Airway Special Interest Area (SIA) at Royal Cornwall Hospital
(Anaesthesia for Patients with Complex Airways)
Welcome to your Airway Fellowship at RCHT. Our hospital is a 750-bed district general hospital, however due to our isolated geographic location we manage a range of complex chronic conditions as well as head and neck cancers. We are also relatively self sufficient at managing some simple paediatric airway cases. Due to our location as the only hospital in Cornwall we are expected to manage airway emergencies in both children and adults and have a supportive culture of team working and assisting each other amongst our different specialty colleagues.
Within our Head and Neck service we manage diagnosis and treatment of laryngeal and supraglottic cancers, neck masses (including neck dissections), thyroid, parathyroid, parotid masses and a range of laryngeal pathologies (papillomatosis, subglottic stenosis, reinke’s oedema, dysplasia). The Head and Neck team carry out elective and emergency tracheostomies as well as tracheostomy revision surgery. Our Max Fax team manage a range of facial, oral and tongue base malignancies as well as complex reconstructive work following trauma or removal of skin cancers. They also manage mandibular, maxillary and orbital fractures.
We have a number of anaesthetists here with specialist interests in Airway Management. We are an enthusiastic department with a lot of motivation and varied experiences, and are passionate about creating an environment where Airway Fellows can get the maximum out of their placement with us:
- Mark Lambert- Airway Lead for RCHT, experience working at the Royal TN&E hospital prior to RCHT, many airway contacts at UCLH. mark.lambert7@nhs.net
- Libby Fontaine- ENT, laryngeal surgeries, jet ventilation, high flow nasal oxygen, airway education lead, paeds ENT. libby.fontaine1@nhs.net
- Roger Langford- ENT, laryngeal surgery, jet ventilation, front of neck access (FONA) in paeds and adults, paediatrics.
- Lewis Connolly- ENT, major ears and Max Fax, contacts at Aintree Hospital, clinical lead for Anaesthesia at RCHT.
- Geoff Tavener- ENT, airway surgery, FONA training
- Gareth Meredith- Airway, simulation training
- Emilie Nicholls- Max Fax, ENT experience, paeds.
- Andy Lee- major ears, paediatric ENT.
Paediatric ENT Consultants- Leslie Milne, Ross Milton, Russ Evans, Tom Bevir, Georgia Brooker.
Other useful contacts:
-
- Katharine Sprigge (College Tutor)
- Nila Cota (College Tutor)
- Guy Hooper (external fellowship coordinator)
While you are with us we would hope to give you as much exposure to Airway relevant lists as possible, with some other mixed elective work relevant to your level of training. You would also contribute out of hours to our Senior Anaesthetic Trainee (SAT) rota. This 1:8 rota commitment* involves covering theatre and being a senior point of contact for ICU and Obstetrics. As a mixed role you will get good exposure to critically unwell children and adults requiring ICU support as well as urgent surgery. Your educational supervisor would have expertise in complex airway anaesthesia.
There are opportunities for airway education here at RCHT and they are listed at the end of this document. Many educational sessions are already set up but if you wish to pursue your own ideas you are very welcome.
QI is encouraged and you will be supported if you wish to pursue posters, publications or articles. We recently displayed four posters at WAMM 2025 in Florence, led by residents and supported by departmental consultants. We are currently working on improving our sustainability with non-disposable laryngoscopes and upgrading our HFNO system. You will be entitled to 8 days per 6 months for educational development (EDT) time which can be used towards QI or other project work.* This can be taken as 16 half days if preferred.
Stage 3 SIA Curriculum RCoA
Key Capabilities
- Senior decision maker within MDT
- Attends regular airway lists (Monday ENT Th 12, Tuesday ENT Th12, Wednesday MaxFax Th 12) and assists in decision making when planning elective anaesthesia for airway cases
- During SAT role attends to emergency airways and assists in decision making and planning
- Can proficiently manage difficult paediatric airways that present to any non-specialised hospital
- Attends regular paeds ENT lists
- Experience on SAT rota
- Paediatric airway teaching
- Performs awake and asleep intubation in all patients with advanced airway pathology
- Request asleep fibreoptic intubation (FOI) training on regular lists
- Take opportunities to assist and lead awake FOI training- send out regular Whatsapps to ‘Daily Chat’ and communicate with Emergency Floor Anaesthetist (EFA) in case emergencies arise during work hours.
- Airway training courses- faculty and candidate
- Train and train others on the ORSIM bronchoscopy trainer
- Can plan and manage at risk extubation
- Elective and emergency work
- Utilises techniques for apnoeic oxygenation and ventilation
- Utilises high flow nasal oxygen (HFNO) where possible
- Proficient in FONA
- Training at Treliske Airway Day, and other courses
- Assists surgeons during tracheostomy surgery, experience in ICU
- Proficient in independently managing anaesthesia for patients needing a wide range of major head and neck surgeries
Experience
- Pre-op Assessment (POA) clinic (with Anaesthetic POA team)- may require communication with team to see relevant cases (Ed Costar is our POA Lead)
- ENT Clinic with Ms Grobbelaar/ Ms Hartill/ Mr Reddy (Head and Neck)
- Monday ENT Th 12, Tuesday ENT Th 12, Wednesday Max Fax Th 12
- Paediatrics: Good basic experience best seen in Th1 on Fridays Week B and Miss Lambert’s list Week A, Thursdays. Other Paeds lists on offer are:
- Week A Thurs Th1 Mitchell/Lambert, Friday Th 1 Tan.
- Week B Tues Th 1 Tan, Weds Th 1 Markey, Friday Th 1 Kel.
Supervised Learning Events (SLEs) can be used to demonstrate:
- pre-operative assessment and management of complex head and neck surgery patient
- leadership of multi-disciplinary planning for patients with complex airways
- practical procedures such as:
- video-laryngoscope assisted intubations using both MAC and hyperangulated blades
- pre-operative nasendoscopy (ENT clinics, Roger Langford’s nasendoscopy course)
- awake and asleep fibre-optic intubation (see Key Capabilities)
- awake bronchoscopies (to be arranged with Respiratory team nearer the time)
- front of neck access techniques: ultrasound guided, mannequin, cadaver (see Key Capabilities)
- jet ventilation (tubeless surgeries) (Theatre 12 experience)
- apnoeic oxygenation techniques (see Key Capabilities)
- ability to interpret investigations like CT head & neck and CT chest to aid the planning of complex airway management (Theatre experience, attend H&N MDT)
- use of innovative techniques for complex airway management.
Personal Activities and Personal Reflections may include:
- National and international meetings related to management of complex airways, for example Difficult Airway Society meetings (November each year), WAMM (every 5 years)
- Difficult airway training courses- Guy’s Airway Course June each year, RCoA, GOSH etc
- Presentation at relevant meeting ie abstract or free paper
- Development of guidelines and policies related to airway management. Current trust guidelines:
- Airway preparation for FOI
- Paeds OSA and adenotonsillectomy
- Removal of supraglottic device
- Care of tracheostomy
- Paediatric airway emergencies
- Use of throat packs
- Avoidance of FB aspiration during intubation
- Failed intubation in the obstetric patient
- Leadership of QI projects related to airway management
- Involvement with local/regional educational programs for teaching airway skills
- Treliske Airway Day (early summer, yearly)
- Airway Governance (autumn, yearly)
- ODP Teaching sessions (2 year rolling rota)
- Final FRCA Teaching (June, yearly)
- Additional teaching sessions eg tea trolley or ad hoc skills
- Leadership training
- Attendance at MDT ENT - radiology teaching sessions.
- Attendance at ENT clinics (nasendoscopy experience)
- Attendance at respiratory bronchoscopy sessions (to be arranged)
- Attendance at Derriford Hospital to see retrosternal thyroid case and laryngectomy case (to be arranged nearer the time).
Additional experiences (to be arranged by Fellow as required)
- UCL placement (Mark Lambert)
- Aintree Hospital (Lewis Connolly)