Andy Downs

I do

Anaesthetists: do you monitor EtCO2 on the journey to theatre recovery? Literally nowhere I’ve worked has the kit to do this, yet apparently it’s an @assocanaes.bsky.social guideline to do so. I don’t even think our Philips mini-me monitors can do this …. 🤔 #AnSky

I've used the Fresenius ones in the past. They seem OK, but maybe interface a bit basic / clunky? Have also used the B-Braun ones a while ago, but I remember them seeming pretty flimsy, and again, terrible interface (IMHO).

Anaesthestists: I'd like your opinion on #TIVA pumps. We have BD Alaris PK+, which are OK, but dated, and no Eleveld. Researching alternatives. BD Nexus / Fresenius Kabi / B-Braun Perfusor Space / Arcomed SP6000. Any others to consider that I've missed? Opinions on the various options? #AnSky

Ok, have tried the inflated glove trick in practice a few times now. Works like a dream! Delightfully low tech and really effective. Thanks ☺️

I heard that you guys don’t have TCI pumps either? If true, seems strange. Absolute mainstay of my day-to-day practice and I would be lost without them - for both TIVA and sedation. #AnSky

Laura Aikman (who played Sonia) didn’t tell her family she was back in Gavin & Stacey until she popped up on the screen last night. #GavinAndStacey

Ah, found it on the otjer place…. x.com/snookernstuf...

You got a link to video of the “incident”?

Like the sound of this one! Inventive and inexpensive! Will give it a try when I’m back at work next week ☺️

Which to be fair, isn’t really Philips’ fault, just no one thought to check.

We have found that the monitor “forgets” the calibration upon disconnection. Which is problematic with our setup because vast majority of colleagues prefer to use anaesthetic room and then transfer to theatre once anaesthetised and intubated. This wasn’t discovered until after we’d bought them ☹️

Nice! Which manufacturer is this?

Our local Circle hosp. has GE ones (with integral brace), and these for me work much better in practice vs Philips NMT. I'd (?mistakenly) assumed the GE ones were more reliable due to more reliable positioning of the thumb. Maybe the accelerometer is better on the GE one? Or some other factor?

Love the sound of this. Might help the situation, *and* using something that would otherwise be thrown in the bin.

Yeah, we fix the accelerometer to the thumb with tape. But the thumb doesn't necessarily stay in an optimal position. Especially if the arms are wrapped by the sides, as is increasing with laparoscopic / robotic surgery.

I'm thinking, maybe some kind of makeshift thumb brace, fashioned from bits of tape and ETT tube? The more Heath-Robinson the better! Whilst we're on the subject, any recommendations for actual good TOF monitors that aren't a small separate box that will go missing? Something that can be bolted down

Anaesthetists: the only TOF monitors we have in our hospital are these Philips NMT ones and they are crap. The rep did give us one (!) thumb brace, but in reality they are going to go missing within 5 minutes. Has anyone got any top tips/ hacks to make the NMT more useable in practice? #AnSky

A well deserved winner in the infographic contest!

Speaker Mark Barley, at the lectern.

"MAC is not a brain concept, it is a spinal cord concept."

#SIVA24

Excellent presentation on processed EEG monitoring by Drs Mark Barley and Tom Blanks. Learning about “top down” vs “Bottom up” induction of anaesthesia #SIVA24 #AnSky

I work in one such institution! Would be great to have 2%, but worries about drug errors prevent it happening 🤨

Just trying to make this change myself. I’m liking siting them more proximal.

Seems to be really common in vascular patients post lower limb bypass. Pain relief at surgical site is generally not a problem, but they are shouting the house down in recovery about needing to void. Spoiling an otherwise smooth emergence!

All fair points Tom. Reason I ended up down the Dexdor rabbit hole; am looking for some preventative (as opposed to rescue) treatment for catheter related bladder dysfunction. The evidence I could find was for Dexdor, not clonidine. Happy to be corrected though as would be less hassle!

Really useful posts, thanks Gavin!

(Am aware this is off-label in UK)

Intraop dexmedetomidine as an adjunct to TIVA. Seems to be evidence for several potential advantages (opioid sparing, less post op pain, less delirium, less catheter related bladder discomfort). Main issue is ