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
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 |
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 |