Hans Huitink

2025 DAS guidelines for the management of unanticipated difficult airway published today in the British Journal of Anaesthesia. #airway #difficultairway #intubation #anaesthesia #anesthesia

https://www.bjanaesthesia.org/article/S0007-0912(25)00693-2/fulltext

a man wearing a white shirt and a mask says magnets how do they work Alt: a man wearing a white shirt and a mask says magnets how do they work

Every time I write "explained anaesthetic" in the notes as part of a pre-assessment, I'm reminded of the fact that even the most expert professor of anaesthesia wouldn't *really* be capable of making that true.

Postoperative sore throat has an incidence of up to 62%.

The current literature lacks high-quality randomised controlled trials on treatments that prevent a complication that is of importance to patients and their recovery.

#AnSky #MedSky

doi.org/10.1111/anae...

Airway Triage App

Airway Triage App reviews

#airwaytriageapp

Save the date

#AAF26

Sustained, exhaled carbon dioxide by waveform capnography is an essential component of tracheal intubation.

But what if there is bronchospasm?

Tracheal intubation can be confirmed using flexible bronchoscopy.

#AnSky

doi.org/10.1002/anr3...

Having said that in that first case of hyperacute onset, neurological symptoms started almost immediately post op and peaked after two days. That would be quite the coincidence.

Maybe high dose corticosteroids?

Guillain-Barré syndrome after surgery: a literature review Guillain-Barré syndrome (GBS) is a rare postoperative complication that is sometimes characterized by serious motor weakness and prolonged weaning from mechanical ventilation. Although the exact natur...

A more plausible mechanism would be the inflammatory effects of surgery, rather than toxicity/triggering from a spinal. I feel like the spinal is an innocent bystander.

In this SR of case reports, the majority of surgeries are spine and cardiac.

pmc.ncbi.nlm.nih.gov/articles/PMC...

Fully agree

I think it is a coincidence. GBS can occur within 4 weeks of campylobacter infection. Preop diarrhoea can be common in some populations (eg bariatrics ~ nearly 10%), and it isn’t usually asked about.

Have any authors proposed a mechanism whereby a central drug exposure creates a peripheral neuropathy?

“Do not intubate in the “coffin position””. Quote Dr Richard Levitan

Agree

One could probably calculate the odds of it arising by chance using the prevalence of GBS in the general population and the odds of needing a spinal/epidural

Yes I wondered that too. Association is not causation

You could also write that case as “patient developed GBS one day after shopping at the supermarket. Is there causation? It can be coincidence?!

Interesting, the question remains if this also would have happened with GA. There probably is an activation of some kind of autoimmune response due to surgery or anaesthesia or stress? Are there hypothesis in the article?

Onset apparently almost immediate, peaking day two post spinal

jmedicalcasereports.biomedcentral.com/articles/10....

This article reported acute onset GBS in 4 patients within 1-2 weeks of epidural anaesthesia
www.neurology.org/doi/10.1212/...

This case report of a pt developing GBS 4-5 days post spinal for renal calculi. It's rare, but it happens. www.jcpsp.pk/archive/2013...

How much time between spinal and onset GBS symptoms?

Although quite rare, I think there are enough independent case reports of spinals triggering acute GBS (temporally linked) to support the claim that there is some association that we don't yet understand.
That's not the same as saying it's unsafe to do a spinal on a post-GBS pt. I don't think it is.

Ping @gonggasgirl.bsky.social

And now neck rescue again please @bobfunn.bsky.social

Nobody knows for sure how GBS is caused, nobody knows how some pts get a second GBS episode (a relative of me had it twice which is rare), nobody knows if spinal anaesthesia or GA can trigger GBS. Probably not related. There is some evidence that finds links to prior Epstein Barr 🦠 or CMV infection

Carbon footprint of total intravenous anaesthesia vs. inhalational sevoflurane anaesthesia in adults: a modelling study

#AnSky #climate #MedSky

doi.org/10.1111/anae...

Yes you can blame Anaesthesia for everything🤣. Part of our job to deal with that 🥊

Green advertisement card. Info includes: Safe Anaesthesia Liaison Group (SALG) Patient Safety Conference 12 November 2025, Online Logos include: SALG, RCoA, Association of Anaesthetists and NHS

Save the date 📆

The SALG Patient Safety Conference is coming up!

This year’s themes are👇

➡️Local Anaesthetic Systemic Toxicity (LAST)
➡️Rapid Sequence Induction (RSI)
➡️Plus poster competition for anaesthetists in training

Book👉 ow.ly/YAvo50WXl9v

#Ansky #Medsky