Airway management

Published: 14/08/2019

Airway management

Core airway knowledge and skills have also been included within the first six months “Basis of Anaesthetic Practice” section. Those competencies are repeated here in a standalone airway section, designed to reflect the fundamental importance of airway knowledge and skills to the novice Anaesthetist.

Core clinical learning outcomes:

Able to predict difficulty with an airway at preoperative assessment and obtain appropriate help
Able to maintain an airway and provide definitive airway management as part of emergency resuscitation
Demonstrates the safe management of the can’t intubate can’t ventilate scenario
Maintains anaesthesia in a spontaneously breathing patient via a facemask for a short surgical procedure [less than 30 mins]

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C.

Knowledge

Competence	Description	Assessment Methods	GMP
AM_BK_01	Explains the methods commonly used for assessing the airway to predict difficulty with tracheal intubation [Ref; OA_BK_05]	A,C,E	1,2
AM_BK_02	Describes the effect of pre-oxygenation and knows the correct technique for its use [Cross Ref;induction of GA]	A,C,D,E	1,2
AM_BK_03	Describes the principles of management of the airway including techniques to keep the airway open and the use of facemasks, oral and nasopharyngeal airways and laryngeal mask airways [Cross Ref; induction of GA]	A,C,D,E	1,2
AM_BK_04	Explains the technique of inhalational induction and describes the advantages and disadvantages of the technique. [Cross Ref; induction of GA]	A,C,D,E	1,2
AM_BK_05	Knows the factors influencing the choice between agents for inhalational induction of anaesthesia [Cross Ref; induction of GA]	A,C,D,E	1,2
AM_BK_06	In respect of tracheal intubation: Lists its indications Lists the available types of tracheal tube and identifies their applications Explains how to choose the correct size and length of tracheal tube Explains the advantages/disadvantages of different types the laryngoscopes and blades including, but not exclusively, the Macintosh and McCoy Outlines how to confirm correct placement of a tracheal tube and knows how to identify the complications of intubation including endobronchial and oesophageal intubation Discusses the methods available to manage difficult intubation and failed intubation Explains how to identify patients who are at increased risk of regurgitation and pulmonary aspiration and knows the measures that minimise the risk Understands the airway management in a patient with acute illness who is at risk of gastric reflux Categorises the signs of pulmonary aspiration and the methods for its emergency management [ Cross Ref;induction of GA; emergency surgery]	A,C,D,E	1,2
AM_BK_07	In respect of restoring spontaneous respiration and maintaining the airway at the end of surgery: Explains how to remove the tracheal tube and describes the associated problems and complications Recalls/describes how to manage laryngospasm at extubation Recalls/lists the reasons why the patient may not breathe adequately at the end of surgery Recalls/identifies how to distinguish between the possible causes of apnoea Lists the possible causes of postoperative cyanosis Understands how to evaluate neuro-muscular block with the nerve stimulator [Cross Ref; post-operative]
AM_BK_08	With respect to oxygen therapy: Lists its indications Knows the techniques for oxygen therapy and the performance characteristics of available devices Describes the correct prescribing of oxygen Recalls/explains the causes and management of stridor [Cross Ref; post-operative]
AM_BK_09	Discusses the indications for RSI [Cross Ref; intra-operative]
AM_BK_10	Describes the care of the airway in an unconscious patient in the recovery room, including safe positioning [Cross Ref; postoperative]
AM_BK_11	Lists advantages and disadvantages of different techniques for airway management during resuscitation, including but not limited to: Oro and nasopharyngeal airways Laryngeal Mask type supraglottic airways including but not limited to: LMA, Proseal, LMA supreme, iGel Tracheal intubation [Cross Ref; management of respiratory and cardiac arrest]
AM_BK_12	Compares the methods by which ventilation can be maintained in a patient suffering a respiratory or cardiac arrest, using: Mouth to mask Self-inflating bag Anaesthetic breathing system Mechanical ventilator [Cross Ref; management of respiratory and cardiac arrest]
AM_BK_13	Discusses the different types of laryngoscope blades available in routine practice and the indications for their use
AM_BK_14	Outlines the advantages/disadvantages and reasons for development of new laryngoscopes [e.g. glidescope]
AM_BK_15	Outlines the indications for fibre-optic intubation and how awake intubation may be achieved
AM_BK_16	Describes the management of the ‘can’t intubate, can’t ventilate’ scenario
AM_BK_17	Describes the principles of, and indications for, the use of needle cricothyrotomy and manual jet ventilation

Skills

Competence	Description	Assessment Methods	GMP
AM_BS_01	Demonstrates satisfactory proficiency in performing a relevant clinical examination and assessment of the airway and dentition [Cross Ref; intra-operative]	A,D,E	1
AM_BS_02	Identifies normal appearances and significant abnormalities in radiographs including: Cervical spine, chest Head CT and MRI showing clear abnormalities relevant to the airway [Cross Ref; intra-operative]	A,C,E	1
AM_BS_03	Reliably predicts the level of supervision they will require [Cross Ref; intra-operative]	A, C,E	1
AM_BS_04	Demonstrates effective pre-oxygenation, including correct use of the mask, head position and clear explanation to the patient [Cross Ref; induction of GA]	A,D	1,2,3
AM_BS_05	In respect of airway management: Demonstrates optimal patient position for airway management, including head tilt, chin lift, jaw thrust Manages airway with mask and oral/nasopharyngeal airways Demonstrates hand ventilation with bag and mask [including self- inflating bag] Able to insert and confirm placement of a Laryngeal Mask Airway Demonstrates correct head positioning, direct laryngoscopy and successful nasal/oral intubation techniques and confirms correct tracheal tube placement Demonstrates proper use of bougies Demonstrates correct securing and protection of LMAs/tracheal tubes during movement, positioning and transfer Correctly conducts RSI sequence Correctly demonstrates the technique of cricoid pressure [Cross Ref; management of respiratory and cardiac arrest; induction of GA]	A,D	1,2,3
AM_BS_06	Demonstrates correct use of advanced airway techniques including but not limited to Proseal, LMA supreme, iGel [Cross Ref; management of respiratory and cardiac arrest]	D,S	1,2
AM_BS_07	In respect of inhalational induction of anaesthesia: Satisfactorily communicates with the patient during induction Satisfactorily conducts induction [Cross Ref; induction of GA]	A,D	1,2,3
AM_BS_08	Demonstrates the ability to maintain anaesthesia with a face mask in the spontaneously breathing patient [Cross Ref; intra-operative]	A,D	1,2
AM_BS_09	Demonstrates failed intubation drill [Cross Ref; induction of GA]	D,S	1,2
AM_BS_10	Demonstrates management of ‘can’t intubate, can’t ventilate’ scenario [Cross Ref; critical incidents]	D,S	1,2
AM_BS_11	Demonstrates correct use of oropharyngeal, laryngeal and tracheal suctioning [Cross Ref; induction of GA]	A,D	1,2
AM_BS_12	Demonstrate appropriate management of tracheal extubation, including; Assessment of return of protective reflexes Assessment of adequacy of ventilation Safe practice in the presence of a potentially full stomach [Cross Ref; postoperative]	A,D	1
AM_BS_13	Demonstrates how to turn a patient into the recovery position [Cross Ref; postoperative]	A,D	1
AM_BS_14	Demonstrates small and large bore needle cricothyrotomy and manual jet ventilation	D,S	1,2
AM_BS_15	Demonstrates surgical cricothyrotomy	D,S	1,2