Hot topics Lauren Weekes

What’s this session about?

• Highlighting high yield areas

• Signposting some areas you may wish to investigate further

• Disclaimer- these are not question predictions! Simply topical subjects that might make good SAQs…

September 2015 Paper

• Procedural sedation

• Patients with SCI

• Regional anaesthesia shoulder

• VAP

• POCD after bypass

September 2015 Paper

• Procedural sedation CEACCP 2012

• Patients with SCI BJAE2015

• Regional anaesthesia shoulder BJAE 2015

• VAP BJAE 2015

• POCD after bypass CEACCP 2013

March 2015 Paper

• Recovery from NMB

• Autistic Spectrum Disorder

• Critical Illness Weakness

• Anticoagulation on CPB

• Liver disease

• ECT

March 2015 Paper

• Recovery from NMB CEACCP 2012

• Autistic Spectrum Disorder CEACCP 2013

• Critical Illness Weakness CEACCP 2012

• Anticoagulation on CPB CEACCP 2007

• Liver disease CEACCP 2010

• ECT CEACCP 2010

Sept 14 Paper

• Analgesia for thoracic trauma

• Surgery in early pregnancy

• Cardioplegia

• ASD in children

• Propofol infusion syndrome

• Rheumatoid disease

• Myotonic dystrophy

• Ankle block

Sept 14 Paper

• Analgesia for thoracic trauma (CEACCP 2014)

• Surgery in early pregnancy (CEACCP 2012)

• Cardioplegia (CEACCP 2009)

• ASD in children (CEACCP 2012)

• Propofol infusion syndrome (CEACCP 2013)

• Rheumatoid disease (CEACCP 2006)

• Myotonic dystrophy (CEACCP 2011)

• Ankle block (CEACCP 2013)

High yield resources • RCoA

– Chairman’s report – Their books (Guide to the Final 180 MCQ 30SBA) – The website – The Gas newsletter – The Candidate newsletter

• CEACCP/BJAE • Guidelines & publications:

– SALG – AAGBI – National Audit Projects – NICE – NCEPOD

Continuing Education in Anaesthesia, Critical Care and Pain (CEACCP), now

BJA Education

• The RCOA writes the exam and is involved in the production of CEACCP

• > 70 topics a year in CEACCP

• Topical and pitched at final FRCA level

• Has a podcast (as does BJA)

CEACCP 2014- which articles have appeared in exams?

• Percutaneous tracheostomy

• Intra-arterial monitoring

• Posterior fossa surgery

• Pharmacology IV agents

CEACCP 2013

• Anaesthesia for shoulder surgery

• Burns

• Sympathetic blocks

• Cerebral Palsy

• Awareness

CEACCP 2012

• Chemotherapy

• Ultrasound

• EVARs

• Pulmonary Embolism

• Nutrition

• Head and facial injuries

WHERE MIGHT YOU LOOK?

Guidelines & Reports NICE:

– Major trauma/spinal injury – Blood transfusion – Antibiotic stewardship – Diagnosis/mx type II DM – Diabetic mothers – Pneumonia – Drug allergy – IV fluids in hospital – AF management – Neuropathic pain – Acute Kidney Injury – Depth of anaesthesia

NHS England – Never events – NATSSIPS

NCEPOD – GI haemorrhage – Lower limb amputation – Tracheostomy care – Sepsis – Alcohol – Subarachnoid haemorrhage

National Audit Projects – 3: regional – 4: airway – 5: awareness – 6: anaphylaxis

AAGBI – Standards of Monitoring During Anaesthesia and Recovery – Peri-operative management of the surgical patient with diabetes – Reducing risk from cemented hemiarthroplasty (in March 2015 paper)

– Perioperative management of the obese pt – Skin antisepsis prior to neuraxial anaesthesia – Post anaesthetic recovery guidelines – Perioperative Care of the Elderly (esp. delirium) – Regional anaesthesia in pts with abnormal coag. – Dental damage (SALG) – Epidural haematoma (SALG)

RCoA – Syringe labelling in critical care areas – Remote site anaesthesia – Child protection – Safe sedation – Diabetes

BJA Education (from April 2015-formerly CEACCP)

• Adult epilepsy and anaesthesia

• Major obstetric haemorrhage

• Hyponatraemia (?MCQ/SBA)

• Periop hypertension/Antihypertensive drugs (see also BJA)

• DKA in adults

• Pain after thoracotomy

• Pain after amputation (&PSP in general)

BJAE cont

• Sleep physiology and the perioperative care of patients with sleep disorders

• Rib fracture management

• Update on the intraoperative management of adult cadaveric renal transplantation

• Pathophysiology of cardiovascular dysfunction in sepsis

• Principles of total intravenous anaesthesia: basic pharmacokinetics and model descriptions

CEACCP

• Sepsis in obstetrics

• Children with renal disease

• Foreign body inhalation

• Predicting difficult airway

• Major haemorrhage

• Periop AKI

• Opioid receptors

• Pain in day-case surgery

• Iatrogenic airway injury

• LA toxicity

• Perioperative SVT

• Placental structure, function and drug transfer

• Tracheostomy management

• Awake intubation

CEACCP cont

• Uses of tranexamic acid

• Inherited disorders coagulation

• Fungal infections in ICU

• Major spinal surgery/anaesthesia in prone position

• Diabetic neuropathy

• Paracetamol

• Rhabdomyolysis

• Assessment of high risk patients

• COPD and anaesthesia

• Traumatic brain injury

• Acute spinal cord injury

BJA & Anaesthesia editorials/review articles

• Treatment of preoperative anaemia

• Perioperative stroke

• Cerebral perfusion pressure

• DAS Guidelines 2015

• Peripheral neuropathic pain

• Regional for carotid endarterectomy

• Neurological complications of surgery/anaesthesia

• Pregabalin

• CKD

• Pulmonary hypertension in non-cardiac surgery

• Trauma coagulopathy

• Communicating periop risk

• Periop hypertension

FOAMed

• BJA podcasts (BJA & BJA Education)

• Critical Care Reviews

• Other podcasts:

– RAGE

– EmCrit

– SMACC (video)

WHAT WOULD I WRITE AN SAQ ABOUT?

Paediatric Analgesia

• MHRA Guidance 2013

– Codeine should not be used in any child under 12 or in any child with OSA

– Ultra-Fast metabolisers to morphine (genetic variant of P450 CYP2D6)

• APA guidelines re: alternative opioids in children 2013

• Alternative – Oral morphine 100mcg/kg

Paracetamol in children

• MHRA : Dose greater than 75mg/kg/day constitutes an overdose requiring treatment

• APA and BNFc currently recommend 90mg/kg/day

• Summary : – in hospital up to 90mg/kg/day is fine

– Out of hospital should be decreased to 75mg/kg/day (i.e 18.75mg/dose QDS)

– IV paracetamol maximum doses 60mg/kg/day or 30mg/kg if <10kg.

http://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2012.03838.x/pdf

Obstructive Sleep Apnoea

• Associated with increased perioperative airway, respiratory, and cardiovascular complications.

• The STOP-BANG Questionnaire is an eight-point patient-administered screening – A score of ≥5 indicates a high probability of moderate or

severe OSA.

• Day-case surgery may be reasonable in patients with OSA

• Consideration should be given to managing patients at risk of OSA with a local or regional technique.

• Patients with e.g narcolepsy may be treated with stimulant medication that has a sympathomimetic potential.