CCT in Anaesthetics - Intermediate Level Training

Published: 05/09/2019

Cardiothoracic anaesthesia and cardiothoracic critical care

Learning outcomes:

  • To gain knowledge and understanding of the underlying principles of anaesthesia for cardiac surgery, both ‘on’ and ‘off’ pump, and thoracic surgery
  • Understands the skills required to provide safe and effective anaesthetic care to patients undergoing elective cardiac and thoracic surgery  
  • To understand the pathophysiology and presentation of advanced cardiac disease to better understand the peri-operative management of such patients who undergo coincidental surgery

Core clinical learning outcome:

  • Deliver safe and effective perioperative anaesthetic care to patients undergoing elective coronary artery surgery and minor thoracic investigative procedures under direct supervision

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Final examination identified in the FRCA examination blueprint section.

Knowledge

CARDIAC

Competence

Description

Assessment

Methods

GMP

CT_IK_01

Describes the principles of the perioperative anaesthetic management of patients for cardiac surgery

A,C,E

1,2,3,4

CT_IK_02

Understands and explains the principles of cardiopulmonary bypass including the use of cardioplegia

A,C,D,E

1

CT_IK_03

Learns from the perioperative management of patients with cardiac disease knowledge applicable to those requiring non cardiac surgery

A,C,E

1,2,3,4

CT_IK_04

Understands the pathophysiological changes and organ dysfunction associated with cardiac disease, and their implications in the perioperative period

A,C,E

1,2

CT_IK_05

Correctly assesses the risk  of operation in a patient who has cardiac or respiratory disease, using common scoring systems

A,C,E

1

CT_IK_06

Explains the results of the special investigations used during the assessment of patients with cardiac disease including, Xrays, coronary angiography, ECHO, and Scanning techniques including CT, MRI and PET

A,C,E

1,3,4

CT_IK_07

Understands and explains the principles of antibiotic prophylaxis in patients with cardiac disease

A,C,E

1,2

CT_IK_08

Recalls/describes the anaesthetic and surgical problems associated with “off pump” cardiac surgery 

A,C,E

1,2

CT_IK_09

Describes the problems associated with post-cardiac surgery including bleeding and the clinical signs and symptoms of cardiac tamponade, and its management 

A,C,E

1,2

CT_IK_10

Evaluates the indications for invasive and non-invasive cardiovascular monitoring, and is able to interpret the common findings

A,C,D,E

1

CT_IK_11

Describes the methods used to cool and re-warm patients during cardiac surgery, and the complications

A,C,E

1,2

CT_IK_12

Explains the need for, and methods of, altering blood coagulability during cardiac surgery 

A,C,E

1

CT_IK_13

Recalls/describes the indications for cardiac  pacing and lists the different modes available

A,C,E

1

CT_IK_14

Describes the principles of action, and the use of, Intra-aortic balloon counter-pulsation and other assist devices

A,C,E

1

CT_IK_15

Recalls/explains the abnormalities found in the adult patient with congenital heart disease [including corrected or partially corrected], and the implications for anaesthesia in these patients 

A,C,E

1

CT_IK_16

Recalls/explains the indications for the use of inotropes and vasodilators during cardiac surgery

A,C,E

1

THORACIC
Competence Description Assessment Methods GMP

CT_IK_17

Explains the significance of preoperative functional investigations of respiratory and cardio-respiratory performance

A,C,E

1

CT_IK_18

Describes specific risks associated with induction and maintenance of anaesthesia in patients requiring thoracic surgery and precautions to be taken to minimise these risks

A,C,E

1,2

CT_IK_19

Describes commonly performed thoracic surgical procedures and the relevant anaesthetic problems

A,C,E

1

CT_IK_20

Describes commonly used methods of local and general anaesthesia for bronchoscopy including techniques of ventilation

A,C,E

1

CT_IK_21

Describes the airway management of a patient undergoing one-lung ventilation and anaesthesia including placement of double lumen endobronchial tubes and bronchial blockers [Ref; EN_IK_11]

A,C,E

1

CT_IK_22

Recalls/explains the changes that occur during one lung ventilation and the strategies to manage these changes

A,C,E

1

CT_IK_23

Recalls the causes, symptoms and signs of a pneumothorax and explains the principles of its management

A,C,E

1

CT_IK_24

Describes the common problems associated with the postoperative care of patient who have had thoracic surgery and the methods that can be used to minimise these

A,C,E

1,2

Skills
CARDIAC

Competence

Description

Assessment methods

GMP

CT_IS_01

Demonstrates the ability to assess and give a risk assessment for patients presenting for cardiac surgery including those with valvular and ischemic heart disease

A,D

1,2,3,4

CT_IS_02

Demonstrates the ability to assess patients with intra thoracic aortic pathology such as aneurysm, dissection and coarctation, and give an informed judgement on the risks and benefits of anaesthesia and surgery for the procedure

A,C,D,M

1,2,3,4

CT_IS_03

Demonstrates safe delivery of perioperative anaesthesia for a patient undergoing elective coronary bypass including the management of:  

  • A patient during cardiopulmonary bypass
  • A patient having cardiac surgery off bypass
  • Coagulation management

A,C,D,M

1,2,3,4

CT_IS_04

Forms postoperative care plans appropriate to the surgery and the patient’s condition including postoperative analgesia and respiratory support 

A,D

1

CT_IS_05

Demonstrates correct use of invasive and non-invasive monitoring in patients with cardiac or respiratory disease including non-invasive cardiac output monitoring devices utilising a variety of technologies, such as LIDCO, PICCO and ODM

A,D

1

CT_IS_06

Demonstrates an understanding of effective and evidence based use of inotropes and vasodilators

A,C,D,E

1,2

CT_IS_07

Demonstrates the ability to provide anaesthesia for procedures in cardiac intensive care including re-sternotomy, reintubation, tracheostomy and cardioversion 

A,C,D

1,2,3,4

CT_IS_08

Perform anaesthesia for patients having cardiological electrophysiological procedures, including pacemaker insertion

A,C,D

1,2,3,4

THORACIC
Competence Description Assessment Methods GMP

CT_IS_09

Demonstrates ability to assess and recommend treatments to optimise a patient about to undergo thoracic surgery

A,C,D

1,2,3,4

CT_IS_10

Demonstrates safe delivery of perioperative anaesthetic care to patients for minor thoracic procedures, in particular bronchoscopy, including the safe use of the Sanders injector

A,C,D,M

1,2,3,4

CT_IS_11

Demonstrates correct selection of appropriate airway management for the intended procedure and the ability to correctly insert single or double lumen endobronchial tubes and bronchial blockers [Ref; AM_IS_05]

A,D

1,2

CT_IS_12

Demonstrates correct use of clinical and endoscopic methods to confirm correct tube placement 

A,D

1,2

CT_IS_13

Demonstrates safe delivery of perioperative anaesthetic care for major thoracic procedures, including correct airway and ventilatory management, positioning and patient protection

A,C,D

1,2,3,4

CT_IS_14

Demonstrates the ability to manage a patient undergoing one lung ventilation

A,D

1,2

CT_IS_15

Demonstrates the ability to formulate correct post-operative care plans, taking into account the patient’s condition and the surgical procedure, including an assessment of the need for management in Intensive care or high dependency 

A,C,D,M

1,2,3,4