2021 Curriculum learning syllabus: stage 3 special interest areas

Published: 25/02/2021

Anaesthesia for Hepato-Pancreato-Biliary Surgery

  • Group 2: 3 to 6 months

Learning outcomes

  • Provides safe perioperative anaesthetic care for a wide variety of complex hepato-pancreato-biliary procedures
  • Is capable of leading the delivery of care in this area of anaesthetic practice, to the benefit of both patients and the organisation

Key capabilities

A

Provides comprehensive safe anaesthetic perioperative care for major hepatobiliary surgery

B

Manages the perioperative care of patients undergoing major pancreatic surgery recognising and planning for the metabolic consequences of the procedure

C

Manages the perioperative care for patients undergoing intra-abdominal organ transplantation

D

Management of portal hypertension with an emphasis on provision of anaesthesia or monitored anaesthesia care for transjugular intrahepatic portosystemic shunt (TIPS) procedure

Examples of evidence

Experience and logbook:

  • attendance at hepatobiliary pre-assessment clinic, assessing patients for major cancer work affecting the liver and pancreas
  • attend theatre - deliver anaesthesia for a wide range of cases including lap and open liver resections, pancreatic surgery – PPPD, Whipples, distal pancreatectomy and splenectomy; understand the differences in techniques and the risks associated for the patient
  • gain an understanding of neuroendocrine and adrenal tumours, such as phaeochromocytomas where experience is available
  • liver transplantation – risks/ benefits/assessment – attendance at inpatient and outpatient assessment clinics and MDT
  • attendance at monthly hepatobiliary and liver MDT
  • assess patients for surgery secondary to liver transplants – hernias/ biliary reconstruction
  • understand thrombo-elastography (TEG) and the management of major haemorrhage
  • vascular access / Lidco / TOE / Pulmonary artery floatation catheters.
​​​​Supervised Learning Events (SLEs) can be used to demonstrate:
  • pre-operative assessment for hepatobiliary patients including high risk cases
  • understanding and discuss of the techniques used for different operations and understand why they are used
  • delivery of anaesthesia for simple liver resections and pancreatic surgery independently
  • discussion of the management of neuro-endocrine tumours and adrenal patients where experience is available
  • management of parts of a liver transplant operation based on skillset and abilities
  • planning post-operative analgesia based on the operation
  • observed practice of practical skills – TEG interpretation/ venous access/ thoracic epidurals.
Personal Activities and Personal Reflections may include:
  • national and international meetings related to anaesthesia for HPB surgery
  • presentation at relevant meeting eg abstract or free paper
  • development of guidelines and policies related to management of patients for HPB surgery
  • leadership of QI projects related to anaesthesia for HPB surgery
  • leadership training
  • participation in audit and/or research in the liver unit.
Other evidence
  • satisfactory MSF.

Suggested supervision level

  • 3 - supervisor on call from home for queries able to provide directions via phone or non-immediate attendance.

Cross links with other domains and capabilities

  • all generic professional domains of learning
  • Perioperative Medicine and Health Promotion
  • General Anaesthesia
  • Intensive Care