ABA Anesthesiology common mistakes
ABA Anesthesiology · Understand the traps and how to avoid them.
On pharmacology and dosing stems, converts units on the fly (mg/kg to mcg/kg/min, percent solution to mg/mL) instead of writing out the dimensional chain, and answers minimum-alveolar-concentration questions with the standard adult value without adjusting for age, pregnancy, hypothermia, or adjuvant opioids.
Time pressure in a single-best-answer format encourages mental shortcuts, and residency taught drugs as fixed dose cards rather than as functions of patient state, so the adjustment step never became automatic.
What to do instead
Drill a written conversion template (stated unit, then per kilogram, then per minute) on 20 mixed items until it is mechanical, and rebuild every MAC fact as a curve: state which direction and roughly how far the value shifts with age over 40, pregnancy, hypothermia, opioids, and chronic alcohol use.
Skips quantitative physics items, such as oxygen cylinder duration, circuit compliance and fresh-gas flow effects, laminar versus turbulent flow, and pressure drop along a narrow catheter, by choosing the option that sounds most physiologic instead of actually setting up the equation.
Physics is typically studied by reading rather than by working problems, so the candidate recognises the vocabulary but has never executed the calculation against a clock.
What to do instead
Maintain a fixed set of about 15 calculation types and rehearse each as a recipe until it is overlearned: cylinder duration equals gauge pressure times the cylinder factor (0.28 L per psi for an E cylinder) divided by flow; also Poiseuille, Reynolds number, LaPlace, and the respiratory time constant. Sanity-check the answer's units before selecting.
Reads an intraoperative crisis stem (hypotension with rising airway pressure, or desaturation with urticaria) and immediately selects the treatment for the first diagnosis that comes to mind, rather than the next discriminating step or the immediate stabilising action.
Pattern recognition from familiar real cases feels efficient and is rewarded clinically, while examination stems deliberately include two plausible diagnoses with overlapping features to punish premature closure.
What to do instead
Before answering, name the top two candidate diagnoses and ask which single action is both immediately safe and differentiating, such as auscultation, a transient drug challenge, or bedside ultrasound. Discard any option that commits to a diagnosis the stem has not yet supported.
Chooses the definitive management (surgical consultation, computed tomography, an elective definitive airway) over the immediate life-preserving action in a stem that describes a deteriorating patient.
Clinically the definitive answer is what ultimately matters, and many textbooks present definitive therapy as the presented first line, so the next-thirty-seconds priority is not rehearsed.
What to do instead
Apply an invariant ordering rule to every crisis item: oxygenation and ventilation first, then perfusion, then diagnosis, then definitive therapy, then disposition. Treat imaging and consultation options as wrong unless the stem explicitly describes a stable patient and the question asks for the next diagnostic step.
Recites a guideline threshold (delay surgery, hold the antiplatelet agent, check a coagulation value) without applying the surgical urgency, the indication for the drug, or the neuraxial timing rules stated in the stem.
Guidelines are memorised as single numbers, but almost all are risk-stratified and time-dependent, so the conditional structure that the item tests is lost.
What to do instead
For each comorbidity and drug class, rehearse a three-question frame: what changes monitoring, what changes the anesthetic plan, and what would make me delay or alter timing. Write out hold intervals for anticoagulants, antiplatelets, and direct oral anticoagulants, plus neuraxial timing, from a table until recalled exactly.
Selects or accepts a reflexive test (stress testing, echocardiography, a routine coagulation panel) as the safe answer, and mislabels functional capacity or misapplies a cardiac risk index.
More testing feels safer to a cautious trainee, and risk indices are memorised as names without knowing which variables they actually weight or what decision their result would change.
What to do instead
Learn the specific management decision each test would alter, and choose the test only when a positive result changes care. Practise assigning functional capacity from concrete activities (climbing a flight of stairs, heavy housework) and apply formal risk tools to short vignettes until the scoring inputs are automatic.
Manages critical care vignettes with operating-room reflexes, increasing inspired oxygen and tidal volume for hypoxaemia and giving fluid boluses for any hypotension, instead of applying lung-protective ventilation and a structured shock assessment.
Operating-room habits are overlearned and applied under time pressure, while intensive care physiology such as acute respiratory distress syndrome, sepsis, and right ventricular failure is encountered less often in daily practice.
What to do instead
Rehearse ARDS targets (about 6 mL/kg predicted body weight, plateau pressure under 30 cm water, permissive hypercapnia, PEEP titration) and a shock framework covering preload, contractility, afterload, and obstruction, with two worked cases each. Identify which haemodynamic pattern the stem describes before choosing any therapy.
Under-treats or mis-sequences local anesthetic systemic toxicity: gives the wrong lipid emulsion dose or gives it only after prolonged conventional resuscitation, and misstates maximum local anesthetic doses with and without epinephrine.
The event is rare in training, the protocol is read once and rarely rehearsed, and dose ceilings are remembered as a single number rather than per drug, per route, and per patient.
What to do instead
Write out and rehearse the full sequence from memory: stop injecting, secure the airway, use benzodiazepine for seizures, give 20 percent lipid emulsion at about 1.5 mL/kg bolus followed by an infusion, avoid vasopressin, beta-blockers, and calcium channel blockers, and consider cardiopulmonary bypass early. Drill per-drug maximum doses and add toxicity across multiple simultaneous blocks.
Picks a regional technique or needle approach from the block name alone, without reconstructing the plexus level, target nerves, expected dermatomal and myotomal coverage, or the complication profile specific to that approach.
Block names are stored as labels rather than as anatomy, and passively learned anatomy decays quickly when it is not drawn or used in three-dimensional reasoning.
What to do instead
For each block, draw from memory the relevant plexus level, target nerves, expected sensory and motor coverage, surface landmarks, needle trajectory, and the two most serious complications. Answer only from the drawing, then check it, so that the label and the anatomy become inseparable.
Answers patient safety and quality items by blaming an individual clinician, or conflates quality improvement tools (plan-do-study-act cycles, root cause analysis, failure mode and effects analysis, statistical process control charts) when the stem's wording points to one specific method.
Clinical training emphasises personal accountability and rapid individual action, while quality improvement methodology is taught superficially, so the tools sound interchangeable and system-level causation is underweighted.
What to do instead
Build a trigger-word map: repeated small tests of change mean plan-do-study-act; a single serious event means root cause analysis; prospective risk assessment means failure mode and effects analysis; variation over time means a control chart. Before choosing, classify the vignette as system, process, or individual level.