CURRICULUM

FOR
DOCTOR OF MEDICINE IN ANAESTHESIOLOGY
(MD ANAESTHESIOLOGY)

KATHMANDU UNIVERSITY
DHULIKHEL, KAVRE
NEPAL
2017

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 KATHMANDU UNIVERSITY

Post Graduate Training Programme in Anaesthesiology

General Informa9on

Three years MD Anaesthesiology is a medical speciality, which includes

patient's assessment and provisions of life support, analgesia for surgical
procedures and childbirth as well as assessment and management of critically ill
patients and management of pain. This postgraduate training programme in
anaesthesiology of the Kathmandu University was started from the academic
year 2002 and has been running at the medical colleges under the university
together with placements of trainees at recognized health institutions of the
country.

This curriculum is a general guide and the student should use as such. This
curriculum guides the student to master the commoner problems and to become
familiar with many other problems so that he/she is able to search for additional
information whenever it becomes necessary. The recent advances and new
information in anaesthesiology are so vast that it is almost impossible to keep
on self up to date.

The subject committee will add or modify the subject contents from time to
time and this will be included in the annex V.

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 Contents

Page

1. Course Description 1

2. Overall Objectives 1

3. Course Objectives 2

4. Eligibility Criteria 2

5. Selection Criteria 2

6. Academic, Administrative Rules and Regulation 3

7. Specific Objectives 4

8. Outline of the Syllabus 6-11

9. Training Requirements and training schedules 12-13

10.Training Centres 14

11.Evaluation 14

12.Degree 15

13.Annex I : Thesis 16-17

14.Annex II : Evalua9on Scheme 18-20

15.Annex III : Evalua9on criteria for wriKen thesis 21

16.Annex IV :Suggested Reading 22-23

17.Annex V : Subject Content 24-42

Annex VI: Chart models for final exam 43-46

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1. COURSE DESCRIPTION

The MD Anesthesiology course is designed to provide a proportionate blend

of practical work in all the specialties - sugery, reconstructive surgery,
cardiothoracic surgery, neurosurgery, urology, gastroenterology, orthopaedics
with special reference to total replacement of joints, prosthesis etc.,
maxillofacial as well as paediatric surgery, otorhinolaryngology,
ophthalmology and obstetrics & gynecology. The theoretical studies cover the
entire spectrum of the various branches of anesthesiology - anatomy,
physiology, pharmacology and physis as applicable to anesthesia. This
curriculum is designed to give students the basic theoretical knowledge in
managing life supportive therapy for critically ill patients in intensive care
unit during their clinical posting.Moreover, pain management is an integral
part of anaesthesiology,so basic pain medicine has been elaborated in the
course.

The course will have its appropriate emphasis on the problems encountered in
this part of the world. The student is expected to gradually develop problem
solving skills through a blend of instruction, supervision and intensive
practical training and individual reading. The student will also be encouraged
to acquire skills in Anaesthesia techniques, teaching and clinical research
work.

2. OVERALL OBJECTIVES

Overall objective is to train, educate and produce anaesthesiologist who will

attain minimum standards at par with prevalent standards in the developed
world.

The other objective is to induce in the trained anaesthesiologist a desire to

make continuing education a part and parcel of his/her career, through
intensive practical work and introduction to a wide range of reading
material.

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3. COURSE OBJECTIVES

At the end of the specified three years of training the trainee is expected to be
able to
1. Assess and prepare patients for anaesthesia.
2. provide insensibility to pain during surgical, obstetric, therapeutic and
diagnostic procedures and manage these patients
3. monitor and restore homeostasis in the critically ill, injured and seriously
ill patients.
4. manage and teach cardiac pulmonary and cerebral resuscitation
5. manage painful syndromes
6. supervise, teach and evaluate performances of both medical and other
health personal involved in anaesthesia, respiratory and critical care
patients.
7. conduct research at the clinical and basic science level to explain and
improve the care of patients.
8. develop qualities of initiatives, creativity, sound judgement and logical
deduction so as to provide academic leadership in anaesthesia
9. Should be aware of the recent advances and developments in medical
sciences as related to anaesthesia, analgesia and critical care.

4. ELIGIBILITY CRITERIA

The candidates should have:

• MBBS or equivalent degree in modern medicine from a recognized
university, or
• Post-graduate qualification recognized by the university.
• Full registration (temporary/permanent registration) with Nepal Medical
Council.

5. SELECTION CRITERIA

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 Selection will be based according to the rules and regulations of the
university: Norms and Standards for Postgraduate Medical Degree
Programme.

6. ACADEMIC, ADMINISTRATIVE RULES AND

REGULATIONS
• The postgraduate students will go through a 3 years full time residential
training.
• No special time off will be allowed for thesis work.
• Two weeks leave is permitted during one academic year and not more than
one week at a time.
• Besides the rules and regulations of the university, the candidate must
∗ Be present on time and sign an attendance register.
∗ Be familiar with duty schedule, expected role and responsibilities.
∗ Obey the rules and regulations of the institution where they are
working.
∗ Perform expected duties and share the responsibilities as a unit team
member.
∗ Get leave sanctioned by the concerned authority.
∗ Inform their respective preceptor/ programme co-ordinator when they
are sick.
∗ Have to be on emergency duty, where applicable at least twice a week
as assigned by the head of the department.
∗ Not get involved in private practice.
∗ Have full time engagement: resident may need to live in the hospital
premises as and when required.
∗ Be primarily responsible for the pre-anesthesia evaluation,
premedication, anesthesia techniques/procedures and post-operative
recovery phase of the patients under the supervision of the teacher/
consultants.
∗ Be responsible for guiding and instructing his/her juniors as per the
directions of the programme director or a person delegated by him.
∗ Maintain a logbook, which should be entered regularly for the whole
period of training and not retrospectively.
∗ Get the signature of the preceptor/supervisor regularly.

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 ∗ Be present for inspection to the subject committee co-ordinator every
three months and at the time of application to sit for the Final MD
Examination.
7. SPECIFIC OBJECTIVES

Year wise training schedule:-

FIRST YEAR
Student should be able to
• Have knowledge on Basic sciences related to Anesthesiology
• Understand Setting up of operation theatre
• Gain knowledge on Basics of computer, Internet, biostatistics, research
methodology
• Choose thesis topic, submit thesis proposal, collect research literatures as
per University direction
• Perform and demonstrate Basic skills in CPR
• Manage anaesthesia for ASA grade I, II patients,
• Interpret radiological findings, ECG, common laboratory investigations
• Participate in topic presentations & other departmental academic
activities.
• Communicate effectively with patients, patients relatives and colleagues
• acquire and develop emotional intelligence in work place (OR, ICU, Pre-
anesthetic consultation area and PACU)
• Sit for internal assessment at the end of first year

SECOND YEAR
Student should be able to
• Gain Thorough knowledge of scientific basis of Anaesthesia, critical care,
resuscitation & pain management
• Detecting & managing perioperative problems
• Organize departmental academic meetings. - Case presentations, seminars
& journal presentations
• Attend CME/conference & present scientific paper
• Complete thesis work, periodic reviews of thesis work with preceptor
• Manage anaesthesia for ASA grade III, IV patients.
• Manage anaesthesia for superspecialised surgical procedures under
supervision.
• Teach junior staff and students

