Anaesthetics for Junior Doctors and Allied Professionals: The Essential Guide

243 Pages·2013·3.93 MB·English

by  Daniel Cottle

Anaesthetics for Junior Doctors
and Allied Professionals
The essential guide
Edited by
DANIEL COTTLE
Consultant in Anaesthesia
Lancashire Teaching Hospitals NHS Foundation Trust
and
SHONDIPON LAHA
Consultant in Anaesthesia
Lancashire Teaching Hospitals NHS Foundation Trust
Foreword by
PETER NIGHTINGALE
MB BS, FRCA, FRCP, FFICM, FRCP Ed
Consultant in Anaesthesia & Intensive Care Medicine
University Hospital of South Manchester
Radcliff e Publishing Ltd
33–41 Dallington Street
London
EC1V 0BB
United Kingdom
www.radcliff ehealth.com
_____________________________________
© 2013 Daniel Cottle and Shondipon Laha
Daniel Cottle and Shondipon Laha have asserted their right under the Copyright, Designs and Patents Act
1988 to be identifi ed as the authors of this work.
Every eff ort has been made to ensure that the information in this book is accurate. Th is does not diminish
the requirement to exercise clinical judgement, and neither the publisher nor the authors can accept any
responsibility for its use in practice.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmit-
ted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without
the prior permission of the copyright owner.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN- 13: 978 184619 551 8
Typeset by Darkriver Design, Auckland, New Zealand
Contents
Foreword vi
Preface vii
List of contributors viii
Acknowledgement x
1 The fundamental principles of anaesthesia 1
Daniel Nethercott
2 A very brief history of anaesthesia 5
Daniel Nethercott
3 The anaesthetic day 8
Daniel Cottle
4 Preoperative assessment and investigations 12
Daniel Cottle and James Hanison
5 Intra- operative patient monitoring 22
Jess Briggs and Shondipon Laha
6 The anaesthetic machine 32
Anna Crosby and Shondipon Laha
7 Anaesthetic breathing systems 39
Justin Roberts and Leanne Darwin
8 Ventilation 46
Fiona Wallace, Claire Allen and Daniel Cottle
9 Airway assessment 51
Charlotte Ash
10 Airway management 58
Andrew Davies and John Moore
iii
iv CONTENTS
11 Basic patient positioning 66
Daniel Cottle, Ruth Nicholson, Katie Carden and Daniel Flaherty
12 Recovery, handover and protocols 73
Jasbir Chhabra
13 Post-o perative analgesia 78
Cristian Salbaticu and Amanda Shaw
14 Drugs that put you to sleep 88
Daniel Cottle
15 Drugs to keep you asleep: the inhalational agents 95
Kate Bailey
16 Muscle relaxants 101
Peter Frank and Craig Spencer
17 Drugs that stop you vomiting 106
Nicola Smith and Kenneth McGrattan
18 Emergency drugs 111
Jess Briggs and Claire Moore
19 NCEPOD categories and anaesthetic implications 127
Nick Doree
SPECIAL CIRCUMSTANCES
20 The pregnant patient 131
Sophie Bishop
21 The obese patient 136
Gillian Campbell
22 The cardiac patient presenting for non- cardiac surgery 140
Balsam Altemimi
23 The patient with respiratory disease 152
Justin Roberts and Nick Wisely
24 Paediatric anaesthesia 158
Natalie Cooper and Simon Maguire
25 Day case surgery and anaesthesia 166
Kailash Bhatia
CONTENTS v
26 Transferring the anaesthetised patient 172
Matthew Stagg and Paul Dean
27 Regional anaesthesia 177
Zara Townley
28 Stridor 188
Vandana Girotra and Geraint Briggs
29 Anaphylaxis 193
Vandana Girotra and Geraint Briggs
30 Major haemorrhage 197
Natalie Cooper and Steven Benington
31 Rapid sequence induction at a remote site 203
Nitin Arora
32 Asthma and anaesthesia 206
Tina Duff
Appendix 1: Management of a patient with suspected anaphylaxis
during anaesthesia – safety drill 213
Appendix 2: Checklist for anaesthetic equipment 2012 – AAGBI safety
guideline 215
Appendix 3: AAGBI safety guideline – management of severe local
anaesthetic toxicity 217
Appendix 4: Guidelines for the management of a malignant
hyperthermia crisis 219
Appendix 5: DAS guideline – unanticipated diffi cult tracheal intubation
during rapid sequence induction of anaesthesia in a non- obstetric adult
patient 220
Appendix 6: DAS guideline – can’t intubate, can’t ventilate 221
Index 223
Foreword
When asked to write this foreword for Anaesthesics for Junior Doctors and Allied
Professionals the thought crossed my mind as to why, in today’s world of easy inter-
net access, when access to information is just a few clicks away on a smartphone, do
people still buy books such as this one? It was Samuel Johnson who said ‘Knowledge
is of two kinds. We know a subject ourselves, or we know where we can fi nd infor-
mation upon it.’ Th is statement, and the title of the book, gives the answer. Beginners
in any discipline need a template and didactic facts to start the process of achieving
mastery in their fi eld. In a little over 240 pages, this book, written by anaesthetists in
daily active practice, distils the essence of what anaesthesia is about for neophytes and
those who work with anaesthetists. It provides the basic background and ground rules
for how anaesthetists work, how they approach a problem and how one can prepare
for it. Some of the initial chapters could be usefully read by all surgeons, especially
those in Foundation Training posts, and medical students considering an anaesthetic
or intensive placement. Th e use of lists, key points and limited use of references help
make the book easy to read, or dip into between cases, and keep it a manageable size
whilst still providing a mine of information for the target audience – it’s all in the title.
Peter Nightingale MB BS, FRCA, FRCP, FFICM, FRCP Ed
Consultant in Anaesthesia & Intensive Care Medicine
University Hospital of South Manchester
June 2013
vi
Preface
Arriving in the anaesthetic room for the fi rst time can be a daunting experience. You
will be closely supervised, but everything will seem very new. Surgery is a stressful
life-e vent for the patient and your job as an anaesthetist is to make it as safe and as
comfortable as you can while ensuring the best outcome possible. As anaesthesia is
induced and the patient becomes unconscious the patient entrusts his or her life to
the anaesthetic team. As part of that team we must look aft er some of the patient’s
most basic functions that maintain life.
Anaesthesia is no longer the preserve of the medical anaesthetist. It increasingly
features in undergraduate education and postgraduate programmes of the varied
professions that care for our patients. Many of the competencies may have to be
acquired in a short period of time, alongside the use of many new drugs and much
new equipment.
Th ere are many anaesthesia textbooks on the market. Th e majority detail the com-
plicated physiology, pharmacology and physics required to gain a deep understanding
of the subjects, to prepare for a consultant career and to pass the Fellowship of the
Royal College of Anaesthetists exams.
Th is is not an exam preparation book, although it will provide a basis for the
Fellowship of the Royal College of Anaesthetists Primary examination. Th is book
is not just aimed at anaesthetists at the beginning of their career. We hope that
Foundation trainees, Acute Care Common Stem trainees, Intensive Care Medicine
trainees and medical students, operating department trainees and nurses also fi nd it
of benefi t. It provides practical and clinically relevant advice in easily understand-
able sections that prepare the novice for his or her days in theatre. It will allow you to
understand the most common drugs and it will provide a rationale for those we use.
Th e later chapters provide a quick, clinical reference for dealing with common
problems and emergencies. We intentionally asked our own trainees to write the
majority of chapters, and their advice is based on their own experiences.
Anaesthesia is a fascinating aspect of hospital practice. We hope that this book
provides a little insight into the basics, especially for the many that spend only a few
months experiencing this discipline.
Daniel Cottle
Shondipon Laha
June 2013
vii
List of contributors
Claire Allen Jess Briggs
Specialist Trainee Specialist Trainee
North West Deanery North West Deanery
Balsam Altemimi Gillian Campbell
Consultant in Anaesthesia Specialist Trainee
Aintree University Hospital NHS Trust North West Deanery
Nitin Arora Katie Carden
Consultant in Anaesthesia Anaesthetic Practitioner
Heart of England NHS Trust East Lancashire Hospitals Trust
Charlotte Ash Jasbir Chhabra
Specialist Trainee Consultant in Anaesthesia
North West Deanery Dudley Group of Hospitals NHS Trust
Kate Bailey Natalie Cooper
Specialist Trainee Specialist Trainee
North West Deanery North West Deanery
Steve Benington Daniel Cottle
Consultant in Anaesthesia Consultant in Anaesthesia
Central Manchester University Hospitals Lancashire Teaching Hospitals NHS
Foundation Trust
Kailash Bhatia
Consultant in Anaesthesia Anna Crosby
Central Manchester University Hospitals Specialist Trainee
North West Deanery
Sophie Bishop
Consultant in Anaesthesia Leanne Darwin
University Hospital of South Manchester Specialist Trainee
North West Deanery
Geraint Briggs
Consultant in Anaesthesia Andrew Davies
University Hospital of South Manchester Specialist Trainee
North West Deanery
viii
LIST OF CONTRIBUTORS ix
Paul Dean John Moore
Consultant in Anaesthesia Consultant in Anaesthesia
East Lancashire Hospitals Trust Central Manchester University Hospitals
Nick Doree Daniel Nethercott
Consultant in Anaesthesia Consultant in Anaesthesia
Wrightington, Wigan and Leigh NHS Bolton NHS Foundation Trust
Foundation Trust
Ruth Nicholson
Tina Duff Operating Department Practitioner
Consultant in Anaesthesia East Lancashire Hospitals Trust
Central Manchester University Hospitals
Justin Roberts
Daniel Flaherty Specialist Trainee
Th eatre Support Worker North West Deanery
East Lancashire Hospitals Trust
Cristian Salbaticu
Peter Frank Specialist Trainee
Specialist Trainee North West Deanery
North West Deanery
Amanda Shaw
Vandana Girotra Consultant in Anaesthesia
Specialist Trainee Lancashire Teaching Hospitals NHS
North West Deanery Foundation Trust
James Hanison Nicola Smith
Specialist Trainee Specialist Trainee
North West Deanery North West Deanery
Shondipon Laha Craig Spencer
Consultant in Anaesthesia Consultant in Anaesthesia
Lancashire Teaching Hospitals NHS Lancashire Teaching Hospitals NHS
Foundation Trust Foundation Trust
Simon Maguire Matthew Stagg
Consultant in Anaesthesia Specialist Trainee
University Hospital of South Manchester North West Deanery
Kenneth McGrattan Zara Townley
Consultant in Anaesthesia Specialist Trainee
Lancashire Teaching Hospitals NHS North West Deanery
Foundation Trust
Fiona Wallace
Claire Moore Specialist Trainee
Consultant in Anaesthesia North West Deanery
University Hospital of South Manchester
Nick Wisely
Consultant in Anaesthesia
University Hospital of South Manchester