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II CLINICAL ANESTHESIA
2.1 Neuroanesthesia
Monitoring EEG Evoked Potentials ICP Transcranial Doppler
Anesthetic Consideration re: Increased ICP Supratentorial masses Post Fossa Surgery Cerebral Aneurysms Occlusive Cerebrovascular Disease AVM Spinal Cord Surgery Interventional neuroradiology Epilepsy Surgery Pediatric Neurosurgery Neuroendocrine Disease Induced Hypotension
Postoperative management Severe head injury Spinal cord injury Subarachnoid hemorrhage Seizures
Complications Electrolyte Disorders – SIADH Cerebral salt – wasting Syndrome Air embolism Intracranial hypertension
Methods of Brain Protection
Declaration of Brain Death 2.2 Thoracic Anesthesia
Preoperative Assessment Appropriate Investigations Risk Stratification Specific Considerations in Pulmonary Malignancies Perioperative Optimization
Considerations in Specific Respiratory Diseases Asthma COPD Cystic Fibrosis Pulmonary Fibrosis Pulmonary Hypertension
Anesthetic Considerations re: Pathophysiology Lateral Position and Open Thorax One Lung Anesthesia Bronchoscopy Mediastinoscopy Lobectomy Pneumonectomy Tracheal Resection Thoracoscopic Surgery Airway Laser Surgery Esophageal Surgery
Management of Specific Problems Mediastinal Mass Bronchopleural Fistula Pulmonary Hemorrhage Bullae Pneumothorax
Postoperative Management Techniques of Post-Thoracotomy Analgesia
2.3 Cardiac Anesthesia
Preoperative evaluation Appropriate Investigations Risk Stratification
Monitoring Use of Hemodynamic Monitoring TEE
Anesthetic Considerations in Patients with CAD CHF – Right and left ventricular dysfunction Hypertension Cardiomyopathies Tamponade Valvular Disease Dysrhythmias Pacer, Defibrillator Prior Cardiac Transplant Congenital Heart Disease Minimally invasive CABG
Management of CPB, Ventricular Assist Devices
Postoperative Management Pain Management Postoperative Complications – Esteems, MI, Arrhythmia’s, LVF, RVF Neurological Complications Cardiogenic Shock – Pathophysiology and management
ACLS Protocol
2.4 Obstetrical Anesthesia
Preop Assessment Physiologic Changes of Pregnancy Medical Diseases in the Parturient Physiology of the Uteroplacental Unit – Placental Drug Transfer Principles of Fetal Assessment and Monitoring Informed Consent in the obstetrical patient
Methods of Pain Management for Labor and Delivery Regional anesthesia Pharmacologic Agents Other modalities
Effects of Anesthesia/Analgesia on uterine blood flow/uterine activity
Management of Preterm Labour Prolapsed cord Pre-eclampsia, Eclampsia, HELLP Multiple Gestations Abnormal Presentations, Shoulder dystocia Pre and Postpartum Hemorrhage, Uterine Dehiscence, Uterine Inversion, Amniotic Fluid Embolism Operative vaginal delivery Cesarean Section Non-obstetrical Surgery in the Pregnant Patient CPR in the Pregnant Patient Neonatal Resuscitation
Complications Complications of Regional Anesthesia Neurological Complications
2.5 Regional Anesthesia
Pharmacology of Local Anesthetic Drugs Knowledge of Anatomy, Indications & Contraindications, and Complications of Spinal anesthesia Epidural anesthesia Combined spinal/epidural anesthesia Caudal anesthesia Upper extremity blocks Axillary block Interscalene blocks Supraclavicular block Intravenous regional technique Lower extremity blocks Femoral-sciatic block Ankle block Popliteal block Miscellaneous blocks Ocular Blocks Anesthesia of airway for FOB Intercostal block Intrapleural block Paravertebral block
2.6 Trauma
Trauma Protocol and role of Anesthesia
Assessment and management Principles in Acute Trauma Blunt Trauma Penetrating Trauma Airway Trauma/Airway Management Head and Spinal Cord Injury Thoracic Trauma CVS Trauma Abdominal Trauma Major Orthopedic Trauma Hypotension in the trauma patient
Management of the Acutely Traumatized Patient in the OR
Management of Trauma Patient for Repeated Surgical Procedures.