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 • Prepare for internal assessment at the end of second year

• ACQUIRE PROCEDURAL SKILLS :

1. Insert central venous Iines (Int. jugular, subclavian, femoral) under

supervision.
2. Insert arterial catheter independently.
3. Perform spinal sub arachnoid, epidural blocks independently.
4. Perform regional blocks - Brachial, Sciatic, Femoral nerve blocks, caudal
block in children both topographical and ultrasound guidance.
5. Insert peripheral IV lines in neonates and infants.
6. Assemble and calibrate transducer independently.
7. Perform fibreoptic endotracheal intubation under supervision.
8. Perform emergency airway maneuvers including tracheostomy,
percutaneous cricothyrodotomy under supervision.
9. Set up the mechanical Ventilator in ICU

THIRD YEAR
Student should be able to

• Be Well versed with knowledge of anaesthesiology & allied specialities

• Have Knowledge regarding recent advances in the subject
• Be Competent in basic pain therapy & palliative care
• Help senior faculties in complicated procedures & resuscitation
• Have Leadership role in critical care & resuscitation team
• Develop Good teaching & communication skills
• Manage anaesthesia for superspecialised surgery independently/under
guidance.
• Manage patients on long term mechanical ventilation
• Submit thesis at least six months prior to final MD (anesthesia)
examination
• Participate actively in teaching the junior residents/nurses/paramedics/
students of other rnedical departments
• Organize work schedule
• Attend internal assessment at the end of third year prior to final
University exam

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8. OUTLINE OF THE SYLLABUS

The syllabus for the postgraduate course in anesthesiology can be divided

into three parts.
1. Basic Sciences
2. Clinical Sciences
3. Scientific Analysis

The MD degree course in anesthesiology is a three-year course, consisting of

all three parts.

BASIC SCIENCES

Basic Sciences include the following subjects.

• Anatomy
• Physiology
• Pharmacology including applied microbiology and pathology relevant
to critical care of patients
• Physics and measurements
• Equipments

At the end of the course, the postgraduate student should be able to describe -
verbally as well as in writing - the theoretical and applied aspects of

Anatomy of:

Respiratory System
Cardiovascular System
Nervous system including nerve plexuses
Urinary system
Gastrointestinal System
Genitourinary System

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 Physiology of :

Respiratory system
Nervous system and autonomic nervous system
Neuromuscular junction
Gastrointestinal system/Nutrition
Renal system.Fluid and Electrolyte balance
Temperature Regulation
Acid Base Balance
Endocrine System
Coagulation
Pregnancy and neonatology

Pharmacology consisting of :
a. General pharmacology (Routes of drug administration, metabolism,
toxicology and drug interactions )
b. Pharmacokinetics and pharmacodynamics of Opioid analgesics,
Intravenous inducing agents and inhalational anesthetic agents.

Clinical pharmacology of
• Intravenous anesthetic agents
• Inhalational anesthetic agents
• Muscle relaxants and antidotes
• Local anesthetic agents
• Sedatives
• Narcotic analgesics
• Vasoactive agents
• Cardioactive agents
• Bronchodilators
• Anticoagulants and their antidotes
• Agonists and antagonists of autonomic nervous system
• Anticonvulsants
• Diuretics
• Antiemetics
• Histamine antagonists
• Antimicrobials and antibiotics and antifungals
• Hypoglycemic agents

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 • Antithyroid and thyrotropic agents
• Corticosteroids
• Antipsychotic drugs
• Nonadrenergic vasopressures( vasopressin)
• Vasodilators( Nitrate,Sodium natropruside)

Physics and measurements

The definitions and applications of
∗ gas laws
∗ units of measurements
∗ principles governing gas flows/densities/viscosity/pressures/
vaporization

Principles of equipment design and function

Anaesthesia machines including vaporizers and breathing systems
Patient Monitors: Electrocardiography/ Oximetry/ Capnography/
Temperature measurement/ Vascular pressure transducers
∗ Oxygen therapy devices
∗ Artificial ventilators
∗ Humidifiers and nebulisers
∗ Defibrillators
∗ Peripheral nerve stimulators
∗ Infusion pumps/ In line fluid warmers
∗ Spiromerters
∗ Sterilization of equipment
∗ Endotracheal tubes, laryngeal mask, airways, tracheotomy
∗ Equipment for local and regional field block

Medical Statistics
Definition and implication of the following

1. Design of clinical trials and their presentation

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 2. Bias control.
3. Methods of randomization.
4. Sample size calculation (power study)
5. Mean/ median/ mode.
6. Standard deviation.
7. Calculation of p-value and scientific interpretation
8. Students‘t' test/ chi-square test.
9. Odds ratio.
10.Critical Analysis of thesis results, Develop originality during writing of
discussions in thesis work, seek limitations and drawbacks of research
project, be able to give recommendations and draw conclusions as per set
study objectives of thesis work
11.Systems of referencing scientific literatures
12.Basic computer applications

CLINICAL SCIENCES

At the end of the training, the postgraduate student should be able to narrate -
verbally as well as in writing the following.
• Pre-operative assessment and optimization , including assignment to the
physical status as described by the American Society of Anesthesiologists
(ASA), patient education, informed consent and record keeping.
• Methods of preoperative airway evaluation
• Orders for pre-operative fasting, medication and investigations.
• Anesthetic implications of common diseases in Nepal.
• Anesthetic sequence for ASA I to III patients coming for elective as well as
emergency surgery with particular reference to assessment of the upper
airway and management of the difficult airway.
• Anaesthesia for Paediatric surgery (also covering neonatal emergencies).
• Anaesthesia for Orthopedic surgery with emphasis on use of limb
tourniquet, total joint replacement surgery, correction of scoliosis and
trauma.
• Anaesthesia for urological surgery including endoscopic resections,
lithotripsy and renal transplantation.
• Anaesthesia for ophthalmic surgery
• Anaesthesia for dental, maxiofacial, neck and ENT surgery including
endoscopies.

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• Anaesthesia for plastic surgery (especially for acute burns)
• Anaesthesia for endocrine disorders
• Anaesthesia for obstetrics and gynecology (including caesarean section,
Obstetric anaesthesia and neonatal resuscitation).
• Anaesthesia for neuro surgery (with special emphasis on control of
intracranial pressure and problems in sitting position).
• Anaesthesia for cardiac surgery (especially closed heart surgery).
• Anaesthesia for patients with respiratory diseases.
• Anaesthesia for neuro muscular disorders.
• Anesthesia for drug addicts, alcohol withdrawals and other uncommon
diseases.
• Spinal, epidural and other regional techniques.
• Techniques for the relief of acute and chronic pain.
• Steps of resuscitation as per the recommendations of the American Heart
Association.
• Management of critically ill patients in the intensive care unit.
• Medico legal considerations in Anaesthesia. Record keeping in anesthesia.
Reporting critical incidents
• Risk of anesthesia
• Postoperative visual loss
• Patient positioning and anaesthesia
• Monitoring the depth of anaesthesia
• Basic ultrasound use in perioperative care of patients
• Anesthesia for Geriatric patients, Geriatric physiological deviations,
precautions and planning for perioperative care

The postgraduate students also should be familiar with some

special situations like:

• Anaesthesia in unfamiliar surroundings( CT,MRI and endoscopic suits)

• Modified electroconvulsive therapy.
• Laparoscopic surgery.
• Deliberate hypotension techniques.
• Laser resections.

