A. Basic Sciences

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Basic Topics in Anesthesiology

A. Basic Sciences

1. Anatomy

a. Topographical Anatomy As Landmarks

1) Neck: Cricothyroid Membrane, Internal and External Jugular Veins, Thoracic Duct, Carotid and Vertebral Arteries, Stellate Ganglion, Cervical Spine Landmarks (Vertebra Prominens, Chassaignac’s Tubercle)

2) Chest: Pulmonary Lobes, Cardiac Landmarks, Subclavian Vein

3) Pelvis and Back: Vertebral Level of Topographical Landmarks, Caudal Space

4) Extremities: Relationship of Bones, Nerves, and Arteries

b. Radiological Anatomy

1) Chest (Including CT and MRI)

2) Brain and Skull (Including CT and MRI)

3) Spine (Cervical, Thoracic, Lumbar), Including CT and MRI

4) Neck (Including Doppler Ultrasound for Central Venous Access)

2. Physics, Monitoring, and Anesthesia Delivery Devices

a. Mechanics

1) Pressure Measurement of Gases, Liquids

2) Transducers, Regulators, Medical Gas Cylinders

b. Flow Velocity

1) Viscosity-Density; Laminar-Turbulent Flow

2) Flowmeters: Rotameter

3) Principles of Doppler Ultrasound

c. Properties of Liquids, Gases, and Vapors

1) Diffusion of Gases

2) Solubility Coefficients

3) Relative and Absolute Humidity

4) Critical Temperature, Critical Pressure

d. Gas Laws

e. Vaporizers

1) Vapor Pressure and Calculation of Anesthetic Concentrations

2) Vaporizer Types and Safety Features

f. Uptake and Distribution of Inhalation Agents

1) Uptake and Elimination Curves; Effect of Ventilation, Circulation, Anesthetic Systems

2) Concentration Effect

3) Second Gas Effect

4) Nitrous Oxide and Closed Spaces

g. Physics of Anesthesia Machine/ Breathing System

1) Principles: Resistance, Turbulent Flow, Mechanical Deadspace, Rebreathing, Dilution, Leaks, Gas Mixtures, Humidity, Heat

2) Components: Connectors, Adaptors, Mask, Endotracheal Tube, Reservoir Bag Unidirectional Valves, Corrugated Breathing Tubes, Laryngeal Mask Airways, Airway Pressure Relief Valve

3) Characteristics

a) Circle Systems: Closed and Semi-Closed; Adult; Pediatric

b) Non-Circle Systems: Insufflation; Open; Semi-Open

c) Portable Ventilation Devices (Self-Reinflating, Non-Self-Reinflating), Non-Rebreathing Valves

d) CO2 Absorption: Principles, Canisters, Efficiency

e) Toxicity: Compound A, Carbon Monoxide

4) Oxygen Supply Systems: FiO2

5) Waste Gas Evacuation Systems

6) Safety Features (Proportioning Devices, Rotameter Configuration, Pressure Fail-Safe)

7) Design/Ergonomics of Anesthesia Machines

h. Monitoring Methods

1) Neuromuscular Function: Nerve Stimulators, Electromyography (Emg)

2) Ventilation: Respirometers, Inspiratory Force, Spirometry, Flow-Volume Loops

3) Gas Concentrations: O2, CO2, Nitrogen, Anesthetic Gases and Vapors

4) Temperature

5) Oxygen: Oximetry, Co-Oximetry, Pulse Oximetry

i. Instrumentation

1) Arterial and Venous Blood Gases: Electrodes for pH, PO2, PCO2, Calibration, Temperature Corrections, Errors

2) Gas Concentrations: Infrared Absorption, Mass Spectrometry, Raman Scatter Analysis

3) Pressure Transducers: Resonance, Damping

4) Non-Invasive Blood Pressure (BP) Measurement: Doppler, Oscillometry, Korotkoff Sounds, Palpation

