Surgical and Anaesthetic Instruments for OSCEs

A Practical Study Guide

Kelvin Yan

• Publisher: CRC Press
• Year: 2021
• Print ISBN:
  9780367358945
• eBook ISBN:
  9781000177183
• Topic: Medicina
• Subtopic: Anestesiologia e gestione del dolore

This book provides an exam-focused revision guide to both anaesthetic and surgical instruments. This is a comprehensive guide to passing an exam station and includes commonly tested knowledge.

The Anaesthetic section includes airway, breathing, circulation and analgesia equipment. Surgical instruments include those used in cardiothoracic surgery, ENT, general surgery, orthopaedics and urology. Each instrument entry follows a standard format – description, indications for use, contraindications and complications. The standard format ensures that learning about each instrument and when to use it is faster and easier, thus optimising exam recall.

• Fully illustrated with all the core anaesthetic and surgical instruments
• Concise, easy-to-remember text
• Portable and practical
• Suitable for a wide range of health professionals

The instrument syllabus is a small yet significant part of many exams, and this concise study guide will benefit a wide range of medical and surgical trainees, including those sitting the FRCA and MRCS examinations. Healthcare professionals, including nurses (ward or theatre), operating department practitioners and physician assistants (PAs), will also find the content useful as an on-the-job aide.

About the Author:

Dr Kelvin Yan, MRCP, AICSM is an NIHR Academic Clinical Fellow, University of Oxford and an Honorary Clinical Research Fellow, Imperial College London.

Part One

Anaesthetic equipment

1
Airway

1. 1) Endotracheal Tube
2. 2) Laryngeal Mask Airway
3. 3) i-gel
4. 4) Laryngoscope
5. 5) Yankauer Suction Tip
6. 6) Oropharyngeal Airway
7. 7) Nasopharyngeal Airway
8. 8) Heat and Moisture Exchanger
9. 9) Tracheostomy
10. 10) Intubation Fibrescope

Endotracheal Tube

What Is This?

This is an endotracheal tube which is used to secure a definitive airway (Figure 1.1). It is inserted into the trachea to ventilate the patient. It has an inflatable cuff to prevent aspiration.

Figure 1.1 Endotracheal Tube. Courtesy of Intersurgical Ltd.

What Are the Indications?

Main indications are 1) ensuring airway patency for ventilation and 2) preventing aspiration. In an elective situation, these include any prolonged operations, excessive movement of the head and neck during surgery and situations where major intraoperative complications or risks of regurgitation/aspiration are likely. Indications in emergency situations include the inability of a patient to protect their airway and/or ventilate (reduced Glasgow Coma Scale [GCS], cardiac/respiratory arrest), inability of a conscious patient to adequately ventilate (severe/life-threatening asthma attacks, severe chest infections, neuromuscular complications from conditions such as myasthenic crisis and Guillain-Barré Syndrome) and any potential obstruction of the airway such as anaphylaxis and respiratory burns.

What Are the Contraindications?

Severe trauma or airway obstruction proximal to the point at which the tube will be passed (pharyngeal foreign body, massive swelling of the pharynx). Special care must be taken in cases of cervical spine injuries where complete immobilisation is needed.

Do You Know of Any Complications of Using This Device?

Damage to the lips, teeth and oropharynx are not uncommon. Over-inflation of the cuff may cause high pressure on the tracheal wall leading to ischaemia whereas insufficient inflation may lead to a circuit leak. Misplacement/dislodgement of the endotracheal tube may lead to hypoxia and death. One-lung intubation as a result of the tube going too far can also lead to inadequate ventilation.

Laryngeal Mask Airway (LMA)

What Is This?

This is a laryngeal mask airway (Figure 1.2). It is used for supporting the airway sparing tracheal intubation. It was developed by a British anaesthetist, Dr Archie Brain, in the 1980s. It is inserted orally and sits in the hypopharynx against the upper oesophageal sphincter at the C6/C7 level.

Figure 1.2 Laryngeal Mask Airway. Courtesy of Intersurgical Ltd.

What Are the Indications?

It is mainly used for inhalational anaesthesia. It is also used for maintaining the airway in unforeseen circumstances such as managing the airway in emergency situations when intubation is difficult or when expertise for intubation is lacking.

What Are the Contraindications?

LMAs should not be used when a definitive airway is indicated. Examples include perioperative airway management when there is a risk of aspiration, muscle relaxation is needed and the prone position during surgery.

Do You Know of Any Complications of Using This Device?

Laryngospasm is a major complication of LMA during surgery. Other complications include nausea, vomiting, arytenoid dislocation, vocal cord paralysis and a sore throat. Cranial nerve injuries are uncommon but can include the lingual, recurrent laryngeal and hypoglossal nerves.

How Many Types of LMA Do You Know Of?

Supreme LMAs, flexible LMAs, i-gels.

i-gel

What Is This?

This is an i-gel which is a single-use, supraglottic device to support the airway and is available in 7 sizes (Figure 1.3). It is made from thermoplastic elastomer which is inserted supraglottically to form an anatomical seal with the pharyngo-laryngeal structures without the need for any cuff inflation.

Figure 1.3 i-gel. Courtesy of Intersurgical Ltd.

What Are the Indications?

These are by and large similar to those for a LMA. The added benefits of i-gels are...

Table of contents

• Cover
• Half-Title
• Title
• Copyright
• Contents
• Preface
• Author
• Part One Anaesthetic equipment
• Part Two Surgical Instruments
• Index