FRCA Primary - Syllabus

  1. PREOPERATIVE ASSESSMENT
  2. PREMEDICATION
  3. ANAESTHESIA, HDU AND ICU EQUIPMENT: MONITORING AND SAFETY
  4. INDUCTION OF GENERAL ANAESTHESIA
  5. INTRAOPERATIVE CARE (INCLUDING SEDATION)
  6. POSTOPERATIVE AND RECOVERY CARE
  7. INTENSIVE AND HIGH DEPENDENCY CARE
  8. MANAGEMENT OF TRAUMA, STABILISATION AND TRANSFER OF PATIENTS
  9. OBSTETRIC ANAESTHESIA AND ANALGESIA
  10. PAEDIATRIC ANAESTHESIA
  11. ANAESTHESIA AND THE ELDERLY
  12. INFECTION CONTROL
  13. CRITICAL INCIDENTS
  14. MANAGEMENT OF RESPIRATORY AND CARDIAC ARREST
  15. PHYSIOLOGY AND BIOCHEMISTRY
  16. PHARMACOLOGY
  17. PHYSICS AND CLINICAL MEASUREMENT
  18. STATISTICAL METHODS

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PREOPERATIVE ASSESSMENT

  • Implications for anaesthesia of commoner elective conditions requiring gynaecological, abdominal, orthopaedic, ENT, dental, urological and body surface surgery. Knowledge of sub-specialty practice and specialised techniques is not required unless specified elsewhere.
  • The relevance of trauma, intestinal obstruction and acute abdominal emergencies
  • The ASA classification and other scoring systems such as Glasgow coma scale (GCS)
  • The interpretation of relevant preoperative investigations
  • Restriction of food and fluid by mouth, cessation of smoking, correction of dehydration
  • Assessment of difficulties in airway management and the importance of the 'shared airway'
  • Implications for anaesthesia of common medical conditions (ischaemic heart disease, hypertension, diabetes, asthma, rheumatoid arthritis etc)
  • Anaesthetic implications of current drug therapy and whether it should be continued, modified stopped or changed peri-operatively
  • Need for and methods of perioperative antithrombotic treatment
  • The importance of an anaesthetic history and genetic diseases in anaesthesia with respect to suxamethonium apnoea, anaphylaxis and malignant hyperpyrexia
  • Assessment of post-operative analgesic needs
  • Assessment of whether ICU or HDU care will be required post-operatively
  • The importance of consent and the issues surrounding it
  • Dangers of repeat anaesthesia

PREMEDICATION

  • Rationale for use of premedicant drugs
  • Choice of drugs, advantages and disadvantages
  • Rationale for antacid, and prokinetic premedication
  • Rationale for antithrombotic therapy
  • Understanding of causes of delayed gastric emptying

ANAESTHESIA, HDU AND ICU EQUIPMENT: MONITORING AND SAFETY

  • Physical principles underlying the function of the anaesthetic machine, pressure regulators, flowmeters, vaporizers, breathing systems
  • Chemistry of absorption of carbon dioxide
  • Principles of lung ventilators, disconnection monitors
  • Manufacture and storage of oxygen, nitrous oxide, carbon dioxide, compressed air
  • Pipeline and suction systems, gas cylinders
  • Minimum monitoring requirements
  • Basis for pre-use checks of anaesthetic machine, breathing systems and monitoring apparatus
  • Airways, tracheal tubes, tracheostomy tubes, emergency airways, laryngeal masks, fixed and variable performance oxygen therapy equipment, self-inflating bags
  • The content of an anaesthetic record
  • Function and use of resuscitation equipment, transfusion devices
  • Humidification devices
  • Environmental control of the operating theatre including temperature, humidity, air changes and scavenging systems for waste anaesthetic gases and vapours
  • Sterilisation and cleaning of equipment
  • Electrical safety
  • Characteristics of intravenous cannulae, spinal and epidural needles

INDUCTION OF GENERAL ANAESTHESIA

  • Intravenous and inhalational induction of anaesthesia; advantages and disadvantages of each technique
  • Indications for tracheal intubation
  • Selection of tube type (oral, nasal, armoured etc), diameter and length
  • Management of difficult intubation and failed intubation
  • Methods of confirming placement of the endotracheal tube; oesophageal and endobronchial intubation, complications
  • Insertion and use of oral airways, face masks and laryngeal mask airway
  • Causes of regurgitation and vomiting during induction, prevention and management of pulmonary aspiration
  • Cricoid pressure
  • Induction of anaesthesia in special circumstances, (head injury, full stomach, upper airway obstruction, shock)
  • Drugs: pharmacology and dosages of induction agents, relaxants, analgesics, and inhalational agents
  • Side effects of drugs used and their interactions
  • Monitoring during induction
  • Recognition and management of anaphylactic and anaphylactoid reactions including
  • follow up and patient information
  • Management of intra-arterial injection of harmful substances (e.g. antibiotics, thiopentone)
  • Management of asthma, COPD, hypertension, IHD, rheumatoid arthritis
  • Problems of the obese patient

INTRAOPERATIVE CARE (INCLUDING SEDATION)

  • Techniques of maintenance of general anaesthesia involving both spontaneous and controlled ventilation (except sub-specialty and highly specialised practice)
  • Definition of and methods of sedation
  • Management of the shared airway
  • Effects and hazards of the pneumoperitoneum induced for laparoscopic surgery
  • Drugs: Pharmacology, uses and dosages of induction agents used for IV maintenance, relaxants, analgesics, inhalational agents
  • Methods of producing muscle relaxation
  • Choice of spontaneous and controlled ventilation and methods of monitoring them
  • Minimum monitoring standards
  • Additional monitoring for sick patients (e.g. CVP, urine flow)
  • Detection and prevention of awareness
  • Management of important critical incidents occurring during anaesthesia (critical incidents)
  • Diagnosis and treatment of pneumothorax
  • Principles of fluid balance
  • Blood & blood products; synthetic colloids; crystalloids
  • Management of massive haemorrhage, volume expansion, blood transfusion (hazards including incompatibility reaction)
  • Correct intraoperative positioning on theatre table, care of pressure points, avoidance nerve injury: complications of supine and prone positions
  • Management of asthma, COPD, hypertension, IHD, rheumatoid arthritis, jaundice, steroid therapy, diabetes
  • Content of the anaesthetic record
  • Modification of technique in repeat anaesthesia
  • Understanding basic surgical operations

POSTOPERATIVE AND RECOVERY CARE

  • Causes and treatment of failure to breathe at end of operation
  • Distinguishing between opiate excess, continued anaesthetic effect and/or residual paralysis
  • Care of the unconscious patient
  • Monitoring the patient in recovery
  • Interpretation of nerve stimulator patterns
  • Oxygen therapy, indications and techniques
  • Management of cyanosis, hypo- and hypertension, shivering and stridor
  • Postoperative fluid balance and prescribing
  • Assessment of pain and methods of pain management
  • Methods of treating of postoperative nausea and vomiting
  • Causes and management of post-operative confusion
  • Management of asthma, COPD, hypertension, IHD, rheumatoid arthritis, jaundice, steroid therapy, diabetes
  • Management of the obese patient
  • Recovery room equipment
  • Prevention, diagnosis and management of postoperative pulmonary atelectasis, deep vein thrombosis and pulmonary embolus
  • Criteria for discharge of day-stay patients

INTENSIVE AND HIGH DEPENDENCY CARE

SHO trainees in anaesthesia are required to spend a total of 3 months in intensive care training. The SHO knowledge, skills and attitudes lists below are compatible with the recommendations of the Intercollegiate Board for Training in Intensive Care Medicine (IBTICM)9 for SHO training in intensive care medicine. Because these are reproduced in full, there is obviously repetition of material that appears in other sections of this document. There is, in addition, guidance on assessment for ICM.