5) Blood Warmers, Autotransfusion Devices

6) Body Warming Devices: Forced Air, Heating Lamps, Insulation Devices, Warming Blankets, Water-Flow “Second Skin” Devices

j. Ventilators

1) Classifications: Flow Generation vs. Pressure Generation

2) Principles of Action: Assistors, Controllers, Assist-Control; Pressure-Limited, Volume-Limited; FiO2 Control; Periodic Sigh, Inverse Ratio, High Frequency Ventilation, Intermittent Mandatory Ventilation (IMV), Synchronized IMV, Pressure Support, Airway Pressure Release Ventilation (APRV), Pediatric Adaptation, Non-Invasive Techniques: Biphasic Positive Airway Pressure (BIPAP), Others

3) Monitors; Pressure (Plateau, Peak), Oxygen, Apnea, Inspiratory/Expiratory Ratio, Dynamic Compliance, Static Compliance

k. Alarms and Safety Features: Operating Room, Electrical, Anesthesia Machine, Ventilators, Capnometer, Oxygen, Hemodynamic Monitors

l. Defibrillators: Automatic Internal, External, Implantable; Energy, Cardioversion, Types of Waveforms (Monophasic, Biphasic); Paddle Size and Position; Automated External Defibrillators (AEDs)

m. Electrical; Fire and Explosion Hazards; Basic Electronics

1) Source of Ignition; Static

2) Prevention: Grounding, Isolation Transformers

3) Macro and Micro Current Hazards

4) Safety Regulations; National Fire Protection Association (NFPA) Standards

3. Mathematics

a. Simple Math: Logarithms; Graph of Simple Equations; Exponential Function, Analysis of Biologic Curves

b. Statistics: Sample and Population; Probability; Mean, Median, and Mode; Standard Deviation and Error; T-Test; Chi-Square; Regression Analysis/Correlation; Analysis of Variance, Power Analysis, Meta-Analysis, Confidence Intervals, Odds Ratio, Risk Ratio, Bland-Altman Plot

c. Computerized Patient Records

1) Basic Computer Knowledge: Programs vs. Operating System, Computer Virus, Disk Or Central Processing Unit (CPU) Failure, Amplifiers, Microprocessors

2) Data Handling, Processing, and Analysis

4. Pharmacology

a. General Concepts

1) Pharmacokinetics and Pharmacodynamics, Protein Binding; Partition Coefficients; PKA; Ionization; Tissue Uptake; Compartmentalization and Exponential Models

a) Pharmacokinetics of Neuraxial Drug Administration: Epidural and Subarachnoid

b) Tolerance and Tachyphylaxis

2) Termination of Action

a) Elimination; Biotransformation; Context-Sensitive Half-Time

b) Impact of Renal Disease

c) Impact of Hepatic Disease

3) Drug Interactions

a) Enzyme Induction and Inhibition

b) Hepatic Blood Flow

c) Drug-Drug Binding

d) Alternative and Herbal Medicines: Perioperative Implications

4) Drug Reactions (Anaphylactoid, Anaphylaxis, Idiosyncratic)

b. Anesthetics-Gases and Vapors

1) Physical Properties

2) Mechanism of Action

3) Effects on Central Nervous System (CNS)

4) Effects on Cardiovascular System

5) Effects on Respiration

6) Effects on Neuromuscular Function

7) Effects on Renal Function

8) Effects on Hepatic Function

9) Effects on Hematologic and Immune Systems

10) Biotransformation and Toxicity

11) Minimum Alveolar Concentration (MAC), Factors Affecting Mac

12) Trace Concentrations, OR Pollution, Personnel Hazards

13) Comparative Pharmacodynamics

c. Anesthetics-Intravenous (Opioid and Non-Opioid Induction and Anesthetic Agents)

1) Opioids

a) Mechanism of Action

b) Pharmacokinetics and Pharmacodynamics

(1) Intravenous

(2) Epidural and Intrathecal

c) Metabolism and Excretion

d) Effect on Circulation

e) Effect on Respiration

f) Effect on Other Organs

g) Side Effects and Toxicity

h) Indications and Contraindications

2) Barbiturates

a) Mechanism of Action

b) Pharmacokinetics and Pharmacodynamics

c) Metabolism and Excretion

d) Effect on Circulation

e) Effect on Respiration

f) Effect on Other Organs

g) Side Effects and Toxicity

h) Indications and Contraindications

3) Propofol

a) Mechanism of Action

b) Pharmacokinetics and Pharmacodynamics

c) Metabolism and Excretion

d) Effect on Circulation

e) Effect on Respiration

f) Effect on Other Organs

g) Side Effects and Toxicity

h) Indications and Contraindications

4) Etomidate

a) Mechanism of Action

b) Pharmacokinetics and Pharmacodynamics

c) Metabolism and Excretion

d) Effect on Circulation

e) Effect on Respiration

f) Effect on Other Organs

g) Side Effects and Toxicity

h) Indications and Contraindications

5) Benzodiazepines

a) Mechanism of Action

b) Pharmacokinetics and Pharmacodynamics

c) Metabolism and Excretion

d) Effect on Circulation

e) Effect on Respiration

f) Effect on Other Organs

g) Side Effects and Toxicity

h) Indications and Contraindications

i) Antagonism

6) Ketamine

a) Mechanism of Action

b) Pharmacokinetics and Pharmacodynamics

c) Metabolism and Excretion

d) Effect on Circulation

e) Effect on Respiration

f) Effect on Other Organs

g) Side Effects and Toxicity

h) Indications and Contraindications

d. Anesthetics - Local

1) Uptake, Mechanism of Action

2) Biotransformation and Excretion

3) Comparison of Drugs and Chemical Groups

4) Prolongation of Action

5) Side Effects and Toxicity

a) CNS: Seizures, Cauda Equina Syndrome, Transient Neurological Symptom

b) Cardiac

c) Allergy

d) Preservatives/Additives

e) Methemoglobinemia

e. Muscle Relaxants (Depolarizing, Non-Depolarizing)

1) Mechanism of Action

2) Pharmacokinetics and Pharmacodynamics, Abnormal Responses

3) Prolongation of Action; Synergism

4) Metabolism and Excretion

5) Side Effects and Toxicity

6) Indications and Contraindications

7) Antagonism of Blockade

8) Drug Interactions (Antibiotics, Antiepileptics, Lithium, Magnesium, Inhalational Anesthetics)

B. Clinical Sciences: Anesthesia Procedures, Methods, and Techniques

1. Evaluation of the Patient and Preoperative Preparation

a. Physical Examination Including Airway Evaluation

b. Laboratory Evaluation

1) American Society of Anesthesiologists (ASA) Preoperative Testing Guidelines

2) American College of Cardiology/American Heart Association Guidelines for Perioperative Cardiovascular Evaluation

c. ASA Physical Status Classification

d. Premedication

1) Interaction with Chronic Drug Therapy; Interaction with Anesthetic Agents

2) Adverse Reactions to Premedications; Patient Variability, Dose Response Curves, Side Effects

3) Specific Problems in Disease States: Hyperthyroidism and Hypothyroidism, Drug Abuse, Glaucoma, Uremia, Increased CSF Pressure, Chronic Steroid Ingestion, Obesity, Obstructive Sleep Apnea, Depression, COPD, Hypertension

4) Pediatric and Geriatric Doses, Routes of Administration

5) Role in Patients with Allergies

6) NPO and Full Stomach Status; Implications for Airway Management, Choice of Anesthesia Technique and Induction of Anesthesia; Gastric Emptying Time; Preoperative; Full Stomach and Induction of Anesthesia

a) Alteration of Gastric Fluid Volume and pH, Sphincter Tone

7) Continuation vs. Discontinuation of Chronic Medications: Antihypertensives, Anti-Anginal, Antihyperglycemics, Antidepressants, Platelet Inhibitors, Etc.

