while also considering the practical implications of anatomical variations and the potential for adverse outcomes. The pressure to adhere to patient preferences, especially when they are strongly held, can create a difficult ethical tightrope to walk. Correct Approach Analysis: The best professional practice involves a thorough, patient-centred discussion that prioritises informed consent and shared decision-making. This approach requires the anaesthetist to clearly explain the anatomical considerations relevant to the patient’s specific situation, detailing why the proposed technique might be suboptimal or carry increased risks due to their unique anatomy. It necessitates outlining alternative anaesthetic plans that are considered safer and more appropriate, explaining the rationale behind these recommendations based on established clinical guidelines and anatomical knowledge. The anaesthetist must then actively listen to the patient’s concerns, address any misunderstandings, and collaboratively arrive at a plan that respects the patient’s values while ensuring their safety and well-being, aligning with the principles of beneficence and non-maleficence. This aligns with the ethical imperative to provide care that is both safe and respects the patient’s right to make informed choices about their medical treatment. Incorrect Approaches Analysis: One incorrect approach involves overriding the patient’s stated preference without a comprehensive discussion of the anatomical risks and alternatives. This fails to uphold the principle of patient autonomy and can lead to a breakdown of trust. It also neglects the anaesthetist’s duty to ensure the patient is fully informed about the implications of their choices, potentially leading to a situation where consent is not truly informed. Another incorrect approach is to proceed with the patient’s preferred technique despite significant anatomical contraindications, without adequately exploring the risks or offering safer alternatives. This directly contravenes the principle of non-maleficence, as it knowingly exposes the patient to a higher risk of harm. It also demonstrates a failure in professional responsibility to advocate for the safest possible anaesthetic management. A further incorrect approach is to dismiss the patient’s concerns about their anatomy as irrelevant or misinformed without a proper explanation. This can be perceived as paternalistic and disrespectful, undermining the collaborative nature of the doctor-patient relationship. It also misses an opportunity to educate the patient and build confidence in the anaesthetist’s expertise and care. Professional Reasoning: Professionals should employ a structured approach to ethical dilemmas involving patient autonomy and clinical judgment. This involves: 1) Actively listening to and understanding the patient’s perspective and wishes. 2) Conducting a thorough clinical assessment, including a detailed anatomical evaluation relevant to the proposed procedure. 3) Clearly and empathetically communicating the findings of the assessment, including any anatomical variations and their implications for anaesthetic management, using plain language. 4) Discussing all available and appropriate anaesthetic options, outlining the risks, benefits, and alternatives for each. 5) Collaboratively developing an anaesthetic plan that balances patient preferences with clinical safety and best practice, ensuring informed consent is obtained. 6) Documenting the discussion and the agreed-upon plan thoroughly.

Scenario Analysis: This scenario presents a professional challenge due to the inherent risks associated with regional anaesthesia, specifically the potential for nerve injury or vascular puncture during ultrasound-guided interscalene brachial plexus block. The anaesthetist must balance the benefits of the block with the need to minimise complications, requiring a thorough understanding of regional anatomy and adherence to best practice guidelines. The pressure to proceed efficiently in a busy operating theatre environment can exacerbate the challenge, necessitating a systematic and evidence-based approach. Correct Approach Analysis: The best professional practice involves performing the interscalene brachial plexus block with ultrasound guidance, ensuring the needle tip is visualised throughout the procedure and the local anaesthetic is injected incrementally with careful aspiration for blood or clear fluid prior to each injection. This approach directly addresses the core principles of safe regional anaesthesia by providing real-time visualisation of anatomical structures, allowing for precise needle placement and minimising the risk of inadvertent vascular puncture or intraneural injection. This aligns with the ANZCA Professional Document PS06, “Guidelines on Sedation and Analgesia for Diagnostic and Interventional Procedures,” which emphasises the importance of appropriate training, patient assessment, and monitoring, and implicitly supports techniques that enhance safety and reduce complications. Furthermore, it reflects the ethical obligation to provide care that is both effective and minimises harm. Incorrect Approaches Analysis: Proceeding with the block without ultrasound guidance, relying solely on anatomical landmarks, significantly increases the risk of complications. This approach fails to provide the real-time visualisation necessary to identify critical structures such as the subclavian artery or pleura, increasing the likelihood of inadvertent vascular puncture, pneumothorax, or intraneural injection. This deviates from contemporary best practice and the spirit of patient safety promoted by professional bodies. Performing the block with ultrasound but without visualising the needle tip throughout the procedure, and injecting local anaesthetic without aspiration, introduces substantial risks. Without continuous needle visualisation, the anaesthetist cannot confirm the needle is not in a vessel or nerve. The failure to aspirate before injection, especially in the absence of complete needle tip visualisation, significantly elevates the risk of intravascular injection or intraneural spread of local anaesthetic, both of which can lead to severe systemic toxicity or nerve damage. This contravenes fundamental safety checks for regional anaesthesia. Using ultrasound to identify the interscalene groove but then proceeding with a rapid, single injection of the entire local anaesthetic volume without incremental delivery or aspiration is also professionally unacceptable. While ultrasound is used, the lack of incremental injection and aspiration means that if the needle is inadvertently placed intravascularly or intraneurally, a large volume of local anaesthetic can be rapidly delivered, exacerbating systemic toxicity or nerve injury. This approach neglects crucial safety steps designed to mitigate the consequences of needle misplacement. Professional Reasoning: Professionals should adopt a systematic approach to regional anaesthesia, prioritising patient safety. This involves a thorough pre-procedure assessment, including patient consent and review of relevant anatomy. The decision to use ultrasound should be based on its proven ability to enhance safety and efficacy. During the procedure, continuous visualisation of the needle, incremental injection with aspiration, and careful monitoring of the patient are paramount. Adherence to professional guidelines and a commitment to ongoing skill development are essential for providing high-quality regional anaesthesia.

