CPD modules: Anaesthetics
You are free to download, print and study the modules. Once you have completed your reading come back and take the multichoice test. If you obtain a pass mark of over 80% you will have the option of printing out a certificate of completion.
Getting the best out of videolaryngoscopy
The benefits of videolaryngoscopy, especially in unexpected difficult intubations, are numerous but they are not just conventional laryngoscopes with screens. Many have different techniques and need specific training. This module gives tips on how it to use it to its best advantage.
An Introduction to Paracetamol
Paracetamol is a commonly used medicine that can help treat pain and reduce a high temperature. In normal doses it is considered safer than many analgesics as it has no effect on the cardiovascular and respiratory systems and unlike Non-steroidal anti-inflammatory drugs (NSAIDs) it does not cause gastric irritation or bleeding.
One caution, especially for the perioperative environment, is that as IV paracetamol has close to 100% bioavailability and IV doses must be adjusted in low weight individuals to prevent overdose.
Paediatric Anaesthetic Emergencies: Pt I
Paediatric anaesthetic emergencies can happen faster and leave less time to react then in adults. They present complex, potentially life-threatening situations that everyone engaged in giving paediatric anaesthetic should be aware of and be able to treat.This first article covers laryngospasm and suxamethonium apnoea.
Length of Study: 50 min
Difficulty: Medium
Arterial Blood Pressure Measurement – The physics and principles.
Intra-arterial blood pressure measurement is often considered to be the gold standard of blood pressure measurement. This accuracy however, depends on a number of physical principles of the systems used, which are explored in this advanced module.
The is also a separate easier module available covering setting up and using arterial lines.
Length of Study: 75 min
Difficulty: Difficult
An introduction to the autonomic nervous system
As many procedures and drugs used in anaesthetic practice have a direct influence on the autonomic nervous system, it is essential that the anaesthetic assistant should have an understanding of its structure and function although this is a very simplified introduction of a large and complex topic.
Pulmonary aspiration of gastric contents
This module discusses aspiration which is a relatively rare, but potentially fatal complication of general anaesthesia occurring most commonly in emergency patients. Prevention is the key, and there are several mandatory requirements that must be fulfilled in the at-risk patient. However, in the event of aspiration occurring, treatment is essentially supportive once the airway has been secured.
The Difficult Paediatric Airway
There are anatomical and physiological differences between the infant, child and adult that make even the normal paediatric airway difficult for the inexperienced practitioner, particularly in children under one year of age. Good preoperative assessment and preparation is therefore key to success of the management of the difficult airway in children. This article covers this and more.
Length of Study: 75 min
Difficultly: Difficult
Pre-eclampsia and Anaesthetics
Pre-eclampsia is a pregnancy complication characterised by high blood pressure and signs of damage to another organ system, often the kidneys. Left untreated, pre-eclampsia can lead to serious even fatal complications for both mother and baby and the only cure is delivery.
Length of Study: 60 min
Difficulty: Easy
Nonin 9590 Onyx Vantage Finger Pulse Oximeter – Proact (sponsored)
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Catastrophes of many kinds can occur in childbirth…
This moving article is about a pregnant woman dying from amniotic fluid embolism. It is a very well written piece about how even when we do everything right, sometimes the worst happens. This should be essential reading for anyone working in obstetrics. There is not test/certificate but this is the perfect piece to base a reflective account on.
Muscle Relaxants; reversal and the use of peripheral nerve stimulators.
This module discusses residual block, why, when and how muscle relaxants are reversed, and the importance of using a peripheral nerve stimulator when assessing the depth of block. It also covers the different patterns the stimulators use to assess how deep a neuromuscular block is.
Length of Study: 60 min.
Difficulty: Medium
Safe tracheal extubation
This article covers complications occurring during emergence, extubation and later in recovery. It details the DAS guidelines on safe extubation and explains the factors that increase the risks of
adverse events. It also describes how to optimise conditions before tracheal extubation.
