Published: 13/08/2019

Conduct of anaesthesia

Induction of general anaesthesia

The use of simulators may assist in the teaching and assessment of some aspects of this section e.g. failed intubation drill

Learning outcomes:

  • To conduct safe induction of anaesthesia in ASA grade 1-2 patients confidently
  • To recognise and treat immediate complications of induction, including tracheal tube misplacement and adverse drug reactions
  • To manage the effects of common complications of the induction process
  • To conduct anaesthesia for ASA 1E and 2E patients requiring emergency surgery for common conditions (e.g. uncomplicated appendicectomy or manipulation of forearm fracture/uncomplicated open reduction and internal fixation)
  • Demonstrates safe practice behaviours including briefings, checklists and debriefs
  • Demonstrates correct pre-anaesthetic check of all equipment required ensuring its safe functioning [including the anaesthetic machine/ventilator in both the anaesthetic room and theatre if necessary]
  • Demonstrates safe induction of anaesthesia, using preoperative knowledge of individual patients co-morbidity to influence appropriate induction technique; shows awareness of the potential complications of process and how to identify and manage them

Knowledge
Competence Description Assessment Methods GMP
IG_BK_01
  • Recalls the pharmacology and pharmacokinetics, including doses, interactions and significant side effects of drugs used during induction of anaesthesia
  • Describes the factors that contribute to drug errors in anaesthesia and strategies used to reduce them
 A,C,D,E 1
IG_BK_02
  • Describes the basic function of monitors
  • Recall consensus minimum monitoring standards and the indications for additional monitoring
  • Explains the functions and safety features of the anaesthetic
 A,C,D,E 1,2
IG_BK_03

In respect of the induction of anaesthesia:

  • Describes the effect of pre-oxygenation and knows the correct technique for its use
  • Explains the techniques of intravenous and inhalational induction and understands the advantages and disadvantages of both techniques
  • Describes the pharmacology of common intravenous induction agents
  • Describes the physiological effects of intravenous induction
  • Describes how to recognise an intra-arterial injection of a harmful substance and its appropriate management
  • Describes anaphylactic reactions and explains the appropriate management including follow up and patient information
  • Lists the factors influencing the choice between agents for inhalational induction of anaesthesia
  • Discusses the additional hazards associated with induction of anaesthesia in unusual places [e.g. Emergency Room] and in special circumstances including but not exclusively: brain injury; full stomach; sepsis; upper airway obstruction
  • Identifies the special problems of induction associated with cardiac disease, respiratory disease, musculoskeletal disease, obesity and those at risk of regurgitation/pulmonary aspiration.
 A,C,D,E 1,2
IG_BK_04

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
 A,C,D,E 1,2
IG_BK_05

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 of 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
  • Categorises the signs of pulmonary aspiration and the methods for its emergency management
 A,C,D,E 1,2
IG_BK_06 Explains the importance of maintaining the principles of aseptic practice and minimising the risks of hospital acquired infection A,C,D,E 2

Skills
Competence Description Assessment Methods GMP
IG_BS_01

Demonstrates safe practice in checking the patient in the anaesthetic room

 A,D 1,2
IG_BS_02 Demonstrates appropriate checking of equipment prior to induction, including equipment for emergency use A,D 1,2
IG_BS_03

In respect of the equipment in the operating environment:

  • Demonstrates the functions of the anaesthetic machine including
    • Performing proper pre-use checks
    • Changing/checking the breathing system
    • Replenishing the vaporiser
    • Changing the vaporiser
 D 1,2
IG_BS_04 Selects, checks, draws up, dilutes, labels and administers drugs safely A,D 1,2,3
IG_BS_05
  • Obtains intravascular access using appropriately sized cannulae in appropriate anatomical locations
  • Demonstrates rigorous aseptic technique when inserting cannulae
 D 1
IG_BS_06

Demonstrates appropriate placement of monitoring, including ECG electrodes and NIBP cuff

  • Uses monitors appropriately
  • Demonstrates proficiency in the interpretation of monitored parameters
 A,D 1
IG_BS_07 Demonstrates effective pre-oxygenation A,D 1,2,3
IG_BS_08

In respect of intravenous induction:

  • Explains induction to the patient
  • Prepares drugs for the induction of anaesthesia
  • Administers drugs at induction of anaesthesia
  • Manages the cardiovascular and respiratory changes associated with induction of general anaesthesia
 A,D 1,2,3
IG_BS_09

In respect of inhalational induction of anaesthesia:

  • Satisfactorily communicates with the patient during induction
  • Satisfactorily conducts induction
 A,D 1,2,3
IG_BS_10

In respect of airway management:

  • Positions the patient for airway management
  • Maintains the airway with oral/nasopharyngeal airways
  • Ventilates the lungs with a bag and mask
  • Inserts and confirms placement of a Laryngeal Mask Airway
  • Successfully places nasal/oral tracheal tubes using direct laryngoscopy
  • Confirms correct tracheal tube placement
  • Uses bougies correctly
  • Secures and protects LMAs/tracheal tubes during movement, positioning and transfer
  • Correctly conducts RSI
  • Correctly demonstrates the technique of cricoid pressure
 A,D 1,2,3
IG_BS_11 Demonstrates correct use of oropharyngeal, laryngeal and tracheal suctioning A,D 1,2
IG_BS_12 Demonstrates failed intubation drill D,S 1,2
IG_BS_13 (formerly ES_BS_03) Manages rapid sequence induction in the high risk situation of emergency surgery for the acutely ill patient A,D 1
IG_BS_14 (Formerly ES_BS_02) Demonstrates safe perioperative management of ASA 1 and 2 patients requiring emergency surgery A,C,D,M 1,2,3,4