Core Generalist#



Categorise the classification of pain by type: nociceptive, neuropathic, phantom, psychogenic, break-through and incident pain


Describe pain interventions relevant to the pain type and know when referral is required


Identify nerve block techniques, effects, complications and their management


Describe common risk factors for peri-operative adverse events in different age groups


Describe major anaesthesia specific conditions: suxamethonium apnoea & malignant hyperthermia


Describe the principles of management of intra-operative crises: anaphylaxis, bronchospasm, major haemorrhage


Discuss preoperative fasting requirements and common measures used to decrease risk of pulmonary aspiration


Discuss pre and perioperative management of specific requirements eg diabetic medications and fasting, anti-coagulants, antibiotic prophylaxis


Describe the basic pharmacology of sedative/hypnotic agents (propofol, thiopentone, midazolam, ketamine), inhalational agents, opioids, muscle relaxants, reversal drugs and anti-emetic agents, and the selection of agents, given clinical factors eg arrhythmias, obstetric, paediatric, hypotension


Discuss the continuum of hypnosis from sedation to general anaesthesia


Describe the major effects of anaesthesia and analgesia on cardiovascular and respiratory physiology and cognitive/neurological functioning


Consider how the effects of anaesthesia and analgesia interact with common medical conditions


Explain the management of common post-operative problems including pain, nausea, vomiting, hypotension, hypertension, tachycardia, damage to teeth, sore throat, laryngeal damage, nerve injuries, backache, headache, mild allergic reaction mild


Describe the basic structural anatomy of the upper airway including the larynx


Identify the features of history and examinations that may identify a potentially difficult airway


Apply the requirements for safe practice of procedural sedation contained in ANZCA resource: Safe procedural sedation competencies


Discuss potential advantages and adverse consequences of the use of combinations of drugs for procedural sedation


Identify causes, symptoms, and signs of impending cardiac or respiratory arrest


Describe the clinical features and initial management of life threatening post-operative conditions, including anaphylaxis, respiratory depression, myocardial ischaemia, cardiovascular collapse, aspiration pneumonitis, hypothermia, delirium, hypoxic brain damage, pulmonary embolism


Describe indications for use of humidified high flow nasal oxygen


Explain the principles and indicators for mechanical ventilation, the pharmacological management and appropriate monitoring of ventilated patients


Discuss the principles of transport of a patient with invasive ventilation



Undertake pre-operative assessment and risk identification


Manage the pre-anaesthetic care including fasting requirements for management of patients having surgery or other procedures


Provide post-operative care for patients who have received anaesthesia


Perform conscious procedural sedation in appropriately selected patients


Undertake a pain assessment


Provide pain management for acute and chronic pain


Competently perform the following skills:

  • undertake oxygen saturation monitoring
  • deliver oxygen therapy
  • use oxygen concentrators
  • reduce tension pneumothorax
  • deliver blood transfusion


Administer the following local and regional nerve blocks in appropriately selected patients: regional, digital, intercostal, biers, femoral and fascia iliac


Perform the following emergency procedures:

  • face mask ventilation
  • Hudson mask with reservoir bag
  • initiation of humidified high flow nasal oxygen
  • basic airway opening manoeuvres including adjuncts and suction
  • bag and mask ventilation with one and two operator technique using self-inflating bag and anaesthesia circuit
  • application of positive end-expiratory pressure (PEEP), continuous positive airway pressure (CPAP) or Bilevel positive airway pressure (BiPAP) / Pressure support using anaesthesia machine or ventilator
  • insertion of laryngeal mask airway (LMA) and endotracheal tube (ETT)
  • endotracheal intubation, including manoeuvres to improve view of larynx during direct laryngoscopy and use of endotracheal tube inducer or stylet
  • rapid sequence induction, including preoxygenation and appropriate pharmacology


Can’t Intubate – Can’t Oxygenate (CI-CO) procedures including consideration of front of neck access procedures


use of emergency department or transport mechanical ventilator for invasive ventilation and non-invasive ventilation

  • intra-osseous access
  • peripheral venous and arterial line, including Seldinger technique
  • insertion and management of peripheral arterial cannula
  • external cardiac massage
  • Advanced Life Support including cardiopulmonary resuscitation (CPR) and defibrillation
  • synchronised direct current (DC) cardioversion
  • administer nitrous oxide (as analgesia)








Advanced Specialised (based on JCCA Curriculum)#



Describe the principles of common or important operations requiring anaesthesia and their appropriateness in Rural Generalist anaesthesia practice


Identify current ANZCA standards for anaesthesia practice


Detail equipment for general anaesthesia and monitoring:

  • range, function, clinical use and hazards of equipment
  • safety issues in the use and maintenance of equipment
  • choosing, assembling and using equipment, eg systematic check of anaesthetic machine
  • balancing benefits of using items, eg endotracheal tubes, against potential complications
  • requirements of, and skills for, equipment maintenance
  • use of pulse oximetry, capnography, volatile agent monitoring, ECG monitor and non-invasive blood pressure monitors
  • use and hazards of diathermy


Detail staff and patient hazards and plans to avoid, including hazards of:

  • the operating theatre
  • infection, (eg HIV, hepatitis B, C, or other blood borne infections)
  • physical injury, electric shock, radiation, surgical and anaesthetic equipment and environmental pollution
  • cross infection, patient posture, and immobility


Describe principles of common or important operations requiring anaesthesia:

  • the effect on the patient
  • the conduct of anaesthesia
  • problems associated with specific procedures and methods to overcome them
  • the appropriateness for Rural Generalist anaesthesia


Detail the respiratory system, including:

  • basic respiratory physiology
  • control and function of the respiratory system
  • common respiratory problems and their management
  • symptoms and signs of respiratory failure
  • interpretation of radiography and lung function testing
  • mechanisms of changes in blood gases and capnographs


Explain oxygen therapy, including:

  • pathophysiology of hypoxaemia
  • indications for oxygen therapy
  • indications for hyperbaric oxygen therapy
  • hazards in respiratory failure and prematurity


Detail ventilator use including:

  • the principles and practice of respiratory support and ventilation
  • indications for mechanical ventilation
  • safety features
  • methods of monitoring
  • use and choice of ventilators in patients with varying degrees of resistance and compliance
  • use of ventilators in theatre, intensive care and awaiting or during transport


Discuss artificial airway

  • indications
  • advantages and disadvantages of each airway type
  • insertion of pharyngeal airways, laryngeal masks, oral and nasal tracheal tubes and tracheostomy
  • management of immediate and delayed complications of an artificial airway, eg laryngeal spasm


Discuss physiology and anatomy relevant to local, topical and conduction anaesthesia


Discuss pharmacology, including:

  • pharmacology of local anaesthetic drugs
  • indications for different drugs
  • management of overdose or abnormal response


Detail narcosis and analgesia, including:

  • induction of unconsciousness and sensory blockade
  • theory of mechanisms involved in narcosis, anaesthesia and sensory blockage
  • pharmacology of drugs used to modify consciousness, opioid drugs, sedatives, neuroleptics agents and tranquillisers as well as those used to provide sensory and reflex blockage
  • choice and administration of suitable drugs to induce and maintain unconsciousness and provide intra operative analgesia
  • factors involved in choice of agents for induction and maintenance of anaesthesia
  • physical and mental states which may influence conduct of anaesthesia
  • patients’ emotional response to induction
  • venepuncture, airway maintenance and tracheal intubation, including cricoid pressure and rapid sequence induction, and indications for the relevant techniques
  • failed intubation drill, particularly for obstetric anaesthesia
  • use of ‘difficult airway’ equipment, eg bougies, alternative laryngoscopes or any other suitable equipment for unexpected difficult intubations


Detail muscle relaxation, including:

  • the mechanisms of muscle tone
  • the pharmacology of muscle relaxants
  • safe provision and reversal of muscle relaxation
  • physiology of muscle relaxation
  • indications and complications
  • provision of satisfactory relaxation
  • plan for management of inappropriate response
  • understanding of the principles, and use of a nerve stimulator


Discuss the pre-requisites for day only surgery, including:

  • principles for selection of patients
  • surgical procedures that are suitable
  • social/domestic pre-requisites


Discuss factors relating to pre-operative medication, including:

  • pharmacology principles
  • administration objectives
  • the emotional impact of patients undergoing surgery
  • informed consent


Detail the practice of local, topical and regional anaesthesia, including:

  • techniques, effects, complications and their management
  • techniques of subarachnoid anaesthesia and commonly used nerve blocks, eg axillary and ischaemic arm blocks
  • physiological responses to subarachnoid and epidural blockade
  • monitoring techniques for use in local and conduction anaesthesia management of immediate and delayed complications
  • use of sedative and neuroleptic drugs in conjunction with local and conduction anaesthesia
  • implications of general anaesthesia in conjunction with local and conduction anaesthesia


Discuss the considerations associated with the primary (surgical) condition, including:

  • effect of surgical illnesses and injuries on anaesthesia, operative and post-operative management
  • aetiology, natural history and effect of surgical illness relevant to rural anaesthesia practice
  • the effects of anaesthesia on the patient’s condition and incidence of post-operative complications
  • urgency of surgery, preparation of patient, and suitability for transportation
  • preparation of patient for surgery with emphasis on resuscitation
  • the effect and treatment of surgical diseases on body systems


Discuss the anaesthesia considerations associated with patient’s medications, including:

  • physiological response to anaesthesia
  • principles of drug interactions
  • interactions between anaesthesia drugs, and drugs used in the treatment of disease
  • modification of existing drug therapy for anaesthesia and surgery
  • drug therapy modification, eg stopping anticoagulation with the treating surgeon


Discuss the considerations for anaesthesia and intercurrent disease, including:

  • local and general effects of relevant medical diseases
  • its relevance to case selection for rural GP anaesthesia
  • principles of management
  • effect of anaesthesia and surgery on intercurrent disease
  • effect on anaesthesia
  • consultation with specialist anaesthetist in pre-operative preparations


Discuss the relevance of medical, surgical and previous anaesthetic events such as failed intubation, anaphylaxis, family and genetic disorders, oesophageal reflux, obese patients, cognitive impaired patients, previous cardiac stents, diabetic patients, obstructive sleep apnoea, spinal conditions


Detail the principles and considerations of paediatric anaesthesia, including modification required of apparatus and technique


Discuss the considerations of anaesthesia in the elderly


Discuss the considerations in obstetric anaesthesia and analgesia, including:

  • important physical and emotional changes in pregnant women, relevant to anaesthesia
  • analgesic and anaesthetic factors which influence foetal wellbeing
  • analgesic techniques in obstetrics
  • neonatal resuscitation


Discuss signs of raised pressure and anaesthesia techniques which minimise untoward changes if emergency neurosurgery is required to control intracranial pressure


Discuss how to control secretions and air leak if emergency thoracic surgery is required


Describe the natural history of post-anaesthesia recovery, including the:

  • emotional impact of recovery phase
  • causes of post-operative discomfort (including pain)
  • criteria for discharge from recovery room


Discuss post-operative pain management, including:

  • effective pain management in modifying surgical stress response
  • inter-patient variability in analgesic requirement
  • opioid and non-opioid agents which modify pain conduction
  • patient controlled infusion devices,
  • supplementation of analgesia with regional techniques eg: epidural analgesia, nerve block


Discuss the management of chronic non cancer pain, including:

  • influence of emotional, psychological and social factors on an individual’s pain response
  • visual analogue scores for quantifying pain
  • effect of psychosocial issues
  • management of chronic pain using non-opioid medication
  • pain clinic services


Discuss the management of chronic cancer pain, including:

  • anatomical and pathological mechanisms
  • psychological effects
  • therapeutic needs
  • assessment for pain clinic referral
  • common methods of treating pain, drugs used, mode of administration, eg subcutaneous infusion
  • empathy and communication skills with patients and family



Establish and utilise a comprehensive professional referral network


Administer anaesthesia services in accordance with knowledge, skills and subject to local infrastructure and jurisdictional credentialing


Assess the risk of anaesthesia and surgery in consultation with a specialist anaesthetist if necessary, with consideration of

  • clinical services capability
  • urgency of the surgery in relation to the risk of anaesthesia, eg a higher anaesthesia risk may be accepted if surgery is life saving
  • prediction of pre-operative, intra-operative and post-operative anaesthesia risks
  • age, health, body mass index of patient


Undertake a pre-operative assessment including:

  • physical and mental state
  • family history
  • patient history including previous medical, surgical and anaesthetic events
  • clinical examination and investigations
  • primary (surgical) condition
  • medications/treatments
  • intercurrent disease
  • post-operative pain relief


Identify significant symptoms and signs requiring further investigation:

  • relevant history, eg chest pain suggestive of ischaemic heart disease
  • physical signs, eg prediction of difficult intubation
  • recent food and fluid ingestion
  • laboratory and radiological investigations
  • conditions requiring post-operative intensive care, eg respiratory failure


Identify features of the pre-operative assessment which will require specialist anaesthesia services and refer appropriately


Operate and maintain general anaesthesia equipment


Administer anaesthesia services, including:

  • local, topical and regional anaesthesia
  • epidural anaesthesia
  • general anaesthesia
  • intra-operative analgesia
  • reverse muscle relaxation
  • intravenous fluids during operations
  • suction to clear respiratory secretions
  • humidification


Provide post-anaesthesia care, including:

  • management of unconscious patient, especially maintaining an unobstructed airway
  • management of disturbances of physiology, especially airway
  • maintenance of respiration and circulation
  • pain relief
  • physiotherapy


Identify and manage complications of anaesthesia, including:

  • CI-CO
  • adult cardiac/ respiratory arrest
  • anaphylaxis
  • massive haemorrhage
  • malignant hyperthermia
  • laryngospasm
  • Manage pain
  • acute pain and chronic pain
  • cancer and non-cancer pain







Clinical courage

Last updated on by acrrmbot