CCT in Anaesthetics - Stage 2 Training

Published: 22/10/2024

General Anaesthesia (GA)

2_GA_A: Explains the specific factors in providing safe anaesthetic care for patients at extremes of age, including neonates, children, and older people with frailty, and implements these in practice

2_GA_A_1	Knowledge of applied basic sciences to all age groups including neonates and the elderly
2_GA_A_2	Influence of age on drug pharmacokinetics and pharmacodynamics
2_GA_A_3	Use strategies to minimise post-operative cognitive dysfunction
2_GA_A_4	Chooses appropriate choice of anaesthetic technique for patients with complex comorbidities

2_GA_B: Provides appropriate anaesthesia care for patients undergoing day case surgery in all settings

2_GA_B_1

Demonstrates knowledge of advances and controversies in anaesthesia for day surgery

2_GA_C: Describes the principles of intra-operative haemostasis and manages major haemorrhage

2_GA_C_1	Principles of management of intra-operative haemostasis
2_GA_C_2	Management of massive blood loss including the use of rapid infusion devices
2_GA_C_3	Use of blood conservation strategies in orthopaedic surgery including the use of cell salvage when major haemorrhage is predicted
2_GA_C_4	Management of haemorrhage within trauma including use of permissive hypotension, tranexamic acid, and knowledge of relevant studies
2_GA_C_5	Resuscitation and management of patients who have suffered major vascular accidents including ruptured aortic aneurysms

2_GA_D: Provides safe care for ASA 1-3 adult patients with multiple injuries from arrival in hospital to post-operative care and seeks help appropriately

2_GA_D_1	Perioperative anaesthetic management of patients with multiple injuries including head, facial, neck/spinal, thoracic, abdominal, pelvic, and peripheral trauma
2_GA_D_2	Implications, prevention and management of coagulopathy, hypothermia, and acidosis in multiply injured patients

2_GA_E: Describes the anaesthetic-related problems associated with trauma including burns, poisoning, electrical injuries, and drowning

2_GA_E_1	Management of acute poisoning: including but not limited to, aspirin, paracetamol, opioids, aminophylline, digoxin, ecstasy and other social drugs, antidepressants, alcohol
2_GA_E_2	Initial assessment, management, and resuscitation of patients with: • Severe burns • Electrical injuries • Drowning and near drowning • Crush injuries • Hypothermia
2_GA_E_3	Explains the principles of anaesthetic management of burns patients for surgery including dressing changes, grafting and related procedures
2_GA_E_4	Pathophysiology of burn injury including thermal airway injury, smoke inhalation and fluid loss

2_GA_F: Applies physiological & pharmacological principles to reduce the risk of secondary brain injury in patients presenting with a severe head injury

2_GA_F_1

Strategies for minimising secondary brain injury in patients with multiple injuries

2_GA_G: Recognises, mitigates against risks and manages complications relating to patient positioning during surgery, including reference to the obese patient

2_GA_G_1

Anatomy relevant to the avoidance of injury to patients due to posture and positioning during anaesthesia- including

prone
lateral
park bench
sitting positions

2_GA_H: Applies a sound understanding of anatomy, physiology, biochemistry, pharmacology, physics and clinical measurement to anaesthetic practice (may be incorporated into other sections)

2_GA_H_1	Relevant anatomy for anaesthetic procedures and understanding of surgical operations
2_GA_H_2	-Drug toxicity - causes and avoidance. -Management of malignant hyperthermia. -Potential risks of drug additives
2_GA_H_3	Therapeutics in pathologic states: problems associated with organ transplantation, anaesthetic relevance of drugs used in malignancy, therapy in acute and chronic respiratory diseases
2_GA_H_4	Problems of drug dependency and addiction
2_GA_H_5	Assessment of cognitive dysfunction issues such as delirium, POCD and dementia, and implications

2_GA_I: Safely manages patients with complex airways including the ability to perform video laryngoscopy with local supervision

