TomH

Either do the three way tap trick, or just hit the Ce at 6 and augment with an extra 10mls in the cannula port.

TIVA purists will flap with the latter but you titrate to effect anyway so it makes no difference.

All else being equal, GA (volatile + BIS) and block. Spinal if resp/airway badness.

FWIW I don’t like slugging patients with Alf/Midaz and flipping them over for a spinal when a GA is perfectly safe. Just my practice, if spinal works for you then go for it

Interesting, I always consent/warn parents about it but I guess I don’t need to anymore

Mandatory antenatal consent for neuraxial anaesthesia in advance. If they say no (eg they are footballer/dancer and can’t risk nerve damage) then we see in clinic to talk about it and plan GA if appropriate.

On arrival on LW everyone gets it reiterated while lucid. Then when they ask we crack on

Easy. GA. suprainguinal Fib. Go

+\- art line based on valve badness and vibes

Fun fact there’s plenty of cases of this happening in the literature. Usual drug errors/wrong packet etc.

Despite this I’ve worked in precisely one hospital with pre-diluted metaraminol and phenyl

Is this cause for 20mg ketamine or S-ketamine ampules to be more widely available? Because I see the “well I’ve opened 200mg so might as well use a proper dose” rationale quite a bit..

Ooh ooh @maffygirl.medsky.social - I have a new thing we can all argue about:

“Category 3 caesarean sections have no place out of hours unless a second team is immediately available“

My personal views aren’t particularly strong but I like sitting eating popcorn.

For extra flavour: #obsky #ansky

Both ideas are pretty unworkable.

Better question is; should be AFOI all mallampati 4/ predicted difficult like the Swiss apparently do. Increases safety and obviously improves the skill set

The correct phrase is “send send send” otherwise it doesn’t work

Absolutely yes!

No. While the environmental impact is wildly overblown (see Slingo and Slingo in Anaesthesia), it was just rubbish. Everyone coughs, it’s horribly expensive, and even in the obese barely made a difference, especially if you pay attention.

Yep, glycopeptide like Vanc but you just bang it in like other Abx.

…. Then notice the anaphylaxis and give adrenaline

Orthopaedics like it here. It’s also often the go-to in cases of penicillin “allergy”

It was the UK NAP 6 audit that found Teic was a troublemaker. Probably because we hand it out like smarties

Fabulous improvement. Thank you

Doing an axillary block? Open the patient’s Lancaster sling early, take the back strap, wrap it round the head of the bed somewhere then they have something to hang on to and keep their arm abducted appropriately

Drawing up Teicoplanin in a hurry?. Slam in the water, shake all you want.

Then get a non filter needle, aspirate as much air as you can to generate negative pressure, then disconnect syringe from needle and boom. No bubbles. Draw up as normal

Whoever is doing the GA SEES THE CHILD THEMSELVES. Trust is fleeting and so useful.

Give the child a job as soon as they enter the room. They love a helper job. “Hold your sticker (tegaderm) for me, help me move your bed”. Now you’re a team.

Be quick, be fun, be calm. True for adults too

A good study on actual trained anaesthetists in Europe… we all know VL is good, so where is the guidance I can wave at purchasing to let us have more than one glidescope between seven theatres*?

Said guidance also needs to let us train and maintain DL as a core competency

(*hyperbole)

Can I get in early and say I hate the vortex? Too much lingo, too abstract.

If you say out loud “I’m in the vortex here” to people who don’t know it they’ll assume you’ve been getting at the ketamine

I don’t but have no issue with those that do. I do reach for it early

Hard no. Useful for addictor canal to avoid wanging nerve to vastus, also useful in Axillary if musculocutaneous is playing hide and seek

Completely agree. Why the hell did they need people to know how a fire extinguisher empties?

Time to start a fight.

I think non-anaesthetists don’t realise how difficult epidurals/spinals can be, and don’t appreciate the experience and skill it can take to take someone screaming at 10/10 pain to chilling in bed with a 10-20 minute procedure #ansky

Half the UK seems team GlideOscope which drives me mad

Tried to read and it’s not working on two different devices - says it might not be uploaded?

Le shuttle booking portal charges specifically for dogs, cats and ferrets

I’d love to know the backstory here…

Completely agree. Anaesthetists need to get over themselves and put a proper line in for patients coming to ICU for a long stay. Break out the ultrasound rather than boshing in a ratty abbocath that won’t last until handover.