Objectives and Contextualisation

1. To recognise risks and problems of anaesthesia as a medical doctor, to be able to advice surgical patients how to prepare physically and psycologically before surgery and anaesthesia.

2. To know special problems of anaesthesia for different surgical procedures and different kind of patients so that in the future the student, no matter the chosen specialty, will be able to help and advise other medical doctors on medical problems related to anaesthesia and surgery.

3. To apply basic principles of physiopatology and pharmacology to diagnose and treat critical ill patients: different coma states, cardiovascular and respiratory insufficency, cardio-respiratory arrest, traumatism, shock status, etc.

4. To familiarise with acute pain evaluation using analgesic drugs through different admnistration routes and to perform some techniques to be able to relieve pain in situations of chronic pain.

5. To know and recognise general principles of Postoperative Resuscitation, most frequent complications and their treatment

 

Specific objectives

1. To know general surgical indications, perioperative risks and postoperative complications

Knowledge

• Risk factors of anaesthetic and surgical procedures
• General and specific postoperative complications in different surgical specialties
• Postoperative pain
• Thrombotic risk associated to anaesthesia, prophylaxis in different surgical procedures

Clinical abilities (to do)

• To detect the most important anaesthetic-surgical risk factors afecting: anatomic abnormalities, cardiovascular diseases, respiratory diseases, hepatic and renal diseases, metabolic diseases and nutritional alterations, extreme ages, coagulation disorders, nervous system diseases, allergies, pregnancy.
• To detect relationship between chronic treatments and anaesthetic-surgical procedures
• To detect early postoperative complications depending on surgical risk factors and patient's comorbilities.

Clinical abilities (to know how to do)

• Full preanaesthetic evaluation and decision making about anaesthetic-surgical procedures

2. To know general principles of anaesthesia and resuscitation

Knowledge

• Clinical guides (phases) of the surgical patient
• Preoperative evaluation
• Preoperative preparation of the patient
• Multimodal prehabilitation concept and objectives
• IV and inhalatory general anaesthesia
• Sedation and analgesia 
• Differences between general anaesthesia, sedation, regional and local anaesthesia
• OR and Day-Hospital organisationación 
• Ethics and laws of the clinical practice of anaesthesia and resuscitation

Clinical abilities (to know to do)

• To give general information about anaesthesia to the patient: safety, risks, sensations and side effects
• To perform correctly local topic and infiltration anaesthesia
• Safety administration of mild sedation

Clinical abilities (to know how to do)

• Neuroaxial and regional blocks

3. To know principles of different drug groups, dosages, administration routes, and pharmacokinetics. Analgesic drugs.

Knowledge

• Clinical pharmacology of general anaesthetics, benzodiazepines, muscle relaxants and local anaesthetics
• Perioperative use of opioids
• Non-opioid analgesic drugs

Clinical abilities (to know to do)

• To administer sedative drugs, neuroleptics, antiepileptic drugs, antibiotics, etc. safetly

Clinical abilities (to know how to do)

• Lumbar puncture

To indicate adequate treatments in most frequent acute and chronic processes and in terminal ill patients.

4. To know epidemiology,social-economic consequences and physiopatologic basis of acute and chronic painand its treatment.

Knowledge

Pain and itstreatment. Definition and types of pain. Pain treatment as a fundamental human right.

a) Pain as a Public Health Problem

• Epidemiology. Individual and socioeconomic repercussions
• Ethics aspects
• Human and animal research

b) To know implicated mechanisms of transmission and modulation of pain and its evolution from acute to chronic pain.

• Neuroanatomy, physiology and biochemistry: Transmission and modulation routes of pain. Transmissors implicated. Psychology of pain.

c) To know how to evaluate pain, suffering and dyscapacity and the efficacy of treatments. Scales and questionnaires

d) To know standard treatments used in acute and chronic pain

• Pharmacologic treatment: opioid and non-opioid analgesics and adjuvants. Administration routes and forms
• Invasive treatments: blocks, radiofrequency, neurostimulation
• Psychologic techniques and physiotherapy

e) To know clinical characteristics and treatment in most frequent clinical scenarios afected by pain:

Acute postoperative pain and pain treatment in emergency room

Muscle-skeletal pain

Neuropathic pain

Oncologic pain

Pain in children and elderly patients

Pain and pregnancy

Pain in drug dependent patients

Pain in palliative care

f) Derivation criteria and patient visits in Pain Unit

g) Principles of analgesia and palliative sedations

Clinical abilities (to do)

To perform anamnesis, clinical exploration, y solicitar pruebas complementarias de enfermos con dolor agudo y crónico

• To evaluate acute and chronic pain intensity using visual and oral analogic scales 
• To prescribe combined analgesic treatments. To prevent and treat side effects.
• To treat pain correctly in special situations: pregnancy, breat feeding, pediatry, geriatry, drug dependent pacients.
• To prescribe opioids and combined opioid drugs through different administration routes (oral, transdermic, etc.) at home. To prevent and treat side effects. To recognise opioid addiction signs in patients with chronic pain.
• Follow-up of oncologic patients under high dosages of opioids through different administration routes
• Peripheric infiltrations with local anaesthetics with analgesic purposes
• Follow-up ("pain dairy") of chronic pain and treatment efficacy

Clinical abilities (to know how to do)

• To evaluate clinical trial protocols on pain issues
• To know the correct use of questionnaires in chronic pain management
• To know the correct safe IV admnistration of opioids in acute pain treatment
• To know the correct administration of analgesic drugs with "patient controlled analgesia" (PCA)
• To know the indications of central and peripheric nerve blocks in pain treatment
• To know pain treatment in labour with epidural analgesia
• To know the use of opioids in terminal ill patients
• To know opioids rotation and/or admnistration routes

This Guide describes the framework, contents, methodology and general rules of the subject, in accordance with the current curriculum. 
The final organization of the subject with respect to the number and size of groups, distribution in the calendar and dates of examinations, 
specific evaluation criteria and review of exams, will be specified in each of the hospital teaching units (UDH), which will make it explicit
 through its web pages and the first day of class of each subject,through the professors responsible for the subject at the UDH.

Teaching methodology and evaluation proposed in this guide may be modified according to current pandemic restrictive official regulations.
										
											
										
											For the present course, the professors appointed by the departments as responsible for the subject at the Faculty and the UDH level are: