Anaesthesiology and Intensive Care
The EDAIC Part I domain 'Anaesthesiology and intensive care' tests applied basic science and clinical management across the perioperative and critical care continuum. Paper A emphasises physics, pharmacology, physiology, anatomy and statistics; Paper B tests clinical anaesthesia, intensive care, pain and perioperative medicine.
Core rules and concepts
- Pre-operative risk: assess ASA physical status, functional capacity and organ-specific disease. Aortic stenosis: maintain afterload and sinus rhythm; avoid tachycardia and sudden afterload reduction.
- Airway: predict difficulty, pre-oxygenate, and use rapid sequence induction for a full stomach. Capnography is mandatory to confirm tracheal tube placement.
- Pharmacology: dose = target concentration × volume of distribution; clearance determines maintenance rate. Context-sensitive half-time matters for infusions.
- Sepsis: take cultures, give broad-spectrum antibiotics within 1 hour, 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, and start noradrenaline to MAP ≥65 mmHg.
- ARDS: tidal volume 6 mL/kg predicted body weight, plateau pressure ≤30 cmH2O, PEEP ≥5 cmH2O. Consider prone positioning if PaO2/FiO2 <150.
- ICU supportive care: target light sedation (RASS -2 to 0); use CRRT for refractory hyperkalaemia, acidosis or fluid overload.
Worked example
A 60-year-old man with septic shock from perforated diverticulitis needs emergency laparotomy. MAP is 55 mmHg despite 30 mL/kg crystalloid; lactate is 5 mmol/L. How do you induce anaesthesia? Reasoning: avoid a propofol bolus because it worsens hypotension. Use ketamine 1–2 mg/kg or etomidate 0.2–0.3 mg/kg, and start noradrenaline before induction to keep MAP ≥65 mmHg. Give rocuronium 1.2 mg/kg for rapid sequence induction; suxamethonium is relatively contraindicated if hyperkalaemia risk (crush injury, burns, denervation). Ventilate with 6 mL/kg predicted body weight because sepsis increases ARDS risk. Assess fluid responsiveness dynamically (passive leg raise, stroke volume variation).
Traps
- Using actual body weight for ARDS tidal volume; always use predicted body weight.
- Giving a large propofol bolus in hypovolaemic or septic shock.
- Forgetting cultures before antibiotics in sepsis, or delaying antibiotics beyond 1 hour.
- Missing suxamethonium contraindications (burns, denervation, crush injury, prolonged immobility).
- Assuming spinal anaesthesia is safe in aortic stenosis; it can cause precipitous afterload drop.