8) Prophylactic Cardiac Risk Reduction: Beta-Adrenergic Blockers, Etc.

9) Prophylactic Antibiotics

a) Indications

b) Risks of Administration

c) Drug Interactions

2. Regional Anesthesia

a. General Topics: Premedication, Patient Position, Equipment, Monitoring and Sedation

b. Spinal, Epidural, Caudal, Combined Spinal/Epidural

1) Indications, Contraindications

2) Sites of Actions

3) Factors Influencing Onset, Duration, and Termination of Action

4) Systemic Toxicity, Test Dose

5) Complications; Precipitating Factors, Prevention, Therapy, Implications of Anticoagulants and Platelet Inhibitors: American Society of Regional Anesthesia and Pain Medicine (ASRA) Guidelines

3. General Anesthesia

a. Stages and Signs of Anesthesia; Awareness Under Anesthesia

b. Techniques: Inhalational, Total Intravenous, Combined Inhalational/Intravenous

c. Airway Management

1) Assessment/Identification of Difficult Airway: Anatomic Correlates, Mallampati Classification, Range of Motion

2) Techniques for Managing Airway: Awake vs. Asleep, Use vs. Avoidance of Muscle Relaxants, Drug Selection, Retrograde Intubation Techniques, Asa Difficult Airway Algorithm

3) Devices: Flexible Fiberoptic, Rigid Fiberoptic, Transillumination, Laryngoscope Blades, Alternative Intubating Devices

4) Alternatives and Adjuncts: Laryngeal Mask Airway (Traditional and Modified), Esophageal Obturator Airways, Occlusive Pharyngeal Airways

5) Transcutaneous Or Surgical Airway: Tracheostomy, Cricothyroidotomy, Translaryngeal Or Transtracheal Jet Ventilation

6) Endobronchial Intubation: Double-Lumen Endobronchial Tubes; Bronchial Blockers (Integral to Endotracheal Tube Or Separate), Placement and Positioning Considerations, Postoperative Considerations

7) Intubation and Tube Change Adjuncts: Bougies, Jet Stylettes, Soft and Rigid Tube Change Devices; Complications

8) Endotracheal Tube Types: Tube Material (Polyvinyl Chloride, Silicone, Laser-Resistant, Silver Impregnated, Other), Tube Tip Design (Murphy Eyes, Flexible Tip, Moveable Tip, Short-Bevel), Cuff Design (High vs. Low Volume/Pressure, Cuffed Vs Uncuffed, Cuff Shape), Cuff Pressure Management (Lanz Valves, Active Management, Pilot Balloon, Inflation Valve), Specific Tube Types (Wire-Reinforced, Nasal and Oral Rae®, Microlaryngeal, Supraglottic Secretion Suctioning, Other)

d. ASA Monitoring Standards

4. Monitored Anesthesia Care and Sedation: ASA Guidelines for Sedation, Sedation Guidelines for Non-Anesthesiologists

5. Intravenous Fluid Therapy During Anesthesia: Water, Electrolyte, Glucose Requirements and Disposition, Crystalloid vs. Colloid

6. Complications (Etiology, Prevention, Treatment)

a. Trauma

1) Upper Airway, Epistaxis

2) Larynx, Trachea, and Esophagus

3) Eyes: Corneal Abrasions, Blindness, Post-op visual loss 4) Vascular; Arterial and Venous Thrombosis; Thrombophlebitis; Sheared Catheter, Intra-Arterial Injections, Air Embolism, Cardiac/Vascular Perforations, Pulmonary Artery Rupture

5) Neurological: Pressure Injuries of Mask, Tourniquet, Body Position, Intraneural Injections, Retractors, Peripheral Neuropathies

6) Burns

b. Chronic Environmental Exposure; Fertility, Teratogenicity, Carcinogenicity, Scavenging

c. Temperature

1) Hypothermia: Etiology, Prevention, Treatment, Complications (Shivering, O2 Consumption), Prognosis

2) Nonmalignant Hyperthermia; Complications, Treatment

d. Bronchospasm

e. Anaphylaxis

1) Latex Allergy

2) Other

f. Laryngospasm

g. Postobstructive Pulmonary Edema

h. Aspiration of Gastric Contents

7. Postoperative Period

a. Pain Relief

1) Pharmacologic

a) Drugs: Opioids, Agonist-Antagonists, Local Anesthetics, Alpha-2 Agonists, Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), N-Methyl-D-Aspartate (NMDA) Receptor Blockers, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitor (SSRI)

b) Routes: Oral, Subcutaneous (SC), Transcutaneous, Transmucosal, Intramuscular (IM), Intravenous (IV), Including Patient-Controlled Analgesia (PCA), Epidural, Spinal, Interpleural, Other Regional Techniques

2) Other Techniques; Transcutaneous Electrical Nerve Stimulation (TENS); Cryotherapy; Acupuncture, Hypnosis b. Neurologic Consequences of Anesthesia: Confusion, Delirium, Cognitive Dysfunction, Failure to emerge from anesthesia

b. Respiratory Consequences of Anesthesia and of Surgical Incisions

c. Cardiovascular Consequences of General and Regional Anesthesia: Differential Diagnosis and Treatment of Postoperative Hypertension and Hypotension

d. Nausea and Vomiting

1) Physiology; Etiology; Risk Factors, Preventive Strategies

2) Use of Antacids, Histamine-2 (H2) Blockers, Metoclopramide, Transdermal Scopolamine, Droperidol, Serotonin Antagonists, Proton Pump Inhibitors, Dexamethasone, Multimodal Therapy, Acupressure/Acupuncture

e. Neuromuscular Consequences: Residual Paralysis, Muscle Soreness, Recovery of Airway Reflexes

C. Organ-Based Basic and Clinical Sciences

1. Central and Peripheral Nervous Systems

a. Physiology

1) Brain

a) Cerebral Cortex; Functional Organization

b) Subcortical Areas: Basal Ganglia, Hippocampus, Internal Capsule, Cerebellum, Brain Stem, Reticular Activating System

c) Cerebral Blood Flow

(1) Effect of Perfusion Pressure, Ph, PaCO2, PaO2, and Cerebral Metabolic Rate for O2 (CMRO2); Inverse Steal; Gray vs. White Matter

(2) Autoregulation: Normal, Altered, and Abolished

(3) Pathophysiology of Ischemia/Hypoxia: Global vs. Focal, Glucose Effects, Effects of Brain Trauma or Tumors

d) Cerebrospinal Fluid

(1) Formation, Volume, Composition, Flow and Pressure

(2) Blood-Brain Barrier, Active and Passive Molecular Transport Across, Causes of Disruption

(3) Relation to Blood Chemistry and Acid-Base Balance

e) Cerebral Protection

(1) Hypothermia

(2) Anesthetic and Adjuvant Drugs

2) Spinal Cord

a) General Organization

b) Spinal Reflexes

c) Spinal Cord Tracts

d) Evoked Potentials

3) Neuromuscular and Synaptic Transmission

a) Morphology; Receptors, Receptor Density

b) Membrane Potential; Mechanism

c) Action Potential; Characteristics, Ion Flux

d) Synapse; Transmitters, Precursors, Ions, Termination of Action, Transmission Characteristics, Presynaptic and Postsynaptic Functions

4) Skeletal Muscle Contractions; Depolarization, Role of Calcium, Actin/Myosin; Energy Source and Release

5) Pain Mechanisms and Pathways

a) Nociceptors and Nociceptive Afferent Neurons, Wind-Up Phenomenon

b) Dorsal Horn Transmission and Modulation

c) Spinal and Supraspinal Neurotransmission and Modulation; Opioid Receptors

d) Autonomic Contributions to Pain; Visceral Pain Perception and Transmission

e) Social, Vocational and Psychological Influences on Pain Perception

f) Gender and Age Differences in Pain Perception

6) Autonomic Nervous System

a) Sympathetic: Receptors; Transmitters, Synthesis; Storage; Release; Responses; Termination of Action

b) Parasympathetic: Receptors; Transmitters; Synthesis; Release; Responses; Termination of Action

c) Ganglionic Transmission

d) Reflexes: Afferent and Efferent Limbs

7) Temperature Regulation

a) Temperature Sensing; Central, Peripheral

b) Temperature Regulating Centers; Concept of Set Point

c) Heat Production and Conservation

d) Heat Loss; Mechanisms

e) Body Temperature Measurement; Sites; Gradients

f) Effect of Drugs/Anesthesia on Temperature Regulation

g) Special Pediatric Considerations

b. Anatomy

1) Brain

a) Cerebral Cortex

(1) Cerebellum, Basal Ganglia, Major Nuclei and Pathways

(2) Brain Stem

(a) Respiratory Centers

(b) Reticular Activating System

(3) Cerebral Circulation; Circle of Willis, Venous Sinuses and Drainage

2) Spinal Cord and Spine

a) Variations in Vertebral Configuration

b) Spinal Nerves (Level of Exit, Covering, Sensory Distribution)

c) Blood Supply

d) Sacral Nerves: Innervation of Pelvic Structures

3) Meninges: Epidural, Subdural and Subarachnoid Spaces

4) Parasympathetic Nervous System: Location of Ganglia, Vagal Reflex Pathways

5) Sympathetic Nervous System: Ganglia, Rami Communicantes, Sympathetic Chain

a) Cranial Nerves

b) Carotid and Aortic Bodies, Carotid Sinus

c) Ganglia, Rami Communicantes, Sympathetic Chain

d) Nociception

(1) Peripheral Nociceptors: Transduction

(2) Afferent Pathways: Neurons, Dorsal Horn, CNS Pathways

2. Respiratory System

a. Physiology: Lung Functions and Cellular Processes

1) Lung Volumes

a) Definitions; Methods of Measurement; Normal Values; Time Constants

b) Spirometry; Static and Dynamic Volumes; Deadspace; Nitrogen Washout, O2 Uptake, CO2 Production, Exercise Testing

2) Lung Mechanics

a) Static and Dynamic Compliance, Pleural Pressure Gradient, Flow-Volume Loops and Hysteresis, Surfactant, Laplace Law

b) Resistances; Principles of Gas Flow Measurement

c) Methods of Measurement

d) Work of Breathing

e) Regulation of Airway Caliber

3) Ventilation - Perfusion

a) Distribution of Ventilation

b) Distribution of Perfusion, Zones, Hypoxic Pulmonary Vasoconstriction

4) Diffusion

a) Definition, Pulmonary Diffusion Capacity

b) Apneic Oxygenation, Diffusion Hypoxia

5) Blood Gas Transport

a) O2 Transport; O2 Physical Solubility; Oxyhemoglobin (Hb-O2) Saturation, Hb-O2 Dissociation Curve; 2,3-Diphosphoglycerate (2,3-DPG), P50, Respiratory Enzymes; Hemoglobin (Hb) As A Buffer

b) CO2 Transport; Blood CO2 Content; Carbonic Anhydrase; CO2 Dissociation Curve; Bohr Effect, Haldane Effect

c) Systemic Effects of Hypercarbia and Hypocarbia

d) Systemic Effects of Hyperoxia and Hypoxemia

6) Control of Ventilation

a) Respiratory Center

b) Central and Peripheral Chemoreceptors; Proprioceptive Receptors; Respiratory Muscles and Reflexes; Innervation

c) CO2 and O2 Response Curves

7) Non-Respiratory Functions of Lungs: Metabolic, Immune

b. Anatomy

1) Nose

2) Pharynx: Subdivisions; Innervation

3) Larynx

a) Innervation; Muscles; Blood Supply; Cartilages

b) Vocal Cords, Positions with Paralysis

c) Differences Between Infant and Adult

4) Trachea

a) Structure and Relationships in Neck and Chest

5) Muscles of Respiration, Accessory Muscles

c. Pharmacology

1) Bronchodilators

a) β-agonists

b) Anticholinergics

2) Antiinflammatory medications

a) steroids

b) leukotriene modifier drugs

c) mast cell stabilizers

d) Immunoglobulin E (IgE) blockers

3. Cardiovascular System

a. Physiology

1) Cardiac Cycle

a) Control of Heart Rate

b) Synchronicity of Pressure, Flow, ECG, Sounds, Valve Action

c) Impulse Propagation

d) Normal ECG

e) Electrophysiology; Ion Channels and Currents

2) Ventricular Function

a) Frank-Starling Law; Preload and Afterload, Intracardiac Pressures

b) Force, Velocity, Length, Rate of Shortening

c) Myocardial Contractility, Measurement Limitations

d) Cardiac Output: Determinants and Regulation

e) Myocardial Oxygen Utilization

f) Systolic and Diastolic Function

3) Venous Return

a) Vascular Compliance/Venous Capacitance; Controlling Factors

b) Muscle Action; Intrathoracic Pressure; Body Position

c) Blood Volume and Distribution

4) Blood Pressure

a) Systolic, Diastolic, Mean, and Perfusion Pressures

b) Intracardiac, Pulmonary, Venous

c) Systemic and Pulmonary Vascular Resistance, Viscosity

d) Baroreceptor Function

5) Microcirculation

a) Capillary Diffusion; Osmotic Pressure, Starling’s Law

b) Pre-Post Capillary Sphincter Control

c) Viscosity; Rheology

6) Regional Blood Flow and Its Regulation

a) Cerebral and Spinal Cord

b) Coronary

c) Pulmonary

d) Renal

e) Splanchnic – Hepatic

f) Muscle and Skin

g) Uterine and Placental

7) Regulation of Circulation and Blood Volume

a) Central: Vasomotor Center, Hypothalamic-Pituitary-Adrenal Axis

b) Peripheral: Receptors and Reflexes

c) Hormonal Control

d) Mixed Venous Oxygen Tension and Saturation

b. Anatomy

1) Normal Anatomy of Heart and Major Vessels

2) Coronary Circulation

a) Heart Conduction System; Innervation

b) Blood Supply of Other Major Organs

c. Pharmacology

1) Digitalis; Actions and Toxicity

2) Inotropes

3) Phosphodiesterase III Inhibitors (Inodilators): Milrinone, Others

4) Antiarrhythmics

5) Antianginal Drugs

6) Vasodilators: Nitroprusside, Nitroglycerin, Hydralazine, Nesiratide, Calcium Channel Blockers, Others

7) Angiotensin Converting Enzyme Inhibitors and Angiotensin Blockers

8) Electrolytes (Potassium, Magnesium, Phosphorus, Calcium): Cardiovascular Effects

9) Non-Adrenergic Vasoconstrictors: Vasopressin and Congeners

4. Gastrointestinal / Hepatic Systems

a. Physiology: Hepatic Function

1) Dual Blood Supply and Its Regulation

2) Metabolic and Synthetic Functions

3) Excretory Functions

4) Mechanisms of Drug Metabolism and Excretion, Cytochrome P450

5. Renal and Urinary Systems/ Electrolyte Balance

a. Physiology

1) Blood Flow, Glomerular Filtration, Tubular Reabsorption and Secretion

2) Renal Function Tests

3) Hormonal Regulation of Extracellular Fluid

4) Hormonal Regulation of Osmolality

5) Regulation of Acid-Base Balance

6) Drug Excretion

7) Water and Electrolytes: Distribution and Balance; Compartments

b. Pharmacology

1) Diuretics

a) Mechanism of Action

b) Comparison of Drugs

c) Effect on Electrolytes and Acid-Base Balance

d) Adverse Effects

2) Dopaminergic Drugs

6. Hematologic System

a. Pharmacology

1) Anticoagulants, Antithrombotics, and Anti-Platelet Drugs

a) Mechanism of Action

b) Comparison of Drugs

c) Drug Interaction

d) Monitoring of Effects

e) Side Effects and Toxicity

f) Alternatives to Transfusion: Hemodilution, Sequestration, Autotransfusion, Blood Substitutes, Erythropoietin

2) Immunosuppressive and Anti-Rejection Drugs

b. Transfusions

1) Indications

2) Blood Preservation, Storage

3) Blood Filters and Pumps

4) Effects of Cooling and Heating; Blood Warmers

5) Blood Components, Volume Expanders

6) Preparation for Transfusion: Type and Cross, Type and Screen, Uncrossmatched Blood, Autologous Blood, Designated Donors

7) Synthetic and Recombinant Hemoglobins

c. Reactions to Transfusions

1) Febrile

2) Allergic

3) Hemolytic: Acute and Delayed

d. Complications of Transfusions

1) Infections: Hepatitis, Human Immunodeficiency Virus (HIV), Cytomegalovirus (CMV), Others

2) Citrate Intoxication

3) Electrolyte and Acid Base Abnormalities

4) Massive Transfusion: Coagulopathies, Hypothermia

5) Pulmonary

a)Transfusion-Related Acute Lung Injury

b)Transfusion-Related Circulatory Overload

6) Immunosuppression

7. Endocrine and Metabolic Systems

a. Physiology

1) Hypothalamus, Pituitary; Thyroid; Parathyroid, Adrenal Medulla, Adrenal Cortex and Pancreas

b. Biochemistry of Normal Body Metabolism

1) Carbohydrates

a) Aerobic and Anaerobic Utilization; Chemical Processes, Enzymes

b) Relationship to Hormones; Insulin; Human Growth Hormone, Glucocorticoids; Glucagon, Epinephrine

c) Effect of Stress

2) Proteins

a) Functions, Hormones, Antibodies

b) Cyclic Adenosine Monophosphate (CAMP); Cyclic Guanosine Monophosphate (CGMP)

c) Lipids: Triglycerides, Lipoproteins, Cholesterol

(1) Specific Organ Metabolism (Brain, Heart, Liver, Muscle)

8. Neuromuscular Diseases and Disorders

a. Physiology of Neuromuscular Transmission

1) Prejunctional Events: Acetylcholine Synthesis and Release, Modulation By Nicotinic and Muscarinic Prejunctional Receptors

2) Postjunctional Events: Acetylcholine Binding to Acetylcholine Receptors, Ion Flow Through Acetylcholine Receptor

b. Anatomy of the Neuromuscular Junction

1) Prejunctional Components: Motor Neurons, Neuronal Transport System, Synaptic Vesicles

2) Postjunctional Components: Muscle Cell, Acetylcholine Receptor

3) Perijunctional voltage-gated channels

D. Special Problems Or Issues in Anesthesiology

1. Physician Impairment Or Disability: Substance Abuse, Fatigue, Aging, Visual and Auditory Impairment, American Disabilities Act

2. Ethics, Practice Management, and Medicolegal Issues

a. Professionalism and Licensure

b. Ethics, Advance Directives/Do Not Resuscitate (DNR) Orders; Suspended DNR, Patient Privacy Issues, e.g., Health Insurance Portability and Accountability Act (HIPAA)

c. Informed consent (principles, components)

d. Patient Safety

1) Medication Errors: Assessment and Prevention

2) Disclosure of Errors to Patients

II. Advanced Topics in Anesthesiology

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