Wednesday 05 February, 2025
المجلس العراقي للاختصاصات الطبية
Iraqi Board for Medical Specializations
(زمالة تخصصية) في تخدير عمليات الأطفال
الدراسة تكون تحت مظلة المجلس العلمي للتخدير والعناية المركزة
يتدرب ألأطباء المقبولين في الدراسة تحت عنوان (طبيب زميل متدرب)
مدة الدراسة: سنتان
المركز التدريبي
منهاج الدراسة التدريبي:
السنة الأولى:
السنة الثانية:
يحصل الطالب عل لقب (زمالة تخصصية) في تخدير ألأطفال/ المجلس العراقي للاختصاصات الطبية
بعد ان يجتاز الامتحان ألأولي (الكتابي) في نهاية السنة ألأولى و النهائي (الكتابي والعملي) في العلوم السريرية بعد اتمامه السنة الثانية وكافة متطلبات الدراسة الاخرى وبنفس شروط النجاح وعدد المحاولات المعتمدة في المجلس العربي للاختصاصات الطبية.
Modules:
The fellows will acquire an understanding of the anatomic, physiologic, pharmacologic, andpsychological differences between neonates, children, and adolescents in relation toanesthesia practice. They must demonstrate knowledge concerning:
o The Respiratory System
─ Anatomic differences of the neonate and pediatric airway
─ Age differences in control of respiration, compliance, lung volumes, oxygen
consumption
─ Neonatal postoperative apnea
o The Cardiovascular System
─ Anatomy and physiology of transitional circulation
─ Maturation of the myocardium and autonomic nervous system
─ Normal vital signs for ages
o The Central Nervous System
─ Anatomic differences: fontanels
─ Age differences: intracranial pressure, cerebral blood flow, and autoregulation
o The Genitourinary System
─ Renal Maturation
─ Fluids & electrolytes, maintenance requirements, hydration assessment
o The Gastrointestinal/Hepatic System
─ Feeding, fasting guidelines
─ Glucose control
─ Maturation of hepatic function
o Hematological System
─ Normal values in infants and children
─ Natural history of fetal hemoglobin
─ Blood component therapy
o Thermoregulation
─ Body surface area and heat loss
─ Differences and ability to thermoregulate
─ Heat loss & prevention
o Psychological Issues
─ Anxiety/fear at different ages
─ Separation anxiety and parental anxiety
─ Use of premeditations
o Pharmacology
─ Pediatric induction techniques, inhalation, intravenous, sedation
─ Age differences in: volume of distribution, pharmacokinetics,
pharmacodynamics, and toxicity
o Pain Management
─ Options for regional and neuraxial analgesia, ultrasound guidance
─ Multi-modal analgesic techniques
─ Differences in performing epidural blocks in children vs. adults
o Anesthesia Equipment
─ Equipment specific to patient age, circuit ventilators
─ Sizes of masks, endotracheal tube, laryngeal mask airway, laryngoscopy blades,
bronchoscope, GlideScope
─ Vascular access and invasive monitoring
─ Regional block equipment
─ Warming devices
Pediatric-Specific Diseases
The fellow should demonstrate understanding of coexisting diseases in pediatric patients toaid in providing safe anesthetic care for children. Such patients include:
o Full term infants, former preterm infants, and healthy children and adolescents
presenting for common surgical procedures, as well as neonates and premature
infants requiring anesthetic management
o Respiratory Disease
─ Upper respiratory tract infections
─ Asthma
─ Cystic fibrosis
─ Obstructive sleep apnea
─ Stridor (congenital and acquired), e.g., cystic hygroma, epiglottitis, croup,
retropharyngeal abscess
o Gastrointestinal Disease
─ Hepatobiliary disease
─ Gastroesophageal reflux
─ Feeding disorders
o Neuromuscular Disease
─ Hydrocephalus
─ Repaired Spina Bifida
─ Cerebral palsy
─ Muscular dystrophy
─ Myotonic dystrophy
─ Seizure disorders and developmental delay
o Infections
─ Hepatitis, tuberculosis, HIV
o Endocrine and Metabolic
─ Diabetes
─ Thyroid
─ Obesity
─ Mitochondrial Disease &mucopolysaccharidosis
o Hematologic/Oncologic
─ Anemias: sickle cell disease, thalassemia
─ Bleeding disorders: hemophilia, von Willebrand
─ Malignancies
─ Mediastinal masses
o Common Syndromes
─ Down syndrome
─ Other syndromes: e.g., Pierre Robin Sequence, Crouzon, Goldenhar, Treacher
Collins, etc.
