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Contents 1. Introduction 3 2. Clinical governance and ultrasound 10 3. Recommended essential ultrasound knowledge and skills 11 4. Regional anaesthesia and pain medicine 15 5. Vascular procedures 21 6. Thoracic ultrasound 25 7. Abdominal ultrasound 30 8. Echocardiography 34 9. References 40 Appendix 1 – RCoA DOPS form 43 To be reviewed in 2016 © The Association of Anaesthetists of Great Britain & Ireland, The Royal College of Anaesthetists and The Intensive Care Society 2011 2
1. Introduction This document presents a goal for the delivery of training of procedures using ultrasound in anaesthesia and critical care. The document not only sets out a practice-based curriculum for those who already hold a Certificate of Completion of Training (CCT) but also describes how the trainee might organise their own training within the Royal College of Anaesthetists’ (RCoA’s) CCT curriculum or Out-of- Programme Training (OOPT) to match these aspirations. Over the last 10 years, ultrasound has developed into an indispensable tool in anaesthesia and intensive care. The combination of National Institute of Health and Clinical Excellence (NICE) guidance for central venous access [1] and the availability of small, portable, ‘point of care’ machines has led to the introduction and increasingly widespread use of ultrasound in clinical practice. More recently, further NICE guidance on the use of ultrasound for epidurals [2] and regional anaesthesia [3] has ensured that ultrasound is now deeply embedded within anaesthetic practice. Other uses now include: thoracic scanning for diagnosis and treatment of pleural effusions and pneumothoraces; abdominal scanning (Focused Assessment with Sonography in Trauma - FAST) looking for intra-abdominal fluid; and focused transthoracic echocardiography in non-traumatic resuscitation (Focused Echocardiography in Emergency Life support – FEEL). The widespread introduction of ultrasound has brought with it many concerns relating to competency and training. Ultrasound is not new to medicine but its use in anaesthesia is. With the greater availability of machines and an increasing number of clinical indications, it is important to remember that there is a requirement for employing hospitals to ensure that clinicians are competent in the use of any equipment used by an employee [4]. Ultrasound has a distinct learning curve and trainee usage is characterised by common novice behaviour and mistakes [5,6]. The aim of this document is to produce a set of broad guidelines for current trainees and those who completed their formal training programmes before the introduction of ultrasound. Whilst the core knowledge and skills required to perform ultrasound are identical in both groups, it is recognised that the competencies will be gained in different ways. These can be termed the ‘trainee-based College programme pathway’ and the ‘practice pathway’ for non-trainees. Recommendations for the use of ultrasound for non–radiologists have been published by the Royal College of Radiologists (2005) [7], the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) [8] and the College of Emergency Medicine (CEM) [9]. The importance of these recommendations is that they specify both a training syllabus and requirements that should be met by an individual using ultrasound. 3
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OPERATING THEATRE WORK Safe care of
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majority of currently advertised co
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TRAINING AND EXAMS Entry to basic t
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LESS THAN FULL TIME TRAINING If you
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USEFUL CONTACTS Group of Anaestheti
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Group of Anaesthetists in Training
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Membership of the working party Con
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The practical changes were that a c
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was undertaken in standard or premi
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For most consultants, the majority
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6. Leave of all sorts Annual leave
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Maternity leave, domestic, personal
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Changes to the frequency of on-call
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to give him the flexibility to atte
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Job planning is by agreement, not d
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elated and other specialty activiti
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Each individual consultant anaesthe
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although NHDs may be flexible in ti
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15. References 1) British Medical A
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Workload for Consultant Anaesthetis
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Contents 1. Key points 3 2. Introd
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2. Introduction The 2008 (Connaught
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Terms and conditions Appointment an
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If a consultant remains in the hosp
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Consultants eligible to hold contra
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consultants once the overall ratio
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5. Consultant work schedule Introdu
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internal activities, (ii) external
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Recommendations • The consultant
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• Consider his/her need for addit
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7. Academic consultants All terms o
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following statements: (i) “Traine
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9. The European Working Time Direct
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for junior doctors in the 48-hour w
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Medical Council • Medical Council
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Implementation. Guidance to health
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Consultant anaesthetist with a spec
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Appendix 3. Non-clinical Activities
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Research • Research meetings •
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• Access to confidential telephon
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42
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AAGBI SAFETY GUIDELINE UPDATE Safet
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GUIDELINES Safety in magnetic reson
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Safety in magnetic resonance units
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Malignant Hyperthermia Crisis AAGBI
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Recommended Contents of Malignant H
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PROVISION OF ANAESTHETIC SERVICES I
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Contents Page Section I Summary 1 S
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Section II: Introduction Magnetic r
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MR compatible pulse oximeters must
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Scavenging of anaesthetic gases The
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Gauss (G) see Tesla. Gauss is a uni
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Section X: References 1. Health Bui
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Association of Anaesthetists of Gre
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Three principle methods of achievin
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3. Testing could take place with th
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Appendices: 1. Needlestuck 2. Analy
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Editorial Anaesthesia, 2007, 62, pa
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Analysis of Benefits and Harms of C
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AAGBI Needlestick Injuries Working
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AAGBI NEEDLESTICK INJURIES WORKING
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when asking for the family’s posi
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Needle-stick Injuries from a Patien
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OAA / AAGBI Guidelines for Obstetri
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Contents 1. Key recommendations 2 2
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2. Introduction This is the third v
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Recommendations Medical staff The t
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appointed directly from other count
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Peripartum care Pre-operative asses
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Intravenous patient-controlled opio
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depression. In the absence of contr
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of clinical deterioration, as recom
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5. Training and education Each obst
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• Skills and drills training: ana
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• The midwife caring for a woman
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7. Support services, equipment, fac
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Equipment for PCA must be available
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8. The future The delivery of healt
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The following national guidelines s
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19. Obstetric Anaesthetists’ Asso
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21 Portland Place, London, W1B 1PY
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Membership of the working party (de
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from the occupational health depart
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those whose complex problems cannot
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5. There should be arrangements in
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European Directive 2010/32/EU speci
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5c. Manual handling and back care M
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Associated risks to the fetus 1. Ph
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When making a referral to the occup
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• modifying instructions or refer
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16. The Workwell model: an integrat
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Definitions The times that can be c
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Members of the working party: Dr Ka
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This guideline was originally publi
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operatively. The advice presented i
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Table 1 World Health Organization c
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Sleep-disordered breathing describe
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Table 2 The four most useful terms
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Table 3 Suggested initial dosing sc
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score 4-5 on the OS-MRS are more li
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indicator and when greater than 60
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adipose tissue, standard doses of l
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trolled, ventilation. The addition
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Routine discharge criteria are met
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Sedation Pre-operative evaluation f
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an increased decision-to-delivery i
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mended in all patients who have a g
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This is designed as an aide memoire
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28. Parkin L, Sweetland S, Balkwill
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the epidural space in obese parturi
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project’ (2010). 2011. http://www
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AAGBI SAFETY GUIDELINE Peri-operati
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Anaesthesia 2014, 69 (Suppl. 1), 81
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Griffiths et al. | Guidelines: Peri
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Perioperative fasting in adults and
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Membership of the working party (de
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1. Recommendations This guidance ha
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2. Introduction Preparing a patient
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3. Before planned admission Pre-ope
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Pathologies that predictably progre
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• Have balanced the pros and cons
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tool for survival prediction in add
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4. After planned admission Anaesthe
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ecommendations for optimisation in
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6. Children and young people Childr
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competent minor to refuse treatment
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comorbidity and complexity of the s
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It is extremely important that adeq
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9. Older P, Hall A, Hader R. Cardio
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Appendices 1. Fasting guidelines in
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Post-operative resumption of oral i
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Appendix 3 Surgical severity (from
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Appendix 5 Systemic disease (from N
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Regional Anaesthesia and Patients w
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Guidelines Regional anaesthesia and
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W. Harrop-Griffiths et al. | Guidel
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Anaesthesia 2016 Bodenham et al. |
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AAGBI SAFETY GUIDELINE Safe Managem
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Contents 1. Summary 2 2. Introducti
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2. Introduction The Association of
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3.3 Duties of the equipment officer
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In addition to items for which the
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that can conduct electricity direct
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Regulations, including those transp
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6.3 Assessing equipment and the fin
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7. Public sector procurement regula
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More guidance on the application ca
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8. Commissioning new equipment The
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10. Maintenance 10.1 Planned preven
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For ‘in-house’ departments, qua
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12. Disposal 12.1 General Unreliabl
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13. User training 13.1 General Anae
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anaesthetic simulators already play
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implications for patients or users
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15. Audit 15.1 Internal This is par
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References 1. Association of Anaest
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Useful numbers and websites For rep
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All AAGBI guidelines are reviewed t
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eyond its initial application. In o
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sion: the Royal College of Anaesthe
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Despite chlorhexidine’s proven ef
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the duration of antimicrobial activ
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21. Henschen A, Olson L. Chlorhexid
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MEMBERSHIP OF THE WORKING PARTY Pro
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SUMMARY OF THE RECOMMENDATIONS 1. L
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SECTION 2. MEDICINES ACT 1968 The M
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In order of preference, the supply
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SECTION 4. GUIDELINES The developme
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(d) Controlled drugs coming into th
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SECTION 6. SOLUTIONS FOR INFUSION O
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SECTION 7. DISPOSAL OF CONTROLLED D
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REFERENCES Report of a Working Part
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Practical advice from the GAT Commi
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Contents Foreword 4 1. Introduction
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Introduction Anaesthetics has tradi
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JOIN THE ASSOCIATION OF ANAESTHETIS
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co-ordinator or secretary. It alway
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Equipment competencies - You may be
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summarise your training, assessment
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The current training programme, ove
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Foundation doctor (two years) (Or a
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• Whether the case was discussed
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move to intermediate level training
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is to confirm the possession of the
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to gain the complementary specialty
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history-taking, physical examinatio
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But, it does not help to answer the
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Anaesthetic training in Scotland Au
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Professionalism and accountability
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The BMA Counselling Service for doc
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MMC Modernising Medical Careers SAS
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38 39
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Inter-hospital transfer of the crit
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1. SUMMARY OF RECOMMENDATIONS 1. A
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available, and without immediate tr
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6. THE TRANSFER ITSELF The anaesthe
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4. No other anaesthesia-accompanied
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21 Portland Place, London W1B 1PY T
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Guidelines: Day case and short stay
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Peri-operative management of the su
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Anaesthesia 2015 Guidelines doi:10.
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Barker et al. | Guidelines on peri-
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Membership of the working party Dr
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1. Recommendations 1. Management of
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2. Introduction In the past, decisi
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3. Definitions Do not attempt resus
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4. Ethical framework Advance decisi
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As in the UK, this publication high
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If an advance decision does not mee
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6. Why is it necessary to review a
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7. How to review a DNAR decision It
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Option one: The DNAR decision is to
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8. Conflict resolution When dealing
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9. Duration of the DNAR management
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At the end of the decision making p
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10. Human Rights Act 1998. http://w
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Appendix 1 DNAR management consent
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DNAR management option agreed: Opti
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32
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Membership of the working party (De
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1. Summary The vast majority of ana
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Opioid abuse The incidence of non-a
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Availability The fact that anaesthe
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Warning signs of drug abuse [6, 27]
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Where the individual is a trainee,
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There is a real possibility of self
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7. Treatment, support and monitorin
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Monitoring Mandatory biochemical mo
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to label all anaesthetists with opi
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11. Booth JV et al. Substance abuse
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33. Foll B Le, Gallo A, Strat Y Le,
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Dependence syndrome (addiction) The
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Appendix 2: Sources of support More
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Royal Medical Benevolent Fund (RMBF
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2.4 To foster a climate that will e
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the OHS who will refer for treatmen
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Appendix 4: Identifying unsafe drin
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8. During the past year, have you b
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Contents Page 1 Introduction 2 2 Sc
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3 Patient selection and consent 3.1
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5.2 The tip of the epidural cathete
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8 Patient monitoring 8.1 Patients m
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9.4 Hourly assessments are recommen
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References 1 Good practice in the m
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INSIDE BACK COVER - TO BE LEFT BLAN
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Fatigue and Anaesthetists Published
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Contents 1. Preface 2 2. Recommenda
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2. Recommendations • In keeping w
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Most adults require eight hours of
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5. What are the risks? Performance
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7. References 1. Fatigue Risk Manag
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30. Lockley SW, Barger LK, Ayas NT,
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Appendix 2 Sample Sleep Diary Date
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Membership Questionnaire 2 (Health
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Anaesthesia 2011 Griffiths et al. |
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The Royal College of Anaesthetists
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Contents ❚ Foreword 4 Introductio
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Introduction ❚ The Good Anaesthet
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Related guidelines and sources of i
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Domain A: knowledge, skills and per
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Domain B: safety and quality Attrib
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Domain C: communication, partnershi
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Domain D: maintaining trust Attribu
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Good Practice Guide 2006 Foreword
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Good Practice Guide 2006 Chapter 1
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Good Practice Guide 2006 A further
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Good Practice Guide 2006 11 1.3.2.2
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Good Practice Guide 2006 13 and hea
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Good Practice Guide 2006 15 6, 15-1
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Good Practice Guide 2006 17 2.4 Pro
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Good Practice Guide 2006 19 Para 48
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Good Practice Guide 2006 21 Chapter
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Good Practice Guide 2006 23 5.1 Loc
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Good Practice Guide 2006 25 Each de
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Good Practice Guide 2006 29 However
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Good Practice Guide 2006 31 ❚ ❚
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Good Practice Guide 2006 35 Anaesth
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Good Practice Guide 2006 39 overall
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Good Practice Guide 2006 41 Fitness
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Good Practice Guide 2006 43 Referra
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Good Practice Guide 2006 45 42 Effi
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Good Practice Guide 2006 47 Provisi
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Good Practice Guide 2006 49 Appendi
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Good Practice Guide 2006 51 Intensi
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Good Practice Guide 2006 53 Knowled
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Good Practice Guide 2006 55 Knowled
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Design and layout by The Royal Coll
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publications highlighting complicat
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y which patients undergo such surge
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event (Table 2) [11]. All hip fract
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The Association of Anaesthetists of
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CONTENTS Glossary of terms 3 Introd
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PCA pCO2 PDP PONV PPE QIS RAE RCN R
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The clinical components are: • As
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Articulates role within peri-operat
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COMPETENCY 3: CLINICAL LEADERSHIP C
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4.4 Demonstrate and promote the del
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5.3 Understands features of oxygen
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COMPETENCY 6: ASSESSMENT AND MANAGE
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COMPETENCY 8: ASSESSMENT OF LEVEL O
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9.3 Perform charting of physiologic
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COMPETENCY 11: APPLIED KNOWLEDGE OF
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COMPETENCY 12: MANAGEMENT OF POSTOP
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COMPETENCY 13: RECOVERY EMERGENCIES
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13.10 Short term management of a pa
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14.7 Urinary catheters and bladder
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Members of the Working Party Dr W H
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Key Points • Independent practice
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indemnity subscription, have more c
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Anaesthetists practising in the pri
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an elective list; it would not be a
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Some of these documents will need t
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Investigations by the Inland Revenu
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Indemnity for Independent Practice
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Independent Medicolegal Practice Me
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Moving on There are also organisati
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Independent Practice in Pain Medici
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Independent Practice in Intensive C
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Accurate records of procedures unde
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Chambers and Group Practice For ana
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treasurer, but the arrangements of
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30
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Membership of the Working Party Dr
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Infection control in anaesthesia An
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AAGBI SAFETY GUIDELINE Interhospita
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CONTENTS Section 1 Recommendations
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Section 2 Background The AAGBI Coun
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Section 4 The decision to transfer
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Section 5 Stabilisation before tran
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Level 3: Patients requiring advance
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Section 8 The ambulance The Europea
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Section 9 Documentation and handove
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References 1. Mackenzie PA, Smith E
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17
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Management of Anaesthesia for Jehov
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2
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SECTION 1 1. Introduction 1.1 The f
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2.5 It may be helpful to regard the
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SECTION 3 3. The legal position in
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SECTION 4 4. Clinical Management 4.
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4.2 Intra-operative Management 4.2.
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In Ireland the issue of the “matu
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6. Consequences of Bloodless Anaest
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6.4 Other considerations 6.4.1 Stre
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7. Conclusion 7.1 The Association o
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15. NHS Reference Costs 2003 and Na
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Appendix 2 Hospital Liaison Committ
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anaesthetic that he proposes to use
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Appendix 4 Simplified Procedure for
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Immediately Give an initial intrave
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AAGBI: Consent for anaesthesia 2017
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Anaesthesia 2017 Guidelines doi:10.
