SIA - Anaesthesia for Patients with Complex Airway
Introduction
The advanced training module in Head and Neck airway management is for ST6-7 trainees with an interest in ENT and Maxillofacial anaesthesia and in teaching and training in advanced airway management. It is designed to provide trainees with clinical experience in a variety of advanced airway management techniques including fibre optic intubation. A commitment to audit, research and teaching in airway management is essential to trainees interested in doing this post. This programme is for a period of 6 months (9 months LTFT).
On completion the trainee is expected to have acquired a high level of knowledge and experience suited to management of difficult airway problems. The trainee is expected to have participated actively in audit, research and teaching and should have reached a level of competence suitable to take up a post of Consultant Anaesthetist with an interest in difficult airway management.
Programme
It is anticipated that the trainee will be allowed a minimum of 2 days per week dedicated to this module. This time will be spent with one of the named consultants with an interest in difficult airway management (page 2). In addition, where appropriate, all service provision lists will be conducted in an ENT or Maxillofacial list. Each trainee will be allocated an educational supervisor, who can be approached to discuss your training requirements.
Theatre lists
ENT and Maxillofacial lists occur in Theatre 8, Theatre 9 and Theatre 10 every day and all lists offer a range of interesting cases. Check CLW as these lists change occasionally. Every day there is one maxillofacial and two ENT lists.
Major resections
You should contact the booking secretary rebecca.handley3@nhs.net to ask for the dates and lists with upcoming major head and neck resections in advance. Then liaise with anaesthetic admin on ghn-tr.anaestheticadminteam@nhs.netto ask to be allocated to these lists.
MDT meetings
There is a Head and Neck MDT meeting which happens every Tuesday morning at GRH in the Redwood Education Centre at 08.15
Head and neck clinic
The Head and Neck clinics that are available for you to practice nasendoscopy occur on Tuesdays after the MDT meeting in ENT outpatients.
Email Mr Hall or Mr Constable with the dates that you are available so that he can check which would be most suitable.
On call
The trainee will be on the third on call rota whilst undertaking their Advanced Head and Neck Training module. This is a 1:8 on call.
Departmental airway training sessions and QI projects
The advanced trainee is expected to run regular teaching sessions in a ‘tea trolley style’ and protected time to do this can be arranged. Dr Patton co-ordinates this. These may also be delivered during an all-day head and neck case if agreed in advance with the supervising consultant.
This should aim to be on different days throughout the month to accommodate different job plans and trainee shift rotas. A list of topics and dates they have been covered will be available from Katie Patton (Catherine.patton@nhs.net) - the airway lead or the previous advanced trainee. The aim should be to deliver these equally across CGH and GRH. Suitable topics to cover include:
1) Emergency front of neck techniques (eFONA)
2) Plan B techniques such as use of Aintree catheter and fibrescope
3) Blocked or displaced trache management
4) Unanticipated difficult airway algorithm
5) Management of unanticipated difficult airway in special circumstances e.g. Paed, Obs, ICU
6) Jet ventilation techniques- more complex to organise
eFONA teaching
Contact Katie Patton (Catherine.patton@nhs.net) to get involved. This is a multi-disciplinary afternoon run with animal models and you will have the opportunity to take an organisational role.
Quality improvement and audit projects
The Advanced trainee is expected to play an active role in airway QI/research projects. We would support and encourage presentation of findings at local, regional or national meetings.
Clinical placements
Trainees are offered the opportunity to visit other NHS Trusts to gain experience of management of Head and Neck cases in different centres.
Oxford Heath NHS Foundation Trust
ENT and Maxillofacial services in Oxford are provided within two hospitals; the John Radcliffe and the Churchill. Every day they have multiple lists across both sites offering a wide range of cases.
To gain hands on experience during your attachment you will need to obtain an honorary contract. To do this, first contact Dr Shaun Scott (airway lead) on shaun.scott@ouh.nhs.uk to arrange a date for the clinical visit. Please note you will need to leave at least 12 weeks to allow the honorary contact to be issued, so plan early.
You will need to complete an honorary contract form available from Medical staffing (Maxine.grout@ouh.nhs.uk), and then return it to Dr Scott to complete the second part. This will be forwarded to HR who will then need you to complete a number of different forms as pre-employment checks; this will include an occupational health check and ID check. To chase up how it is progressing contact dominic.crowder@ouh.nhs.uk in the HR department.
You will have to visit the HR department to do your ID check before they will issue your honorary contract. To avoid an extra trip to Oxford for just an ID check consider spending one day in theatre as an ‘observer’, to meet Dr Scott and complete your ID check, then returned 6 weeks later on an official honorary contract.
On the day you start, take a copy of your honorary contract and photographic ID to the security office and they will issue you with a hospital ID page to allow you access throughout both hospitals (you can’t even use the toilet without this card!)
Royal National Throat Nose and Ear Hospital
To organise this clinical placement contact Dr Anil Patel (Clinical Lead) on anil.patel@uclh.nhs.uk. He will ask you to liaise with the department PA Jennifer Barton (Jennifer.barton@uclh.nhs.uk) to organise the appropriate forms.
You will only be offered an observer contract, which means it is much easier to organise. After completing one form you will hear back from HR who will need you to complete a limited online occupational health check. You will also need to organise an ID check. This ID check can be done the day before or the morning you start your placement as they will issue your contract immediately after seeing your ID. Start planning early and leave at least 8 weeks.
Anaesthetic Consultants with a specialist interest in Head & Neck and Airway
Dr Sarah Bakewell
Dr Kay Chidley*
Dr Simon Webster
Dr Dan Evans
Dr Sock Koh*
Dr Pete Sanderson*
Dr Judith Stedeford*
Dr Sam Andrews
Dr Marcin Pachuki
Dr Jim Self
Dr Ellie Waters
Dr Katie Patton- Airway lead
* Consultants who regularly jet ventilate.
ENT & Maxillo-facial Surgeons
The Anaesthetic department have a very good relationship with the ENT & Maxillofacial department who are very supportive of our trainees and our efforts to organise and deliver airway training.
ENT Consultants
- Mr Matthew Clark (Otology)
- Mrs Tira Galm (Rhinologist)
- Mr Charlie Hall*
- Mr John Hamilton (Otology)
- Mr Mike Thomas
- Mr Hugh Wheatley*
- Mr Oke Okankwo (Rhinologist)
- Mr Basu
- Miss Nina Mistry (Otology and paeds)
- Mr James Constable *
* Specialise in Head and Neck cancer
Maxillofacial Consultants
- Mr Simon Whitley**
- Mr Greg Knepil (Orthogynathic)
- Miss Margaret Coyle
** Cancer and Facial reconstruction work
Head and Neck SIA sign off:
Dr Patton and Dr Andrews are the module leads and will be responsible for signing off your module at the end of your 6 months.
Please refer to the SIA HALO Guidance in Appendix 1 of this document to see Key Capabilities and examples of evidence needed for HALO sign off at the end of the SIA module.
Structured Learning Events (SLEs)
There is no minimum requirement for numbers of SLEs during the SIA module but it is useful to undertake these regularly and to use them as evidence towards your sign off at the end.
Example DOPS (Direct Observation of Procedural Skills)
- Uses an alternative airway device in patients (e.g. iLMA, C Mac, AirTraq)
- Performs elective asleep fibre-optic intubation in the anaesthetised patient
- Anaesthetises the airway for awake fibre-optic intubation
- Performs elective fibre-optic intubation in awake patient
- Demonstrates skill in the use of conscious sedation for awake fibre optic intubation
- Performs a fibre optic intubation in emergency situation
- Performs jet ventilation for airway surgery
- Demonstrates use of Aintree catheter for intubation/extubation
Example A-CEX (Anaesthetic Clinical Evaluation Exercise)
- Undertakes a list of cases for surgery in the airway and where airway difficulty is anticipated
- Undertakes anaesthesia for laser surgery in or near airway
- Undertakes pre-assessment and discussed the available options for management of an anticipated difficult airway case
- Undertake anaesthesia for major ENT or maxillo-facial surgery such as laryngectomy or major resection for cancer and flap surgery
- Assess and anaesthetise patient requiring awake fibre-optic intubation including all discussions with the patient and preparation of equipment and operating theatre
Example CBD (Case Based Discussion)
- Discuss the anaesthetic technique and complications of any major head and neck case that you have done.
Example ALMAT (Anaesthetic List Management Tool)
- Undertakes anaesthesia for a list of maxillo-facial or ENT cases including complex operations (panendoscopy/pharyngeal pouch surgery/facial reconstruction/mandibular +/_ maxillary osteotomies/complex facial fracture reconstructions)
Example A-QIPAT (Anaesthetic Quality Improvement Project Assessment Tool)
- Undertakes Airway/Head and Neck related QI project and received appraisal and feedback
SIA leads