Knowledge

Factors determining perioperative risk
Methods of optimising high risk surgical patients
Importance of preoperative health status on postoperative outcomes
Indications for, and interpretation of pre-operative investigations
Dangers of emergency anaesthesia & surgery
Effect of gastric contents and dehydration on perioperative risk
Anaesthetic risk factors complicating recovery: suxamethonium apnoea, anaphylaxis, malignant hyperpyrexia, difficult airway
Criteria for admission to, and discharge from ICU - factors influencing intensity and site of care (ward, high dependency unit (HDU), intensive care unit (ICU))
Major neurosurgical procedures, peri-operative management of the patient undergoing major neurosurgery, and potential complications occurring within 24 hours of surgery
Perioperative implications of current drug therapy
Solid organ-specific transplantation (heart-lung, liver, renal): peri-operative considerations, pharmacological management, post operative care and potential complications
Consent and assent in the competent and non-competent patient
Surgical interventions in patients with cardiac disease, perioperative management of the cardiovascular surgery patient and potential complications occurring within 24 hours of cardiac surgery
Immunosuppression and rejection
Implications for postoperative care of common acute and chronic medical conditions (see 3.1 & 3.2)
Indications and choice of agent for antibiotic prophylaxis
Indications for and methods of perioperative anti-thrombotic treatment
Recognition, assessment and management of acute pain
Implications of type of anaesthesia (general/regional/local) for perioperative care
Implications of type / site of surgery for postoperative management and potential complications within the first 24 hours of surgery
Assessment and management of commonly encountered perioperative conditions & complications including:
Respiratory: Interpretation of symptoms and signs of respiratory insufficiency in the surgical patient; the unprotected airway; upper and lower airway obstruction including laryngeal trauma & oedema; pneumonia, collapse or consolidation, pulmonary infiltrates including acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) and their causative factors; pulmonary oedema; pleural effusion, haemo/pneumothorax (simple and tension); use of chest drains; factors affecting patients following thoracotomy, lung resection, oesophagectomy, cardiac surgery and thymectomy.
Cardiovascular: Interpretation of symptoms and signs of cardiovascular insufficiency in the surgical patient; recognition of bleeding; management of hypo/hypertension; operative risk factors in patients with ischaemic heart disease; pulmonary embolus; cardiac tamponade; surgery for acquired and congenital cardiac disease; management of patients following cardiac surgery (coronary grafting, valve replacement) and aortic surgery (arch, thoracic, abdominal); heart and heart-lung transplantation
Renal: Causes of perioperative oliguria and anuria; prevention and management of acute renal failure; rhabdomyolysis; consequences of nephrectomy, ileal conduits; management post-renal transplantation
Neurological: causes of post-operative confusion, stroke (CVA), coma and raised intracranial pressure; determinants of cerebral perfusion and oxygenation; prevention of secondary brain injury; perioperative management of patients with neuropathies and myopathies; intracranial pressure monitoring; intracerebral haemorrhage; spinal cord injury & ischaemia; brachial plexus injury; complications of neuromuscular blockade
Gastrointestinal: Interpretation of abdominal pain and distension; peptic ulceration and upper GI haemorrhage; diarrhoea, vomiting and ileus; peritonitis; intestinal ischaemia; perforation; abdominal hypertension; pancreatitis; jaundice; cholecystitis; management of the pre- and post-liver transplant patient; perioperative nutrition; post operative nausea & vomiting
Haematology and oncology: Care of the immunosuppressed or immunoincompetent patient; complications of chemotherapy; management of severe acute haemorrhage and blood transfusion; correction of coagulation disorders and haemoglobinopathies.
Metabolic & hormonal: Perioperative management of patients with diabetes; blood glucose control; hypo- and hyperadrenalism, surgery to thyroid, adrenal and pituitary glands; perioperative management of electrolyte disorders.
Sepsis and Infection: fever and hypothermia; postoperative hypoperfusion and impaired oxygen delivery; wound infection; opportunistic and nosocomial infection; perioperative infection risk and prophylactic antibiotics; necrotising fasciitis; peritonitis; intestinal ischaemia; antibiotic selection and prescribing
Musculo-skeletal: principles and management of external fixators and casts; perioperative positioning; pressure area care; compartment syndromes; paralysed patients; principles of salvage surgery

Skills & Behaviours

Optimise high-risk surgical patients before surgery: consider site of care and management plan
Consider the impact of long-term and chronic treatment on acute surgical care
Monitor and manipulate cerebral perfusion pressure (CPP)
Communicate the risk of surgery to patients and family
Accurately assess the airway for potential difficulties with airway management
Ensure the necessary resources are available for safe post-operative care
Identify pre-operative health status and intercurrent disease, medications, allergies and their interaction with the nature of anaesthetic and surgery
Obtain relevant information from the patient, relatives and other secondary sources
Interpret pre-operative investigations, intra-operative findings and events/complications, and respond to them appropriately
Review and monitor perioperative immunosuppressive therapy
Assess conscious level and conduct a careful systems review
Select & determine adequacy and route of administration of analgesia
Document, monitor and manage fluid balance, circulating volume, drains, systemic oxygen supply
Establish a plan for postoperative management
Identify life-threatening cardiorespiratory complications; manage hypovolaemia and impaired oxygen delivery
Manage post-operative hypo and hypertension
Differentiate and manage tension pneumothorax, cardiac tamponade & pulmonary embolus
Describe the risk period for use of depolarizing neuromuscular blocking agents in patients undergoing repeated surgical procedures
Manage post-operative stridor
Lead, delegate and supervise others appropriately according to experience and role
Recognise and manage perioperative emergencies and seek assistance appropriately

Attitudes

Recognises personal limitations, seeks and accepts assistance or supervision (knows how, when and who to ask)
Consults, communicates and collaborates effectively with anaesthesiologist, surgeon, nursing staff, other professionals, patients and relatives where appropriate
Desire to minimise patient distress
Attention to and control of pain

Basic Sciences also underpin the competencies within this domain. These are presented in full in the Basic Sciences Syllabus.