ANZCA Examinations
Australian and New Zealand College of Anaesthetists. Comprehensive coverage of the Primary and Final Fellowship examinations.
Pharmacology, Physiology, and Physics/Measurement principles.
Clinical anaesthesia, perioperative medicine, and pain management.
High-yield prompts and topic coverage for oral examination preparation.
Acid-Base Physiology
Acid-base homeostasis is maintained through the interplay of three major buffer systems: bicarbonate (primary), phosphate, and protein buffers. The Henderson-Hasselbalch equation (pH = pKa + log[HCO₃⁻/(0.03 × PCO₂)])...
Acid-Base Physiology
Acid-base balance maintains arterial pH 7.35-7.45 through chemical buffering, respiratory compensation, and renal regulation. pH: Negative logarithm of [H⁺]; normal [H⁺] 40 nEq/L (35-45); pH 7.40 = [H⁺] 40 nEq/L; pH...
Adductor Canal Block
Roof (Superficial Wall): Sartorius muscle : Forms the roof of the canal for most of its length Fascial thickening : Strong fascia covering sartorius contributes to canal formation Attachment : Fascia blends with...
Airway Assessment
Systematic airway assessment identifies 80-90% of difficult airways but has limited positive predictive value ( 10-15%), meaning many predicted difficult airways are easily managed and some predicted easy airways...
Airway Fire in the Operating Room - Prevention and Management
Immediate Management (Critical First 60 Seconds): Simultaneously: Remove all airway devices (ETT, LMA, nasal tube, etc.) Disconnect oxygen source - flood circuit with air Pour sterile saline into airway (300-500 mL if...
Alfentanil and Sufentanil Pharmacology
Alfentanil and sufentanil are synthetic 4-anilidopiperidine opioid agonists derived from fentanyl, sharing its characteristic phenylpiperidine structure but with distinct pharmacokinetic profiles that determine their...
Anaesthesia for Aortic Arch Surgery
Aortic arch surgery requires deep hypothermic circulatory arrest (DHCA) with or without selective cerebral perfusion (SCP) . Indications : Aortic aneurysm, acute dissection (Type A), atherosclerotic disease. Core...
Anaesthesia for Aortic Surgery
Aortic surgery ranges from open repair (high risk, physiological insult) to endovascular stent grafting (EVAR/TEVAR, less invasive but still significant). Anatomy: Ascending aorta (coronary arteries, aortic valve),...
Anaesthesia for Awake Craniotomy
Awake craniotomy allows direct cortical mapping of speech, motor, and sensory areas during resection of lesions near eloquent cortex. Indications : Low-grade gliomas, epileptogenic foci, deep brain stimulation...
Anaesthesia for Burns Patients
Burns anaesthesia presents challenges: airway management (inhalation injury, swelling), fluid resuscitation (Parkland formula: 4 mL/kg/%TBSA in 24 hours - half in first 8 hours), temperature control (massive heat loss...
Anaesthesia for Cardiac Valve Surgery
Valve surgery requires understanding of hemodynamic goals specific to each lesion . Aortic stenosis (AS): Maintain sinus rhythm, normal-high preload, avoid hypotension/tachycardia, treat dynamic obstruction with...
Anaesthesia for Carotid Artery Stenting (CAS)
Carotid artery stenting (CAS) is a minimally invasive alternative to carotid endarterectomy (CEA) for carotid stenosis. Indications : High surgical risk (medical comorbidities, hostile neck, previous CEA/restenosis),...
Anaesthesia for Carotid Endarterectomy
Carotid endarterectomy (CEA) removes atherosclerotic plaque to prevent stroke. Indications : Symptomatic carotid stenosis 50-70% (recent TIA/stroke), asymptomatic 80% (selective). Monitoring : Arterial line, cerebral...
Anaesthesia for Cerebral Aneurysm Clipping
Cerebral aneurysm clipping requires strict blood pressure control (avoid hypertension pre-clipping, maintain normotension/mild hypotension during dissection), brain relaxation (mannitol, CSF drainage), and readiness...
Anaesthesia for Coronary Artery Bypass Grafting
Coronary artery bypass grafting (CABG) requires myocardial protection during ischemic arrest, hemodynamic optimization , and management of bleeding/coagulopathy . Preoperative : Continue antiplatelet agents (aspirin),...
Anaesthesia for Day Surgery
Day surgery (ambulatory surgery) requires rapid, smooth emergence , effective analgesia allowing oral intake and mobility, minimal PONV , and safe discharge . Patient selection : ASA I-III generally acceptable, BMI...
Anaesthesia for Deep Brain Stimulation
Deep brain stimulation (DBS) requires awake intraoperative assessment for optimal electrode placement (microelectrode recording + clinical testing). Anaesthesia strategy : light general anaesthesia for frame...
Anaesthesia for Dental Extractions
Dental extraction anaesthesia requires managing the "shared airway" with the dental surgeon while ensuring patient safety and comfort. Key considerations: (1) Airway management : Nasal intubation, reinforced LMA...
Anaesthesia for Endoscopic Sinus Surgery
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive technique for treating chronic rhinosinusitis, nasal polyps, and skull base pathology. Key anaesthetic challenges include:
Anaesthesia for Head Injury
Traumatic brain injury (TBI) affects 700 per 100,000 population annually in Australia, with anaesthetic management focused on preventing secondary brain injury by optimizing cerebral oxygenation and perfusion....
Anaesthesia for Heart Transplantation
Heart transplantation is the gold standard treatment for end-stage heart failure refractory to medical/device therapy. Indications : Dilated cardiomyopathy (50-60%), ischemic cardiomyopathy (25-35%), congenital heart...
Anaesthesia for Laparoscopic Surgery
Laparoscopic surgery presents unique physiological challenges: pneumoperitoneum (CO₂ insufflation 12-15 mmHg) increases intra-abdominal pressure causing cardiovascular effects (↓venous return initially, then ↑SVR and...
Anaesthesia for Laser Eye Surgery
Comprehensive guide to anaesthesia for PRK, LASIK, sedation requirements, and patient fixation for ANZCA Fellowship examination
Anaesthesia for Lung Resection
Lung resection includes pneumonectomy (entire lung), lobectomy (single lobe), segmentectomy/wedge (sublobar), and sleeve resection (bronchoplastic). Indications : Primary lung cancer (NSCLC 85%, SCLC 15%),...
Anaesthesia for Lung Transplantation
Lung transplantation is performed for end-stage lung disease refractory to medical therapy. Indications : COPD (30-35%), interstitial lung disease (25-30%), cystic fibrosis (15-20%), pulmonary hypertension (5-10%),...
Anaesthesia for Middle Ear Surgery
Middle ear surgery encompasses tympanoplasty, mastoidectomy, stapedectomy, and cholesteatoma surgery. Key anaesthetic considerations include:
Anaesthesia for Myasthenia Gravis
Myasthenia gravis (MG) is an autoimmune neuromuscular disorder causing fatigable muscle weakness due to anti-acetylcholine receptor (AChR) antibodies (80-85%) or anti-MuSK antibodies (5-8%). Anaesthetic challenges :...
Anaesthesia for Obesity
Obesity (BMI 30 kg/m²) affects 30% of Australian adults and presents significant anaesthetic challenges due to physiological changes including reduced functional residual capacity (FRC), increased airway resistance,...
Anaesthesia for Ophthalmic Trauma
Comprehensive guide to anaesthesia for open globe injuries, orbital fractures, and intraocular pressure management for ANZCA Fellowship examination
Anaesthesia for Organ Transplantation
Organ transplantation presents unique challenges: Kidney transplant (most common, end-stage renal disease) - avoid nephrotoxins, maintain perfusion, manage hyperkalemia, avoid hypotension post-anastomosis. Liver...
Anaesthesia for Parotid Surgery
Comprehensive guide to anaesthesia for parotidectomy including facial nerve monitoring, Frey syndrome, and sialogogue use for ANZCA Fellowship examination
Anaesthesia for Patients with Pacemakers and ICDs
Patients with cardiac implantable electronic devices (CIEDs) including pacemakers and implantable cardioverter-defibrillators (ICDs) require systematic perioperative management to prevent device malfunction from...
Anaesthesia for Posterior Fossa Surgery
Posterior fossa surgery (sitting/prone park bench position) carries unique risks: venous air embolism (VAE, 20-40% incidence, 1% clinically significant), trigeminal-cardiac reflex (TCR, severe bradycardia/asystole...
Anaesthesia for Pyloric Stenosis
Infantile hypertrophic pyloric stenosis (IHPS) is a medical emergency requiring correction of hypochloraemic hypokalaemic metabolic alkalosis BEFORE surgery - it is NOT a surgical emergency. Presentation is typically...
Anaesthesia for Radical Neck Dissection
Comprehensive guide to anaesthesia for radical neck dissection including airway compromise, carotid protection, and shoulder dysfunction for ANZCA Fellowship examination
Anaesthesia for Renal Transplantation
for ANZCA Finals : - ESRD Physiology : Cardiovascular disease (leading cause of death), anaemia, platelet dysfunction, hyperkalaemia, metabolic acidosis, altered drug pharmacokinetics - Preoperative : Dialysis within...
Anaesthesia for Salivary Gland Surgery
Salivary gland surgery requires meticulous attention to the facial nerve (parotid surgery) and airway management. Key considerations: (1) Facial nerve preservation : Electromyography (EMG) monitoring mandatory for...
Anaesthesia for Spinal Surgery
Spinal surgery anaesthesia requires positioning considerations (prone/lateral/sitting), neurophysiological monitoring (SSEPs/MEPs), blood loss management (cell salvage, controlled hypotension), and air embolism...
Anaesthesia for the Septic Patient
Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection, with septic shock defined as sepsis with persistent hypotension requiring vasopressors despite adequate fluid...
Anaesthesia for Thoracic Aortic Surgery
Thoracic aortic surgery includes open repair and endovascular (TEVAR) approaches. Open repair requires left heart bypass (partial) or deep hypothermic circulatory arrest (DHCA) for arch/proximal descending, with...
Anaesthesia for Tonsillectomy
Tonsillectomy presents unique anaesthetic challenges due to the shared airway with the surgeon, risk of post-tonsillectomy haemorrhage (PTH) , and frequent paediatric population. Key considerations include:
Anaesthesia for Trauma
Trauma is the leading cause of death in Australians aged 1-44 years, with major trauma requiring coordinated multidisciplinary care including damage control resuscitation (DCR) principles. Primary survey follows ABCDE...
Anaesthesia for Vitreoretinal Surgery
Comprehensive guide to anaesthesia for scleral buckle, pneumatic retinopexy, gas tamponade, and complex vitrectomy for ANZCA Fellowship examination
Anaesthesia in Liver Failure
Liver failure presents complex perioperative challenges due to impaired synthetic function, coagulopathy, fluid shifts, and multi-organ involvement. Classification: Acute liver failure (ALF—encephalopathy within 8...
Anaesthesia in Renal Failure
Chronic kidney disease (CKD) stage 4-5 (eGFR <30 mL/min) and acute kidney injury (AKI) present significant perioperative risks due to fluid overload, electrolyte abnormalities, coagulopathy, and altered drug...
Anaesthesia in the Elderly
Ageing physiology significantly impacts anaesthetic management due to reduced functional reserve in cardiovascular, respiratory, renal, hepatic, and neurological systems. Pharmacokinetic changes include reduced lean...
Anaesthesia in the Elderly
Geriatric anaesthesia (age 65-70) requires understanding of age-related physiological changes and pharmacokinetic/pharmacodynamic alterations . Cardiovascular : Reduced compliance, diastolic dysfunction, fixed stroke...
Anaesthetic Machine
Modern anaesthetic machines integrate gas delivery, vaporization, breathing systems, and monitoring with multiple safety features. Gas supply: Central pipeline (oxygen 400 kPa, air, nitrous oxide) or cylinders (oxygen...
Anaesthetic Monitoring Standards
ANZCA Professional Standard PS41 (Anaesthetic Machine Monitoring Standards) mandates minimum monitoring for all patients undergoing general, regional, or sedation anaesthesia. Continuous monitoring: Inspired and...
Atracurium and Cisatracurium: Pharmacology
Atracurium is a benzylisoquinolinium non-depolarizing neuromuscular blocker with unique Hofmann elimination (chemical degradation at physiological pH and temperature) and ester hydrolysis by plasma cholinesterases....
Atracurium Pharmacology
Atracurium besylate is an intermediate-acting, non-depolarizing benzylisoquinolinium neuromuscular blocking agent (NMBA) characterised by organ-independent elimination through Hofmann elimination (spontaneous chemical...
Atropine Pharmacology
Atropine is a naturally occurring tropane alkaloid and the prototypical competitive muscarinic acetylcholine receptor antagonist. As a tertiary amine with a pKa of 9.7, it crosses the blood-brain barrier and produces...
Autonomic Nervous System & Cardiovascular Control
The autonomic nervous system (ANS) regulates involuntary functions, divided into sympathetic (thoracolumbar T1-L2, fight-or-flight) and parasympathetic (craniosacral S2-S4, rest-and-digest) divisions. Sympathetic...
Awareness Under Anaesthesia
Accidental awareness during general anaesthesia (AAGA) is the unintended recall of intraoperative events by patients who received general anaesthesia, occurring in approximately 0.1-0.2% of general surgical cases (1-2...
Awareness Under Anaesthesia and Depth of Anaesthesia Monitoring
Accidental awareness during general anaesthesia (AAGA) is a rare but devastating complication with an incidence of approximately 1:19,000 anaesthetics in the UK (NAP5 data). It is defined as explicit recall of sensory...
Axillary Block
Axillary brachial plexus block targets the terminal branches of the brachial plexus as they surround the axillary artery in the axilla. Coverage : Forearm, wrist, hand (entire upper limb below mid-humerus)....
Bariatric Surgery Anaesthesia
Mechanical Alterations: Increased intra-abdominal pressure : Elevated by 5-15 mmHg above normal due to central adiposity, reducing diaphragmatic excursion Decreased FRC : Reduced by 30-50% in morbid obesity (BMI 40...
Beach Chair Position Anaesthesia
Beach chair position (BCP) involves elevating the head and torso 30-70 degrees from supine with legs lowered, primarily used for shoulder surgery. Physiological effects : Gravitational effects on cerebral perfusion...
Beta-Blockers Pharmacology
Beta-adrenergic receptor antagonists (beta-blockers) competitively inhibit catecholamine binding at beta-adrenoceptors, producing negative chronotropy (reduced heart rate), negative inotropy (reduced contractility),...
Brachial Plexus Blocks
The brachial plexus (C5-T1 roots) provides motor and sensory innervation to the upper limb. Four principal approaches exist for brachial plexus blockade: interscalene (shoulder surgery, 100% phrenic nerve palsy),...
Breathing Circuits and Systems
Anaesthetic breathing circuits deliver fresh gas to patient and remove expired CO₂, classified by rebreathing characteristics and presence of CO₂ absorption. Mapleson classification (non-rebreathing): A (Magill):...
Bupivacaine
Bupivacaine is a potent, long-acting amide local anaesthetic widely used for neuraxial blocks (epidural, spinal), peripheral nerve blocks, and labour analgesia. Structure: Amide local anaesthetic (pipecoloxylidide),...
Caesarean Section Anaesthesia
Caesarean section is the most common major surgical procedure in Australia, with approximately 30-35% of births delivered by caesarean section. Neuraxial anaesthesia (spinal, epidural, or combined spinal-epidural) is...
Calcium Channel Blockers Pharmacology
Calcium channel blockers (CCBs) inhibit voltage-gated L-type calcium channels, reducing calcium influx into cardiac and vascular smooth muscle cells. Classification is based on chemical structure : dihydropyridines...
Can't Intubate Can't Oxygenate (CICO)
What is it? Can't Intubate Can't Oxygenate (CICO) is a life-threatening airway emergency where tracheal intubation has failed AND oxygenation cannot be achieved via facemask or supraglottic airway (SGA). This...
Cancer Pain Management - WHO Ladder and Beyond
Cancer pain affects 30-50% of patients during treatment and 70-90% of patients with advanced disease. It is the most feared symptom of cancer and significantly impacts quality of life, function, and psychological...
Cancer Surgery and Anaesthesia
What is it? Anaesthesia for cancer surgery requires specialized knowledge of cancer biology, immunosuppression effects, optimal surgical timing, and perioperative considerations that differ significantly from...
Capnography - Physics, Waveform Analysis, and Clinical Applications
Capnography is the continuous measurement and graphical display of carbon dioxide (CO₂) concentration in respiratory gases. It utilises infrared absorption spectroscopy at the characteristic CO₂ wavelength of 4.26 μm...
Carbon Dioxide Transport
Carbon dioxide (CO2) is transported from tissues to lungs via three mechanisms: dissolved CO2 (5-10%), bicarbonate (60-70%), and carbamino compounds (20-25%). The bicarbonate pathway involves carbonic anhydrase...
Cardiac Cycle & Pressure-Volume Loops
The cardiac cycle consists of systole (isovolumetric contraction, ejection) and diastole (isovolumetric relaxation, filling). Pressure-volume (PV) loops graphically represent left ventricular pressure vs volume...
Cardiac Tamponade
Cardiac tamponade is life-threatening compression of the heart by fluid (blood, effusion) in the pericardial space impairing diastolic filling and reducing cardiac output. Pathophysiology: Pericardial pressure...
Cardiomyoplasty and Skeletal Muscle Ventricle
Cardiomyoplasty is an experimental surgical technique using skeletal muscle to assist or replace cardiac function. Two approaches exist: (1) Dynamic cardiomyoplasty—wrapping the latissimus dorsi muscle around the...
Cardiopulmonary Bypass Cannulation
Cardiopulmonary bypass (CPB) cannulation establishes extracorporeal circulation for cardiac surgery. Arterial cannulation (ascending aorta 95%, femoral 3%, axillary 2%) delivers oxygenated blood (cannula size: 20-24...
Cardiovascular Physiology
The cardiovascular system maintains perfusion to all tissues through coordinated heart function, vascular tone, and blood volume regulation. Cardiac output (CO): 5-6 L/min (HR 60-100 bpm × SV 60-100 mL); determined by...
Cerebral Blood Flow and Metabolism
Cerebral blood flow (CBF) is tightly regulated to maintain constant oxygen and glucose delivery to the brain, which has high metabolic demand (20% of resting oxygen consumption, 2% of body weight). Normal CBF: 50...
Cerebrovascular Surgery: AVMs, Moyamoya, and Stroke Revascularisation
Cerebrovascular surgery (AVM resection, Moyamoya bypass, stroke revascularisation) requires meticulous haemodynamic control to maintain cerebral perfusion while avoiding catastrophic complications. Key principles:
Chronic Pain Assessment
"Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
Clinical Governance in Anaesthesia
Comprehensive guide to quality improvement, audit, morbidity meetings, and clinical governance frameworks for ANZCA Fellowship examination
Clonidine Pharmacology
Clonidine is a selective alpha-2 (α2) adrenergic receptor agonist with central sympatholytic, sedative, and analgesic properties that make it valuable in perioperative medicine. It is an imidazoline derivative that...
Coagulation and Haemostasis
Haemostasis maintains blood fluidity while preventing bleeding through vascular, platelet, and coagulation factors working in concert. Primary haemostasis: Vascular spasm, platelet adhesion (glycoprotein Ib-von...
Communication Skills in Anaesthesia
Comprehensive guide to difficult conversations, breaking bad news, escalation protocols, and patient-centered communication for ANZCA Fellowship examination Professional Skills component
Complex Regional Pain Syndrome (CRPS)
Reflex Sympathetic Dystrophy (RSD): Originally described by Mitchell et al. (1864) in Civil War soldiers with persistent burning pain after nerve injury. The term implied sympathetic nervous system involvement.
Congenital Diaphragmatic Hernia (CDH)
CDH is a developmental defect where abdominal contents herniate into the thorax through a defect in the diaphragm, causing pulmonary hypoplasia and pulmonary hypertension. Key anaesthetic principles:
Corticosteroids Pharmacology
Corticosteroids are synthetic analogues of endogenous cortisol with varying ratios of glucocorticoid (anti-inflammatory, metabolic) to mineralocorticoid (sodium retention) activity. In anaesthesia, they are used for...
Day Surgery Anaesthesia
Day surgery (ambulatory surgery) constitutes 70-80% of elective surgical procedures in Australia, requiring rapid recovery, minimal side effects, and safe discharge criteria. Patient selection: ASA 1-2 (selected ASA 3...
Dental Anaesthesia
Challenges: Airway obstruction : Surgeon's hands and instruments in airway Monitoring difficulty : Face and airway obscured by surgical drapes Limited access : Cannot easily perform laryngoscopy or adjust airway...
Depth of Anaesthesia Monitoring
Depth of anaesthesia (DoA) monitors process electroencephalogram (EEG) signals to assess the hypnotic component of general anaesthesia. The three main technologies are: (1) Bispectral Index (BIS)—algorithm combining...
Desflurane: Pharmacology and Clinical Use
Desflurane is a fluorinated methyl ethyl ether with lowest blood/gas partition coefficient (0.42), providing most rapid emergence of volatile agents. Physical properties : High vapor pressure (669 mmHg at 20°C),...
Dexmedetomidine Pharmacology
Dexmedetomidine is a highly selective alpha-2 adrenoceptor agonist (α2:α1 ratio 1620:1 ) used for sedation in intensive care and procedural settings. It produces "cooperative sedation" via inhibition of noradrenergic...
Dexmedetomidine: Pharmacology and Clinical Use
Dexmedetomidine is a highly selective alpha-2 adrenergic agonist with sedative, anxiolytic, and analgesic properties. Mechanism : Acts on alpha-2A receptors in locus coeruleus (sedation), spinal cord (analgesia), and...
Diazepam: Pharmacology and Clinical Applications in Anaesthesia
Diazepam is a long-acting benzodiazepine that acts as a positive allosteric modulator at the GABA-A receptor, producing anxiolysis, sedation, amnesia, and anticonvulsant effects. Its clinical utility is limited in...
Difficult Airway Management
The upper airway consists of the nasal cavity, oral cavity, pharynx, and larynx. Critical anatomical relationships determine the ease or difficulty of airway management:
Difficult Ventilation - Can't Intubate Can't Ventilate (CICV) Management
Immediate Recognition of Can't Intubate Can't Ventilate (CICV/CICO): Failed intubation: Multiple attempts unsuccessful Failed face mask ventilation: Cannot achieve chest movement, EtCO2, or SpO2 Failed SGA rescue:...
Direct Oral Anticoagulants (DOACs) Pharmacology
Direct Oral Anticoagulants (DOACs), also termed Non-vitamin K Antagonist Oral Anticoagulants (NOACs), represent a pharmacological revolution in anticoagulation therapy, offering predictable pharmacokinetics, fixed...
ECG Monitoring in Anaesthesia
Electrocardiography (ECG) monitors cardiac electrical activity through surface electrodes that detect voltage changes generated by myocardial depolarization and repolarization. The signal represents the algebraic sum...
ECMO Cannulation and Vascular Access
Extracorporeal membrane oxygenation (ECMO) cannulation establishes vascular access for temporary mechanical circulatory and/or respiratory support. Two configurations exist: (1) Veno-arterial (VA) - femoral vein...
Electrical Injury and Lightning Strike
Electrical injuries cause devastating deep tissue damage, cardiac arrhythmias, and systemic complications disproportionate to visible burns. Key principles:
Electroconvulsive Therapy (ECT) Anaesthesia
Electroconvulsive therapy (ECT) involves inducing a generalized tonic-clonic seizure under general anaesthesia for treatment of severe psychiatric disorders. Anaesthetic goals : Provide brief unconsciousness (2-5...
End-of-Life Care in Anaesthesia
Comprehensive guide to palliative care, organ donation in Australia/NZ, and withholding/withdrawing treatment for ANZCA Fellowship examination Professional Skills component
Ephedrine Pharmacology
Ephedrine is a non-catecholamine sympathomimetic amine with both direct and indirect actions at alpha and beta adrenergic receptors. It is a naturally occurring alkaloid found in plants of the Ephedra species....
Epidural Anaesthesia
Epidural anaesthesia involves injection of local anaesthetic into the epidural space (potential space between ligamentum flavum and dura) producing segmental sensory block with less motor block than spinal. Anatomy:...
Epilepsy Surgery and Awake Craniotomy
Epilepsy surgery requires seamless transitions between general anaesthesia (GA), conscious sedation, and awake cooperative states to enable intraoperative electrocorticography (ECoG) and functional cortical mapping....
Erector Spinae Plane Block
Composition: The erector spinae is a large, complex muscle group located posterior to the vertebral column, consisting of three columns:
Ethics, Consent, and Capacity in Anaesthesia
Comprehensive guide to informed consent, capacity assessment, advance directives, and refusal of treatment for ANZCA Fellowship examination Professional Skills component
Etomidate Pharmacology
Etomidate is an imidazole-derived intravenous anaesthetic agent distinguished by its remarkable haemodynamic stability, making it the induction agent of choice for patients with cardiovascular compromise or...
Evidence-Based Medicine and Research in Anaesthesia
Evidence-based medicine (EBM) integrates individual clinical expertise with the best available external clinical evidence from systematic research. Hierarchy of evidence : Systematic reviews and meta-analyses of RCTs...
Extracorporeal Membrane Oxygenation (ECMO): VV and VA Configurations, Cannulation, and Management
Extracorporeal Membrane Oxygenation (ECMO) provides temporary cardiopulmonary support by draining venous blood, removing carbon dioxide and adding oxygen through a membrane oxygenator, and returning oxygenated blood...
Failed Spinal Anaesthesia: Management Options and Intubation Strategy
Failed spinal anaesthesia occurs in 1-5% of caesarean sections , with complete failure reported in 0.5-1% of cases. When spinal anaesthesia fails to provide adequate surgical anaesthesia, the anaesthetist must rapidly...
Femoral Nerve Block
Origin and Course: Formed from : L2-L4 lumbar plexus (posterior divisions) Exits : Lateral border psoas muscle Passes : Beneath inguinal ligament Position : Lateral to femoral artery, deep to fascia iliaca,...
Fentanyl
Fentanyl is a synthetic phenylpiperidine opioid agonist with 100× potency of morphine and rapid onset (1-2 minutes IV), making it ideal for intraoperative analgesia and balanced anaesthesia. Mechanism: Selective...
Fluid and Electrolyte Physiology
Total body water (TBW) is approximately 60% body weight in males, 50% in females, 65-70% in infants, 50% in elderly. Distribution : 2/3 intracellular (ICF), 1/3 extracellular (ECF). ECF divided into interstitial fluid...
Flumazenil Pharmacology
Flumazenil is a competitive benzodiazepine antagonist at the GABA-A receptor benzodiazepine binding site. Chemically classified as an imidazobenzodiazepine, it reverses the sedative, anxiolytic, and amnestic effects...
Foreign Body Aspiration - Acute Upper Airway Obstruction and Bronchoscopy
Foreign body aspiration is the inhalation of objects into the airway, most commonly affecting children aged 1-3 years (peak incidence). It is a life-threatening emergency requiring prompt diagnosis and intervention....
Gabapentinoids Pharmacology (Gabapentin and Pregabalin)
Gabapentinoids (gabapentin and pregabalin) are anticonvulsant medications that bind to the α2δ subunit of voltage-gated calcium channels (VGCCs) , reducing presynaptic calcium influx and neurotransmitter release...
Gas Laws in Anaesthesia - Boyle's, Charles', Dalton's, Henry's, Graham's, Fick's
Gas laws form the foundation of respiratory physiology and anaesthetic practice. Boyle's law (P₁V₁ = P₂V₂) describes the inverse relationship between pressure and volume at constant temperature, governing lung...
General Anaesthesia Induction
General anaesthesia induction is the transition from consciousness to unconsciousness with loss of protective airway reflexes, requiring controlled manipulation of physiology and airway management. Rapid sequence...
Glyceryl Trinitrate (GTN) Pharmacology
Glyceryl trinitrate (GTN), also known as nitroglycerin, is an organic nitrate vasodilator that has been used clinically for over 150 years for the treatment of angina pectoris and heart failure. It is a triester of...
Glycopyrrolate
Glycopyrrolate is a quaternary ammonium anticholinergic agent with peripheral muscarinic receptor antagonism, used primarily to counteract muscarinic side effects of anticholinesterases during neuromuscular blockade...
Glycopyrrolate Pharmacology
Glycopyrrolate (glycopyrronium bromide) is a synthetic quaternary ammonium anticholinergic agent that acts as a competitive muscarinic receptor antagonist at M1, M2, and M3 receptor subtypes. Its quaternary ammonium...
Haemodynamics: Blood Flow, Pressure, and Resistance
Haemodynamics describes blood flow through the cardiovascular system based on pressure gradients and vascular resistance. Poiseuille's Law: Q = ΔP × πr⁴ / (8ηL), where Q = flow, ΔP = pressure gradient, r = vessel...
Hepatic Physiology
The liver is the largest solid organ (1.5 kg) performing over 500 functions including metabolism, detoxification, protein synthesis, and bile production. Blood supply: Dual supply from hepatic artery (25% flow, 50%...
High Spinal and Total Spinal Block - Recognition and Management
Immediate Recognition: Sensory level above T4 (high spinal) with respiratory symptoms Progressive ascending weakness (numbness in hands T1-T4, respiratory C3-C5) Severe hypotension with bradycardia (sympathetic...
Hydralazine: Direct Vasodilator Pharmacology and Clinical Use
Hydralazine is a direct-acting arterial vasodilator that relaxes vascular smooth muscle through unclear mechanisms, possibly involving interference with calcium influx and activation of potassium channels. It produces...
