CCT in Anaesthetics - Core Level Training

Published: 14/08/2019

Paediatrics

The use of simulators may assist in the teaching and assessment of some aspects of this section e.g. paediatric resuscitation

Learning outcomes:

  • Obtain knowledge of the principles underlying the practice of anaesthesia for children aged 1 year and older and the specific needs therein
  • Have completed training in child protection

Core clinical learning outcomes:

  • Demonstrates correct management of the paediatric airway in the following ways [if case mix allows, down to one year of age, but at least down to five years of age]:
    • Is able to size airway devices correctly [i.e. oral airways and tracheal tubes]
    • Is able to insert airway devices correctly
    • Is able to ventilate an apnoeic child using a bag and mask +/- an oral airway
    • Is able to intubate a child correctly, using the most appropriate size tracheal tube, placed at the correct length  
  • Maintains anaesthesia in a spontaneously breathing patient via a facemask for a short surgical procedure [less than 15 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.

It is anticipated that the competences listed will be gained throughout CT1/2 without a dedicated period spent in paediatric anaesthesia. It is accepted that not all trainees will have sufficient clinical opportunity to progress beyond direct supervision as the variation in paediatric exposure will differ amongst trainees during CT 1/2.

Trainees should take whatever opportunities they can to obtain the skills listed below.

Knowledge

Competence

Description

Assessment

Methods

GMP

PA_BK_01

Recalls/explains the relevance of the basic sciences specific to children aged 1 year and above [cross ref basic sciences]

A,C,E

1

PA_BK_02

Describes the preoperative assessment and psychological preparation of children aged 1 year and above [and their parents] for surgery

A,C,E

1,3,4

PA_BK_03

Explains the importance of avoiding excessive starvation times 

A,C,E

1,2

PA_BK_04

Describes how anaesthesia can be induced for children aged 1 year and above

A,C,E

1

PA_BK_05

Describes maintenance of anaesthesia for children aged 1 year and above

A,C,E

1

PA_BK_06

Describes how recovery from anaesthesia is managed in children aged 1 year and above

A,C,E

1,2

PA_BK_07

Explains the management of postoperative pain, nausea and vomiting in children

A,C,E

1

PA_BK_08

Describes the management of acute airway obstruction including croup, epiglottitis and inhaled foreign body

A,C,E

1

PA_BK_09

Recalls/explains how blood volume is estimated and how correct solutions and volumes are used for replacement of fluid loss. Particular attention must be given to the risks of hyponatraemia if hypotonic solutions are used for fluid resuscitation

A,C,E

1,2

PA_BK_10

Explains the importance of modification of drug dosages

A,C,E

1,2

PA_BK_11

Describes how pain-relief is provided for children undergoing surgery including the use of common regional techniques [e.g.

Caudal epidural, ilioingiunal block]

A,C,E

1

PA_BK_12

Explains the place of premedication, including topical anaesthesia for venepuncture

A,C,E

1

PA_BK_13

Describes paediatric anaesthetic equipment and the differences from adult practice

A,C,E

1

PA_BK_14

Recalls/explains how to calculate tracheal tube sizes and the reasons for its importance; sizing of face masks and airways

[oro- and naso-pharyngeal and LMAs]

A,C,E

1,2

PA_BK_15

Explains the choice of breathing systems and  the appropriate fresh gas flow rates

A,C,E

1

PA_BK_16

Explains the importance of identifying when upper respiratory tract infections are/are not significant and, as a result, when to cancel operations

A,C,E

1,2,4

PA_BK_17

Explains how to obtain consent for anaesthesia in children

A,C,E

1,3,4

PA_BK_18

Explains the importance of Child Protection regulations and what action must be taken when non-accidental injury is suspected

A,C,E

1,3,4

Skills

Competence

Description

Assessment

Methods

GMP

PA_BS_01

Undertakes satisfactory preoperative assessment of fit children aged 5 and over

A,D,M

1,3

PA_BS_02

Demonstrates ability to anaesthetise fit children aged 5 and over for elective and urgent minor surgery [including general,

ENT, orthopaedic, minor trauma and other non-specialist procedures]. This includes induction, maintenance and recovery

[including management of pain, nausea and vomiting]

A,D,M

1,2,3

PA_BS_03

Shows how to manage the environment during the induction of anaesthesia in children

A,D,M

1,3

PA_BS_04

Demonstrates ability to secure peripheral venous access in children aged 5 and over

A,D

1

PA_BS_05

Demonstrates ability to perform intraosseous cannulation [S]

D,S

1

PA_BS_06

Demonstrates ability to manage the airway correctly including selection of the correct masks, airways, laryngeal mask airways and tracheal tubes

A,D

1,2

PA_BS_07

Demonstrates ability to perform both intravenous and gaseous induction of general anaesthesia in children

A,D

1,3

PA_BS_08

Demonstrates the management of laryngospasm in children [S]

A,D,S

1,2

PA_BS_09

Demonstrates ability to stabilise and manage the sick or injured child aged 5 or over until senior help arrives [S]

A,M,S

1,2,3,4

PA_BS_10

Demonstrates ability to perform paediatric resuscitation as described by the Resuscitation Council [UK] [S]

D,S

1,2,3,4

PA_BS_11

Shows sensitivity when communicating with children and their parents/carers 

A,D,M

1,3,4

PA_BS_12

Shows how to recognise signs leading to suspicion of non-accidental injury or abuse and the correct action

A,D,S

1,2,3,4