  • An understanding of the potential benefits of high dependency and intensive care
  • Common causes of admission to high dependency and intensive care
  • Method of examination of the unconscious patient
  • The principles of brain stem death diagnosis
  • An understanding of sepsis and the basic patterns of failure of the major organs
  • The common causes of cardiac and respiratory arrest
  • The anatomy of the oropharynx, larynx, trachea & bronchial tree
  • Basic anatomy of neck, upper thorax, arms, wrists, inguinal region and foot relevant to insertion of venous and arterial access
  • Method of inserting a chest drain and relief of tension pneumothorax
  • Understanding of the choice of intravenous fluids appropriate for use in major fluid loss, and their pharmacology
  • The recognition of basic cardiac dysrrhythmias and the current therapies (physical (carotid sinus massage), electrical (defibrillation & countershock), electrolytic (Mg++, Ca++), and pharmacological (adrenaline (epinephrine), atropine, lignocaine and 2nd line drugs)
  • Pharmacology of the common inotropic agents used in the critically ill (adrenaline (epinephrine), nor-adrenaline (nor-epinephrine))
  • Pharmacology of major analgesics used as respiratory depressants (morphine, fentanyl series), and common side effects and contra-indications
  • Pharmacology of common muscle relaxants (depolarising and non-depolarising) and common side effects and contra-indications
  • Pharmacology of intravenous sedative and anaesthetic induction agents used in the critical care unit
  • Thromboprophylaxis in intensive and high dependency patients
  • Choice of antibiotics
  • Use of diuretics for cardiac and respiratory failure and to maintain urine output
  • The basic cardiac and respiratory physiology
  • The basic physiology of respiration and the consequences of positive pressure ventilation
  • An understanding of common blood gas abnormalities
  • An understanding of the use of ventilation in use on critically ill patients, with a knowledge of the vocabulary
  • An understanding of the uses and limitations of monitoring equipment
  • The content of an ICU record
  • An insight into likely outcome based upon severity scoring
  • The grief response

Regional Anaesthesia

  • Pharmacology of local anaesthetics & spinal opioids
  • Anatomy of spine, nerve roots, cauda equina, intercostal nerves, brachial plexus, femoral nerve, inguinal canal, nerves at wrist and ankle, nerve supply of larynx
  • Dermatomes and levels for common operations (e.g. inguinal hernia, haemorrhoids)
  • Technique of spinal and epidural (including caudal) anaesthesia: single shot and catheter techniques
  • Management of the complications of spinal and epidural (including caudal) analgesia (associated hypotension, shivering, nausea & anxiety)
  • Management of accidental total spinal blockade
  • Management of dural tap
  • Techniques and complications of intravenous regional anaesthesia (IVRA),
  • Toxicity of local anaesthetic agents and its management
  • Management of failed/ deteriorating regional block
  • Methods of sedation
  • Absolute and relative contraindications to regional blockade

MANAGEMENT OF TRAUMA, STABILISATION AND TRANSFER OF PATIENTS

  • Performance and interpretation of the primary and secondary survey
  • Emergency airway management
  • Anatomy and technique of cricothyrotomy/tracheostomy/mini-tracheotomy
  • Establishing IV access: interosseous cannulation
  • Immediate specific treatment of life-threatening illness or injury, with special reference to thoracic and abdominal trauma
  • Recognition and management of hypovolaemic shock
  • Effects of trauma on gastric emptying
  • Central venous access: anatomy and techniques
  • Central venous pressure monitoring
  • Arterial pressure monitoring
  • Pleural drain insertion
  • Peritoneal lavage
  • Principles of the management of head injury
  • Mechanisms and effects of raised intra-cranial pressure: coup and contra-coup injuries
  • Methods of preventing the 'second insult' to the brain
  • Principles of anaesthesia in the presence of a recent head injury
  • Management of cervical spine injuries
  • Principles of the safe transfer of patients
  • Understanding portable monitoring systems
  • Recognition and management of dilutional coagulopathy
  • Factors affecting intraocular pressure

OBSTETRIC ANAESTHESIA AND ANALGESIA

  • Physiological changes associated with a normal pregnancy
  • Functions of the placenta: placental transfer: feto-maternal circulation
  • The fetus: fetal circulation: changes at birth
  • Pain pathways relevant to labour
  • Methods of analgesia during labour: indications and contraindications
  • Effect of pregnancy on the technique of general and regional anaesthesia
  • Principles of anaesthesia for incidental surgery during pregnancy

PAEDIATRIC ANAESTHESIA

(infants and children)

  • Anatomical differences in the airway, head, and spinal cord from the adult
  • Deciduous and permanent dentition
  • Physiological differences from the adult
  • Haematological and biochemical changes with age
  • Estimation of blood volume, replacement of fluid loss
  • Modification of drug dosages
  • Analgesia for children
  • Premedication, including local anaesthesia for venepuncture
  • Calculation of tube sizes, selection of masks and airways
  • Choice of breathing system
  • Upper respiratory tract infections and when to cancel operations
  • Psychological aspects of sick children

