Rebecca P

I realise that most of the rest of the world uses IT morphine but I’d be really interested to see these data with IT diamorph…

Oh no. I am so sorry to hear this.That is going to be a really hard conversation but at least you can be there for each other & your Dad. Thinking of you

What do pregnant people understand about nitrous oxide use in the context of concerns regarding the environment and occupational exposure?

#AnSky #ClimateSky #MedSky #ObSky

doi.org/10.1111/anae...

There are some important considerations when discussing the potential reduction or removal of nitrous oxide on the labour ward.

Read more about it here: "Nitrous oxide for labour analgesia: whose dilemma is it?"

#AnSky #ClimateSky #MedSky #ObSky

doi.org/10.1111/anae...

Want to mitigate the harmful impacts of nitrous oxide whilst maintaining parturient autonomy?

Here is a framework for improvement which includes considerations that should be made when implementing nitrous oxide mitigation strategies.

#AnSky #ClimateSky #MedSky #ObSky

doi.org/10.1111/anae...

“We acknowledge that economic & logistical factors may limit the universal implementation of VL in all settings. However, as pt safety is paramount, our findings suggest that investment in this technology may be justified, partic when considering the potential costs of failed tracheal intubation”

Yes, & we should do absolutely everything possible to avoid it. We should discuss it when either the patients wants to or when we think it’s a material risk. I am just not sold on it as a routine part of consent with a chance in most elective surgery as less than 1:20,000.

I always do in obs.

Absolutely they don’t but even the Montgomery statement assumes “a reasonable person in the patients position”

I would be happy to discuss all the pros, cons variations to technique to avoid awareness etc to anyone who wants me to. But is it the right thing for everyone?

Hips and knees usually done under spinal +\- sedation, as it LSCS when the patient is fully aware throughout.

Is awareness an issue? As long as it’s not painful? #controversial

Montgomery & shoulder dystocia was a much higher risk 9-10% not 1:10,000

But would it? Most surgery is clinically needed for a defined reason - would a reasonable person say I’m not going to have my cancer surgery because the risk of awareness is 1:20,000? Given all other associated risks 🤷🏼‍♀️

I do when I’m “primed”… or asked directly. I don’t without specific risk factors.

CMCU box set:

1. The illusion of informed consent associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

2. Asking key questions in the consent process associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

3. The paradox of informed consent

@maffygirl.medsky.social possible topic for an #ansky debate?

Which brings us back to Labour epidurals. Is it really a considered decision/consent when you’re in pain, exhausted & using other drugs? Would it be considered consent if these factors were imposed in a different context? 🤷🏼‍♀️
Absolutely we should do epidurals for Labour anything else in inhumane but…

All very valid observations…. & yet our highest acuity work, in the early hours of the morning is (mostly) done by on call teams who rarely if ever work together. Anaesthetists & surgeons often working outside their specialty area. Should there be more sub spec on call? #ansky #medsky

Ideally both!

The paradox of informed consent Click on the article title to read more.

Does attempting to meet legal requirements for informed consent have the potential to *undermine* patient autonomy?

From me, @hypoxicchicken.medsky.social & @maryannturner.bsky.social.

Free full text for a limited time i @anaesjournal.bsky.social

I try to abide by the Montgomery principles and tell the patient risks they would consider important. I use numbers, ratios & percentages with examples 1:50,000 1 person in a football stadium as well as common, rare etc. most still don’t get it & in the event of a complaint consent won’t protect you

Letter to Dame Carrie McEwan and Charlie Massey (GMC) from Dr Tom Dolphin (BMA chair), on BMA letterhead paper outlining the findings on the Leng review, discuss next steps with Government and offer an opportunity for GMC to acknowledge mistakes.

Regulation must not blur the lines between doctors and non-doctors.
We’ve written to the GMC following the Leng review 👇
We've also been granted permission to appeal our judicial review case against the GMC. The court says our appeal raises important issues for public safety.

My centre has a sub spec paeds rota & I don’t anaesthetise children often. I have a dental list but mostly adult with occasional child; usually 10+ & all 5+. I struggle with the play & distraction bit as well as getting the explanations right. I am reluctant to restrain or force in any way. Premed 👍🏻

Human nature, human potential Alice Roberts explores the questions at the heart of humanism: ‘What are we?’ ‘What are we capable of?’ and ‘How should we make best use of our capacities?’

We teamed up with @profaliceroberts.bsky.social to explore the humanist approach to life in a new animation for children. ‘Human nature, human potential’ is the latest resource from @humanismedu.bsky.social, our programme supporting humanism in schools across the country.

As I come to the end of my training, and my 27th and final rotation, I have reflected on this rotational aspect. It has made me extremely adaptable and provided a rich background of experience. But equally, it has broken me, prevented me from creating the social connections that are so... human.

Hello, I’m an anaesthetist in a film. I stand around during surgeries & wait for the fictional surgeon to shout instructions at me after they have intubated the patient. The audience have no idea why I’m there or what I’m supposed to do!

Oh Rob I am so sorry to hear this. It’s been 15 years since my dad died & I still miss him everyday. Be kind to yourself and take things slowly, you’re probably not going to be quite yourself for a while. Thinking of you & your Mum

Picture of a baked cheesecake

Slice of a baked cheesecake with blueberry sauce

Made @nigella.bsky.social Burnt Basque Cheesecake today & it’s fabulous #food #weekend #cheesecake #treats

I think that can be true, but depends on individual circumstances. I always consent with another AHP in the room - midwife/ODP & the birth partner. I leave the OAA risks leaflet with them & encourage both to read it.

Pre labour information is vital but engagement is low esp if non-English speaking

I loved Australia - was there in 2008 for 6 months on an exchange program with my university. I was in Newcastle & I loved every second of it. I was so homesick when I got back to the UK. I haven’t been back, mostly because I daren’t 😂 if I set foot on Aussie soil again I don’t think I’ll leave!

Well I might agree but as you said the question divides a room… so probs best not to tell the other half they’re wrong! 😂

The Royal College of Obstetrics & Gynaecology are consulting on their draft good practice guidance for the provision of planned caesarean birth services in the UK.

Instead of talking about Labour as a transcendent process where you’re in the zone & there are waves of pressure etc Maybe talking about the honest full scope of experience would help women engage with all the information which is out there to help them make informed choices.