This question was universally answered badly. Clearly most candidates had never anaesthetized a patient for the procedure nor had any knowledge about the procedure despite being part of the syllabus. Knowledge of the effects of one-lung anaesthesia, effects of a capnothorax and indications for a sympathectomy were relevant in the answer. The pass mark had been adjusted to reflect the level of difficulty (“hard”).
These ten key facts would have been sufficient for a pass (there were 23 in the model answer). a) Indications for transthoracic sympathectomy Hyperhidrosis Chronic pain/upper limb regional pain syndrome
b) General Implications Large bore IV access Potential for major haemorrhage May need arterial line Airway implications ￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼￼May need double lumen tube
c) Intraoperative problems Hypotension from capnothorax Hypoxia Postoperative problems May have residual pneumothorax May be painful
The mean score was 7.7/20. The question was a strong discriminator. Whilst the question appeared difficult most of the answer required a systematic approach.
a) What are the indications for “one lung anaesthesia”? (30%) b) List the methods of pre-operative assessment you would use to decide whether an adult could tolerate “one lung anaesthesia”. (30%) c) How could you manage the development of hypoxaemia during “one lung anaesthesia”? (40%)
Question11 Critical care/management of airway problem/tracheostomy