This scenario presents a professional challenge due to the inherent tension between the desire to adopt innovative practices and the paramount need for patient safety, underpinned by established historical precedents and evolving ethical considerations in anaesthesia. The anaesthetist must navigate the potential benefits of a new technique against the risks associated with its unproven nature and the ethical imperative to provide care based on evidence and established standards. Careful judgment is required to balance progress with patient well-being. The best professional approach involves a thorough review of existing literature and guidelines, consultation with experienced colleagues, and a structured assessment of the risks and benefits specific to the patient’s condition. This approach prioritises evidence-based practice and a systematic evaluation of the proposed innovation. It aligns with the ethical principles of beneficence and non-maleficence, ensuring that any deviation from standard practice is well-justified and minimises potential harm. Furthermore, it reflects a commitment to continuous professional development and the responsible integration of new knowledge, as encouraged by professional bodies. An incorrect approach would be to immediately adopt the new technique based solely on anecdotal evidence or the enthusiasm of a colleague. This fails to adequately assess the risks and potential for harm, potentially contravening the principle of non-maleficence. It bypasses the crucial step of evidence-based evaluation, which is a cornerstone of safe medical practice. Another incorrect approach would be to dismiss the new technique outright without any investigation, based on a rigid adherence to established methods. While caution is necessary, an overly conservative stance can stifle innovation and prevent patients from benefiting from potentially superior treatments. This approach may not fully uphold the principle of beneficence if the new technique offers a genuine advantage. Finally, implementing the new technique without appropriate patient consent, after a thorough explanation of its experimental nature and potential risks, would be professionally unacceptable. This violates the principle of patient autonomy and informed consent, a fundamental ethical requirement in healthcare. Professionals should employ a decision-making framework that begins with identifying the clinical problem and potential solutions. This involves a critical appraisal of available evidence, consultation with peers and experts, and a comprehensive risk-benefit analysis. Patient-specific factors must be considered, and informed consent obtained. If a novel technique is considered, a structured approach to its evaluation, potentially including a pilot study or audit, should be undertaken before widespread adoption.

This scenario presents a professionally challenging situation due to the inherent unpredictability of anaesthesia and the critical need to prioritise patient safety above all else. The anaesthetist must balance the immediate need for effective pain and haemodynamic control with the potential for delayed or unforeseen complications, all within the context of established professional standards and ethical obligations. Careful judgment is required to assess the evolving clinical picture and make timely, appropriate interventions. The best approach involves a systematic and evidence-based response that prioritises patient stability and safety. This includes recognising the potential for a significant intraoperative bleed, initiating appropriate resuscitation measures, and ensuring clear communication with the surgical team. Specifically, this involves promptly administering crystalloids and colloids to support circulating volume, initiating blood product transfusion based on clinical indicators of haemorrhage, and alerting the surgical team to the suspected complication and the need for prompt surgical intervention. This aligns with the ANZCA Professional Document PS05: Management of the Difficult Airway, which, while focused on airway management, underscores the principle of prioritising patient safety and utilising available resources effectively in critical situations. Furthermore, it reflects the ethical imperative to act in the best interests of the patient, as outlined in professional codes of conduct, which mandate vigilance and prompt action in the face of potential harm. An incorrect approach would be to delay definitive management of the suspected bleed while continuing with routine anaesthetic maintenance. This fails to acknowledge the urgency of the situation and the potential for rapid haemodynamic deterioration, thereby compromising patient safety. It also neglects the collaborative nature of patient care, as failing to promptly inform the surgical team hinders their ability to address the underlying cause of the bleeding. Another incorrect approach would be to solely rely on vasopressors to manage the haemodynamic instability without addressing the underlying volume deficit and potential for ongoing blood loss. While vasopressors have a role in haemodynamic support, they are not a substitute for volume resuscitation and blood product replacement in the context of significant haemorrhage. This approach risks masking the severity of the bleed and delaying essential interventions. Finally, continuing with the planned surgical procedure without a clear understanding of the cause of the haemodynamic instability and without adequate resuscitation would be professionally unacceptable. This demonstrates a failure to adapt to the evolving clinical situation and prioritises the surgical plan over the patient’s immediate well-being. Professionals should employ a structured approach to such critical events, often guided by algorithms or checklists for managing specific complications. This involves: 1. Recognising the deviation from the expected course. 2. Assessing the severity and potential causes. 3. Initiating immediate, life-saving interventions. 4. Communicating effectively with the multidisciplinary team. 5. Reassessing and adapting the management plan as the situation evolves.