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Yentis et al. | AAGBI: Consent for
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Management of a Patient with Suspec
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The use of blood components and the
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Guidelines AAGBI guidelines: the us
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Klein et al. | AAGBI blood transfus
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Anaesthesia 2016 Klein et al. | AAG
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The Anaesthesia Team 3 Published by
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Contents 1. Recommendations 3 2. In
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2. Introduction It is now over 20 y
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The role of the clinical service ma
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5. The operating department Managem
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Assistance for the anaesthetist Tra
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Professional associations Continuin
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6. Recovery post-anaesthetic care u
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7. Postoperative pain management Ba
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References 1. The Association of An
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20
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AAGBI SAFETY GUIDELINE Suspected An
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GUIDELINES Suspected Anaphylactic R
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Suspected anaphylactic reactions as
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Appendix 2a Frequently asked questi
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or another technique, to the point
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process has not been followed, he/s
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Appendix 2b Frequently asked questi
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8. What level of detail of anaesthe
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It is feasible that different peopl
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23. What should I do if a patient h
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contamination errors in arterial li
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Figure 1 Open and closed systems fo
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(a) (b) Figure 2 Appearance of sodi
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Pressurising devices All pressurisi
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• special connections between the
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Section 1-Summary 1. The availabili
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provide cover for off-site location
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Section 4-Detailed Recommendations
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assistant. As such there is little
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Rostering Who is responsible for th
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References 1. The Anaesthesia Team,
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The life changing POWER OF ULTRASOU
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3.0: Societal changes and financial
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4.0: Age, physiological changes and
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5.0: Workforce patterns and workfor
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The removal of an age-related retir
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These three publications incorporat
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6.4: The role of the public Appendi
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THE ROYAL COLLEGE OF ANAESTHETISTS
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ANNUAL CONGRESS BIRMINGHAM 14 -16 S
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MEMBERSHIP OF THE WORKING PARTY Dr
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SECTION I - SUMMARY AND RECOMMENDAT
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SECTION III - INTRODUCTION Patients
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purchase these services. They must
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SECTION VI - PREPARATION FOR THE TR
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A patient who remains hypotensive d
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A patient who has been made physiol
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4. Other equipment • suction •
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important to involve those who take
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REFERENCES 1. Association of Anaest
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APPENDIX II TRANSFER CHECKLIST FOR
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Introduction Recent health controve
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1.2 Communication needs In the opin
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2. Neonatal resuscitation in hospit
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3.2 Who is in charge? Children with
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Nursing care of the critically ill
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7. Summary The purpose of this docu
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MEMBERSHIP OF THE WORKING PARTY Dr
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SECTION 1. SUMMARY • The majority
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involved according to individual ne
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aftermath. A decision will need to
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It may be necessary to conduct a se
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SECTION 5. THE TRUST RESPONSE Each
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equired for the incident. This is a
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Fear You may become afraid of new t
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When to ask for help Sometimes even
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has a responsibility to ensure they
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Suspension It is not unusual for a
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The potential implications of a cri
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SECTION 9. SOURCES OF HELP Consult
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Sick Doctors Trust 0870 444 5163 ww
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15. Emmerik AAP, Kamphuis JH, Hulsb
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Membership of the working party Pro
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1. Recommendations • The use of I
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3. Getting organised and competenci
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Competencies Documents supporting c
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5. Technical aspects The surgical t
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6. Special circumstances The decisi
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Bowel contamination The use of ICS
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7. Financial considerations To keep
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8. Takemura M, Osugi H, Higashino M
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Appendix 1 Procedures and situation
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Appendix 2 Diagram of ICS set-up Dr
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AAGBI SAFETY GUIDELINE Checking Ana
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Guidelines Checking Anaesthetic Equ
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Hartle et al. | Checking anaestheti
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This checklist is an abbreviated ve
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Contents Introduction 1 Summary of
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1.0 Summary of recommendations 1.1
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3.0 Before treatment 3.1 Whenever p
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3.10 The consultant should tell the
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5.0 After treatment 5.1 Accounts 4
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6.0 Emergencies 6.1 Emergency treat
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Appendix 2 EXAMPLE OF AN INVOICE To
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