Dr Pieter Peach

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#Ansky #Medsky

We come across this delicate balance every time we discuss proceeding vs postponing in children with URTIs.
Explaining low severity consequences of laryngospasm when managed appropriately, while still giving the option of postponing for purely elective procedures where they may be better in a month

Do you specifically consent for risks of anaphylaxis, cardiac arrest, haemorrhage, aspiration? Given the consequences of any of these for the patient can vary from nothing to death, how do you expect patients to integrate that information into their decision making? #MedSkyDebate #MedSky #AnSky

And it used to broadly risk stratify for patient selection for rural GP anaesthetists, along with a minimum age, to provide what appears to be a well considered and so far not obviously unsafe national system from provision of remote/rural anaesthetic services.

Presumably depends on the specific risk in question.

No risk score will be perfectly implemented. You still ultimately see some correlation in outcomes, in this case mortality after intra-operative cardiac arrest in the @webairs.com dataset. Limitations: voluntary adverse event reporting, no denominator. doi.org/10.1177/0310...

What a ride

xkcd.com/1732/

Thanks 🙏

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doi.org/10.1001/jama...

Revisit the February 2025 Infographic in Anesthesiology - Safe or Skip? Association Between Intraoperative Midazolam in Elderly Patients and Rates of Postop Delirium 🎨 ow.ly/Z7Tx50UH1jQ

Are you a paediatric anaesthetist? Check out this great new guideline!

"Consensus recommendations for paediatric airway topicalisation using lidocaine"

#AnSky #MedSky #PedsAnesSky #PaedsAnaesSky #PharmSky

doi.org/10.1111/anae...

Totally appropriate given the volume of practice and patient selection. Not all children need to travel to large centers and this arrangement definitely takes the load off waiting lists.

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Here is the midweek #MedSkyDebate, a topic provided by @drnavsidhu

“You don’t need a paediatric anaesthetist to anaesthetise children”

What do you think and do you have a cut off age where you will not anaesthetise them?
Is it just particular cases??

Tell us what you think.

Over my career I’ve seen many occasional paeds anaesthetists run into difficulty managing laryngospasm requiring the assistance of someone more experienced with it. Some decide not to expose themselves to that risk again.

Sufficient training & ongoing volume of practice relevant to the age & procedure the patient is having. The judgement on whether the anaesthetist is appropriate usually comes down to them/proceduralist. Where it becomes problematic is when they succumb to pressure to proceed when uncomfortable.

That is quite a photo

When the midwives in our units use this term it’s usually not referring to the level of pain, more the duration. If someone has been labour for a prolonged period of time they get sleep deprivation, which is reinforced by the number of women who immediately fall asleep after I insert an epidural.

Interesting. It’s the common language used by midwives in the hospitals I work in. It’s not used in a derogatory sense but could see how it could be taken that way.

Excellent topic. We can absolutely do better. Would be interested to hear stories from institutions that have implemented preadmission consent processes.

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The weekend #MedSkyDebate is from Anaesthesia Journal @anaesjournal.bsky.social
How do you consent for an Obstetric epidural and how can we improve this process?
#MedSky #AnSky


https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.16697

I wonder why it’s a quicker onset. I always understood ropiv and bupiv to have similar onset for regional blocks

Never heard of this

Thankyou

The type of passive, low pressure regurgitation that may be amenable to reduction with cricoid is the same that can likely be prevented with a head-well-above-stomach position, coincidentally, also the optimal position for intubation that should always be used in any case.

Stories like these from our future selves are worth reading

#Ansky

Would love to read more of these

Does the patient’s postoperative analgesia include opioids?

A computer can never be held accountable. Therefore a computer must never make a management decision.

Taps the sign

Interesting. Is there a particular reason?

What is the indication for its use in your department?