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• Fundamentals of cardiopulmonary bypass.
• Hypothermia.
• Outpatient anaesthesia
• Operating room management
• Fire and Electrical safety in the operating rooms
• Management of postanaesthesia care unit (PACU) and discharge criterias
from PACU
• Anaesthetic accidents and their prevention.
• Blood conservation techniques.
• Smoking/ alcohol and anaesthetic implications.
• Management of bleeding disorders.
• Anesthetic implications and implanted pacemakers.
• Anaesthesia for obese patients,obstructive sleep apnoea.

SCIENTIFIC ANALYSIS AND PRESENTATION

During the course, the postgraduate student will be trained to

• critically analyze scientific articles in medical journals
• plan and execute a scientific study in the clinical settings
• present the outcome of a study in the form of thesis (including a review of
relevant literature)
• have preliminary experience in commonly used teaching methods

9. TRAINING REQUIREMENTS

The minimum of three years of approved training includes the following:

A. Two years of approved resident training in anaesthesia. This period is

designated as the primary training for the science and clinical practice
of anaesthesia. The following minimum requirement may be undertaken as
separate/rotations or interspersed with one another, provided that experience
fulfilling the minimum requirements is obtained:

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 a) Adult anaesthesia - will include anaesthesia for general surgery,
Trauma and orthopaedics,gynaecology, ENT, ophthalmology and
plastic surgery etc.; and anaesthesia for psychiatry, radiological
procedures, maxiofacial and dental surgery and day case anaesthesia.
b) Some experience in obstetric and paediatric anaesthesia during the first
year is also desired. A minimum of six months will be spent in adult
anaesthesia before posting to obstetric or paediatric anaesthesia.
c) In the second year there will be posting in each of obstetric and
paediatric anaesthesia.
The thesis work should also complete within this year.

B. Remaining period will be posting in cardiac and neuroanaesthesia and

posting in ICU and pain management. There should also be posting for a
period of time in the department of medicine. This will allow the trainee to
develop mature and effective physician - patient relationship and to acquire
the general medical knowledge necessary to function as a competent
consultant in anaesthesia.

C. In the third year there will be an elective period. In this period posting will
be one at the discretion of the programme director/preceptor in one or more
of the following areas:
i. At a surgical camp.
ii. To a clinical or basic science area where the candidate is deficient,
as recommended by the preceptor.
iii. To a clinical or basic science area requested by the candidate.
iv. to any other approved hospital for acquiring special and useful
experience.
v. rotation to acute and chronic pain management.

The purpose of this training is to address deficiencies in earlier training,

diversify the resident's experience, or to develop subspecialty interests.

The trainee will be on emergency duty twice a week including night duty

Training Schedule

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 PG 1 year PG 2 year PG3 year
Month General OR Ambulatory Elective
1 anaesthesia
Month ICU General OR
2
Month General OR
3

Month Obstetrical General OR

4 Anesthesia
Month Pain Management Medical Posting(Respiratory/
5 cardiology/nephrology)

Month Cardiac Anesthesia ICU

6
Month Pediatric Anesthesia
7
Month Preoperative clinic Neuro Anesthesia Obstetrics Anesthesia
8
Month Post Anesthesia Regional Anesthesia
9 Care Unit

Month Obstetric Anesthesia Thoracic General OR

10 Anaesthesia
Month Pain Management Gynecology and General OR
11 Obstetrics anesthesia
Month Basic radiology/image ENT Neck ,Dental General OR
12 reading(MRI/CT/US/ Maxiofacial
Plain films) Anesthesia

The following teaching activities are recommended:-

• Topic presentations
• Subject seminars
• Multidisciplinary symposiums
• Journal clubs
• Case presentations
• Problem oriented case discussions
• Morbidity & mortality meetings
• Critical Evaluation of complications

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 • Inter departmental discussions
• CME programmes & conferences (at least one participation / presentation
by the candidate would be better)

10. TRAINING CENTRES

• Medical college and hospitals under Kathmandu University.

• Other institutions and hospitals approved by the university.

11. EVALUATION (see Annex II)

• The evaluation will consist of formative and summative.

• Formative Evaluation

i. This is a continuous process throughout the period of training in the

form of a periodic assessment both by the preceptor and the supervisor
under whom the candidate is working. The preceptor will be
responsible for evaluating the report and take necessary action. The
report will be submitted to the university as required.
ii. The grading will be based on:
iii. Log book entries
iv. Bedside discussions
v. Participations and performance in various academic activities
vi. Internal assessment

• Approved Thesis will be compulsory for Final Examination (see Annex

I).

• Summative Evaluation
· Summative Evaluation will be carried out at the end of the course
by the university.

12. DEGREE

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 The successful candidates will be awarded the degree of Doctor of Medicine
in Anaesthesiology [ MD Anaesthesiology] by Kathmandu University.

ANNEX-I

THESIS
A. Implementation plan for thesis

Time (months)

1. Submission of abstracts on three different topics along with the

review of Literature. Approx.4.5

2. Approval of the topic by the subject committee. " 6

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3. Approval of the protocol by the subject committee. " 7
4. Collection of the data to be completed. " 20
5. Submission of thesis/dissertation to the preceptor for preliminary
approval. " 24
6. Submission of thesis/dissertation to the university. " 32
7. A copy of the approved thesis/dissertation to be sent to the
expert. " 34
8. The final approval of thesis/dissertation to be done by the Expert/External
Examiner.

B. Format of thesis/dissertation

1. Pages: the number of pages should not exceed 100 pages.

2. Size of the paper: A4
3. Justification: both sides
4. Typed double space.
5. Margins: at least 2.5 cm. on each side.
6. The font of the letters should be 12 points.
7. The cover page should show the topic, name of the candidate, the degree for
which it is being submitted and the year of submission.

8. The thesis/dissertation should be written on the following broad headings,

which may be modified at the discretion of the preceptor.

a. First page: should mention the topic, degree for which it is being
submitted, name and previous educational qualifications of the candidate,
institution where he study was carried out.
b. Dedications to persons if any.
c. Declaration: The candidate must declare and sign stating that the thesis
has not been submitted in candidature for any other degrees. The
preceptor should also certify the thesis/dissertation.

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d. Acknowledgements
e. Ethical committee clearance Certificate.
f. Table of contents
g. An abstract of the completed work should be attached
h. Glossary of abbreviations.
i. Text of the thesis/dissertation:
1. Introduction
2. Review of literature
3. Present study
1. Aims and Objectives of the study
2. Methodology
3. Results
4. Discussion
5. Summary of the study and recommendations
4. Appendix
5. Index of references: will be based on Vancouver system

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ANNEX II
Evaluation Scheme

1. Formative Evaluation

The grading will be as follows:

Grade A - Excellent Grade B - Good Grade C - Satisfactory
Grade D - Poor Grade E - Very Poor

Marking in relation to A, B, C, D and E

Excellent - G o o d - Satisfactory - C Poor - D Very Poor - E

A B 60 - 69% 40 - 59% < 40%
90 - 100% 70 - 89%

Candidates with Grade D will be given written warning. Further progress

will be monitored. Grade E will be made to repeat the rotation.

Formative assessment will give proper feed back to the student about his/her
continuing performance in respective training centre periodically and decide
towards eligibility for appearance in the final University examination at the
end of the course.

Grade A, B, or C will be needed to be eligible for the university examination.

Reports and results of assesments to be sent to the university

2. Summative Evaluation

I.Eligibility for summative evaluation

a) Certification of thesis as satisfactory.
b) Grade A, B or C from formative examinations at the end will be
needed to be eligible for the university examination.

II. Theory Examination: Total marks 300.

Theory papers will be in the form of MCQs and short answer
questions and will consist of three papers:

a) Paper I - Applied Basic Sciences: Total Marks - 100. Time - 3 Hrs.

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 (Questions only from - Anatomy, Physiology, Pharmacology, Physcis,
Medical statistic, equipments)
Section A - Marks - 50. Time - 1 Hr.
MCQs. : Single response type with 4 alternatives - 50 Qs.
Section B - Marks - 50. Time - 2 Hrs.
SAQS - 10 Qs. (5 marks each Q., 12 minutes per Q.)

b) Paper II - Clinical (Clinical anesthesia ) : Total Marks - 100. Time - 3

Hrs.

(Questions from basic sciences , subspecialities and recent advance topics

not to be asked in this paper- Questions should only be from clinical and
general anesthesia only)

Section A - Marks - 50. Time - 1 Hr.

MCQs. : Single response type with 4 alternatives - 50 Qs

Section B - Marks - 50. Time - 2 Hrs.

SAQs - 10 Qs. (5 marks each Q., 12 minutes per Q)

c) Paper III - Subspecialties and Recent Advances: Total Marks - 100.

Time - 3 Hrs.

(Subspeciality subjects are - Cardiac, Paediatric and neonatology,

Neuro, Obstetric, Thoracic, ICU, recent advances and pain)

Section A - Marks - 50. Time - 1 Hr.

MCQs. : Single response type with 4 alternatives - 50 Qs

Section B - Marks - 50. Time - 2 Hrs.

SAQs - 10 Qs. (5 marks each Q., 12 minutes per Q

III.Clinical/ Practical, OSCE/OSPE, Viva voce - Total 300 marks

a) Clinical case/Practical exercises 200 Marks

(One long case 100 marks, two short Cases each with 50 marks)

b) OSCE/OSPE (10 stations) 50 Marks

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 c) Viva voce: two tables (25 marks × 2 table) 50 Marks

• Pass Mark:

For the student to be declared pass he/she must fulfill all the criteria laid down
below:
a) a minimum of 50% marks in each theory paper separately
b) a minimum of 60% marks in clinical/practical, OSCE/OSPE and viva-voce

ANNEX III

KATHMANDU UNIVERSITY
School of Medical Sciences
Evaluation Criteria: Written Thesis

Student
Name:................................................................................................................................

Thesis Title:................................................................................................................................

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 Criterion Unsatisfactory Satisfactory Comment
1. Clarity of purpose (s)
for the research

2. Research procedures
appropriate to purpose (s)

3. Analytical skills
demonstrated:

a. research process

b. conclusions drawn

4. Clarity in writing style

5. Presentation/ format
meets international
standards
6. Other (state criterion)

7. Other (state critierion)

Overall Opinion (encircle one): Unsatisfactory Satisfactory

....................................
Date
............................

Examiner

ANNEX IV

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Suggested reading list of books and journals

Books
Basic Sciences.
1. Scientific Foundations in Anaesthesia Scurr, Feldman.
2. Basic Physics and Measurements in Anaesthesia Parbrook.
3. Applied Respiratory Physiology. Nunn.
4. Drugs in Anaesthetic Practice Vickers, Wood
Smith, Stewart
5. Handbook of Pharmacology and Physiology in Stoelting.
Anaesthetic Practice.
6. Respiratory Physiology John B West
7. Principles of physiology for the anesthetists.2nd edition Power and
Kam
8. Anatomy for Anaesthetists H.Illis

General Anaesthesia
9. Practice of Anaesthesia. Wylie, Churcill
Davidson
10. Anaesthesia, Miller
11. General Anaesthesia. Gray and Nunn.
12. Clinical Anaesthesia Barash, Cullen and Stoelting
13. Handbook of Clinical Anaesthesia Barash, Cullen and Stoelting
14. Anaesthesiology Problem-oriented
Patient Management. Yao and Arrusio.
15. Anaesthesia and Co-existing Disease Stoelting,
Dierdorf.
16. Anaesthesia and Uncommon Diseases Katz, Benumof, Kadis
17. Crisis management in anesthesiology David M Gaba,Kevin J
Fish
18.Handbook of preoperative assessment
and management 2nd Edition Bobbie Jean
Sweitzer

Obstetric Anaesthesia
19. Anaesthesia for Obstetrics Schneider.

Paediatric Anaesthesia
20. Manual of Paediatric Anaesthesia Stewart
21. Paediatric Anaesthesia. Gregory.

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Regional Anaesthesia
22. Neural Blockade, 2nd edition. Cousins, Bridenbaugh
23.Ultrasound Guided regional anesthesia
and pain medicine Paul Bigeleisen,Steven orebaugh,Nizar
Moayen

Cardiac and Thoracic Anaesthesia

24. Cardiac Anaesthesia Kaplan
25. Thoracic Anaesthesia Kaplan

Neurosurgical Anaesthesia
26. Handbook of Neural Anaesthesia. Clinical and
Physiologic Essentials. Nufield,
Cottrell
27. Neuroanaesthesia Hunter

Equipment
28. Understanding Anaesthesia Equipment Dorsch and
Dorsch

Internal Medicine
29. Principles of Internal Medicine
Harrison
30. Medical Consultations
Kammerer, Gross
ICU
31. Synopsis of Critical Care Sibbald
32. The ICU Book. Marino
33.Intensive care manual. 7th Edition. Oh's
34.Procedures,techniques and minimally invasive
monitoring in intensive care medicine 4th Edi. Irwin Rippe
Lisbon H
35.Hand book of pulmonary and critical care medicine Jindal

Journals
Anaesthesia, Anaesthesiology, Anaesthesia and Analgesia.
British Journal of Anaesthesia. Canadian Journal of Anaesthesia.
New England Journal of Medicine.
Indian Journal of Anesthesia,KUMJ,JNMA. Journal of Critical care medicine.

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ANNEX V

SUBJECT CONTENT:

The level of instruction in the subjects should be such that a candidate will
reach one of three levels of knowledge identified as follows:

Full grasp of mainstream of knowledge (1).

Working knowledge of the general principles of the topic (2)
Some knowledge is essential (3).

PHYSIOLOGY:
Respiratory system:
1. Spirogram. Lung Volumes and Capacities.Measurement. Clinical
application. Lung function tests. 1
2. Functional residual capacity. Determinants. 1
3. Oxygen cascade. Significance. 1
4. Flow of gas in respiratory passages. Flow: laminar and turbulent. Hagen
Poiseuille's Equation. 1
5. Dead space. Alveolar gas concentration. Alveolar gas Equation1
6. Lung zones. Ventilation and perfusion in different lung areas. Clinical
application. 1
7. Change in V/Q ratio in standing, supine, lateral and prone position.
Awake and under anesthesia. 1
8. Physiology of one lung ventilation. 1
9. Shunts, V/Q mismatch. A-a gradient. Mixed venous oxygen saturation.
1
10.Blood gas transport. Oxygen-hemoglobin dissociation curve and its
clinical applications 1
11.Pulmonary circulation, pulmonary artery resistance pressure. Factors
affecting pulmonary pressure. 1

"27
 12.Lung mechanics. Static and dynamic compliance. Compliance curves.
Muscles of respiration. Diaphragm, its parts. Innervations. 1
13.Effects of altitude on respiration. 2
14.Respiratory centre. Control of respiration. Drugs affecting respiratory
centre. 1
15.Peripheral and central chemoreceptors, their role and innervation.1
16.Flow-volume loops in normal and pathological conditions. 1

Cardiovascular:

1. Central and peripheral circulation. Distribution of blood volume in

arteries, arterioles, capillaries, venules and veins. 1
2. Cardiac output. Measurement. Determinants. 1
3. Blood volume homeostasis and mechanisms 1
4. Innervation/ control of circulation. Pressure receptors and pressure
reflexes. 1
5. Vasculopathy. Shock. 1
6. Coronary circulation. Physiology of supply and demand of oxygen to
myocardium. 1
7. Cardiac cycle with respect to flow, volume and pressure. 1
8. Effect of autonomic nervous system in vasculature. 1
9. Mechanism of cardiac contractility. Assessment of contractility. Pressure-
volume curves in normal and disease states. 1
10.Micro-circulation. Autonomic control and in sepsis/ shock. 1
11.ECG interpretation. Normal and arrhythmias. 1
12.Systolic and diastolic dysfunction. Mechanism and application in
anesthetic practice. 2
13.Explanation of central venous pressure changes during cardiac cycle. 2
14.Cardio-respiratory interdependency. 2
15.Trans-esophageal echocardiography (TEE). Basic principles. Indications,
basic views of TEE. 3

Central Nervous System:

1. Central nervous system nerve transmitters and recept 2

2. Cortical representation of sensory and motor pathways 2
3. Cerebral circulation 1

"28
 4. Cerebro-spinal fluid. Generation, circulation and composition 1
5. Intracranial pressure. Factors affecting. Cerebral perfusion pressure.
Compliance curves. 1
6. Effects of anesthesia on EEG. 2
7. Mechanism of awareness. BIS monitoring. 1
8. Cerebral metabolic rate. 1
9. Fragile brain syndrome. 2
10.Effects of extreme temperature on brain function. 2
11.Basics of brain death tests. 1
12.Phases of sleep. 2
13.Cranial nerves.CNS contribution in autonomic functions. 2

Renal system:

1. Role of kidney in water balance in body. 1

2. Renal circulation. Filtration, absorption, secretion. Functions of glomerulus,
renal tubules and collecting ducts. 1
3. Role of kidney in acid-base balance, electrolyte balance and osmolarity. 1
4. Physiological Mechanism of perioperative oliguria, anuria and polyuria. 1
5. Hormones secreted by kidneys. Their roles in physiology. 1
6. Methods of renal protection in perioperative periods. 1
7. Pathophysiology of pre, intra and post renal failure. 2
8. Assessment of renal functions. 1

Liver physiology:

1. Metabolic functions of liver (glycogen, lipid, protein). 2

2. Hepatic circulation. Factors affecting. 2
3. Portal circulation. 2
4. Liver function tests. 1

Hematology:

1. Blood grouping. Principles. Basics of cross matching. 1

2. Basic principles of stored blood. 1
3. Blood transfusion. Indications. Hazards. 1

"29
 4. Transfusion reactions. 1
5. Component transfusion. FFP, Platelets, Packed cells. Cryoprecipitate.
Indications. Side effects. 1
6. Anemia. types 2
7. Coagulation disorders. 2
8. Abnormal hemoglobin. 2
9. Disseminated intravascular coagulation. Mechanism, phases,
identification, management. 1
10.Massive transfusion. 1
11.Jehovah's witness. 2
12.Blood conservation techniques. 3
13.Perspectives of artificial blood. 3
14.Bleeding time, clotting time, Prothrombin time, INR, ACT. Basic
principles and interpretations. 1

Neuromuscular system:

1. Resting and action potential. 2

2. Mechanism of muscle contraction. 2
3. Neuromuscular junction physiology. 1
4. Neuromuscular transmission disorders. 2
5. Malignant hyperthermia. 2
6. Myopathies. 2
7. Applied physiology relevant to peripheral nerve stimulation. 1

Gastrointestinal system:

1. Gastric secretion, pH and volume. 2

2. Nausea and vomiting. 2
3. Esophageal reflux . 2
4. Abdominal compartment syndrome mechanism 2
5. Pancreatic gland physiology 3

"30
Endocrinology:
1. Thyroid and parathyroid glands physiological role 1
2. Adrenal glands. Pheochromocytomas. 1
3. Autonomic dysfunction in diabetes. Tests of autonomic dysfunction. 1
4. Cardiovascular system involvement in different endocrinopathies:
physiological basis 2
5. Effect of anesthesia and surgical stress upon endocrinological parameters/
systems 2
6. Starvation, ketoacidosis.Pathophysiology. 2

Ophthalmology:

1. Mechanism of intra-ocular pressure. 2

2. Oculo-cardiac reflexes. 1

Pregnancy:

1. Physiology of pregnancy. 1
2. Anesthetic implications of the changes in pregnancy. 1

Neonatology:
1. Prematurity. 2
2. Fetal circulation. 2
3. Pharmacokinetics in neonates. 2
4. Cardiovascular, respiratory and renal systems in neonates. 1
5. Neonatal ventilation. 2
6. Neonatal resuscitation. 1

"31
ANATOMY:

Anatomy of respiratory system:

1. Nasal cavity,oropharynx and nasophyranx. Trachea and bronchus.
Course, measurement and structure. 1

2. Larynx. Innervations. 1
3. Cricothyroid membrane. 1
4. Lungs. Topographical anatomy. Innervations. Circulation. 1
5. Pulmonary veins, Bronchial arteries and veins. Relation between
bronchial and pulmonary circulation. 1
6. Alveolar-capillary unit. 1

Anatomy of spine:
1. Cervical, thoracic and lumbar vertebrae. 2
2. Anatomy of epidural space. 1
3. Spinal cord. Upper and lower extremity innervations. 1
4. Caudal epidural. Boundaries. 1
5. Paravertebral space. Boundaries. 2
6. Anatomy of autonomic nervous system. 1
7. Anatomy of spinal cord,circulation 2

Anatomy of:
1. Brachial plexus at different levels: interscalene, supraclavicular,
infraclavicular and axillary area. 1
2. Femoral, Sciatic nerve and its course. 1
3. Transabdominis plane. 2
4. Stellate ganglion. 2
5. Anatomic course of internal jugular vein 2

"32
PHARMACOLOGY:

1. Pharmacokinetics of inhalational agents .Uptake.Distribution.partition

coefficient,MAC. 1
2. Inducing agents: Sodium Thiopentone, Propofol, Ketamine,
Benzodiazipines. 1
3. Comparative study of benzodiazepines 1
4. Analgesics: Opioids Opioids (Pethidine, Morphine, Fentanyl,
Remifentanil) and non-opioids. 1
5. Local anesthetics: Lidocaine, Bupivacaine, Levo-bupivacaine,
Ropivacaine. Mechanism of action. Doses. Sensory and motor block
characteristics. Physical properties. Toxicity and management.Adjuvants
for prolongation of block effect 1
6. Sympathomimetics. Endogenous synthesis of catecholamines. Receptor
physiology. Effects of MAO inhibitors and drug interactions. 1

7. Cholinergic and anti-cholinergic agents. 1

8. α2-agonists: Clonidine and Dexmedetomidine. Mechanism of action.
Uses. 1
9. Anti-hypertensive agents. 1
10.Ganglion blockers. 2
11.Digitalis. Mechanism of action. Indications. Side effects. 2
12.Anti-arrhythmic agents. Classification and individual drugs. Description.
Amiodarone.Actions.Uses.Adverse effects.Doses. 1
13.Inhalational agents. Ether, nitrous oxide, halothane, isoflurane,
sevoflurane, desflurane. Drug history mechanism of actions. Metabolism.
1
14.Comparative study of systemic effects of halothane, nitrous oxide,
isoflurane, sevoflurane and desflurane. 1
15.Neuroleptic agents. 3
16.Oxytocin and prostaglandins. 3
17.Muscle relaxants. Developmental history/ evolution. Pharmacokinetics
and pharmacodynamics of Pancuronium, Vecuronium, Atracurium,
Rocuronium, succinyl choline. 1
18.Neostigmine, Physostigmine, Sugamadex. 1
19.Diuretics. Mechanism of action. Classification. Side-effects. 2

"33
 20.Osmotic diuretics. Mannitol.Actions.Sideeffects. 2
21.Insulin. Insulin preparations: Short, intermediate and long acting. 2
22.Oral hypoglycemic agents. Classification. Drug description. Interactions.
2
23.Anti-thyroid drugs. Comparative study. 2
24.Thyroid analogue agents. 2
25.Inotropic agents. Inodilators. Mechanism. Effects. Side effects. 1
26.Vasopressors. Classification. Uses. Side effects. 1
27.Statins. Classification. Indications, side effects. 3
28.Antiplatelet drugs. Anti-thrombotic agents. Classification. Mechanism of
action. Side effects. 1
29.Fibrinolytic agents.Coagulation System,Cascades. 2
30.Unfractionated heparin and low-molecular weight heparin. Mechanism of
action, indications, side effects and dosing. 1
31.Activated protein C. Mechanism of action, indications and side effects.2
32.Anti-microbial agents. 2
33.Glucocorticoids. Relative potency of agents. Classification. 2
34.Anti-histamines. H1 and H2 receptor blockers. Proton pump inhibitors.2
35.Beta blockers. Comparative study of B-blockers. Classifications, toxicity
and its management. 1
36.Bronchodilators. Anti-cholinergics. Xanthine derivatives. 2
37.Magnesium. Clinical use in anesthesia. 2
38.Intravenous anesthesia. TIVA. Principles and methods. 1
39.Anticonvulsants. Classification. Side Effects 2
40.Vasopressin. Mechanism of action. Indications. 2
41.Anaphylaxis. Anaphylactoid reaction. 1
42.Drug interactions in anesthesia. 1

Applied PHYSICS in anesthesia

1. Flow and velocity. Laminar and turbulent flow. Viscosity and

density.Newtonian and non-newtonian fluids. 1
2. Principles of rotameter. 1
3. Gas laws. 1
4. Vapour. Vapour pressure. Vaporization. Saturated vapour pressure. 1

"34
 5. Vaporizers. Principles and common vaporizers used in anesthesia.
Azeotropes. 1
6. Heat, thermal conductivity in the body. Latent heat of vaporization.
Methods of heat conservation and heat loss from the body. 2
7. Temperature and methods of temperature
measurement.Thermister,Thermocouples
2
8. Physics of pulse oximetry. 1
9. Physics of capnography. 1
10.Electrical cautery. Monopolar and bipolar. 3
11.Humidification. Types of humidifier. 2
12.Laplace law. Implications in anesthesia and physiology. 2
13.SI units. 1
14.Source of ignition and explosions. 2
15.Bernoulli principle. 2
16.Venturi principles and its applications. 2
17.Radiation hazards in OR 2
18.Sterilization of anesthetic equipments 2
19.pH,PCO2.PO2 measurement 2

ANESTHESIA MACHINE:

1. Gas supply units: 1

i. Pipeline
ii. Cylinder/ compressed gas
iii. Bourdon pressure gauge and strain gauges
iv. Pressure regulators
v. Flowmeters
vi. Anti-hypoxic devices
vii.Vaporizers
viii.Ventilators
ix. Pressure relief valve
x. Oxygen flush
xi. Common gas outlet
xii.Oxygen analyzer

2. Partition of anesthesia machine as per pressure within the system. 1

"35
 3. Safety features of anesthesia machine. 1

EQUIPMENTS:

1. Laryngoscopes. Recent developments. 1

2. Airway devices. 1
3. Face masks. 1
4. Tracheal tubes. Types. Descriptions. 1
5. LMAs. Recent modifications of supraglottic devices. 1
6. Breathing circuits and classifications. 1
7. Peripheral nerve stimulator/ locator. Principles of functioning 2

8. Fiberoptic bronchoscope. 2
9. Ultrasound machine. 3
10.Pulse oximeter. 1
11.Capnograph. 1
12.Gas analyzers. 2
13.ABG machines. 1
14.AMBU bags. 1
15.Artificial ventilators. 1
16.Defibrillator.Types 1
17.Infusion and syringe pumps. 1
18.Humidifiers and nebulizers. 2
19.Oxygen therapy devices. 2
20.Vascular transducers. 2
21.Transtracheal jet ventilator. 3
22.Temporary pacemaker. 3
23.CPAP and BiPAP machine new advance ventilatory modes 1

CLINICAL ANESTHESIA COURSE CONTENT

"36
1. Anesthesia for trauma
- Assessment of trauma patients. 1
- Anesthesia for polytrauma, resuscitation and optimization. 1
- Anesthesia for spinal injury, spinal shock, autonomic dysreflexia. 1
- Pain management and methods of volume replacement in trauma patients,
care of cervical spine. 1
- Role of anesthesiologist in major disaster management. 1
- Anesthesia for patient with post traumatic circulatory shock. 1
- Anesthesia for patients with burns 1
- Resuscitation of Burn Patients 1
- Anesthesia for plastic surgery 1

2. Anesthesia for eye surgery

- Preoperative assessment of patients with history of strabismus. 1
- Penetrating globe injury. 1
- Control of intraocular pressure 1
- Retrobulbar/peribulbar nerve blocks 2
- Anesthetic issues in eye surgery. 1

3. Orthopaedic surgery
- Anesthesia for orthopaedic limb surgery,spine surgery
1
- Tourniquet and its hemodynamic effects 2
- Anesthetic issues in patient with rheumatoid arthritis 1
- Anesthesia for joint replacement surgery, issues on bone cement. 1
- Anesthesia in geriatric patients with fracture neck of femur, methods of
analgesia. 1
- Fat embolism syndrome in long bone fractures. 2

