Visualize the patient in front of you, imagine the equipment, etc. That helped me think things through logically and coherently.
If you get deep in the weeds, pause and gather your thoughts for a couple seconds and move on.
When you're looking at the stems, write down the few key anesthetic concerns on the side of the page. As the case changes gears, as it will, pause a moment and review the key anesthetic concerns on your list so you don't make a stupid mistake. Your mind will still be rethinking your last answers about the seizure, CVA, MI, exsanguination, etc. That's also true of the grab bags. You have to clear your mind of the baggage of the last patient and focus on the task at hand.
Don't be disturbed when things go wrong, they will no matter what you do. That's just the exam, not you're decision making.
Think through your plan, be flexible, but don't go changing things on the fly when "one of your colleagues/the surgeon suggests..." that's usually you're opportunity to explain why that's not a great idea for this patient. Of course it could also be the examiner trying to get you back on track when you're about to make a killing error. Not likely though.
As has been mentioned, just do what you do every day and don't try anything fancy. If you want to do blocks for the awake fiber, you better know how to do them.
Good luck.