2_GA_I_1	Anatomy of the airway including anatomical knowledge relevant to the performance of fibre-optic intubation
2_GA_I_2	Risks associated with fibreoptic endotracheal intubation and the process of obtaining consent for this procedure
2_GA_I_3	The anaesthetic management of potential threats to the airway, including: • External compression • Foreign body, blood clots, masses • Inhalational injury, inflammation • Blunt and penetrating trauma • Use of video laryngoscopes, fibreoptic scopes, tracheostomy
2_GA_I_4	Indications for tracheostomy
2_GA_I_5	The principles of anaesthesia for tracheostomy
2_GA_I_6	Principles of tracheostomy care and management of complications including obstructed/misplaced tracheostomy (including in children)
2_GA_I_7	The specialised airway techniques used for laser surgery in, or near the airway and hazards associated with the use of laser
2_GA_I_8	The principles of anaesthesia for major head and neck surgery and the pathophysiological changes and co-morbidities associated with head and neck cancer
2_GA_I_9	Commonly used methods of local and general anaesthesia for patients having surgery on or below the vocal cords including techniques of ventilation
2_GA_I_10	The principles of the recognition and appropriate management of acute ENT emergencies, including bleeding tonsils, epiglottis, croup, and inhaled foreign body
2_GA_I_11	The emergency management of fractures of the face and other maxillo-facial emergencies such as intra-oral abscesses, and other causes of upper airway obstruction
2_GA_I_12	Recognition of supra-glottic airway obstruction and the indications/contra-indications of different airway devices to bypass such obstruction
2_GA_I_13	Management of failed intubation protocols including front of neck access techniques
2_GA_I_14	The principles of shared decision making when managing complex airways and the benefits and limitations of flexible nasendoscopy
2_GA_I_15	The benefits of advanced imaging techniques when assessing complex airways such as CT and 3D reconstruction of the airway and virtual endoscopy

2_GA_J: Manages non-complex shared airway surgery with distant supervision

2_GA_J_1	Discuss the risks and benefits of using various supraglottic airways for IPPV or SV
2_GA_J_2	The use of high flow nasal oxygen
2_GA_J_3	Management of patients undergoing nasal and middle ear surgery

2_GA_K: Explains the problems associated with laparoscopic, endoscopic and open procedures, including those with major blood loss, and provides safe general anaesthesia for these procedures with distant supervision for ASA 1 to 3 adult patients

2_GA_K_1	The principles of peri-operative management including positioning, physiological consequences and analgesia for the commoner complex cases including, but not exclusively: • Pancreatic and liver resection • Oesophagectomy (including one lung ventilation) • Resection of neuroendocrine tumours e.g. Carcinoid and phaeochromocytoma • Splenectomy • Resection of retroperitoneal masses • Robotic procedures (e.g. cystoprostatectomy and nephrectomy)
2_GA_K_2	The principles of perioperative anaesthetic care for primary and revision pelvic bone and joint surgery and postoperative pain management
2_GA_K_3	Management of anaesthetic techniques appropriate for plastic surgical procedures including major reconstructive cases and free flap surgery
2_GA_K_4	Management of blood flow and surgical field during surgery, including free-flap surgery
2_GA_K_5	The concept of Goal-Directed Therapy
2_GA_K_6	The principles and interpretation of depth of anaesthesia monitoring
2_GA_K_7	Perioperative management of the patient for open major vascular surgery eg abdominal aneurysm repair
2_GA_K_8	Perioperative management of the patient for endovascular surgery eg EVAR
2_GA_K_9	Management of elective carotid artery surgery with general or regional anaesthesia.
2_GA_K_10	Pathophysiology of aortic cross-clamping and renal protection strategies
2_GA_K_11	Morbidity and mortality associated with vascular surgery

2_GA_L: Provides safe general anaesthesia for diagnostic and therapeutic procedures in the non-theatre environment but within the hospital setting for ASA 1-3 adult patients independently, recognising when this is inappropriate

2_GA_L_1	The different techniques of anaesthesia either diagnostic or therapeutic for both elective and emergency procedures in the non-theatre environment e.g. radiology (X-Ray, CT and MRI), angiography, radiotherapy, ECT, endoscopy and the emergency department.
2_GA_L_2	Explains the problems of providing of safe post-anaesthetic care for patients in the non-theatre environment
2_GA_L_3	The unique safety precautions required in each of the environments, particularly MRI
2_GA_L_4	Explains the rationale for the choice of anaesthetic technique for ECT and the physiological effects of this treatment

2_GA_M: Applies relevant anatomical, physiological and pharmacological principles to neurosurgical patients

2_GA_M_1	Relevance of anatomy of the skull, skull base, vertebral column, CSF circulation and cerebral blood flow and central nervous system related to neuroanaesthetic practice
2_GA_M_2	Relevance of applied physiology and pathophysiology of the central nervous system related to neuroanaesthetic practice including interventional procedures
2_GA_M_3	Consciousness and sleep
2_GA_M_4	Depth of anaesthesia – effects of anaesthetics on neurotransmission
2_GA_M_5	Techniques for measuring and decreasing the intra-cranial pressure
2_GA_M_6	How drugs can Impact on neurophysiological monitoring
2_GA_M_7	The specific risks of venous thromboembolic disease in neurosurgical patients and how these are managed
2_GA_M_8	The principles of CSF drainage, including its use in complex endovascular aneurysm cases and the management of spinal cord ischaemia post thoracic aneurysm/ complex EVAR

2_GA_N: Provides safe anaesthetic care to ASA 1-3 adults for simple elective and emergency intracranial, spinal and neuroradiology procedures under local supervision

2_GA_N_1	Perioperative anaesthetic management of patients for neurosurgery and neuroradiology This includes: •Preoperative assessment and optimisation of patients with neurological disease •Induction, maintenance, and reversal of anaesthesia • Early postoperative care including the specific areas of fluid management, control of pain and neurological monitoring
2_GA_N_2	Understanding of anaesthesia for neurosurgical and neuroradiological procedures including but not exclusively: Shunt surgery Evacuation of intracranial haematoma Interventional radiology procedures for cerebral aneurysms and stroke thrombectomy Trans-sphenoidal surgery Supratentorial and posterior fossa surgery Emergency surgery for traumatic brain injury including decompressive craniectomy Spinal column surgery Awake craniotomy including neurophysiological monitoring Stereotactic surgery
2_GA_N_3	The principles of perioperative anaesthetic care for elective and emergency spinal surgery including but not exclusively: • Scoliosis surgery including neurophysiological monitoring • Spinal trauma and the associated complications of spinal cord trauma • Postoperative pain management
2_GA_N_4	The anaesthesia for trigeminal neuralgia including thermocoagulation
2_GA_N_5	Operative spinal cord monitoring and nerve conduction
2_GA_N_6	Peripheral nerve stimulators: assessment of neuromuscular function. Identification of nerves with needle electrode.
2_GA_N_7	Indications for using neurophysiological monitoring including but not limited to EEG, evoked potentials and ICP measurement, to benefit patients requiring neurosurgery/neuro-critical care
2_GA_N_8	The techniques used for recognition and management of air embolism
2_GA_N_9	The special risk associated with prion diseases during neurosurgery

2_GA_O: Applies basic science and clinical anaesthetic principles to patients undergoing cardiac and thoracic surgery

2_GA_O_1	Invasive and non-invasive cardiovascular monitoring, and basic interpretation including use of: PICCO LIDCO Contour analysis ECHO TOE Oesophageal doppler
2_GA_O_2	Interprets information from commonly used modalities for advanced haemodynamic monitoring
2_GA_O_3	Principles of action, and the use of, intra-aortic balloon counter-pulsation and other assist devices eg LVAD, BiVAD
2_GA_O_4	Indications for temporary and permanent cardiac pacing including different modes and advanced functions
2_GA_O_5	Principles of antibiotic prophylaxis in patients with cardiac disease
2_GA_O_6	Cardiovascular physiology and pharmacology relevant to perioperative management of patients presenting for cardiac surgery
2_GA_O_7	Cardiovascular physiology and pharmacology relevant to perioperative management of patients presenting for less invasive procedures eg TAVI
2_GA_O_8	Cardiovascular physiology and pharmacology relevant to perioperative management of patients presenting for electrophysiology procedures eg AF/VT ablations, ICD insertion

2_GA_P: Describes the principles of anaesthesia for on and off bypass cardiac and thoracic surgery

2_GA_P_1	Principles of perioperative anaesthetic management of patients for cardiac surgery including post-operative pain management and respiratory support
2_GA_P_2	Problems associated with post-cardiac surgery including bleeding and the clinical signs and symptoms of cardiac tamponade, and its management
2_GA_P_3	Methods used to cool and re-warm patients during cardiac surgery, and potential complications
2_GA_P_4	Principles of cardiopulmonary bypass Cardioplegia Use of vasodilators/vasoconstrictors and inotropes Management of arrythmias Anticoagulation during bypass Effects on drug pharmacology Clinical effects on organs eg lung, brain
2_GA_P_5	Anaesthetic and surgical problems associated with “off pump” cardiac surgery

2_GA_Q: Provides safe anaesthetic care to ASA 1–3 adults undergoing elective cardiac revascularisation, valvular surgery and cardiology procedures under direct supervision

2_GA_Q_1	Perioperative anaesthetic management of patients undergoing less invasive procedures eg TAVI
2_GA_Q_2	Management of complications of less invasive procedures eg TAVI
2_GA_Q_3	Perioperative management of patients presenting for electrophysiology procedures eg AF/VT ablations, ICD insertion
2_GA_Q_4	Management of complications of electrophysiological cardiac procedures

2_GA_R: Demonstrates safe anaesthetic care for adults requiring non-complex thoracic procedures under direct supervision, including one lung ventilation

2_GA_R_1	Specific risks associated with anaesthesia in patients requiring thoracic surgery and precautions to be taken to minimise them including pre-operative optimisation
2_GA_R_2	Commonly performed thoracic surgical procedures and the relevant anaesthetic problems associated with these
2_GA_R_3	Airway management of a patient undergoing one-lung ventilation and anaesthesia including placement of double lumen endobronchial tubes and bronchial blockers
2_GA_R_4	The changes that occur during one lung ventilation and the strategies to manage these
2_GA_R_5	The common problems associated with the postoperative care of patient who has had thoracic surgery and the methods that can be used to minimise these

2_GA_S: Explains the anaesthetic implications of ophthalmic surgery, in particular the penetrating eye injury and the presence of intraocular gas

2_GA_S_1	The precautions required for revision surgery in patients who have had a previous injection of intraocular gas
2_GA_S_2	The choice of techniques of anaesthesia for patients with penetrating eye injury
2_GA_S_3	The operating conditions required for successful outcomes in ophthalmic surgery and how these can be achieved
2_GA_S_4	The specific factors in the postoperative care of patients who have had ophthalmic surgery

2_GA_T: Provides safe anaesthetic care for elective and emergency obstetric patients including those with co-morbidities and obstetric complications with distant supervision

2_GA_T_1	The influence of concurrent medical diseases on pregnancy and the management of these patients
2_GA_T_2	Analgesia for the labouring parturient
2_GA_T_3	Risk factors, recognition and management of massive obstetric haemorrhage including but not limited to: · use of a massive haemorrhage alert system · the use of blood products and cell salvage · the use of uterotonics and point of care coagulation tests · how the physiological changes of pregnancy affect coagulation and their relevance in this setting · particular causes such as genital tract trauma, uterine atony etc.
2_GA_T_4	Management of venous thromboembolism in pregnancy
2_GA_T_5	Risk factors and management of a patient with abnormal placentation
2_GA_T_6	Risk factors, recognition and management of a patient with pre-eclampsia and eclampsia
2_GA_T_7	Risk factors, recognition and management of amniotic fluid embolus
2_GA_T_8	Risk factors, recognition and management of uterine inversion and uterine rupture
2_GA_T_9	Risk factors, recognition and management of sepsis in pregnancy
2_GA_T_10	Management of pregnant patient presenting for non-obstetric surgery
2_GA_T_11	Obstetric and anaesthetic management of multiple pregnancy
2_GA_T_12	Management of intrauterine death
2_GA_T_12	Management of the complications of central neuroaxial blockade in obstetrics
2_GA_T_13	Recognition and management of Post Dural Puncture Headache, including differential diagnoses, complications and treatment options.
2_GA_T_14	Recognition and understanding of the importance of ongoing national audit of maternal and foetal morbidity and mortality

2_GA_U: Provides safe general anaesthesia for ASA 1-3 children undergoing non-complex elective and emergency surgery aged 1- 5 years with direct supervision, and 5 years and above with distant supervision

2_GA_U_1	Anatomical and physiological changes that occur during development from neonate to older child in relation to the conduct of anaesthesia
2_GA_U_2	Management of analgesic requirements in children undergoing common surgical procedures
2_GA_U_3	Management of children undergoing day case surgery
2_GA_U_4	Paediatric management of fluid balance in the peri-operative period including pre-operative dehydration, 3^rd space loss, requirement for a laparotomy and post- operative maintenance
2_GA_U_5	Peri-operative management of blood products in children
2_GA_U_6	Explains the law as it relates to children in respect of Consent, Restraint and Research and the concept of ‘Gillick competence’

2_GA_V: Explains the principles of anaesthetic care for children of all ages with complex medical problems and/or requiring complex surgical procedures

2_GA_V_1	The implications for anaesthesia of paediatric medical and surgical problems including major congenital abnormalities (e.g. tracheoesophageal fistula, diaphragmatic hernia, congenital heart disease and syndromes such as Trisomy 21
2_GA_V_2	Perioperative management of children with learning disability and neurodiversity

2_GA_W: Explains the principles of the general anaesthetic care of neonates

2_GA_W_1	The specific factors in preoperative assessment and preparation of neonates for surgery
2_GA_W_2	Anaesthetic techniques for neonates
2_GA_W_3	Issues with thermoregulation in the newborn and the measures required to prevent hypothermia
2_GA_W_4	The anaesthetic management of neonates and infants for minor operations, major elective and emergency surgery
2_GA_W_5	The specific anaesthetic and monitoring equipment required for neonates
2_GA_W_6	Common problems in the neonatal period requiring anaesthesia and their perioperative management (e.g. inguinal hernia, intestinal obstruction, pyloric stenosis)
2_GA_W_7	The problems of the premature and ex-premature neonate
2_GA_W_8	The adverse effects of starvation, dehydration and hypoglycaemia in neonates and children

2_GA_X: Uses total intravenous anaesthesia safely in all areas of clinical anaesthetic practice

2_GA_X_1	Pharmacokinetic principles and models for Total Intravenous Anaesthesia (TIVA)
2_GA_X_2	Implications of concurrent disease and obesity on use of TIVA
2_GA_X_3	Practical aspects of the safe use of TIVA including monitoring and the avoidance of accidental awareness
2_GA_X_4	The principles of anaesthesia for middle ear surgery, including but not limited to, use of TIVA and hypotensive techniques
2_GA_X_5	Use of TIVA in children