4. Dental and maxillofacial surgery

- Dental chair anesthesia 2
- Pre-anesthetic issues in maxiofacial/dental surgery 1
- Conscious sedation. Drugs and technique. 2
- Retrograde intubation 2
- Fibreoptic intubation 2

"37
- Blind nasal intubation 2

5. Ambulatory surgery
- Preoperative evaluation of patients subjected for day care surgery 1
- Selection of patients for day case surgery/anesthesia 2
- Drugs used in day care surgery 1
- Advantages and limitations of day care surgery/ anesthesia 1
- Discharge criteria in ambulatory anesthesia 1

6. Anesthesia beyond OT
- Sedation/anesthesia in CT,MRI suits 1
- Anesthesia for ERCP 1
- Anesthesia for UGI endoscopy 1
- Anesthesia for bronchoscopy, colonoscopy 1

7. Thoracic anesthesia
- Preoperative assessment and optimization of patients planned for lung
resection/thoracotomy 1
- One lung ventilation, techniques of lung isolation 1
- Indications of double lumen tube, types, technique of insertion and
confirmation. 1
- Management of hypoxia in OLV 1
- Chest drains, underwater seal drains. 1
- Anesthesia for video assisted thoracoscopy (VATS) 1
- Pneumothorax , diagnosis and management 1
- Anesthesia for pneumonectomy/thoracotomy 1
- Pain management after thoracotomy 1
- Flial chest, treatment, pain management 1
- Anesthesia for esophageal surgery. 1
- Basics of lung ultrasound 3

8. Cardiac anesthesia

- Short History of cardiac anesthesia 2

"38
 - Preoperative assessment in cardiac surgery 1
- Anesthesia for PCI, imaging 2
- Temporary pacing 3
- Monitoring of CVS in cardiac surgery 2
- Principles of cardiopulmonary bypass, cardioplegia 2
- Anesthesia for valve replacement surgery 2
- Anesthesia for CABG 3
- TEE, role of TEE 3
- Anesthesia for major shunt repairing surgery, congenital anomaly 3
- Aortic X-clamp, techniques, indications, systemic effects 3
- Anesthesia for closed heart surgery 2
- Anesthesia for major vascular surgery 3
- Anesthesia for carotid artery surgery 3

9. Anesthesia for patients with cardiovascular diseases:

❖ Anesthesia for hypertensive patients undergoing non-cardiac surgery 1

❖ Ischaemic heart diseases undergoing non-cardiac surgery, evaluation,
optimization, perioperative management 1
❖ Anesthetic issues in patients who had undergone valve replacement
surgery, PCI, CABG and undergoing non-cardiac surgery 1
❖ Anesthetic issues in patient having pacemaker, left ventricular assist
device 1
❖ Systolic dysfunction and anesthesia. Cardiomyopathies, DCM, HOCM,
restrictive peripartum, pathophysiology and anesthetic implications 1
❖ Aortic stenosis/ mitral stenosis/ pulmonic and tricuspid stenosis and
anesthetic management 1
❖ Mitral regurgitation, aortic regurgitation and anesthetic management of
patients undergoing non-cardiac surgery 1
❖ Diastolic dysfunction, pathophysiology, causes, mechanism, flash
pulmonary edema, volume replacement strategy, anesthetic issues 1
❖ Anesthesia to patients with common heart lesions. Pathophysiology,
shunt calculations 2
❖ Anesthetic issues in acute and chronic heart failure 1
❖ Cardiogenic shock, management ,IABP 3
❖ Cardiac tamponade, anesthetic concerns and pathophysiology 1
❖ ACLS. Recent recommendations and steps 1

"39
❖ Anesthesia to patients with different cardiac arrhythmias, brady and
tachyarrhythmias, atrial fibrillation 1
❖ Pulmonary artery hypertension. Anesthesia and pulmonary artery pressure.
Management of PAH 2
❖ Ventricular tachycardia, essentials of diagnosis, classification and therapy
1
❖ Antiplatelate Drugs and surgery timing. Post cardiac surgery cases planned
for noncardiac sugery later in life. 1

10. Neurosurgery
- Preoperative evaluation of neurosurgical patients 1
- Be able to monitor ICP, mange head injuries, bleeding, tumors with
increased ICP 1
- Be able to manage cases in sitting, prone, lateral, jack-knife positions 2
- Anesthesia to neuroradiological procedures 2
- Intracranial aneurysmal surgery 1
- Monitoring in neuroanesthesia 1
- Understanding of neurophysiology 1
- Anesthesia for endo-neurosurgical procedures 2
- Fluid therapy in neurosurgery 1
- SIADH, diabetes insipidus, cerebral salt wasting syndrome. Etiology and
management- 2
- Neuroprotection. Recent updates 2
- Pituitary surgery, perioperative anesthetic issues 2
- Postoperative care and critical care management of neurosurgical cases1

11. Paediatric and neonatal

- Preoperative assessment. Its role in paediatric anesthesia 2
- Prematurity. Its effect on organ system and anesthetic concerns 2
- Tracheoesophageal fistula. Anesthetic issues and management 2
- Congenital pyloric stenosis 1
- Diaphragmatic hernia. Anesthetic management 2
- Esophageal atresia, intestinal obstruction, gastrochisis, omphalocele,
meningomyelocele 2
- Inguinal hernia, phimosis 1
- Premedication and pain management in paediatric anesthesia 1

"40
12. Obstetric anesthesia

- Preanesthetic evaluation of parturients 1

- Premedication of obstetric patients 1
- Anesthesia for LSCS and vaginal delivery 1
- Painless delivery. Methods 1
- Anesthesia to parturients with DCM, PPCM, HTN, valvular heart disease,
bronchial asthma 1
- Anesthetic management in pre-eclampsia and eclampsia 1
- Seizure disorders in pregnant lady and management 1
- Anesthetic management in antepartum haemorrhage, postpartum
haemorrhage. Causes and management strategy 1
- Cord prolapse and anesthetic issues 1
- Anesthesia for obstetric emergencies 1
- Neonatal resuscitation. Recent recommendations. 2

13. Transplant anesthesia

- Kidney transplant and anesthetic management 2
- Anesthetic issues and management . Critical care aspects in Organ
transplants. 2

14. Pain

- Acute and chronic pain. Definition 1

- Pathophysiology of pain, antinociception 1
- Pain pathways, sensory and motor 1
- Somatic and autonomically mediated pain.CRPS 1
- Abdominal cancer pain therapy. Neurolysis. celiac plexus block 2
- Stellate ganglion block, topographic technique. Anatomy and physiology.
Ultrasound technique 2
- Trigeminal neuralgia. Treatment 2
- Treatment of pain arising from thoracic cage 2
- Causalgia. Chronic back pain treatment. Multimodal pain therapy 2

"41
 15.Anaesthesia for patients with respiratory diseases: Chronic
bronchitis,Asthma,Chronic respiratory failure,Sleep apnoea 1
16.Central nervous system disease: Coma,Myasthenia
gravis,Tetanus,poliomyelitis,the Guillian Barre syndrome 2