2.7 Critical Care(Refer also to the Adult ICU, Pediatric ICU and Neonatal ICU rotational objectives)
Knowledge of Indications, Techniques Used and Complications of Invasive and Noninvasive Monitoring in Critical Care Setting CT insertion Blakemore / Linton tube
Pathophysiology and management of Pain and Sedation in ICU Respiratory Failure, Methods of Mechanical Ventilation, Modes of Weaning Shock Sepsis MODS/SIRS Coma, Status Epilepticus Endocrine Dysfunction in Critically Ill Patient Nutritional Support in Critically Ill Patient and NPO Criteria Burn Patient Hypothermia Acute Intoxications Transport of Critically Ill Patient Declaration of Brain Death
Organization and delivery of Critical Care Services Design, Staffing, Services
2.8 Ambulatory Anesthesia
Preoperative Assessment, Preparation and Premedication in Ambulatory Setting Appropriate Patient Selection Design of Facility Anesthetic Techniques Discharge Criteria and Patient Instruction Criteria for Hospital Admission Postoperative Complications
2.9 Transplantation anesthesia
Preoperative Assessment, Preparation and management of Recipient for Kidney Heart Transplantation Lung
Management of Transplant Patient for Non-transplant surgery Transplantation Immunology
Management of Live and Cadaver Organ Donor 2.10 Pain
Anatomy and Physiology of Pain Pathways
Principles and Techniques of Acute Pain Management Systemic Opioids, non-opioid analgesics PCA Regional techniques, nerve blocks
Principles and Techniques of Chronic Pain Management Medications Psychological Support Regional techniques, nerve blocks Neuro-ablative techniques Neuro-augmentative techniques – spinal cord stimulation TENS Acupuncture
Organization of a multi-disciplinary pain service
2.11 Airway Assessment and management
Airway anatomy Indications for Intubation Airway Assessment Prediction of the Difficult Airway Anesthesia of the Airway Techniques of Airway Management Management of acute upper airway obstruction ASA Airway Algorithm Assessment of Management of Extubation Complications of Intubation/Re-Intubation Complications of tracheotomy
2.12 Pediatric Anesthesia
Preoperative Assessment
Anatomical, Physiological and Pharmacologic Considerations in Newborns, Infants and children
Monitoring and Specialized Equipment for Pediatric Anesthesia
Perioperative Fluid and Electrolyte Management – Fasting Guidelines
Perioperative Temperature Management
Anesthetic Management of the Pediatric Patient
Common Pediatric Syndromes and Emergencies: TE fistula, FB in airway, epiglottis, pyloric stenosis Ex-premie Child with Recent URTI Difficult Airway Trauma Congenital Heart Disease for non-cardiac surgery Pain Management and Regional Anesthesia Anesthesia outside the O.R.
2.13 Vascular Anesthesia
Preoperative Assessment Concomitant Diseases Preop Evaluation, Preparation and Premedication
Monitoring for Major Vascular Surgery
Anesthetic Considerations in Thoracic Aneurysm Surgery Abdominal Aneurysm Surgery Peripheral Vascular Surgery Carotid Endarterectomy Emergency Vascular Surgery
Post-op pain management
Post-op complications
2.14 Anesthesia for Genitourinary Surgery
Preoperative Evaluation, Preparation and Premedication Concomitant Disease
Anesthetic Considerations for Nephrectomy Lithotripsy Prostate surgery Percutaneous nephrolithotomy
Postop Management Pain management Complications – TURP syndrome
2.15 Anesthesia for Endoscopic Surgery
Preoperative Assessment and Preparation of the Patient for Endoscopic Surgery Risks/Benefits of Endoscopic Approach Relative and Absolute Contraindications
Anesthetic Considerations in Endoscopic Surgery Positioning Physiology of CO2 pneumoperitoneum Physiology of Thoracoscopic Surgery Complications Indications for Conversion to open procedure
2.16 Anesthesia for Orthopedic Surgery
Preoperative Assessment and preparation of the Patient for Orthopedic Surgery Concomitant Disease DVT Prophylaxis Choice of anesthetic technique – Risks/Benefits GA vs. Regional
Anesthetic Considerations in Major Lower Extremity Arthroplasty Surgery Spinal Surgery Shoulder Surgery Fractures Surgery under Tourniquet Cement implantation syndrome
Postop Pain Management
Postop Complications Fat Embolism Pulmonary Embolism Compartment Syndrome
2.17 Anesthesia for ENT Surgery
Preoperative Assessment and Preparation Concomitant Disease Airway Assessment
Anesthetic Considerations for Ear Surgery Nasal Surgery Tonsillectomy/Adenoidectomy Laryngoscopy/laryngeal surgery Bronchoscopy ENT tumors ENT infections Facial trauma Tracheostomy Induced Hypotension
Postoperative Care
Pain management Postoperative Complications
2.18 Anesthesia for Plastic Surgery
Preoperative Assessment and Preparation
Anesthetic considerations in: Burn patient Quadriplegic patient Major reimplantation surgery Cosmetic surgery
2.19 Ophthalmologic Anesthesia
Preoperative Assessment and Preparation Concomitant Diseases Consideration re intraocular pressure Effects of Ophthalmologic medications
Anatomy, Techniques of and Complications of Retrobulbar and Peribulbar Block
Anesthetic Considerations in Open eye injuries Cataract Surgery Retinal Surgery Strabismus Surgery
Postoperative Complications
2.20 Anesthesia for laser surgery
Types of lasers and their use Hazards of laser surgery and appropriate precautions Management of an airway fire
2.21 Anesthesia in Remote Locations
Special Considerations Location and personnel Patient selection Monitoring Transport Recovery
Considerations in Anesthesia for Radiological Procedures – MRI, CT, Angiography Cardioversion Emergency room procedures ECT
2.22 Dental and Orofacial Surgery
Preoperative Assessment and Preparation
Anesthetic Considerations in: Maxillary/Mandibular Surgery Anesthesia in a dental office Dental surgery in an uncooperative patient
2.23 Geriatric Anesthesia
Physiologic Effects of Aging Pharmacologic Considerations Drug Distribution/Metabolism/Pharmacodynamics Patient Medications Effects of Anesthetic Medications
Anesthetic Considerations Positioning Temperature Control
Postoperative Management Hypoxemia Confusion Placement
2.24 Anesthesia for Patients with Systemic Disease
Anesthetic Considerations for patients with Endocrine Disease Diabetes Thyroid Disease Parathyroid Disease Pituitary Disease Adrenal Disease/Pheochromocytoma Carcinoid
Collagen Vascular & Neuromuscular Disease Rheumatoid Arthritis SLE, scleroderma, Ankylosing Spondylitis Myopathies, Myasthenia Gravis, Myotonia, Muscular Dystrophy M.H. Guillain Barre Parkinson’s Disease
Hematologic Disease Hemoglobinopathies Hemolytic Anemia’s Hemophilia Von Willebrand’s Disease
Malignancy Paraneoplastic Syndromes Effects of Chemotherapeutic Agents
Genetic Disorders Turner’s Syndrome Trisomy 21
Infectious Diseases AIDS Hepatitis Concurrent URTI Other Systemic Infection/Sepsis
Substance Abuse Acute intoxication Chronic addiction
2.25 PACU
Facilities and Staffing
Monitoring Standards
Transfer to PACU personnel and PACU orders
Discharge Criteria
Complications in the PACU PONV Respiratory CVS CNS Pain
Hypo/hyperthermia 2.26 Cardiopulmonary Resuscitation
Physiology of CPR ACLS Protocols Specific Algorithms Controversies Pharmacology of Resuscitation Drugs Neonatal and Pediatric Resuscitation
2.27 Complications of Anesthesia
Diagnosis and management of Anesthesia Complications
CNS Awareness under anesthesia Acute postoperative confusional state CVA Hypoxic encephalopathy
RESP Upper airway Dental trauma Laryngospasm Laryngeal trauma Laryngeal edema Esophageal perforation Aspiration Negative pressure pulmonary edema Pneumothorax
CVS Myocardial ischemia and infarction Dysrhythmias Congestive heart failure
Miscellaneous Anaphylaxis MH Halothane hepatitis Complications of positioning
2.28 Crisis Resource Management
Minimal monitoring standards Anticipation of problems according to procedure, patient condition Define urgency and communicate it Utilization of resources available in and outside or SRK model of crisis resource management 2.29 Anesthesia Consults
Purpose of a consultation
Writing consultations: Appropriate organization Dissemination of information - Advice/recommendation Format, length Organization of an anesthesia consult clinic
Role of anesthesia in the pre-assessment process
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