ANAESTHESIA AND THE ELDERLY

  • Physiological changes with age
  • Altered pharmacological response
  • Erosion of physiological reserve
  • Frequent co-morbidities
  • Positioning difficulties
  • Communication difficulties (eyesight, hearing, CVAs)
  • Mental clarity, memory loss
  • Causes of post-operative confusion
  • Importance of social circumstances

INFECTION CONTROL

  • Universal precautions and good working practices (hand washing, gloves etc)
  • Cross infection: modes and common agents
  • Emergence of resistant strains: antibiotic policies in a hospital
  • Common surgical infections: antibiotic choice and prophylaxis
  • Infections from contaminated blood
  • Hepatitis and HIV infections: modes of infection: natural history: at risk groups
  • Immunisation policy
  • Sterilisation of equipment
  • Strategy if contaminated

CR ITICAL INCIDENTS

  • Common causes of critical incidents
  • Principles of the causes, detection and management of:
    • Cardiac and / or respiratory arrest
    • Unexpected Hypoxia with or without cyanosis
    • Unexpected increase in peak airway pressure
    • Progressive fall in minute volume during spontaneous respiration or IPPV
    • Fall in end tidal CO2
    • Rise in end tidal CO2
    • Rise in inspired CO2
    • Unexpected hypotension
    • Unexpected hypertension
    • Sinus Tachycardia
    • Arrhythmias (ST segment changes; sudden tachydysrhythmia; sudden bradycardia;
  • Ventricular Ectopics - Ventricular tachycardia - Ventricular Fibrillation)
    • Convulsions
  • Management of the following specific conditions:
    • Aspiration of vomit
    • Laryngospasm
    • Bronchospasm
    • Tension Pneumothorax
    • Gas / Fat / Pulmonary embolus
    • Adverse drug reactions
    • Anaphylaxis
    • Transfusion of miss-matched blood or blood products
    • Malignant hyperpyrexia
    • Inadvertent intra-arterial injection of irritant fluids
    • High spinal block
    • Local Anaesthetic toxicity
    • Failed intubation
    • Difficulty with IPPV and sudden or progressive loss of minute volume

MANAGEMENT OF RESPIRATORY AND CARDIAC ARREST

This section should be read in conjunction with Section 2.1 and Appendix 1. Trainees can be regarded as achieving the necessary competencies if they have successfully completed an ALS course in the last 12 months.

  • Patient assessment: diagnosis of causes of cardio-respiratory arrest
  • Causes of cardio-respiratory arrest during induction, maintenance and recovery from anaesthesia
  • Importance of considering non-cardiac causes of cardio-respiratory arrest
  • Methods of airway management (mouth-mouth/nose, bag-mask, LMA, intubation)
  • Recognition and management of life-threatening arrhythmias including defibrillation and drug therapy
  • Recognition and management of non-cardiac causes of cardio-respiratory arrest
  • Knowledge of specific problems of paediatric resuscitation
  • Ethical aspects of resuscitation

ANATOMY

Trainees should be able to demonstrate a good understanding of human anatomy relevant to the practice of anaesthesia at SHO level and to support progress to SpR 1/2 training

  • Respiratory System
    • Mouth, nose, pharynx, larynx, trachea, main bronchi, segmental bronchi, structure of bronchial tree: differences in the child
    • Airway and respiratory tract, blood supply, innervation and lymphatic drainage
    • Pleura, mediastinum and its contents
    • Lungs, lobes, microstructure of lungs
    • Diaphragm, other muscles of respiration, innervation
    • The thoracic inlet and 1st rib
    • Interpretation of a normal chest x-ray
  • Cardiovascular system
    • Heart, chambers, conducting system, blood and nerve supply.
    • Pericardium
    • Great vessels, main peripheral arteries and veins
    • Fetal and materno - fetal circulation
  • Nervous system
    • Brain and its subdivisions
    • Spinal cord, structure of spinal cord, major ascending and descending pathways
    • Spinal meninges, subarachnoid and extradural space, contents of extradural space
    • CSF and its circulation
    • Spinal nerves, dermatomes
    • Brachial plexus, nerves of arm
    • Intercostal nerves
    • Nerves of abdominal wall
    • Nerves of leg and foot
    • Autonomic nervous system
    • Sympathetic innervation, sympathetic chain, ganglia and plexuses
    • Parasympathetic innervation
    • Stellate ganglion
    • Cranial nerves: base of skull: trigeminal ganglion
    • Innervation of the larynx
    • Eye and orbit
  • Vertebral column
    • Cervical, thoracic, and lumbar vertebrae
    • Sacrum, sacral hiatus
    • Ligaments of vertebral column
    • Surface anatomy of vertebral spaces, length of cord in child and adult
  • Surface anatomy
    • Structures in antecubital fossa
    • Structures in axilla: identifying the brachial plexus
    • Large veins and anterior triangle of neck
    • Large veins of leg and femoral triangle
    • Arteries of arm and leg
    • Landmarks for tracheostomy, cricothyrotomy
    • Abdominal wall (including the inguinal region): landmarks for suprapubic urinary and peritoneal lavage catheters

PHYSIOLOGY AND BIOCHEMISTRY

Trainees should have a good general understanding of human physiology, be able to apply physiological principles and knowledge to clinical practice at SHO and have sufficient knowledge to support progress to SpR 1/2 training.

  • General
    • Organisation of the human body and control of internal environment
    • Variations with age
    • Function of cells; genes and their expression
    • Cell membrane characteristics; receptors
    • Protective mechanisms of the body
  • Biochemistry
    • Acid base balance and buffers
    • Ions e.g. Na + , K+, Ca++ , Cl-, HCO3
    • Cellular metabolism
    • Enzymes
  • Body fluids and their functions and constituents
    • Capillary dynamics and interstitial fluid
    • Osmolarity: osmolality, partition of fluids across membranes
    • Lymphatic system
    • Special fluids especially cerebrospinal fluid: also pleural, pericardial
    • and peritoneal fluids
  • Haematology and Immunology
    • Red blood cells: haemoglobin and its variants
    • Blood groups
    • Haemostasis and coagulation
    • White blood cells
    • Immunity and allergy
  • Muscle
    • Action potential generation and its transmission
    • Neuromuscular junction and transmission
    • Muscle types
    • Skeletal muscle contraction
    • Smooth muscle contraction: sphincters
    • Motor unit
  • Heart/Circulation
    • Cardiac muscle contraction
    • The cardiac cycle: pressure and volume relationships
    • Rhythmicity of the heart
    • Regulation of cardiac function; general and cellular
    • Control of cardiac output (including the Starling relationship)
    • Fluid challenge and heart failure
    • Electrocardiogram and arrhythmias
    • Neurological and humoral control of systemic blood pressures, blood volume and blood flow (at rest and during physiological disturbances e.g. exercise, haemorrhage and Valsalva manoeuvre)
    • Peripheral circulation: capillaries, vascular endothelium and arteriolar smooth muscle
    • Characteristics of special circulations including: pulmonary, coronary, cerebral, renal, portal and foetal
  • Renal tract
    • Blood flow and glomerular filtration and plasma clearance
    • Tubular function and urine formation
    • Assessment of renal function
    • Regulation of fluid and electrolyte balance
    • Regulation of acid-base balance
    • Micturition
    • Pathophysiology of acute renal failure
  • Respiration
    • Gaseous exchange: O2 and CO2 transport, hypoxia and hyper- and hypocapnia, hyperand hypobaric pressures
    • Functions of haemoglobin in oxygen carriage and acid-base equilibrium
    • Pulmonary ventilation: volumes, flows, dead space
    • Effect of IPPV on lungs
    • Mechanics of ventilation: ventilation/perfusion abnormalities
    • Control of breathing, acute and chronic ventilatory failure, effect of oxygen therapy
    • Non-respiratory functions of the lungs
  • Nervous System
    • Functions of nerve cells: action potentials, conduction and synaptic mechanisms
    • The brain: functional divisions
    • Intracranial pressure: cerebrospinal fluid, blood flow
    • Maintenance of posture
    • Autonomic nervous system: functions
    • Neurological reflexes
    • Motor function: spinal and peripheral
    • Senses: receptors, nociception, special senses
    • Pain: afferent nociceptive pathways, dorsal horn, peripheral and central mechanisms, neuromodulatory systems, supraspinal mechanisms, visceral pain, neuropathic pain, influence of therapy on nociceptive mechanisms
    • Spinal cord: anatomy and blood supply, effects of spinal cord section
  • Liver
    • Functional anatomy and blood supply
    • Metabolic functions
  • Gastrointestinal
    • Gastric function; secretions, nausea and vomiting
    • Gut motility, sphincters and reflex control
    • Digestive functions
  • Metabolism
    • Nutrients: carbohydrates, fats, proteins, vitamins and minerals
    • Metabolic pathways, energy production and enzymes; metabolic rate
    • Hormonal control of metabolism: regulation of plasma glucose, response to trauma
    • Physiological alterations in starvation, obesity, exercise and the stress response
    • Body temperature and its regulation
  • Endocrinology
    • Mechanisms of hormonal control: feedback mechanisms, effect on membrane and intracellular receptors
    • Hypothalamic and pituitary function
    • Adrenocortical hormones
    • Adrenal medulla: adrenaline (epinephrine) and noradrenaline (norepinephrine)
    • Pancreas: insulin, glucagon and exocrine function
    • Thyroid and parathyroid hormones and calcium homeostasis
  • Pregnancy
    • Physiological changes associated with normal pregnancy
    • Materno-fetal, fetal and neonatal circulation
    • Functions of the placenta: placental transfer
    • Fetus: changes at birth

PHARMACOLOGY

Trainees should have a good understanding of general pharmacological principles, together with knowledge of drugs likely to be encountered in (a) anaesthetic practice and (b) current treatment of patients presenting for anaesthesia. The level of knowledge should be sufficient to enable clinical practice at SHO level and able to support progress to SpR 1/2 training.

  • Applied chemistry
    • Types of intermolecular bonds
    • Laws of diffusion. Diffusion of molecules through membranes
    • Solubility and partition coefficients
    • Ionization of drugs
    • Drug isomerism
    • Protein binding
    • Oxidation and reduction
  • Mode of action of drugs
    • Dynamics of drug-receptor interaction
    • Agonists, antagonists, partial agonists, inverse agonists
    • Efficacy and potency. Tolerance
    • Receptor function and regulation
    • Metabolic pathways; enzymes; drug: enzyme interactions; Michaelis-Menten equation
    • Enzyme inducers and inhibitors
    • Mechanisms of drug action
    • Ion channels: types: relation to receptors. Gating mechanisms
    • Signal transduction: cell membrane/receptors/ion channels to intracellular molecular targets, second messengers
    • Action of gases and vapours
    • Osmotic effects. pH effects. Adsorption and chelation
    • Mechanisms of drug interactions:
    • Inhibition and promotion of drug uptake. Competitive protein binding. Receptor interactions
    • Effects of metabolites and other degradation products.
  • Pharmacokinetics and pharmacodynamics
    • Drug uptake from: gastrointestinal tract, lungs, transdermal, subcutaneous, IM, IV, epidural, intrathecal routes
    • Bioavailability
    • Factors determining the distribution of drugs: perfusion, molecular size, solubility, protein binding
    • The influence of drug formulation on disposition
    • Distribution of drugs to organs and tissues: Body compartments
    • Influence of specialised membranes: tissue binding and solubility
    • Materno-fetal distribution
    • Distribution in CSF and extradural space
    • Modes of drug elimination:
      • Direct excretion
      • Metabolism in organs of excretion: phase I & II mechanisms
      • Renal excretion and urinary pH
      • Non-organ breakdown of drugs
    • Pharmacokinetic analysis:
      • Concept of a pharmacokinetic compartment
      • Apparent volume of distribution
      • Clearance
      • Clearance concepts applied to whole body and individual organs
      • Simple 1 and 2 compartmental models: concepts of wash-in and wash-out curves
      • Physiological models based on perfusion and partition coefficients
      • Effect of organ blood flow: Fick principle
      • Pharmacokinetic variation: influence of body size, sex, age, disease, pregnancy, anaesthesia, trauma, surgery, smoking, alcohol and other drugs
      • Effects of acute organ failure (liver, kidney) on drug elimination
      • Pharmacodynamics: concentration-effect relationships: hysteresis
      • Pharmacogenetics: familial variation in drug response
      • Adverse reactions to drugs: hypersensitivity, allergy, anaphylaxis, anaphylactoid reactions
  • Systematic Pharmacology
    • Anaesthetic gases and vapours
    • Hypnotics, sedatives and intravenous anaesthetic agents
    • Simple analgesics
    • Opioids and other analgesics; and opioid antagonists
    • Non-steroidal anti-inflammatory drugs
    • Neuromuscular blocking agents (depolarising & non-depolarising), and anticholinesterases
    • Drugs acting on the autonomic nervous system: cholinergic and adrenergic agonists and antagonists
    • Drugs acting on the heart & cardiovascular system (including inotropes, vasodilators, vasoconstrictors, antiarrhythmics, diuretics)
    • Drugs acting on the respiratory system (including respiratory stimulants & bronchodilators)
    • Antihypertensives
    • Anticonvulsants
    • Anti-diabetic agents
    • Diuretics
    • Antibiotics
    • Corticosteroids and other hormone preparations
    • Antacids. Drugs influencing gastric secretion and motility
    • Antiemetic agents
    • Local anaesthetic agents
    • Plasma volume expanders
    • Antihistamines
    • Antidepressants
    • Anticoagulants
    • Vitamin K, B12 and thiamine

