Bougie or stylet: what to use when the chips are down?

Is it truly possible to consistently and deliberately shape a bougie to fit a hyperangulated blade?

@doctimcook.bsky.social @janhansel.bsky.social

#AnSky #AirwaySky #MedSky

doi.org/10.1111/anae...

Thinking of implementing default videolaryngoscopy in your department?

Here are some common themes encountered & practical advice & strategies recommended by 5 UK hospitals that have made such a change!

#AnSky

@fionafionakel.bsky.social @doctimcook.bsky.social

doi.org/10.1111/anae...

“Hello, my name is” introductions and badges need updating to include full name, title, and role Staff should introduce themselves with their title, name, and role and have badges clearly detailing this to avoid confusion and misdirection, writes Tim Cook The “Hello, my name is” campaign, set up...

Hello my name is…..needs rebooting with name, title & role

: badges & introductions

Without it
-too much confusion
-too much uncertainty
-too much rom for obfuscation

I like to think Dr Kate Grainger would agree
www.bmj.com/content/388/...

5 years ago I complained that w HAVL “I can see but I can’t get the tube in”.

@doctimcook.bsky.social pointed out “that’s a prob w the operator, not the device”.

Having since learned HAVL I’ve used it routinely for 5 years w 100% FPS & never <G1 view.

Time to retire ‘no trace, wrong place’ @doctimcook.bsky.social
Many UOI do have ‘a trace’
It is all about sustained exhaled carbon dioxide @universalairway.org

I agree

Even as someone who had previously worked in the NHS, I found the new roles, titles and acronyms confusing at first

which prompted me to get a #HelloMyNameIs badge!

Roles should be
a) clearly visible
b) clearly stated

Absolutely agree with this. I have a standard patter. “Hello I’m Dr Sullivan I’m a consultant anaesthetist. What do I call you?” I think it speaks to credibility. Do you want to be anaesthetised by “ Gav” or “Dr Sullivan” ?

“No trace = wrong place” should be retired & replaced by the requirement to exclude oesophageal intubation if ‘sustained exhaled CO2’ is not detected.

From @doctimcook.bsky.social, Andy Higgs & me.

🔑🔓Free full text in @bjajournals.bsky.social : kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...

“Hello, my name is” introductions and badges need updating to include full name, title, and role Staff should introduce themselves with their title, name, and role and have badges clearly detailing this to avoid confusion and misdirection, writes Tim Cook The “Hello, my name is” campaign, set up...

Hello my name is…..needs rebooting with name, title & role

: badges & introductions

Without it
-too much confusion
-too much uncertainty
-too much rom for obfuscation

I like to think Dr Kate Grainger would agree
www.bmj.com/content/388/...

AIRWAY RESEARCHERS!!

We’re researching WHICH FACTORS SHOULD BE REPORTED IN ANAESTHETIC AIRWAY STUDIES (the core outcome set)

A 15 min survey now & again in a month (Delphi)

RESEARCHERS please complete

Recruitment ends this week

Link
redcap03.gsttdms.co.uk/redcap/surve...

Pass it on!

Thanks

EVER HAD AN ANAESTHETIC?
What matters to PATIENTS?

We’re researching WHICH FACTORS SHOULD BE REPORTED IN ANAESTHETIC AIRWAY STUDIES

A 15 min survey now & again in a month

Looking for PATIENTS

Recruitment ends this week

Link
redcap03.gsttdms.co.uk/redcap/surve...

Thanks. Pass it on!

AIRWAY RESEARCHERS!!

We’re researching WHICH FACTORS SHOULD BE REPORTED IN ANAESTHETIC AIRWAY STUDIES (the core outcome set)

A 15 min survey now & again in a month (Delphi)

RESEARCHERS please complete

Recruitment ends this week

Link
redcap03.gsttdms.co.uk/redcap/surve...

Pass it on!

Thanks

EVER HAD AN ANAESTHETIC?
What matters to PATIENTS?

