New dynamic self-testing website for trainee anaesthetists from Cambridge

Cambridge Medicine has launched a dynamic new self-testing website for trainee anaesthetists – www.FRCAQ.com

What is FRCAQ.com?
It is an online revision resource of over 1,450 questions, answers and explanations in anaesthesia for trainees preparing for the Primary FRCA MCQ exam. Four different test options give you the flexibility to tailor your exam preparation to your specific needs, and detailed reports allow you to monitor your performance over time and against your peers.

Tell me more…
The site contains questions in both SBA (Single Best Answer) and MTF (Multiple True False) format. The Editors have analysed very component of the Primary FCRA syllabus and written questions on every topic you will encounter in the exam. Each question contains a short and long explanation, giving extensive background information to enhance your anaesthetic knowledge.

Which countries is the site relevant for?
Due to similarities in exam content and structure, the questions and answers on FRCAQ.com are directly applicable to the Irish Primary FCARSCI exam, the European Diploma in Anesthesia, the Australian and NZ FANZCA Part 1 exam, the Hong Kong HKCA Intermediate exam and the South African FCA(SA) Part 1 exam. Trainees preparing for these exams will find the site an invaluable revision resource.

Who are the Editors?
The FRCAQ editors, James Nickells and Ben Walton, are not only highly experienced anaesthetists and intensivists, but also expert medical educators who run the highly regarded Frenchay Final FRCA Crammer course. Members of their writing team are recent successful Primary and Final FRCA candidates or recently appointed consultants, so FCRAQ.com is written by anaesthetists for anaesthetists!

What next?
Try a free demo of FRCAQ
Subscribe to FRCAQ

Which other resources will help with Primary FCRA preparation?
Check out the following bestselling books:
Fundamentals of Anaesthesia, 3rd Edition Edited by Tim Smith, Colin Pinnock, and Ted Lin
Physics, Pharmacology and Physiology for Anaesthetists: Key Concepts for the FRCA Matthew E. Cross, Emma V. E. Plunkett
Pharmacology for Anaesthesia and Intensive Care, 3rd Edition Tom E. Peck, Sue Hill
Dr Podcast Scripts for the Primary FRCA Edited by Rebecca A. Leslie, Emily K. Johnson, Alexander P. L. Goodwin
Concise Anatomy for Anaesthesia by Andreas G. Erdmann

The Ongoing Challenges with the Peri-operative Care of the Morbidly Obese Patient

Blog Post by Jay B. Brodsky, MD and Harry J.M. Lemmens, MD, PhD, and Stanford University School of Medicine, Stanford, CA, 94305

We are all aware that the world is experiencing an obesity epidemic. Given the great numbers of morbidly obese patients currently undergoing surgery and the predicted increases in those numbers for the future, every health care professional must be familiar with the unique management concerns of these potentially complex patients.          

The morbidly obese patient can be especially challenging for their anesthesiologist and surgeon.  There are physiologic changes to almost every organ system, numerous associated medical co-morbidities, altered uptake and distribution of anesthetic agents and other drugs, potentially difficult airways, as well as technical difficulties related to the large size of these patients.

Intensity of renal replacement therapy in critically ill patients with acute kidney injury

Blog Post by Dr Kaushik Bhowmick FRCA, Specialty Trainee in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK and

Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

Acute kidney injury (AKI) is common in critically ill patients in the intensive care unit (ICU). Renal replacement therapy (RRT) is required in approximately 5% of patients in intensive care with severe AKI and is associated with substantial mortality.

There are two broad methods of RRT, continuous and intermittent RRT. Although no significant mortality difference has been demonstrated between the two methods, continuous RRT is preferred method in intensive care units in many countries including UK, Australia and New Zealand. Continuous renal replacement therapy provides continuous fluid removal, steady acid-base and electrolyte correction and relative haemodynamic stability. In spite of much development, the optimal intensity, timing and mode of RRT remain uncertain. One of the many complications of AKI is uraemia. RRT aims not only to reduce the clinical complications of uraemia but also the adverse subclinical pathophysiological effects of uraemia.

Post-thoracotomy regional analgesia

Blog Post by Dr Darcy M Pearson FRCA, Specialty Trainee in Anaesthesia & Intensive Care, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK and Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK

Inadequate postoperative pain relief after thoracotomy increases the risk of respiratory complications and chronic post-surgical pain. A number of regional analgesic techniques may be used for post-thoracotomy analgesia including intercostal,intrapleural, extrapleural, paravertebral, intrathecal and epidural analgesia. Extrapleural and paravertebral techniques may be performed by percutaneously or under direct vision and may involve single injections or continuous infusions.

Anesthesia awareness

Blog Post by George Mashour, University of Michigan School of Medicine

“Anesthesia awareness” refers to consciousness and explicit memory of surgical events.  This complication is thought to occur in approximately 1-2 cases/1000 and can range from a transient auditory perception to the experience of being fully awake, in pain, and chemically paralyzed. Risk factors for this event traditionally include certain cardiac procedures, emergency cases with blood loss, emergency cesarean section, difficult airway management, and cases with total intravenous anesthetic.  Many of these cases (cardiac, trauma, cesarean section) represent situations in which giving adequate anesthesia could be potentially life-threatening.  Other causes include resistance to anesthetics, machine or equipment malfunction, and human error.  The experience of anesthesia awareness can be psychologically devastating.  In a new study by Dr. Kate Leslie and colleagues (Anesthesia & Analgesia, March issue), 5 of 7 awareness patients identified in a larger study met criteria for post-traumatic stress disorder.  The role of brain monitoring for the prevention of awareness is still unclear; several large studies are ongoing to determine the value of one such monitor.  Part of the difficulty of detecting awareness in the surgical setting relates to our limited understanding of the neural correlates of consciousness.  As we develop more sophisticated knowledge of the mechanisms of both consciousness and anesthesia, improved monitoring capabilities may become available.  In the meantime, recognizing high risk cases and vigilance on the part of the anesthesia provider is the first line of defense.    

Now published in the US, and available from the UK and Europe in March 2010, Consciousness, Awareness, and Anesthesia, edited by George Mashour, is a fascinating insight into both the scientific problem of consciousness and the clinical problem of awareness during general anesthesia.