PHYSICS AND CLINICAL MEASUREMENT

Candidates should have a good understanding of the principles of physics and clinical measurement with an emphasis on the function of monitoring equipment safety and measurement techniques.

  • Mathematical concepts: relationships and graphs
  • Concepts only of exponential functions and logarithms: wash-in, wash-out and tear away
  • Basic measurement concepts: linearity, drift, hysteresis, signal: noise ratio, static and dynamic response
  • SI units: fundamental and derived units
  • Other systems of units where relevant to anaesthesia (e.g. mmHg, bar, atmospheres)
  • Simple mechanics: mass, force, work and power
  • Heat: freezing point, melting point, latent heat
  • Conduction, convection, radiation
  • Mechanical equivalent of heat: laws of thermodynamics
  • Measurement of temperature and humidity
  • Colligative properties: osmometry
  • Physics of gases and vapours
  • Absolute and relative pressure
  • The gas laws; triple point; critical temperature and pressure
  • Density and viscosity of gases
  • Laminar and turbulent flow; Poiseuille's equation, the Bernoulli principle
  • Vapour pressure: saturated vapour pressure
  • Measurement of volume and flow in gases and liquids
  • The pneumotachograph and other respirometers
  • Principles of surface tension
  • Basic concepts of electricity and magnetism
  • Capacitance, inductance and impedance
  • Amplifiers: band width, filters
  • Amplification of biological potentials: ECG, EMG, EEG
  • Sources of electrical interference
  • Processing, storage and display of physiological measurements
  • Bridge circuits
  • Basic principles and safety of lasers
  • Basic principles of ultrasound and the Doppler effect
  • Principles of cardiac pacemakers and defibrillators
  • Electrical hazards: causes and prevention
  • Electrocution, fires and explosions
  • Diathermy and its safe use
  • Principles of pressure transducers
  • Resonance and damping, frequency response
  • Measurement and units of pressure
  • Direct and indirect methods of blood pressure measurement
  • Principles of pulmonary artery and wedge pressure measurement
  • Cardiac output: Fick principle, thermodilution
  • Measurement of gas and vapour concentrations, (oxygen, carbon dioxide, nitrous oxide, and volatile anaesthetic agents) using infra-red, paramagnetic, fuel cell, oxygen electrode and mass spectrometry methods
  • Measurement of pH, pCO2 , pO2
  • Measurement CO2 production/ oxygen consumption/ respiratory quotient
  • Simple tests of pulmonary function e.g. peak flow measurement, spirometry
  • Capnography
  • Pulse oximetry
  • Measurement of neuromuscular blockade
  • Measurement of pain

STATISTICAL METHODS

Trainees will be required to demonstrate understanding of basic statistical concepts, but will not be expected to have practical experience of statistical methods. Emphasis will be placed on methods by which data may be summarised and presented, and on the selection of statistical measures for different data types. Candidates will be expected to understand the statistical background to measurement error and statistical uncertainty.

  • Data Collection
    • Simple aspects of study design
    • Defining the outcome measures and the uncertainty of measuring them
    • The basic concept of meta-analysis and evidence based medicine
  • Descriptive statistics
    • Types of data and their representation
    • The normal distribution as an example of parametric distribution
    • Indices of central tendency and variability
  • Deductive and inferential statistics
    • Simple probability theory and the relation to confidence intervals
    • The null hypothesis
    • Choice of simple statistical tests for different data types
    • Type I and type II errors