Proact Creative™ PC-3000 Vital Signs Monitor (sponsored)
The Creative PC-3000 Multi Parameter Monitor is an ideal way of tracking the condition of the patient due to the clear and visual display and multiple readings. This patient monitor has easy readings and a long-lasting battery, making it suitable for constant use in a hospital/medical environment.
Muscle Relaxants: the fundamentals
The introduction of neuromuscular blocking drugs revolutionised the practice of anaesthesia. Before the advent of muscle relaxants, anaesthesia was induced and maintained by intravenous or inhalation agents.
This comprehensive module covers all aspects of neuromuscular muscle relaxants.
Length of Study: 90 min
Difficulty: Medium
Surgical smoke: is it safe?
Surgical smoke is now recognised as a hazard that is encountered in all operating theatres. Unfortunately, the dangers and health risks associated with it continue to be overlooked by many surgeons, nurses and theatre staff. It is important to be aware of the dangers of surgical smoke and for everyone to help minimise the risks.
Length of study: 60 min
Difficulty: Easy
Amniotic Fluid Embolism
Amniotic Fluid Embolism (AFE) is a rare but potentially fatal syndrome that is unique to pregnancy. AFE has emerged as one of the leading causes of direct maternal death within developed countries such as Australia, the UK and the USA.
This module discusses AFE, its presentation, diagnosis and treatment.
Length of Study: 75 min
Difficulty: Difficult
Local Anaesthetic Systemic Toxicity
Local anaesthetic systemic toxicity is rare but when it does occur its onset may be sudden and life-threatening so it is prudent to spend time preventing rather than treating it. All theatre staff should be aware of the doses limits of local anaesthetics they use as well as the causes, signs and treatment of LAST.
Length of Study: 50 min.
Difficulty: Easy
Understanding your ECG: a review
Health professionals use the electrocardiograph (ECG) rhythm strip to systematically analyse the cardiac rhythm. Before the systematic process of ECG analysis is described it is important to understand the individual waveforms, segments and intervals of the ECG. This module reviews all these steps.
Length of Study: 90 min
Difficulty: Medium
Anaesthetics for obese patients
The prevalence of obesity has tripled over the past 40 yrs and there are now more than 650 million obese adults worldwide. This article offers an update of the perioperative risk and the associated morbidity that obesity causes and its impact on anaesthetic management.
Perioperative Hypothermia
Inadvertent perioperative hypothermia can occur in up to 40% of surgical patients so it essential for theatre practitioners to know what causes it and how to prevent it.
A well as being very stressful and uncomfortable for patients upon waking, it has many negative consequences including delayed drug metabolism, wound healing and increased infection rates.
Anaesthesia for the patient with a cardiac transplant
For patients who have previously received a cardiac transplant, coming to theatre for non-related surgery is no longer unusual as survival times continue to increase for transplant recipients. With altered physiology, and the effects of long term anti-rejection drugs use, their anaesthetic requirements are more complicated and it is essential to know what works and what doesn’t.
Length of Study 60 min
Difficulty: Medium
Perioperative anaphylaxis
Perioperative anaphylaxis is not uncommon and several commonly used anaesthetic drugs can cause anaphylaxis. This modules covers latest guidelines to identifying and treating anaphylaxis in theatre as well as the post theatre care required.
Length of Study: 60 min
Difficulty: Medium
Supraglottic Airway Devices
First introduced in 1988 the Laryngeal Mask Airway (LMA) or supraglottic airway is now used in over 50% of anaesthetics in the U.K. This module describes the development and use of not only the LMA but the variants of it. This includes 2nd generation supraglottic airway.
Length of Study: 45 min.
Difficulty: Beginner/student
Endotracheal tubes
An endotracheal tube (ETT) is inserted into the trachea for the primary purpose of establishing and maintaining a definitive patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. It is the gold standard for securing an airway, allowing positive-pressure ventilation while preventing contamination of the lungs from the contents of the pharynx and stomach.
