March 2015

A 55 year-old patient is due to have electro-convulsive therapy (ECT) for severe depression.
  • a)  What are the specific pre-operative considerations for ECT? (5 marks)
  • b)  What are the physiological effects of ECT (7 marks) and which physical injuries may occur during
    treatment? (3 marks)
  • c)  The patient is taking lithium and fluoxetine. What are the anaesthetic implications of these agents during ECT? (5 marks)
Electroconvulsive therapy Pass Rate 13.3%, 54.4% of candidates received a poor fail
Performance on this question was highly variable as reflected by the pass and poor fail rates, and the item was strongly discriminatory. Examiners felt that trainees did not have adequate experience of supervised working in non-theatre locations. Few seem to be attending ECT sessions, for example many candidates did not realise suxamethonium would be given and did not appreciate that myalgia is a common side-effect. Many thought that ECT could not be conducted safely in an isolated environment. Consent and mental health issues, problems with patient communication and the likelihood of comorbidity did not feature in many scripts. Of concern was failure to understand the significance of lithium or fluoxetine therapy as patients appearing on routine theatre lists may be taking these drugs; few candidates made mention of the potentiation of relaxants or volatile anaesthetic agents by lithium.
September 2013

You are asked to anaesthetise a 75-year-old man for an urgent DC cardioversion on the Coronary Care Unit (CCU). He has a broad complex tachycardia of 150 beats/minute, but is maintaining a systolic blood pressure of 70 mmHg and has a Glasgow Coma Score of 13/15.

a) List the advantages and disadvantages of providing anaesthesia in the CCU. (30%)

b) What factors must be taken into consideration when choosing an anaesthetic technique for this patient? (30%)

c) What complications may occur as a consequence of the procedure? (40%)
45.7% pass rate.
This question proved difficult for many candidates.

a) The advantages of providing anaesthesia in a Coronary Care Unit for a maximum of three marks included:
Avoiding the transfer an unstable patient to theatre
Cardiology Department skills readily available
Specialist equipment and drugs are immediately accessible
Allows earlier treatment

The most important disadvantage was anaesthetizing a patient in a remote and unfamiliar environment. This statement needed to be expanded to include the potential lack of monitoring (capnography), anaesthetic drugs, recovery and skilled assistance. Few candidates mentioned the difficulty in complying with the filling in of a WHO checklist.

b) Some of the factors that should have been considered before commencing anaesthesia included valid consent, recent investigations, starvation status and a potential need for intra- or inter-hospital transfer.

c) Required both anaesthetic and cardiological complications, the latter included arterial embolism, myocardial ischaemia, pulmonary oedema, burns to the patient and electrical injury to staff.
September 2010

a) What are the considerations when administering a general anaesthetic to a patient in the neuroradiology suite? (50%)

b) List the common interventional neuroradiological procedures that may require general anaesthesia. (20%)

c) Outline the possible complications of interventional neuroradiological procedures. (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2007

a) List the key points in the management of an unconscious (Glasgow Coma Scale 6) trauma patient before transfer to the CT scanner. There are no other apparent injuries but the cervical spine cannot be cleared. (50%)

b) Discuss the safe transfer of this patient to a CT scanner in the same building. (20%)

c) List the specific problems that may be encountered whilst in this environment. (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2006

An adult patient requires angiography and interventional radiology for a cerebral aneurysm.
(a) What potential problems may be encountered anaesthetising a patient in the Angiography Suite? (30%)
(b) What are the key Principles of Anaesthesia in this patient? (60%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question