Anesthesia for other clinical diseases including some rare diseases

1. Sarcoidosis
2. Parkinsonism
3. Transverse myelitis
4. Porphyria
5. Brugada Syndrome
6. Long Q - T interval Syndrome
7. Cerebral Palsy
8. Cystic Fibrosis
9. Athelet's heart
10.Liver diseases and anesthesia
11.Anesthesia for patients on steroid therapy
12.Anaesthesia for diabetic patients and perioperative insulin therapy
13.Anesthesia for pheochromocytoma resection
14.Anesthesia in patients with thyroid problems
15.Electrolyte imbalance ,treatment and anesthetic issues
16.Carcinoid syndrome and anesthetic issues

General Topics on history

1. Narcotic drug control act, drug act and regulation, consumer protection act,
human organ transplant act,
2. National Drug Policy - 1995 and essential drug lists

3. Anesthesia related -
- History of anesthesia in Nepal
- Society of Anesthesiologists of Nepal
- World federation of societies of Anesthesiologists

4. World History of Anaesthesia and Few notable names in Anaesthesia -

a) William T G Morton

"42
 b) Arthur E Guedel
c) John Snow
d) Robert Macintosh
e) BA Sellick
f) E B Tuohy
g) Henry Edmund Gaskin Boyle
h) Hans G. Epstin
i) Thomas Philip Ayre

Critical Care topics:

Objectives

• Candidates should have a good understanding of the diagnosis and

management of the critically ill patient and should be skilled in
resuscitation to an advanced standard.

• An understanding of the particular problems associated with the critically

ill child (excluding neonate2s) will be expected.
• All candidates should be familiar with the monitoring and life support
equipment used in the treatment of critically ill patients.
• Candidates must be able to demonstrate their knowledge of practical
invasive procedures, with an understanding of the principles and hazards
involved. Interpretation of data from such procedures.

• An awareness of the importance of communication skills and

interpersonal relationships will be expected.

Critical care course content Part I (procedures)

1. Central Venous canulation: Land mark and USG technique 1

2. Arterial Line placement and care 1
3. Pericardiocentesis 3
4. Temporary Cardiac pacing (Basic) 3
5. Chest tube insertion and care 2
6. Bronchoscopy and applied anatomy 2
7. Tracheostomy: Procedure and Care, Complication 3
8. Percutaneous Suprapubic cystotomy 3

"43
 9. Anesthesia for bed side procedure in ICU 2
10.Renal replacement therapy in ICU 2
11.Caloric calculation - Nutiton in critically ill patients 1
12.Emergency abdominal Ultrasound in ICU 2
13.Emergency chest Ultrasound in ICU 3
14.Neurologic and ICP monitoring in ICU 3
15.Basic echocardiographic in ICU 3
16.APACHE Scoring systems 1
17.Basics of IABP and ECMO 3

Critical care course content Part II

1. A.R.D.S - Pathophysiology and management 1

2. Sepsis, Septic shock, Early goal directed therapy andmanagement,MODS
1
3. Hypoxia - Pathophysiology, differential diagnosis, Treatment - (A -
a)PaO2, DO2/VO2, PvO2 1
4. Pneumonia, Etiology, course and management 1

5. Invasive and non invasive ventilaton - modes Care of patients under

mechanical ventilation 1
6. Indication for mechanical ventilation and weaning 1
7. Ventilator associated pneumonia and prevention 1
8. Common poisoning, Toxicology and management 2
9. Seizures - causes and treatment 1
10.Coma - causes and treatment 1
11.Common electrolyte imbalances in ICU - Clinical symptoms and
management - Na, K, Ca, Mg, PO4 1
12.Systemwise clinical recordings of critically ill patients 1
13.Acute coronary Syndrome in ICU 1
14.Pulmonary edema - Pathophysiology and treatment 1
15.Pulmonary embolism - Diagnosis and treatment 1
16.DVT prophylaxis in ICU - Drugs and Mechanical methods 1
17.Acute bronchospastic condition and treatment 1
18.Pancreatitis - causes and treatment 2
19.Liver Failure - causes and supportive measures 2
20.Acute kidney injury (AKI) - causes, Prevention and treatment. 2
21.Common obstetric critical illness ( Pre-eclampsia,Eclampsia,hypertensive
crisis, severe haemorrhage, ovarian hyperstimulation syndrome) 1
22.Thyrotoxicosis and Thyroid strome - clinicals and treatment 2

"44
 23.Prevention of bed sores and treatment in ICU 1
24.ICU care of the patients following Thoracotomy, Pneumonectomy and
cardiac surgery 1
25.Brain death test and diagnosis 1
26.Rapport and communication in ICU 1
27.Critical care of patients with cerebral malaria, HIV - AIDS, SARS, and
other Avian infections
2
28.Hepatorenal syndrome,hepatopulmonary syndrome.Diagnosis and critical
care support 3
29.Critical illness myopathy. Etiology.Treatment. 2
30.Antibiotic stewardship in ICU 1
31.Sedation in ICU. Methods.Agents.Sedation scoring system. 1

Annex VI
CHART MODELS TO BE USED DURING FINAL
EXAMINATION.

KATHMANDU UNIVERSITY
FINAL PRACTICAL EXAMINATION
MD (ANESTHESIOLOGY)

Centre -
Date -

"45
Assessesment of long case
Marks - 100
Candidates' Roll number -
Total time allocated - Excellent Good - Satisfactory Poor - D Very
60 minutes -A B -C Poor -
90 - 100% 70 - 60 - 69% 40 - 59% E
89% <
40%
Interview skills
Extracts relevant data
Clinical Examination
Skills
Case presentation
Identification of
problem and
management
Discussion with
examiner
Additional remarks

Remark

Signature of Examiner -
Name of the Examiner -
Note - Examiners should assess separately

"46
KATHMANDU UNIVERSITY
FINAL PRACTICAL EXAMINATION
MD (ANESTHESIOLOGY)

Centre -
Date -
Assessesment of Short Case - Number one / Number Two
Marks - 100 =(50 + 50)
Candidates' Roll number -
Total time allocated - 30 Excellent - Good - Adequate Poor Very
min in each station A B -C -D Poor -
90 - 100% 70 - 60 - 69% 40 - E
89% 59% < 40%
Interview skills
Extracts relevant data
Clinical Examination
Skills
Case presentation
Identification of problem
and management
Discussion with examiner
Additional remarks

Remarks

Signature of Examiner -
Name of the Examiner -
Note - Examiners should assess separately

"47
KATHMANDU UNIVERSITY
FINAL PRACTICAL EXAMINATION
MD (ANESTHESIOLOGY)

Centre -
Date -
Assessesment for VIVA VOCE
Marks - 50 (Two tables - 25 marks each)
Candidates' Roll number -
Total time allocated - 30 Excellent -A Good - Adequate Poor Very
minutes 90 - 100% B -C -D Poor -
70 - 60 - 69% 40 - E
89% 59% <
40%

Remark

Signature of Examiner -
Name of the Examiner -
Note - All Examiners should assess separately

"48
KATHMANDU UNIVERSITY
FINAL PRACTICAL EXAMINATION
MD (ANESTHESIOLOGY)

Centre -
Date -
OSCE / OSPE/ others - 10 stations
Total time allocated - 50 minutes
Marks - 50
Candidates' Roll number -
Table Specimen Marks Obtained
Number
1
2
3
4
5
6
7
8
9
10

Remarks
Signature of Examiner -
Name of the Examiner -

"49
"50