Length of Study: 45 min.
Difficulty: Beginner/student
Spinal Anaesthesia
Spinal anaesthetic, also known as a spinal block, is administered by injecting local anaesthetic, into the cerebrospinal fluid (CSF) just below the end of the spinal cord. This has the effect of blocking the conduction of nerve impulses, including pain signals to the brain. Spinal anaesthesia can be used as the sole anaesthetic or in combination with sedation or general anaesthetic.
This module will discuss the relevant anatomy, techniques, and management of spinal anaesthesia.
Length of Study: 90 min
Difficulty: Medium
COPD and Anaesthesia
Chronic obstructive pulmonary disease (COPD) is a commonly encountered respiratory disorder. Patients with COPD pose a challenge to the anaesthetist because intraoperative and postoperative complications occur more commonly than in those without the disease, and can lead to prolonged hospital stay and increased mortality. This module provides an overview of COPD and discusses implications for the anaesthetic management of patients with the disease.
Length of Study: 75 min
Difficulty Medium
Patient positioning during anaesthesia
Different patient positions are required to provide access for different surgical procedures. Each position has implications for ventilation and haemodynamics, as well as exposing patients to possible complications such as nerve injury and pressure sores.
Length of Study: 60 min
Difficulty: Easy
Deep Brain Stimulators
Deep brain stimulation is an increasingly common treatment for Parkinson’s disease (PD), other movement disorders, certain psychiatric conditions, and chronic pain syndromes.
This module will review current anaesthetic techniques and recommendations for inserting and managing deep brain stimulators.
Length of Study: 45 min.
Difficulty: Medium
The respiratory system – The process of respiration
This module covers the physiological process of respiration, of which breathing is only the first stage. The ultimate function of the respiratory system is gas exchange which consists of supplying the body’s tissues with oxygen and removing carbon dioxide, the waste product.
There are three key elements to this process; pulmonary ventilation, external respiration, and internal respiration.
Length of Study: 60 min.
Difficulty: Beginner/student
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that relieve or reduce pain. Their actions are analgesic, anti-inflammatory and antipyretic.
Perioperatively, using NSAIDs avoids many of the adverse effects of opioids such as respiratory depression, sedation, nausea and vomiting and gastrointestinal stasis. Although an effective analgesic they have significant adverse effects and contraindications which the perioperative practitioner must be aware of.
Blood Component Therapy
Blood products are any therapeutic substances that are prepared from human blood. These can be classified into blood components (red cell concentrates, platelet concentrates, fresh plasma and cryoprecipitate) and plasma derivatives (albumin, coagulation factors and immunoglobulins). In this module we discuss the blood components and plasma derivatives that we encounter in theatre.
Note: for haemoglobin the UK use g/dl while NZ use g/l i.e. 12 g/dl = 120 g/l.
Length of Study: 90 min
Difficulty: Difficult
Paediatric Trauma
Anatomical and physiological differences in children require special consideration and most seriously injured children have multiple injuries. This module is mainly for those who may be called to A&E resus but the general principles are useful for anyone who works with children.
Length of Study: 60 min.
Difficulty: Medium
Paediatric Pain
Good quality, effective management of pain in paediatric patients is an essential component of paediatric anaesthesia. However, achieving this can be difficult for a variety of reasons not least of which is the enormous variations that occur physiologically and psychologically throughout the range of ages encountered in the paediatric population.
Length of Study: 75 min
Difficulty: Medium
Difficult and failed intubation in obstetrics
Obstetric general anaesthesia is associated with a number of deleterious effects and it has long been recognised that airway management can be challenging and tracheal intubation more likely to fail. This module covers whys, hows and what to do when it goes wrong.
Length of Study: 75 min
Difficulty: Medium
Anaesthetic machine safety features
This module covers the safety features built into the modern anaesthetic machine. With more theatres moving to electronic self-checking machines this is a useful reminder of where we have come from and how safety is built into all aspects of the anaesthetic machine. It is also useful for anyone new to anaesthetics.
Length of Study: 60 min
Difficulty: Easy
Temperature Management in Children
Maintenance of normothermia in children under going surgery is challenging. There is clear evidence in adults that even mild intra-operative hypothermia is associated with adverse outcome. This short article discusses the problems and what we can do about it.
Length of Study: 45 min
Difficulty: Easy
Apnoea & Pre-oxygenation
Pre-oxygenation is used in anaesthesia to prolong the time to desaturation during a period of apnoea, such as frequently happens upon induction. This can also be thought of a denitogenation. This article covers the science behind it and discusses some patient groups that need special attention.
Length of Study: 60 min
Difficulty: Easy
Anaesthetic machines back to front
The most important piece of equipment that the anaesthetist uses is the anaesthesia machine. The basic function of an anaesthesia machine is to prepare a gas mixture of precisely known, but variable composition. The gas mixture can then be delivered to a breathing system. The anaesthesic machine itself has evolved from a simple pneumatic device to a complex array of mechanical, electrical and computer–controlled components. This module breaks down the essential features of the anaesthetic machine into its parts, explaining their purpose as it goes.
Length of Study: 45 min.
Difficulty: Beginner/student
Jehovah’s Witnesses and Blood Issues
Jehovah’s Witnesses are well known for their refusal of blood transfusions. But how much do you really know? What can or can’t they have, are epidural blood patches acceptable and what rights do parents have to refuse their children blood transfusions? This article discusses these issues as well as giving background on who are Jehovah’s Witnesses and what they believe in. It also covers the area of consent in both children and adults according to New Zealand law.
Length of Study: 60 min
Difficulty: Medium
Paediatric Anaesthetic Emergencies: Pt 2
Paediatric anaesthetic emergencies can happen faster and leave less time to react the in adults. They present complex, potentially life-threatening situations that everyone engaged in giving paediatric anaesthetic should be aware of and be able to treat.This second article covers malignant hyperthermia and anaphylaxis.
Length of Study 50min
Difficulty: Medium
Surgical tourniquets
Surgical tourniquets are commonly used in the operating theatres, particularly during orthopaedic cases. Although they are very safe when used properly they can have rare but catastrophic consequences. This module covers how, where and when to use them and more importantly when not to.
Length of Study: 60 min
Difficulty: Easy
Changes in Pregnancy Relevant to Anaesthesia
Pregnancy causes major physiological changes to the mother’s body. An understanding of these changes is the key to safe obstetric anaesthesia. The causes of these changes are initially hormonal; metabolic and mechanical factors also contribute as the fetus develops.
Length of Study: 60 min
Difficulty: Medium
Airway adjuncts and intubation aids
Airway adjuncts are designed to increase the success rate of basic airway manoeuvres, help maintain spontaneous respiration or ensuring successful bag-mask ventilation. Intubation aids are used to help the passing of an endotracheal tube through the cords rather than to help with laryngoscopy.
Length of Study: 45 min.
Difficulty: Beginner/student
Urea & Electrolytes: a review
Urea and electrolytes (U&Es) are the most frequently requested biochemistry tests. They provide useful information about several aspects of health, such as the volume of blood and its pH. The most important aspect of U&Es is what they tell us about kidney functioning.
Length of Study: 50 min
Difficulty: Easy
Metal Max COMBI 50 Disposable Laryngoscope Blade & Handle (sponsored)
The Combi is a one piece system with Blade and Handle fixed together allowing Test in the Bag functionality testing prior to use. It is based on a Conventional system with meLED™ (metal enclosed) LED on the blade powered by a preloaded 6V battery handle giving excellent light output when and where it is required.