We’re researching WHICH FACTORS SHOULD BE REPORTED IN ANAESTHETIC AIRWAY STUDIES

A 15 min survey now & again in a month

Looking for PATIENTS

Recruitment ends this week

Link
redcap03.gsttdms.co.uk/redcap/surve...

Thanks. Pass it on!

NAP7: high mortality risk in neonates and very low risk in children Editor—We congratulate Lyne and colleagues1 on their initiative to explore and improve consent around perioperative mortality in children. Providing such data for families and clinicians is a key purp...

PAEDIATRIC DEATHS DURING ANESTHESIA & SURGERY - LESSONS FROM NAP7

Great to see this published
Link attached

www.bjanaesthesia.org/article/S000...

Frequency gambling vs severity gambling - from @doctimcook.bsky.social, Andy Higgs & me in @bjajournals.bsky.social

kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F...

Court gives us the go-ahead - Anaesthetists United Court gives us the go-ahead

@AnaesUnited is challenging the expansion of & arguing for the need of a national scope of practice & regulation for Anaesthesia Associates

This is how the legal cases is going.
Big step take already.

anaesthetistsunited.com/court-gives-...

Our legal case - Anaesthetists United We are less than four months away from the final hearing in our fight against the GMC’s failure to set proper standards for Physician Associates (PAs) and Anaesthesia Associates (AAs) to treat patient...

The issue of the expansion, scope of practice & regulation of MAPs, & for anaesthetists AAs, remains front & centre of the agenda.

@AnaesUnited continue to pursue a legal challenge

This is worth reading

anaesthetistsunited.com/our-legal-ca...

Where it started, where it going

A million of anything is….lots

Very proud

Risks associated with general anaesthesia Everyone is different; it is impossible to know who will have a side effect or risk. These numbers are averages from research studies. The people in the studies usually had routine surgery, were a hea...

A new resource from @rcoanews.bsky.social

Good get better

rcoa.ac.uk/patients/pat...

It’s clearly described in the paper….

Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies* Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ....

The PUMA guidelines for prevention of oesophageal intubation are supported by

-RCOA
-AoA
-FICM
-ICS
-CODP
-DAS

This is true of no other airway guidance I am aware of & make them the de facto UK National guidance

associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

Glad that your only regret…..you’re a lucky man

Tube removal (+ FM/SGA ventilation) is the default action to exclude OI, not only if OI can't be excluded with FB. Tube removal + vent also necessary if desat occurs or sustained exhaled CO2 can't be restored (even if removing tube dangerous or OI apparently excluded w alternative technique).

I would alter “Assume no sustained exhaled CO2 = OI unless proven otherwise (by repeat VL/FOB/US/ODD)”
to
“Assume no sustained exhaled CO2 = OI. Remove tube inks unsafe. If unsafe exclude OI (by repeat VL/ & one of FOB/US/ODD)”

Current wording misrepresents the guideline.

I would change “Assume no sustained exhaled CO2” to
“Assume lack of sustained exhaled CO2” (or “failure to meet the criteria for….”) to avoid any possibly of conflating with “NO trace”

(Gestalt notwithstanding!)

Specific to
RCoA
FICM
AoA
This response to a coronial report is very clear & very explicit

www.judiciary.uk/wp-content/u...

In the case of the RCoA the guidelines were supported by council. FICM sits within RCoA (I assume!)

Thanks Greg

PUMA (which I’m not involved with) is an international collaboration

It includes contributors from the 51st, 52nd & 53rd states of the USofEverywhere

For my Canadian colleagues, PUMA guidance was developed in collaboration with the Canadian Airway Focus Group.

Jan is a clever bloke.
Here the relevant papers wot he wrote

associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

a picture of an owl with the words say what written below it ALT: a picture of an owl with the words say what written below it

If I hear chest rising, tube misting from trainees again, I might vaporise.
I say sustained exhaled C02 is the only accurate indicator according to @doctimcook.bsky.social