Anaesthetics for Junior Doctors and Allied Professionals: The Essential Guide PDF
Preview Anaesthetics for Junior Doctors and Allied Professionals: The Essential Guide
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
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