This is a good read. Paraspjnous spinal. Had a couple of difficult to position patients recently and I wonder if this would have fixed it. #RASky #ansky www.bjaed.org/article/S205...

Hadn’t heard this before either. Interesting!

I do for open abdominal surgery, not much downside. Altho now leaning into IT opiates in a spinal…

Welcome back to the #MedSkyDebate from @bobfunn.bsky.social#MedSkyDebate What do you do? IV Lignocaine yay or nay?? After a rush of enthusiasm in my primary hospital IV Lignocaine has disappeared. I do not use it Get involved #MedSky #AnSky

Just turned 50. (FFS) now thinking about my exit strategy… I figure with lots of experience perioperative medicine is where it’s at. Not more night shifts…

PSA Slow Horses new series up on Apple TV - you’re welcome.

#RCoAUpdates bit of CPD on AI in healthcare. 10 hours of CPD. www.rcsi.com/online/find-...

#RCoAUpdates worrying signs of CHF

#RCoAUpdates types of heart failure. HFrEf Signs and symptoms and EF<40% HFmrEF 41-49% HFpEF >50% but with structural abnormalities Different medications in the HFpEF group Just to keep you on your toes. HF w improved EF! Keep them on their meds… Entresto - just for HFrEF

#RCoAUpdates new NICE guidelines came out a few weeks ago for CHF.

#RCoAUpdates risk of DKA with SGLTi’s probably over stated. Can be stopped day before and day of. Check ketones if worried. And restart when patients are eating and drinking normally, usually next day.

#RCoAUpdates GI symptoms bare no relation to gastric contents… Looks like gastric USS is going to become core practice.

#RCoAUpdates This expert thinks the guidelines on GLP-1’s and aspiration are bunkum! The data is flawed in his opinion. Certainly don’t stop them… hyperglycaemia is well demonstrated to be harmful.

#RCoAUpdates Eligibility for glp-1’s - half of all US adults!!! Lots of people taking them without prescription. >>100 billion USD market, 300 different agents in the making.

Check out the top 10 articles published in @anaesjournal.bsky.social from 2024 - all free to read or open access! associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/toc/10.1...

#RCoAUpdates never heard of this! Electronic frailty index bjgp.org/content/75/7...

#RCoAUpdates frailty - biggest subject of our times. Our largest and fastest growing surgical group is over 75’s

#RCoAUpdates Dr Claire Dunstan - one of my old med school and anaesthetic training buddies! Preop risk prediction tools. Stratifying “amber” patients for elective surgery hubs. Objectify risk. Guide decision making.

#RCoAUpdates echo guidelines 2025 - interesting.

#RCoAUpdates the perioperative pathway - Dr Joanna Simpson. Guidelines anyone? Screen/optimise/review/date when ready/SDM. Leading to Get It Right First Time (GIRFT) not heard of this - some good guidelines eg echo and proBNP gettingitrightfirsttime.co.uk

#RCoAUpdates NHS 10 year plan. Gist of more community care, technology and prevention not cure. Honourable goals! Shortfall of 1900 anaesthetists across the UK… Massive squeeze at the specialty training level. No shortage of applicants. 12:1 for core anaesthetic places.

Useful gastric pocus links 👍 #ansky

Sitting at the rcoa meeting having the morning start up coffee. Seems a bit of a shame that we’re all sitting on separate tables looking at phones. I’m a roaring extrovert i get that - but human connection trumps many other things in life I feel…

WHO statement on autism-related issues The World Health Organization (WHO) emphasizes that there is currently no conclusive scientific evidence confirming a possible link between #autism and use of acetaminophen (also known as paracetamol) during pregnancy Full statement bit.ly/47YsgwI

Challenges of space tourism and suborbital flight. Affluent people with medical problems! High G leading to micro G, noise, motion sickness and psychological effects. Gx- in the AP direction - 4-6g vs Gz which is up/down and is what fighter pilots see. Anaesthesia and aerospace med overlap…

#RCoAUpdates the commercial space era - right up my alley!! Anaesthesia plan in microgravity?! TIVA only! Shelf life of drugs (thio would last a long time 😊) but bubbles in the solution can’t be “tapped” out! But TIVA ketamine is the choice…

#RCoAUpdates post op pain management- Professor Narinder Rawal. Increased knowledge does not equal increased patient satisfaction. 2024 half of postop patients feel moderate to severe pain…

#RCoAUpdates resource for learning gastric USS c/o @rosiehogg.bsky.social

#RCoAUpdates airway ultrasound for prediction and planning. We are awful at identifying the cricothhroid membrane… USS is much more accurate

#RCoAUpdates Lung USS - can answer useful questions

#RCoAUpdates GLP-1’s - everyone will be on them soon! And are often being taken by our patients un prescribed. So gastric USS whether we like it or not is going to become a necessary skill.

#RcoAUpdates @rosiehogg.bsky.social next. POCUS and clinical decision making. Gastric USS hot topic - how can it help me?

My slideset for @rcoanews.bsky.social Anaesthetic Updates 2025 meeting. Key publications in neuroanaesthesia and neurocritical care. sthjournalclub.wordpress.com/2025/09/22/r...

#RCoAUpdates Dr Emma Temple - another amazing bio! Futility in critical care. This is a big deal and will get bigger. Care should be offered if it’s considered beneficial. And we’re into health economics. ICU is expensive - need to do the best for the many not the one??

#RCoAUpdates just met @rosiehogg.bsky.social like being in the presence of anaesthetic royalty 😊 very nice to chat to. Another day of live updates…

To be clear, there are no data that provide a link between short-term use of Tylenol during pregnancy and autism. In fact, one of the best prospective studies w/ sibling controls, if anything, pointed to a protective effect for use less than 7 days acamh.onlinelibrary.wiley.com/doi/10.1002/...

#RCoAUpdates risk of kidney failure. Not seen this one before. kidneyfailurerisk.co.uk

#RCoAUpdates interesting thoughts - thoracic spinal anaesthesia anyone? @bjajournals.bsky.social

#RCoAUpdates Rachel Gibson unfortunately passed away due to LA overdose during THJR. Write down what you want to give in milligrams and millilitres, check with your nursing staff what they have drawn up before they give it.

#RCoAUpdates where’s NRFit up to in Australia?

Dr MariaPaz Sebastian #RCoAUpdates what’s new in #RASky regional anaesthesia. New ASRA guidelines on thinners. Deep plexus or deep peripheral blocks should be treated like CNB. But don’t specify - have to go to the ESRA for that! Treats infraclav like a spinal!

#RCoAUpates. Interesting regional difference here. Talking about hypotension and shoulder surgery - cerebral oximetry being spruiked, not convinced personally. But questions asked about whether using pressor from the outset in these cases. Why wouldn’t you- what’s the downside??! V. Prevalent in Oz

ACOG reaffirms that acetaminophen is safe for managing pain and fever during pregnancy. No reputable studies support suggestions like those in HHS’s recent announcement linking acetaminophen use in pregnancy to autism; in fact, high-quality studies show no such risk. https://bit.ly/47Wxc59

ANZCA and FPM STATEMENT Paracetamol use in pregnancy We are aware of recent claims from the US questioning the safety of paracetamol use in pregnancy. These claims are not based on new evidence. Our full statement is here: tinyurl.com/5yye2npu

#RCoAUpdates Dr Harriet Hall and Dr Phoebe Scarfield - older patient and public involvement in periop care. Patients are getting older and are our core business. The surgical population is getting older and multicomorbid. Over 65 - very diverse population. From frail to running marathons…

#RCoAUpdates Dr Imran Ahmad on the high risk airway next - a predicted difficult airway is difficult. High BMI over represented in the surgical popn and airway complications are over represented in this group. #ansky

#RCoAUpdates post op complications have more influence than pre op and intra op factors on survival. Significantly. Understood this vaguely but it’s really significant…

Prof Bill Fawcett next. His bio is impressive! #RCoAUpdates ERAS update. 30 years new now. CPET expensive and cheaper ways to do it. EEG monitors - jury’s out but should avoid burst suppression probably. IV iron post op is good

Hypertension before surgery due for publish soon - continue the ACE and the AT2 DofS. This is a big change in our neck of the woods. Going to be some inertia getting this change thru… #RCoAUpdates

#RCoAUpdates VL vs DL in spinal cord injury - no difference in spine movement but better 1st pass success which is better for your patient. VL FTW…