Historically, providing anaesthesia was seen as a trivial task requiring little skill. The first academic department of anaesthesia was established relatively recently in 1933. ‘Nuts and bolts’ looks in detail at the role of the anaesthetist in terms of the assessment of the patient, premedication, induction of anaesthetic, maintenance of the anaesthetic, recovery of the patient, and post-recovery of the patient. In some countries today doctors act as the anaesthetist, in others the nurse adopts the role. One of the most popular methods of pain relief is patient-controlled analgesia (PCA) where the patient controls a computerized pump loaded with a reservoir of analgesic.