The fundamentals of arterial lines
This module covers the basic principles behind setting up, inserting and monitoring intra-arterial blood pressure lines that an anaesthetic assistant needs.
There is also an separate advanced module available which covers more of the physics indepth.
Length of Study: 90 min
Difficulty: Easy
Arterial Blood Gas Analysis
This module explains how to do a simple easy to understand arterial blood gas analysis. How to use the 5-step approach to analyse arterial blood gas results as well as explaining how respiration and metabolism are linked and how this effects the results.
Length of study: 90 min
Difficulty: Difficult
Understanding & Establishing Intraosseous Access
Intraosseous (IO) access is an alternative method to providing venous administration of drugs and fluids. Commonly used by the military and pre-hospital medics,it is gaining popularity in the hospital setting where intravenous access is challenging or time critical.
Length of Study: 75 min
Difficulty: Easy
Necrotising Fasciitis
This module describes the diagnosis and common management of NF. Patients need integrated, interdisciplinary management involving surgeons, intensive care physicians and microbiologists. Close monitoring and physiological support in an intensive care unit is often essential.
Length of Study: 60 min.
Difficulty: Easy
Malignant Hyperthermia
Malignant hyperthermia (MH) is a rare life-threatening condition that is usually triggered by exposure to certain drugs used for general anesthesia. This module reviews malignant hyperthermia, its clinical features and presentations as well as its management during an MH crisis.
This module is largely based on the ‘Malignant hyperthermia 2020 Guidelines’ from the Association of Anaesthetists.
Management of Major Obstetric Haemorrhage
Major obstetric haemorrhage is a common cause of maternal morbidity and mortality and the recognition of major obstetric haemorrhage can be challenging. This module discusses it causes, symptoms and importantly anaesthetic management of cases.
Length of Study: 75 min
Difficulty: Medium
Direct vision laryngoscopes
Laryngoscopes are used to aid tracheal intubation and the placement of endotracheal tubes. They allow visualisation of the larynx and are used not only in operating theatres but ITU and A&E. They can also be used to visualise the larynx for suctioning, removal of a foreign body and placing nasogastric tubes and throat packs.
This module covers conventional or direct laryngoscopes. Video laryngoscopes and fibreoptic intubation are covered in different modules.
Length of Study: 45 min.
Difficulty: Beginner/student
Understanding Central Venous Lines
This module discusses various types of central lines and central venous catheters (CVC). They are often needed in critically ill patients or in those requiring prolonged intravenous therapies that cannot be given orally or through peripheral lines.
Length of Study: 120 min.
Difficulty: Medium
Air Embolism & anaesthesia
There is significant morbidity and mortality associated with air embolism. It is therefore important to have an awareness of its risk factors, presentation, means of risk reduction and management of the consequences. These are all covered in this module.
Length of Study: 60 min.
Difficulty: Easy
Parkinson’s Disease & Anaesthesia
Parkinson’s disease is a degenerative disorder of the central nervous system the causes of which are poorly understood. This module covers its management under anaesthetic, discusses which drugs are safe for use in this patient group and whether regional or GA anaesthetic are more appropriate.
Length of Study: 60 min
Difficulty: Difficult
Sugammadex: an overview
Sugammadex is an effective and safe agent for reversing neuromuscular blockade, in particular all depths of rocuronium-induced blockade. Sugammadex provides a real alternative to neostigmine and this module covers everything you need to know.
Length of Study: 60 min
Difficulty: Easy
Awareness under Anaesthesia
Awareness during anaesthesia can be very distressing for a patient, particularly if accompanied by recall of the painful nature of surgery. This article explores the types, incidence, consequences, causes, management and avoidance of intraoperative awareness.
Length of Study: 60 min
Difficulty: Easy
Understanding the circle system
Although the circle system looks relatively simple, it is a deceptively complex arrangement that needs to be fully understood to use safely, especially at low flows.
This module explains the components, setup and both advantages and disadvantages of the circle system.
Total Intravenous Anaesthesia
Total intravenous anaesthesia (TIVA) is a technique of general anaesthesia which uses a combination of agents given exclusively by the intravenous route without the use of inhalation agents. This module explains how TIVA/TCI works, the popular models used and how they affect different patient groups.
Length of Study: 75 min.
Difficulty: Difficult
Physiological effects of transfer for critically ill patients
Critically ill patients can be exposed to significant physiological changes during transfer that can lead to significant instability with hypoxia, hypotension, arrhythmias and changes in intracranial pressure (ICP). This tutorial will explore the physiological effects that land and air transfer have on critically ill patients and describe how these adverse physiological sequelae can be avoided or reduced.
Length of Study: 60 min
Difficulty: Medium
Bronchospasm during general anaesthesia
Bronchospasm is a relatively common event during general anaesthesia. Anaesthetic assistants need to know how to identify and treat bronchospasm. Management begins with switching to 100% oxygen and calling for help early. Increasing the inspired concentration of Isoflurane and Sevoflurane will produce bronchodilatation and is a good start.
Anaesthesia for ECT
ECT (Electroconvulsive Therapy) is a treatment that involves sending an electric current through the brain to trigger an epileptic seizure to relieve the symptoms of some mental health problem. This module covers the anaesthetic aspects of it.
Length of Study: 45 min.
Difficulty: Easy
The respiratory system – Organs and Structures of the Respiratory System
This module covers the anatomy of the respiratory system. The major organs of the respiratory system function primarily to provide oxygen to body tissues for cellular respiration, remove the waste product carbon dioxide, and help to maintain acid-base balance. It covers both the conducting zone and a respiratory zone and describes the difference between the two.
Length of Study: 60 min.
Difficulty: Beginner/student
Emergency front of neck access in airway management
This module describes the guidance for emergency front of neck access, reviews techniques to improve decision making in the transition to eFONA and reviews the ‘scapel, bougie,
tube’ technique when performing eFONA.
Sickle cell disease
Sickle cell disease is a disorder of the blood caused by an inherited abnormal haemoglobin. The abnormal haemoglobin causes distorted (sickled) red blood cells. When the number of red blood cells decreases from rupture (haemolysis), anaemia is the result. The irregular sickled cells can also block blood vessels causing tissue and organ damage and pain.
Length of Study: 60 min
Difficulty: Easy
Oxygen Saturations & Pulse Oximetery
The pulse oximeter provides an indication of oxygen status in the body. However, the link between a pulse oximeter reading and the events occurring in the body can be complex and difficult to evaluate. We all require an understanding of factors associated with oxygen uptake and delivery to be able to use pulse oximetry in a knowledgeable way.
Length of Study: 80 min
Difficulty: Easy
Enhanced Recovery From Surgery (ERAS)
Enhanced recovery is a modern evidence-based approach that helps people recover more quickly after having major surgery. Many hospitals – although not all – have enhanced recovery programmes in place, and it’s becoming standard practice following surgery for many procedures.
Length of Study: 75 min
Difficulty: Medium
Peri-operative Management of Patients on Strong Opioids
It is very common to encounter patients on strong opioid medication. These patients present particularly challenging pain management difficulties in the peri-operative period due to behavioural, psychological and pharmacological consequences of opioid treatment. This module discusses the key concepts in the anaesthetic management of patients taking strong opioids and steps that can be taken to ensure optimum peri-operative care.
Length of Study: 80 min
Difficulty: Medium
When Anaesthetics Go Wrong
This one is a little different. There is no test at the end. The video is the story of Elaine Bromiley who died while under anaesthetic for a routine elective surgical procedure. Viewing this is a must for anyone working in the operating theatre and it is perfect to write up as an example of reflective practice. The PDF is an anonymous version of an Independent Report on the death of Elaine Bromiley.
Length of video: 15 minutes