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…..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…..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!

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...

@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-...

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

A new resource from @rcoanews.bsky.social Good get better rcoa.ac.uk/patients/pat...

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/...

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).

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

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

Responding to an article about consent for anaesthesia in children we analysed (all cause) PAEDIATRIC PERIOPERATIVE MORTALITY in NAP7 Really low for older children Low for infants High for neonates (80x) (Small numbers & wide CIs) www.bjanaesthesia.org/article/S000... 1/n

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/...

1/9 This is a really interesting observational study looking at VL and DL use. Comparison of success rates is flawed - the choice to use VL or DL was dependent on the complexity of the case - the populations aren't comparable But I think there are other lessons analogous to surgical technique #AnSky

The @rcoa is to be congratulated on navigating the treacherous path defining scope of practice for Anaesthesia Associates via -huge surveys of opinion -aiding #Nap7 analysing real life practice -Cochrane review -professional liaison/listening -pragmatic approach to patient safety & existing AAs 1/2

What are the disadvantages of 'total videoscopic tracheal intubation'? • ⬆️ stress response • ⬆️ risk of airway trauma • awkward ergonomics • prevents airway operator managing other aspects of induction @chrimesy.com @doctimcook.bsky.social #AnSky #MedSky #AirwaySky https://buff.ly/4gyjwy7

HYPERANGULATED VL: OPTIMISING TECHNIQUE As ever, I think the answer lies with careful attention to some simple tips 1/7

Also, consciousness is a slippery concept without an agreed definition/mechanism, hence Chalmers “hard problem of consciousness”. Amnesia however is easier to define and measure and a lack of it is what we actually look for when assessing patients post-op or testing things like BIS and Entropy. 2/2

Delighted that Ben Dallyn from @RUHBath won the 1st prize for oral presentation @dasairway He presented A MANIKIN STUDY OF STYLETS & BOUGIES (static & dynamic)….. 1/4

t’s interesting how people define anaesthesia I ask every new resident what anaesthesia is. When they offer me a triad of -Unconsciousness -Muscle relaxation -Analgesia I give them 1 out of 3 Why is that? Am I right?

Great slide in the ETHICS section of #DAS2024 @dasairway from Catriona Ferguson Lovely summary - including the inherent conflicts within the law

DAS ORAL PRESENTATIONS Great to see David Irwin & Sam Gunning 2nd VL TO TEACH DL: SYSTEMATIC REVIEW & METANALYSIS -VL improves FPS -Point estimates of time & overall success favour VL (n/s) -sensitivity analyses support VL -the overall evidence is weak & further good quality study would be good

Thrilled that our @anaesjournal.bsky.social human factors guideline paper has passed 40 000 views! Thank you to @dasairway.bsky.social @assocanaes.bsky.social and all of the authors @drkevinfong.bsky.social @doctimcook.bsky.social @tmeek.bsky.social et al #ansky search.app/UvkCbeESwrcf...

Great slide in the ETHICS section of #DAS2024 @dasairway from Catriona Ferguson Lovely summary - including the inherent conflicts within the law

It's time for some new airway terminology! Introducing "flextension" - flexion of the lower cervical spine & extension of the upper cervical spine It is the optimal position for non-infant airway management #AnSky #MedSky #AirwaySky @chrimesy.com @doctimcook.bsky.social https://buff.ly/4eSw2Yo

Brilliant stuff. Supplementary points: @doctimcook.bsky.social & I have just published on suggesting the term #Flextension to replace 'sniffing position'. bsky.app/profile/chri...

Celebrating the airway! Difficult Airway Society 2024

#CriticalLanguage Time to move from ‘sniffing position’ to the more descriptive #flextension which prompts both base-of-neck flexion & atlanto-occipital extension. @doctimcook.bsky.social @anaesjournal.bsky.social associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

Let’s see what happens….