Scenario Analysis: This scenario presents a professionally challenging situation due to the inherent risks associated with induction of anaesthesia in a patient with a potentially compromised airway. The anaesthetist must balance the need for anaesthesia with the imperative to maintain patient safety, particularly airway patency. This requires a thorough pre-induction assessment and the selection of an induction technique that minimises the risk of difficult intubation or ventilation. Correct Approach Analysis: The best professional practice involves a comprehensive pre-induction assessment to identify potential airway difficulties. This includes evaluating factors such as mouth opening, thyromental distance, Mallampati classification, neck mobility, and the presence of any anatomical abnormalities or previous airway issues. Based on this assessment, the anaesthetist should select an induction technique that prioritises airway control and ventilation. In this case, a rapid sequence induction (RSI) with a cricoid pressure manoeuvre, followed by a videolaryngoscope for intubation, represents the most appropriate approach. This technique is designed to minimise the risk of aspiration and facilitate visualisation and intubation in potentially difficult airways. The use of videolaryngoscopy offers improved glottic visualisation compared to direct laryngoscopy, further enhancing safety. This approach aligns with the principles of patient safety and risk mitigation as espoused by professional bodies and ethical guidelines, which mandate a proactive and evidence-based approach to airway management. Incorrect Approaches Analysis: Administering a standard intravenous induction agent followed by mask ventilation and then attempting direct laryngoscopy without prior airway assessment or a plan for difficult intubation is professionally unacceptable. This approach fails to adequately address the potential for a difficult airway, increasing the risk of failed intubation, hypoxaemia, and aspiration. It neglects the fundamental principle of airway assessment and preparedness. Proceeding directly to a supraglottic airway device without a thorough assessment and a clear rationale, especially when intubation might be feasible and preferable for definitive airway control, is also professionally unsound. While supraglottic airways have a role, their use should be guided by specific indications and a clear understanding of their limitations in managing a potentially compromised airway. Performing a rapid sequence induction with cricoid pressure but without the use of videolaryngoscopy and relying solely on direct laryngoscopy, especially in a patient with suspected airway compromise, increases the risk of failed intubation and potential airway trauma. While RSI is appropriate, the choice of intubation adjunct should be tailored to the assessed risk. Professional Reasoning: Professionals should employ a systematic approach to airway management, beginning with a thorough pre-induction assessment. This assessment should inform the choice of anaesthetic technique and the selection of appropriate equipment and adjuncts. A clear plan for managing both anticipated and unanticipated difficult airways must be in place before induction commences. This involves considering the patient’s individual risk factors, the planned surgical procedure, and the available resources. Continuous re-evaluation of the airway throughout the induction and maintenance phases is also crucial.

This scenario presents a professional challenge due to the inherent variability in patient response to anaesthesia and the potential for subtle but significant deviations from expected depth of anaesthesia. The anaesthetist must balance the need for adequate anaesthesia with the risks of awareness or excessive physiological depression. Careful judgment is required to interpret monitoring data in the context of the individual patient’s clinical status and surgical requirements, adhering to professional standards and guidelines. The best approach involves a comprehensive assessment of multiple physiological parameters, integrating both direct and indirect indicators of anaesthetic depth. This includes continuous evaluation of haemodynamic stability (heart rate, blood pressure), respiratory function (end-tidal CO2, oxygen saturation), and neurological activity (e.g., processed electroencephalography or neuromuscular monitoring where indicated). This multi-modal strategy aligns with the principles of patient safety and best practice in anaesthesia, as advocated by professional bodies like the Australian and New Zealand College of Anaesthetists (ANZCA). It allows for a more robust understanding of the patient’s state, enabling timely and appropriate adjustments to anaesthetic delivery, thereby minimising the risk of adverse outcomes. An approach that relies solely on a single, non-specific physiological parameter, such as heart rate, is professionally unacceptable. While heart rate can be influenced by anaesthetic depth, it is also highly susceptible to other factors like surgical stimulation, pain, hypovolaemia, or pre-existing cardiac conditions. Over-reliance on this single indicator can lead to misinterpretation, potentially resulting in either inadequate anaesthesia (awareness) or excessive anaesthetic administration (haemodynamic compromise). This fails to meet the standard of care expected in anaesthetic practice, which demands a more holistic and nuanced interpretation of patient status. Another professionally unacceptable approach is to disregard monitoring data entirely once a stable haemodynamic state is achieved, assuming anaesthetic depth is adequate. This ignores the dynamic nature of anaesthesia and the potential for gradual changes in anaesthetic requirements or the development of physiological disturbances that may not be immediately apparent. Professional guidelines mandate continuous monitoring and assessment throughout the perioperative period. Failure to do so represents a significant lapse in vigilance and a deviation from established safety protocols. Finally, an approach that focuses exclusively on the patient’s movement in response to surgical stimuli, without considering other physiological indicators, is also inadequate. While gross movement is a clear sign of insufficient anaesthesia, its absence does not guarantee optimal depth. This method overlooks the possibility of awareness without movement, or the physiological consequences of excessive anaesthetic depth that may not manifest as overt movement. It fails to provide a comprehensive picture of the patient’s state and does not align with the comprehensive monitoring expected in modern anaesthetic practice. Professionals should employ a systematic decision-making framework that begins with a thorough pre-anaesthetic assessment, followed by the establishment of appropriate monitoring based on the patient’s risk factors and the planned procedure. During anaesthesia, continuous interpretation of integrated monitoring data, coupled with clinical observation, should guide anaesthetic management. This iterative process of assessment, intervention, and re-assessment ensures that anaesthetic depth is maintained within the desired range, optimising patient safety and outcomes.

The evaluation methodology shows a scenario that is professionally challenging due to the inherent uncertainty in predicting individual physiological responses to anaesthesia, especially in a patient with pre-existing comorbidities. The anaesthetist must balance the need for adequate anaesthesia and analgesia with the risks of adverse haemodynamic or respiratory events. Careful judgment is required to tailor the anaesthetic plan to the individual patient’s physiology and surgical requirements, while remaining vigilant for and prepared to manage potential complications. The best approach involves a comprehensive pre-anaesthetic assessment that meticulously reviews the patient’s medical history, including details of their cardiac condition, previous anaesthetic experiences, and current medications. This assessment should inform a personalised anaesthetic plan that anticipates potential haemodynamic instability and outlines specific strategies for its management, such as the judicious use of vasopressors or inotropes, and appropriate fluid management. This approach is correct because it aligns with the fundamental ethical principles of beneficence and non-maleficence, ensuring that the patient’s best interests are prioritised and harm is minimised. It also reflects the professional duty of care to provide anaesthesia that is safe and appropriate for the individual patient, as guided by professional standards and evidence-based practice. An incorrect approach would be to proceed with a standard anaesthetic protocol without adequately considering the patient’s specific cardiac history. This fails to acknowledge the increased risk associated with their condition and could lead to an inadequate or inappropriate management of haemodynamic fluctuations during surgery, potentially causing significant harm. Another incorrect approach would be to over-rely on intraoperative monitoring alone to detect and manage complications, without a proactive, pre-planned strategy. While monitoring is crucial, it is a reactive tool. A failure to anticipate and plan for potential issues based on pre-existing conditions represents a lapse in due diligence and a departure from best practice in risk management. A further incorrect approach would be to defer significant decision-making regarding the anaesthetic plan to the surgical team. While collaboration is essential, the anaesthetist bears the primary responsibility for the anaesthetic care and must independently develop and implement a safe anaesthetic strategy, consulting with surgeons as necessary but not abdicating their core responsibilities. Professionals should employ a systematic risk assessment framework that begins with a thorough patient evaluation, followed by the development of a tailored anaesthetic plan. This plan should include contingency measures for anticipated complications, informed by the patient’s specific physiology and the nature of the surgery. Continuous re-evaluation of the patient’s condition throughout the anaesthetic and surgical period is paramount, allowing for timely adjustments to the plan as needed.