Hyperthermia and Heat Stroke
Heat stroke is a life-threatening hyperthermic emergency with core temperature 40°C and neurological dysfunction. Rapid cooling is the priority. Key principles:
Hypertrophic Cardiomyopathy - Anaesthetic Considerations
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder (1:500 population), characterised by asymmetric left ventricular hypertrophy with myocardial disarray, presenting significant anaesthetic...
Interscalene Brachial Plexus Block
Formation: Roots : C5, C6, C7, C8, T1 (ventral rami) Interscalene location : C5-C7 roots between anterior and middle scalene muscles Trunks : Form superior (C5-C6), middle (C7), inferior (C8-T1) trunks Interscalene...
Interventional Pain Procedures
Interventional pain procedures provide diagnostic information and therapeutic benefit for chronic pain conditions when conservative management fails. Epidural steroid injection (ESI): Indicated for radicular pain from...
Intra-Aortic Balloon Pump (IABP): Physiology, Timing, and Clinical Applications
The intra-aortic balloon pump (IABP) is a mechanical circulatory support device that improves myocardial oxygen supply-demand balance through diastolic augmentation and systolic unloading (counterpulsation). The...
Intracranial Pressure Management
Intracranial pressure (ICP) is normally 5-15 mmHg (supine). Cerebral perfusion pressure (CPP) = MAP - ICP (target 60-70 mmHg). Monro-Kellie doctrine : Fixed intracranial volume (brain 80%, CSF 10%, blood 10%). ICP...
Intraoperative Bronchospasm - Recognition and Management
Immediate Recognition: Rising peak airway pressure ( 30 cmH₂O with plateau pressure unchanged suggests bronchospasm) Expiratory wheeze (may be absent in severe bronchospasm = "silent chest") Decreased tidal volume...
Isoflurane Pharmacology
Isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether) is a halogenated methyl ethyl ether volatile anaesthetic agent introduced in 1981 that remains widely used globally for maintenance of general...
Ketamine
Ketamine is a phencyclidine (PCP) derivative dissociative anaesthetic producing analgesia, amnesia, and unconsciousness while preserving airway reflexes and cardiovascular stability. Mechanism: Non-competitive...
Ketamine Pharmacology
Ketamine is a phencyclidine derivative dissociative anaesthetic that exists as two stereoisomers: S(+)-ketamine and R(-)-ketamine. The S(+)-enantiomer demonstrates 3-4 times greater analgesic potency and 1.5-2 times...
Labour Analgesia
Cervical Dilation and Uterine Contractions (0-10 cm): Origin: Uterine contractions, cervical dilation, lower uterine segment distension Pathway: Visceral afferents via hypogastric plexus → sympathetic chain → enter...
Lignocaine (Lidocaine)
Lignocaine (lidocaine) is the prototypical amide local anaesthetic, widely used for infiltration, nerve blocks, spinal and epidural anaesthesia, intravenous regional anaesthesia (Bier's block), and as an...
Local Anaesthetic Systemic Toxicity (LAST)
Local anaesthetic systemic toxicity (LAST) is a life-threatening emergency occurring when local anaesthetics enter systemic circulation, causing CNS and cardiovascular toxicity. Incidence: 0.1-0.3% of peripheral nerve...
Local Anaesthetic Systemic Toxicity (LAST) - Management and Lipid Emulsion
Immediate Recognition (Early Warning Signs): Prodromal symptoms: Circumoral numbness, metallic taste, tinnitus Neurological: Agitation, confusion, drowsiness, seizures Cardiovascular: Hypertension, tachycardia...
Local Anaesthetics
Local anaesthetics (LAs) block nerve conduction by inhibiting voltage-gated sodium channels (VGSC) in neuronal membranes, preventing action potential generation and propagation. Classification: Esters (procaine,...
Lower Limb Nerve Blocks
The lumbar plexus forms within the psoas major muscle from the anterior rami of L1-L4 nerve roots. It gives rise to several important branches that innervate the anterior and medial thigh:
Magnesium Pharmacology
Magnesium (Mg²⁺) is the fourth most abundant cation in the body and second most abundant intracellular cation, with critical roles in over 300 enzymatic reactions, neuromuscular transmission, and cardiac...
Malignant Hyperthermia: Recognition and Management
Malignant hyperthermia (MH) is a pharmacogenetic disorder triggered by volatile anaesthetics (sevoflurane, isoflurane, desflurane, halothane) and suxamethonium . Pathophysiology : Ryanodine receptor (RYR1) or DHPR...
Massive Haemorrhage and Transfusion
Massive haemorrhage is defined as loss of 50% total blood volume within 3 hours, or blood loss exceeding 150 mL/min. Mortality ranges from 30-40% for trauma-related massive transfusion and 10-20% for surgical...
Massive Transfusion Protocol (MTP) - Hemorrhage Management
Activation Criteria (Activate MTP if ANY present): Blood loss 1500 mL or 30% blood volume Blood loss 150 mL/min sustained Need for 4 units PRBC in <1 hour Systolic BP <90 mmHg with ongoing bleeding Base deficit...
Maternal Physiological Changes in Pregnancy
Pregnancy induces profound physiological adaptations that significantly impact anaesthetic management. By term, cardiac output increases 40-50% (stroke volume +30%, heart rate +15-20%), blood volume expands 40-50%...
Maze Procedure and Atrial Fibrillation Ablation
The Maze procedure is a surgical treatment for atrial fibrillation (AF) that creates lines of conduction block in the atrial myocardium to restore sinus rhythm. Modern techniques include cut-and-sew Cox-Maze III/IV,...
Mechanical Ventilators
Pneumatic (Gas-Powered): Driven entirely by compressed gas (oxygen or air at 280-600 kPa) No electrical power required for basic function Examples: Ohmeda 7000, Penlon Nuffield 200 Advantages: Simple, reliable,...
Mechanical Ventilators
Mechanical ventilators provide controlled ventilation during general anaesthesia or in critical care settings. Classification: Pneumatic (gas-driven, no electricity required, simple), electronic...
Medical Ultrasound Physics: Knobology, Artifacts, and Doppler Principles
Medical ultrasound imaging relies on the piezoelectric effect —certain crystals (lead zirconate titanate, PZT) convert electrical energy to mechanical sound waves and vice versa. Image generation follows:...
Medicolegal Issues in Anaesthesia
Comprehensive guide to medical negligence, duty of care, documentation requirements, and expert witness responsibilities for ANZCA Fellowship examination Professional Skills component
Metaraminol Pharmacology
Metaraminol is a synthetic sympathomimetic amine used primarily as a vasopressor for the management of intraoperative hypotension, particularly during spinal anaesthesia for caesarean section. It acts through both...
Midazolam Pharmacology
Midazolam is a water-soluble imidazobenzodiazepine that acts as a positive allosteric modulator of GABA-A receptors at the alpha-gamma subunit interface, enhancing chloride conductance to produce anxiolysis, amnesia,...
Midazolam: Pharmacology and Clinical Use
Midazolam is a short-acting benzodiazepine with anxiolytic, amnestic, sedative-hypnotic, and muscle relaxant properties. Mechanism : Positive allosteric modulation of GABA-A receptors (increases chloride conductance,...
Morphine
Morphine is the prototypical phenanthrene μ-opioid receptor (MOR) agonist, the gold standard against which other opioids are compared. Structure: Phenanthrene backbone (5-ring structure), tertiary amine, two hydroxyl...
Morphine Pharmacology
Morphine is the prototypical natural opioid analgesic derived from the phenanthrene alkaloid class, acting as a full agonist at mu (μ), kappa (κ), and delta (δ) opioid receptors with primary clinical effects mediated...
Motor Evoked Potentials in Anaesthesia
Motor evoked potentials (MEPs) monitor corticospinal tract integrity during surgeries risking spinal cord or brain motor pathway injury. Indications : Spinal deformity correction (scoliosis), spinal cord tumor...
Multiple Gestation and Anaesthesia
Multiple gestations (twins, triplets, higher-order multiples) complicate 1.6% of pregnancies in Australia but account for 10-15% of perinatal mortality and morbidity. Twin pregnancies are classified as monochorionic...
Near-Drowning and Submersion Injury
Near-drowning (submersion with survival 24 hours) causes severe hypoxic brain injury, pulmonary complications, and often hypothermia. Key principles:
Neonatal Anaesthesia
Fetal circulation physiology - PVR SVR, PDA-dependent lesions, transition challenges Immature organ systems - Low lung compliance, immature cardiac calcium handling, impaired thermoregulation Pharmacokinetic...
Neostigmine
Neostigmine is a reversible acetylcholinesterase inhibitor used to reverse non-depolarizing neuromuscular blockade (NMB) by increasing acetylcholine (ACh) concentration at the neuromuscular junction, overcoming...
Neostigmine and Anticholinesterase Pharmacology
Neostigmine is a quaternary ammonium anticholinesterase agent that reversibly inhibits acetylcholinesterase through carbamylation, increasing acetylcholine concentration at the neuromuscular junction to reverse...
Neuraxial Anaesthesia in Obstetrics
What is it? Neuraxial anaesthesia encompasses epidural, spinal, and combined spinal-epidural (CSE) techniques for labour analgesia and caesarean delivery. These techniques provide superior pain relief with minimal...
Neuromuscular Junction Physiology
Neuromuscular junction (NMJ) is cholinergic synapse between motor neuron and skeletal muscle. Motor neuron action potential → voltage-gated Ca²⁺ channels open → Ca²⁺ influx → ACh vesicle exocytosis (quantal release)....
Neuromuscular Monitoring
Concept Key Facts --------- ----------- Supramaximal stimulation Current 20-25% above maximal response; ensures all motor fibres activated Electrode placement Ulnar nerve at wrist (adductor pollicis); cathode distal...
Neuropathic Pain - Mechanisms and Management
Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as "pain caused by a lesion or disease of the somatosensory nervous system." It affects 6-10% of the general population, with...
Neurophysiological Monitoring
Intraoperative neurophysiological monitoring (IONM) detects neurological injury during surgery allowing prompt intervention to prevent permanent damage. SSEP (Somatosensory Evoked Potentials): Stimulation of...
Neurophysiology for Anaesthesia
Cerebral blood flow (CBF) is normally 50 mL/100g/min (15% cardiac output). Cerebral metabolic rate for oxygen (CMRO₂) : 3.5 mL/100g/min. Cerebral perfusion pressure (CPP) = MAP - ICP (or CVP, whichever higher), normal...
Neurostimulation & Ultrasound in Regional Anaesthesia
Neurostimulation and ultrasound guidance have transformed regional anaesthesia by improving block success rates and reducing complications. Ultrasound provides real-time visualization of nerves, needle trajectory, and...
Nitrous Oxide Pharmacology
Nitrous oxide (N2O) is a colourless, sweet-smelling inhalational anaesthetic agent with unique physicochemical properties that distinguish it from volatile anaesthetics. Key ANZCA Primary exam points include:...
Nitrous Oxide Pharmacology
Nitrous oxide (N2O) is a colorless, odorless, non-irritating gas and the only inorganic compound used as a general anaesthetic. It is the weakest inhalational anaesthetic with a MAC (minimum alveolar concentration) of...
Non-Invasive Blood Pressure Monitoring
Non-invasive blood pressure (NIBP) monitoring is a fundamental monitoring modality in anaesthesia, with the oscillometric method being the most widely used automated technique. An inflatable cuff occludes arterial...
Noradrenaline (Norepinephrine) Pharmacology
Noradrenaline (norepinephrine) is an endogenous catecholamine and the primary neurotransmitter of the sympathetic nervous system, acting predominantly at alpha-1 adrenoceptors (potent vasoconstriction) with additional...
Obstetric Haemorrhage - PPH and Massive Transfusion
Primary PPH is defined as blood loss ≥500 mL within 24 hours of vaginal delivery or ≥1000 mL following cesarean section. Major PPH is blood loss 1000 mL or blood loss accompanied by signs of hypovolemia. PPH affects...
Ondansetron Pharmacology
Ondansetron is a selective 5-HT₃ (serotonin type 3) receptor antagonist used primarily for the prevention and treatment of postoperative nausea and vomiting (PONV) and chemotherapy-induced nausea and vomiting (CINV)....
Oxycodone and Tramadol Pharmacology
Oxycodone and tramadol represent two distinct approaches to opioid analgesia with fundamentally different pharmacological profiles essential for ANZCA Primary examination. Oxycodone is a semi-synthetic opioid derived...
Oxygen Delivery Systems
Oxygen delivery systems provide supplemental oxygen to patients with varying degrees of efficiency and control. Variable performance devices (nasal cannula, simple mask): Delivered FiO2 depends on patient's...
Oxygen Transport & Haemoglobin Dissociation Curve
Oxygen transport from lungs to tissues occurs via two mechanisms: physically dissolved in plasma (3%) and chemically bound to hemoglobin (97%). Each gram of hemoglobin can bind approximately 1.34 mL of oxygen, giving...
Paediatric Airway Anatomy & Physiology
Paediatric airway management requires understanding of profound anatomical and physiological differences from adults. Infants have a proportionally larger occiput, larger tongue, higher larynx (C3-C4), and...
Paediatric Anaesthesia Principles
Paediatric anaesthesia requires understanding of age-related physiological differences . Airway : Large tongue, cephalad larynx (C3-4 vs C4-5 in adults), narrow cricoid (subglottic region), short trachea, prominent...
Paediatric Cardiac Anaesthesia
Understanding circulation patterns - Systemic vs pulmonary blood flow balance, Qp:Qs ratios Shunt physiology - Direction and magnitude affect oxygenation and cardiac output Single ventricle physiology - Series...
Paediatric Trauma
Blood volume - 80 mL/kg (neonate) to 70 mL/kg (older child); hypovolaemic shock manifests late TBI management - Age-specific GCS, higher tolerance for hypotension but avoid hypoxia at all costs Hypotensive...
Pain Pathways & Transmission (Gate Control Theory)
Pain transmission involves first-order neurons (Aδ myelinated, 5-30 m/s, sharp/fast pain; C unmyelinated, 0.5-2 m/s, dull/slow pain) from peripheral nociceptors → dorsal horn (substantia gelatinosa, Rexed laminae I,...
Paravertebral Block
Medial: Vertebral body (posterior aspect) Intervertebral disc Intervertebral foramen Lateral border of vertebral canal
Pelvic Fracture: Haemorrhage Control and Anaesthetic Management
Pelvic fractures in trauma are associated with life-threatening haemorrhage due to disruption of the extensive pelvic venous plexus and arterial network. Immediate haemorrhage control involves application of a pelvic...
Pericardiectomy for Constrictive Pericarditis
Pericardiectomy is the surgical removal of the pericardium for constrictive pericarditis, a condition where a thickened, fibrotic, or calcified pericardium restricts diastolic filling, creating a "stiff shell" around...
Perioperative Anaemia Management
Comprehensive guide to patient blood management, iron deficiency, EPO, and transfusion triggers for ANZCA Fellowship examination
Perioperative Anaphylaxis
Anaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction mediated by immunological (IgE or IgG) or non-immunological mechanisms. In the perioperative setting, IgE-mediated (Type I)...
Perioperative Anaphylaxis: Recognition, Adrenaline Dosing, and Refractory Management
Perioperative anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction occurring during or immediately after anaesthesia, with an estimated incidence of 1 in 10,000 to 1 in 20,000 anaesthetics....
Perioperative Arrhythmia Management
Comprehensive guide to atrial fibrillation management, beta-blockers, amiodarone, and perioperative cardiac rhythm disturbances for ANZCA Fellowship examination
Perioperative Aspiration: Mendelson Syndrome, Rapid Sequence Induction, and Cricoid Pressure
Perioperative pulmonary aspiration occurs in 1 in 3,000 to 1 in 6,000 general anaesthetics , with significant aspiration (leading to respiratory compromise) in approximately 1 in 10,000 . Mendelson syndrome —the...
Perioperative Cardiac Arrest
Hypoxaemia (25-30% of cases): Inadequate airway: Difficult intubation, CICV scenario, airway obstruction Ventilation failure: Equipment malfunction, circuit disconnection, esophageal intubation Pulmonary pathology:...
Perioperative Diabetes Management
Diabetes mellitus affects 5-10% of Australian surgical patients, with perioperative hyperglycaemia associated with increased wound infections (30% higher), mortality, and hospital length of stay. Preoperative...
Perioperative Diabetes Management: Glycemic Control, Insulin Protocols, and Hypoglycemia Prevention
Diabetes mellitus affects 10-15% of surgical patients , with perioperative hyperglycemia associated with increased morbidity including surgical site infections, delayed wound healing, cardiovascular events, and...
Perioperative Medicine and Optimisation
Comprehensive guide to perioperative optimisation, comorbidity management, and multidisciplinary care pathways for ANZCA Fellowship examination
Perioperative Temperature Management
Comprehensive guide to thermoregulation physiology, hypothermia prevention, temperature monitoring, and therapeutic temperature management for ANZCA Fellowship examination
Pharmacodynamics
The concept of receptors as specific drug recognition sites originated with Langley (1878) and Ehrlich (1900), establishing that drugs exert effects by interacting with discrete molecular targets rather than through...
Pharmacokinetics
The relevance of pharmacokinetics to anaesthesia is profound. Intravenous anesthetics, opioids, neuromuscular blocking agents, and vasoactive drugs all exhibit complex pharmacokinetic profiles that influence onset...
Phenylephrine Pharmacology
Phenylephrine is a synthetic, non-catecholamine sympathomimetic amine that acts as a selective alpha-1 adrenergic receptor agonist with minimal beta-adrenergic activity. Unlike catecholamines (epinephrine,...
Phenylephrine: Pharmacology and Clinical Use
Phenylephrine is a direct-acting α-1 adrenergic receptor agonist with potent vasoconstrictor effects and no β-activity. Mechanism : Stimulates postsynaptic α-1 receptors on vascular smooth muscle → vasoconstriction →...
Pituitary Surgery and Transsphenoidal Hypophysectomy
Transsphenoidal pituitary surgery requires managing endocrine dysfunction, fluid balance, and unique surgical positioning. Key principles:
Popliteal Sciatic Nerve Block
The popliteal fossa is a diamond-shaped space posterior to the knee joint containing the neurovascular structures supplying the lower leg and foot.
Postoperative Nausea and Vomiting Prophylaxis
Postoperative nausea and vomiting (PONV) affects 20-30% of surgical patients and 70-80% of high-risk patients, significantly impacting patient satisfaction, delaying discharge, and increasing costs. Risk...
Postoperative Pain Management
Somatic Pain: Tissue injury from surgical incision and manipulation Mediators: Bradykinin, histamine, prostaglandins, substance P, serotonins Receptors: Aδ and C fibers (Aδ: sharp, localized; C: dull, aching)...
Pre-eclampsia and Anaesthesia
Pre-eclampsia affects 3-5% of pregnancies in Australia and is a leading cause of maternal morbidity and mortality, with higher incidence in Aboriginal and Torres Strait Islander women (5-8%). It is defined as...
Pre-operative Assessment for Cardiac Surgery
Cardiac surgery represents one of the most extensively studied surgical specialties, with robust outcome data:
Pre-operative Cardiovascular Assessment
Perioperative cardiac stress results from sympathetic activation, fluid shifts, pain, and inflammation. Surgical stress increases myocardial oxygen demand while simultaneously compromising supply through tachycardia...
Preoperative Cardiac Risk Assessment
Comprehensive guide to cardiac risk stratification including RCRI, functional capacity assessment, and preoperative testing for ANZCA Fellowship examination
Pressure Transducers & Invasive Monitoring
Pressure transducers convert mechanical pressure into electrical signals for continuous hemodynamic monitoring. Modern disposable transducers use piezoresistive strain gauges arranged in a Wheatstone bridge circuit ,...
Prone Positioning for Surgery
Prone positioning is essential for posterior spinal, neurosurgical, and some plastic/ENT procedures. Physiological effects : Reduced cardiac output (10-20% decrease), increased central venous pressure, decreased...
Propofol
Propofol (2,6-diisopropylphenol) is the most commonly used intravenous anaesthetic agent for induction and maintenance of general anaesthesia and sedation in ICU. Structure: Simple phenol derivative with two isopropyl...
Propofol Pharmacology
Propofol (2,6-diisopropylphenol) is a phenol derivative intravenous anaesthetic that acts primarily as a positive allosteric modulator of GABA A receptors, particularly at the beta-subunit, increasing chloride...
Pulmonary Gas Exchange
Gas exchange between alveolar air and pulmonary capillary blood occurs through passive diffusion across the alveolar-capillary membrane driven by partial pressure gradients. The alveolar-capillary membrane consists of...
Pulse Oximetry
Core Physics: Two wavelengths : Red (660 nm) absorbed more by deoxyhemoglobin (Hb); Infrared (940 nm) absorbed more by oxyhemoglobin (HbO2) Ratio of Ratios (R) : R = (AC/DC)660 / (AC/DC)940, empirically calibrated to...
Pyloric Stenosis
Hypertrophic pyloric stenosis is a condition of acquired gastric outlet obstruction caused by hypertrophy of the pyloric muscle, typically presenting at 3-8 weeks of life with projectile vomiting. Key anaesthetic...
Quadratus Lumborum Block
Structure: The quadratus lumborum (QL) is a thick, quadrilateral muscle located in the posterior abdominal wall, extending between the 12th rib and the iliac crest.
Quality and Safety in Anaesthesia
Patient safety is a core competency for anaesthetists. Human factors : Understanding how humans interact with systems, equipment, and each other; human error inevitable, systems must be designed to prevent or catch...
Rectus Sheath Block
Formation: The rectus sheath is a fibrous compartment formed by the aponeuroses of the three lateral abdominal wall muscles (external oblique, internal oblique, transversus abdominis) as they envelop the rectus...
Remifentanil Pharmacology
Remifentanil is a synthetic ultra-short-acting mu-opioid agonist distinguished by its unique ester linkage that allows rapid hydrolysis by non-specific tissue and plasma esterases, resulting in organ-independent...
Renal Physiology
The kidneys maintain homeostasis through filtration, reabsorption, secretion, and excretion, processing 180 L/day of glomerular filtrate to produce 1-2 L urine. Renal blood flow: 20-25% cardiac output (1.0-1.2 L/min),...
Research Methodology, Statistics and Critical Appraisal
Hierarchy of Evidence: Systematic reviews/Meta-analyses (highest) Randomised Controlled Trials (RCTs) Cohort studies Case-control studies Case series/Case reports Expert opinion (lowest)
Respiratory Mechanics
The respiratory system functions as a pump that moves gas between the atmosphere and alveoli through cyclical changes in thoracic volume. Respiratory mechanics characterizes this pump's performance through three...
Respiratory Physiology
The respiratory system maintains gas exchange through ventilation, diffusion, and perfusion, tightly regulated to maintain PaO₂ 80-100 mmHg and PaCO₂ 35-45 mmHg. Ventilation: Tidal volume (500 mL) × respiratory rate...
Retinoblastoma - Ocular Oncology and Intra-Arterial Chemotherapy
Retinoblastoma is the most common primary intraocular malignancy in children , with an incidence of 1 in 15,000-20,000 live births (approximately 300 new cases per year in the USA, 8-10 per year in Australia). It is...
Robotic Surgery Anaesthesia
Robotic-assisted surgery (RAS) presents unique anaesthetic challenges due to the combination of pneumoperitoneum, steep Trendelenburg position (25-45°), and reduced patient access once robot docked. Da Vinci system :...
Rocuronium
Rocuronium is an aminosteroid non-depolarizing neuromuscular blocking agent (NMBA) with rapid onset (60-90 seconds) making it suitable for rapid sequence intubation (RSI) when succinylcholine contraindicated....
Sciatic Nerve Block
Origin: Formed from : L4-S3 nerve roots (sacral plexus) L4 contribution : From lumbar plexus via lumbosacral trunk Sacral contributions : L5, S1, S2, S3 ventral rami unite in greater sciatic foramen Formation : Within...
Severe Preeclampsia, HELLP Syndrome, and Eclampsia
Severe preeclampsia is defined as preeclampsia with severe features that indicate end-organ dysfunction and increased risk of maternal and fetal complications. It affects 2-8% of pregnancies globally and remains a...
Sevoflurane
Sevoflurane is a fluorinated ether inhalational anaesthetic with blood:gas partition coefficient 0.65 (low solubility), enabling rapid induction and emergence compared to isoflurane (1.4) and halothane (2.4). MAC...
Sodium Nitroprusside Pharmacology
Sodium nitroprusside (SNP) is a potent, rapid-acting, direct-acting vasodilator that produces arteriolar and venous dilation through non-specific release of nitric oxide (NO). It is a complex inorganic compound...
Spinal Anaesthesia
Spinal anaesthesia involves injection of local anaesthetic into the subarachnoid space producing rapid, dense sensory and motor block with predictable dermatomal distribution. Mechanism: Local anaesthetic acts on...
Spinal Cord Injury Anaesthesia
Spinal cord injury (SCI) patients present unique challenges due to autonomic denervation, altered drug responses, and multisystem complications. Key principles:
Spinal Cord Stimulation - Indications, Trial Period, and Complications
Spinal cord stimulation is a neuromodulation therapy that delivers electrical impulses to the dorsal columns of the spinal cord via implanted electrodes, modulating pain signals before they reach the brain. It is...
Spinal Injury Anaesthesia in Trauma
Acute spinal cord injury requires immediate spinal protection, cardiovascular stabilisation, and prevention of secondary injury. Key principles:
Strabismus Surgery - Oculocardiac Reflex, PONV, and Suxamethonium Alternatives
Strabismus surgery (squint surgery) is one of the most common paediatric surgical procedures , correcting misalignment of the eyes by tightening, loosening, or repositioning extraocular muscles. It is typically...
Sugammadex Pharmacology
Sugammadex is a modified gamma-cyclodextrin designed specifically to encapsulate and inactivate steroidal neuromuscular blocking agents (rocuronium vecuronium pancuronium), providing rapid and complete reversal of...
Supraclavicular Brachial Plexus Block
Location: Level : Divisions of brachial plexus (after trunks, before cords) Position : Posterior and lateral to subclavian artery, superior to first rib, inferior to clavicle Space : Interscalene groove continues,...
Suxamethonium (Succinylcholine)
Suxamethonium (succinylcholine) is the only depolarizing neuromuscular blocker in clinical use, providing rapid onset (30-60 seconds) and ultra-short duration (5-10 minutes) ideal for rapid sequence intubation....
Temperature Regulation
Temperature regulation maintains core temperature 36.5-37.5°C through balance of heat production, conservation, and loss, regulated by the hypothalamus. Heat production: Basal metabolic rate (BMR, 80 W at rest),...
Thermoregulation
The hypothalamus serves as the central thermoregulatory integrator, functioning as a biological thermostat with remarkable precision. The preoptic anterior hypothalamus (POAH) contains warm-sensitive neurons that fire...
Thiopentone (Thiopental) Pharmacology
Thiopentone (thiopental sodium) is a thiobarbiturate intravenous anaesthetic agent that was the original gold standard for anaesthetic induction for over 50 years before propofol's dominance. Its structure features a...
Thoracic Anaesthesia
Thoracic anaesthesia requires one-lung ventilation (OLV) for most intrathoracic procedures to provide surgical exposure and protect the dependent lung from contamination. Indications for OLV: Thoracotomy (lobectomy,...
Total Intravenous Anaesthesia (TIVA) and Target Controlled Infusion (TCI)
Total intravenous anaesthesia (TIVA) provides complete anaesthesia without volatile agents using continuous IV drug infusions, offering advantages in PONV reduction (50% lower than volatiles), neurosurgery (reduced...
Tracheo-Oesophageal Fistula (TOF)
TOF is a congenital anomaly where the trachea and oesophagus fail to separate during embryological development, creating abnormal connections. Oesophageal atresia (OA) is usually present. Key anaesthetic principles:
Tranexamic Acid Pharmacology
Tranexamic acid (TXA) is a synthetic lysine analogue antifibrinolytic agent that competitively inhibits plasminogen activation by blocking lysine-binding sites, thereby preventing fibrin clot degradation. TXA is...
Transversus Abdominis Plane (TAP) Block
The TAP block provides analgesia to the anterior abdominal wall (T7-L1 dermatomes) by depositing local anaesthetic in the transversus abdominis plane between internal oblique and transversus abdominis muscles where...
Traumatic Brain Injury: Secondary Injury Prevention and Neuroprotection
Traumatic brain injury (TBI) management focuses on preventing secondary brain injury caused by hypotension, hypoxia, hypercapnia, and intracranial hypertension. Cerebral perfusion pressure (CPP) should be maintained...
Vaporizers
Vaporizers convert liquid volatile anaesthetic agents into vapor for delivery to patients, requiring precise concentration control under varying conditions. Types: Variable bypass (most common, Tec type), measured...
Vasopressin and Analogues Pharmacology
Vasopressin (arginine vasopressin, AVP), also known as antidiuretic hormone (ADH), is an endogenous nonapeptide synthesised in the hypothalamic supraoptic and paraventricular nuclei and released from the posterior...
Vecuronium: Pharmacology and Clinical Use
Vecuronium is an intermediate-acting aminosteroid non-depolarizing neuromuscular blocker . Structure : Steroid nucleus with quaternary ammonium groups (bisquaternary). Mechanism : Competitive antagonist at nicotinic...
Venous Air Embolism - Detection and Management
Immediate Recognition: Sudden drop in EtCO2 (earliest sign) 2 mmHg drop from baseline Mill wheel murmur on precordial Doppler (characteristic churning sound) Sudden cardiovascular collapse during sitting position...
Ventricular Assist Device Implantation
Ventricular assist device (VAD) implantation is a major cardiac surgical procedure for patients with end-stage heart failure. The three configurations are: (1) Left VAD (LVAD) - most common (80%), blood inflow from...