Pediatric-Specific Procedures
o Preterm infant and neonate
─ Tracheoesophageal fistula repair, omphalocele, gastroschisis, congenital
diaphragmatic hernia
─ Bowel obstruction, necrotizing enterocolitis, duodenal atresia, malrotation,
volvulus, imperforate anus
o Term infant
─ Hernia
─ Pyloromyotomy
o General Surgery
─ Appendectomy
─ Cholecystectomy
─ Thoracic surgery, thoracoscopy including the need for lung isolation
o Otolaryngology
─ Tonsillectomy and adenoidectomy, including post-tonsillectomy bleed
─ Myringotomy, mastoidectomy
─ Thyroidectomy, tympanoplasty
─ Laryngoscopy for diagnosis and treatment, airway papillomas, epiglottitis
─ Bronchoscopy, removal of foreign body from the airway
─ Laryngeal/tracheal reconstruction
─ Neonatal airway surgery
o Orthopedic Surgery
─ Fracture reduction
─ Soft tissue surgery
─ Clubfoot repair
─ Congenital/acquired, e.g., cerebral palsy
o Spinal Surgery
─ Plastic surgery
─ Cleft lip/palate, isolated
─ Burn debridement/skin grafting
─ Craniofacial reconstruction surgery
o Neurosurgery
─ Ventriculoperitoneal shunt insertion, revision
─ Tumor resection
─ Myelomeningocele repair
o Urology
─ Circumcision
─ Hypospadias repair
─ Ureteric reimplantation
─ Cystoscopy, nephrectomy
─ Renal transplant
─ Bladder exstrophy repair
o Ophthalmology
─ Strabismus
─ Cataract
─ Laser for retinopathy of prematurity
─ Open globe injury repair
o Dental Surgery
─ Dental extraction/restorations
─ Orthognathic surgery
o Perioperative/postanesthesia care unit (PACU) issues
─ Delirium
─ Post-extubation stridor
─ Pain
─ Laryngospasm
─ Nausea and vomiting
o Regional
─ Single-shot caudal blocks
─ Ilioinguinal
─ Dorsal penile blocks
─ Neuraxial nerve block techniques
─ Ultrasound-guided regional blocks
Pediatric intensive care :
o Understand normal physiology and pathophysiology of major organ systems
o Demonstrate thorough knowledge of etiology, pathophysiology, clinical features,
diagnosis, complications, management, prognosis, and prevention of common PICU
problems such as:
─ Cardiopulmonary failure and arrest
─ Respiratory failure
─ Septic shock and multiple organ dysfunction syndrome (MODS)
─ Nutrition: enteral and parenteral
─ Renal failure, and electrolyte and acid-base abnormalities
─ Hematologic dysfunction and blood product replacement therapy
─ Neurological emergencies: coma, status epilepticus, intracranial hypertension
─ Pain, anxiety, sedation
─ Brain death and organ donation
─ Toxicology
─ Polytrauma, traumatic brain injury, and burns
o Understand the roles and implications of aggressive care, palliative care, and code
status decision
Neonatal intensive care (NIC):
o Understand the physiological, anatomical, and pharmacological considerations for
the premature and neonate
o Be able to identify neonatal patients requiring resuscitation
o Gain an appreciation of the presentation, diagnosis, and/or perioperative
management of the following:
─ Intraventricular hemorrhage
─ Patent ductusarteriosus
─ Neonatal asphyxia
─ Transient tachypnea of the newborn
─ Respiratory distress syndrome
─ Bronchopulmonary dysplasia
─ Pulmonary interstitial emphysema
─ Diaphragmatic hernia
─ Tracheoesophageal fistula
─ Necrotizing enterocolitis
─ Hyperbilirubinemia
─ Omphalocele
─ Gastroschisis
o Interpretation of laboratory results and chest X-ray (CXR) in the newborn and
premature infant
o Assess and initiate resuscitation of the asphyxiated newborn according to Neonatal
Resuscitation Program (NRP) guidelines
o Gain proficiency in the following procedural skills:
-Intravenous access in the premature and newborn infant, including umbilical
vein/artery catheterization
- Perform lumbar puncture in the septic newborn
Pediatric Cardiac Anesthesia
The fellow will demonstrate knowledge of the basic sciences as applied to the preoperative,intraoperative, and postoperative periods of cardiac surgery.
o Physiology and Anatomy. The fellow is expected to:
─ Describe fetal circulation, development of the heart, and fetal physiology
─ Describe the different congenital cardiac anomalies and their surgical
management
─ Describe the single ventricle pathophysiology and specific management
requirements
─ Describe the altered respiratory physiology of immediate postoperative cardiac
cases
─ Describe common physiological changes occurring in the postoperative period
and the impact they have on end-organ function (neurologic, renal, cardiac,
hepatic, gastrointestinal)
o Pharmacology. The fellow is expected to:
─ Compare common medications for cardiac surgical patients including
anesthetic agents, vasodilators, vasoconstrictors, and inotropic agents
─ Explain the use of antifibrinolytic agents
─ Justify use of blood products (packed red blood cells, fresh frozen plasma,
platelets, cryoprecipitate), blood alternatives (e.g., albumin) and homeostasisstabilizingagents (desmopressin, activated factor VIIa)
o Monitoring. The fellow will:
─ Be able to interpret the electrocardiogram (ECG) for ischemia, infarction,
arrhythmias, and paced rhythms
─ Acquire skills of arterial and central venous cannulation (with ultrasound)
─ Interpret central venous pressure and know the indications, complications, and
management
─ Know the basics of introductory transesophageal echocardiography (TEE),
including techniques of probe insertion and several basic views, and implications
and application in the critical care patient
─ Know the significance of temperature management in the intraoperative period,
including hypothermic techniques
─ Understand the indicators of volume status, especially when weaning from
bypass, including the findings from invasive monitors, TEE, and clinical indicators
o Clinical Assessment & Management. The fellow will:
─ Know current indications and recommendations for subacute bacterial
endocarditis prophylaxis
─ Be able to correct common derangements in metabolic and electrolyte
disturbances in the intraoperative period
─ Know the basic principles of cardiac support devices including the intra-aortic
balloon pump and extracorporeal membrane oxygenation (ECMO)
─ Know the common pathophysiology and management of patients with:
Common congenital anomalies, e.g., atrial septal defect, ventricular septal
defect, patent ductusarteriosus, tetralogy of Fallot
Complex congenital heart disease e.g., transposition of the great vessels,
truncusarteriosus, single ventricle physiology, abnormal pulmonary venous
return
Heart transplant recipients
Palliative procedures: e.g., Norwood, bicavopulmonary anastomosis, Fontan
Obstructive lesions and pulmonary hypertension
Valvular heart disease for valve replacement or repair
Shock and the use of volume resuscitation, venodilators/constrictors,
inotropes, and myocardial relaxants
Cardiac tamponade
Dilated, restrictive, or obstructive cardiomyopathy, congestive heart failure
(CHF), and diastolic dysfunction
Aberrant conduction, dysrhythmia, sudden acute and subacute ventricular and
supraventricular arrhythmia
Pacemakers and the indications for and applications of the various modes of
temporary pacing
Pulmonary edema and CHF
Heparin-induced thrombocytopenia and heparin resistance
Neurologic risk stratification during cardiopulmonary bypass procedures
Lectures:
