Anaesthesia and Critical Care – Staff Page

Policies for Anaesthetics and Theatres

• Airways

  • Awake Fibreoptic Intubation Guidelines
  • COVID-19 ICU Intubation Checklist
  • C-Mac D blade tips
  • Difficult Airway Trolleys (DATs)

  Intubation – DAS Guidelines

  • Difficult intubation guidelines – overview
  • Management of unanticipated difficult tracheal intubation in adults
  • Failed intubation, failed oxygenation in the paralysed, anaesthetised patient

  Extubation- DAS Guidelines

  • Extubation – Basic Algorithm
  • Extubation – ‘At Risk’ Algorithm
  • Extubation – Low Risk Algorithm

  Intubation – Obstetrics – DAS Guidelines

  • Master algorithm – obstetric general anaesthesia and failed tracheal intubation
  • Algorithm 1– safe obstetric general anaesthesia
  • Algorithm 2 – obstetric failed tracheal intubation
  • Algorithm 3 – can’t intubate, can’t oxygenate
  • Table 1 – proceed with surgery?
  • Table 2 – management after failed tracheal intubation

  Intubation – Paediatrics – DAS Guidelines

  • Difficult mask ventilation (MV) – during routine induction of anaesthesia in a child aged 1 to 8 years
  • Unanticipated difficult tracheal intubation – during routine induction of anaesthesia in a child aged 1 to 8 years
  • Cannot intubate and cannot ventilate (CICV) in a paralysed anaesthetised child aged 1 to 8 years

• Anaesthetic Emergencies

  Flow Charts

  ALS / BLS

  • Anaphylactic reactions – initial treatment
  • Anaphylaxis algorithm
  • ALS Bradycardia Algorithm
  • ALS Tachycardia Algorithm
  • ALS Paediatric Advanced Life Support
  • ALS Adult advanced life support

  AAGBI

  • Management of Malignant Hyperthermia
  • Management of Severe LA Toxicity

  Tracheostomy

  • Patent upper airway

  Quick Reference Handbook - Association of Anaesthetists

  • 1-1 Key Basic Plan
  • 2-1 Cardiac arrest 
  • 2-2 Hypoxia desaturation cyanosis
  • 2-3 Increased airway pressure 
  • 2-4 Hypotension
  • 2-5 Hypertension 
  • 2-6 Bradycardia 
  • 2-7 Tachycardia 
  • 2-8 Peri-operative hyperthermia
  • 3-1 Anaphylaxis 
  • 3-2 Massive blood loss 
  • 3-3 Can’t intubate, can’t oxygenate (CICO) 
  • 3-4 Bronchospasm 
  • 3-5 Circulatory embolus 
  • 3-6 Laryngospasm and stridor 
  • 3-7 Patient fire 
  • 3-8 Malignant hyperthermia crisis 
  • 3-9 Cardiac tamponade 
  • 3-10 Local anaesthetic toxicity 
  • 3-11 High central neuraxial block 
  • 3-12 Cardiac ischaemia 
  • 3-13 Neuroprotection following cardiac arrest
  • 3-14 Sepsis 
  • 4-1 Mains oxygen failure 
  • 4-2 Mains electricity failure 
  • 4-3 Emergency evacuation 

• Anaesthetics - General Policies

  • Anaesthesia in a non-theatre environment – guidelines
  • COVID-19 Intubation Checklist
  • Essential induction information
  • Inadvertent dural puncture
  • Perioperative complications of neuraxial blockade
  • Perioperative management of the morbidly obese surgical patient – guidance
  • Spinal Pathway (Appendix 2 of Perioperative Complications of Neuraxial Blockade)

• COVID-19

  • COVID-19 CPR Action Card
  • COVID-19 ICU Guidance
  • COVID-19 ICU Intubation Checklist

• Critical Care

  • Acute Bi-Level Non-Invasive Ventilation
  • AKI guidelines
  • Anaesthetic Department ICU Handover
  • Children requiring Intensive Care in absence of IC beds – Escalation Procedure
  • Care of ICU patients when Demand Exceeds Capacity – Guidelines
  • COVID-19 ICU Guidance
  • COVID-19 ICU Intubation Checklist
  • Critical Care Management after Cardiac Arrest Guideline
  • Delirium – Best Practice Guidance
  • Stabilisation and transfer of children
  • Therapeutic tinzaparin monitoring

• Emergency Department

  • Adult Critical Care Transfer Guidelines
  • Emergency Airway Management Statement (RCEM-RCoA)
  • Major Incident Response Plan
  • Paediatric Airway Management

• Obstetrics

  • Care and Planning of Maternal Patients with Cardiac Disease
  • Caesarean Associated Recovery Enhancement (CARE)
  • Drill for High Regional Block in Obstetrics
  • Epidural top-up for CS
  • Epidurals in Obstetric Patients
  • Failed intubation Flowchart
  • Handover of Care – Medical Staff on labour ward
  • Handover of Care – Obs, including transfers
  • Inadvertent dural puncture in Obstetric patients
  • Massive Obstetric Haemorrhage Guide
  • Obstetric Anaesthetic Referral Form
  • Obstetric General Anaesthesia
  • Obstetric Handbook 2021
  • Obstetric Haemorrhage Guide
  • Obstetric High Dependency Care (CNST)
  • Post Anaesthetic Recovery (CNST)
  • Post Operative Analgesia in Maternity Unit
  • Pudendal Nerve Block
  • Referral to the High Risk Obstetric Anaesthesia Clinic
  • Remifentanil PCAS for Analgesia in Labour
  • Spinal Anaesthesia
  • TEG6s Guide for Clotting Product Use on Labour ward

  Intubation – Obstetrics – DAS Guidelines

  • Master algorithm – obstetric general anaesthesia and failed tracheal intubation
  • Algorithm 1– safe obstetric general anaesthesia
  • Algorithm 2 – obstetric failed tracheal intubation
  • Algorithm 3 – can’t intubate, can’t oxygenate
  • Table 1 – proceed with surgery?
  • Table 2 – management after failed tracheal intubation

• Paediatrics

  • ALS Paediatric Advanced Life Support
  • Admission of Children to Adult Wards
  • APA Guidance on Vaccinations
  • Codeine for analgesia: Drug Safety Update – restricted use in children because of reports of morphine toxicity
  • Codeine Guidance – for the administration of codeine and alternative opioid analgesics in children – RCoA
  • Daycase Tonsillectomy + OSA Criteria
  • Children requiring Intensive Care in absence of IC beds – Escalation Procedure
  • Management of children and young people with diabetes during surgery
  • Paediatric Fasting Guideline
  • Paediatric ‘Next Day’ MRI / CT under GA
  • Paediatric Pain Guidelines
  • Stabilisation and transfer of children

  Intubation – Paediatrics – DAS Guidelines

  • Difficult mask ventilation (MV) – during routine induction of anaesthesia in a child aged 1 to 8 years
  • Unanticipated difficult tracheal intubation – during routine induction of anaesthesia in a child aged 1 to 8 years
  • Cannot intubate and cannot ventilate (CICV) in a paralysed anaesthetised child aged 1 to 8 years

• Pain

  • Contacting the inpatient pain service
  • Acute pain management guidelines
  • Acute pain guidelines for analgesic adjuncts
  • Epidural analgesia
  • Intrathecal opiates
  • Ketamine in acute pain management
  • Local anaesthetic infusions via elastomeric pumps
  • Long term opioid guidance
  • Paravertebral infusion
  • PCAS – The use of PCAS for the delivery of intravenous opioid analgesia
  • Prescribe and administer a PCA loading dose or bolus on EPR
  • Prescribe and administer an intrathecal opiate on EPR
  • Prescribing Epidural Infusions on EPR
  • Prescribing Pain Busters on EPR
  • Prescribing Patient Controlled Analgesia on EPR
  • Referral to acute pain team

• Perioperative Medicine (including enhanced recovery pathways)

  • Anaesthesia for Robotic Cystectomy
  • Anaesthesia for Laparoscopic colorectal surgery
  • Arthroplasty Anaesthetic Regimen
  • Handbook of Peri-operative Medicines
  • Oesophagectomy Care Pathways
  • Paediatric Fasting Guideline
  • Perioperative care of the elderly and assessment of frailty
  • Perioperative pacemakers protocol
  • Pre-op Guidelines
  • Post Oesphagectomy Analgesia

• Pre-assessment

  • Management of adults with diabetes
  • Paediatric Fasting Guideline
  • Perioperative pacemakers protocol
  • Pre-op Guidelines

• Post-op Care

  • Discharge Advice Letter (Spinal anaesthesia)
  • Post Oesphagectomy Analgesia
  • Post Operative Analgesia in Maternity Unit
  • Post op nausea and vomiting guidelines
  • Post-procedural review

• Theatres

  • 5 steps and WHO checklist – SOP
  • Care of ICU patients when Demand Exceeds Capacity – Guidelines
  • Death on the table – Appendix 6 of Bereavement Policy
  • Handover protocol
  • Insertion of Throat Packs – SOP
  • Intraocular Lens implantation ENT Theatres – SOP
  • NELA Care Pathway
  • Perioperative pacemakers protocol
  • Pressure Ulcer prevention in theatres – SOP
  • Process for changes to operating lists on day of surgery – SOP
  • SAD (Supraglottic Airway Device) removal protocol – SOP
  • Safe staffing in theatres – SOP
  • Theatres specimen policy – SOP
  • Warming of IV and Irrigation Fluids – Guidelines

• Trust Policies

  • Bereavement Policy
  • Cardiopulmonary Resuscitation Policy
  • Consent Policy
  • Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy
  • Major Incident Response Plan
  • Policy on Sedation for Procedures in Adults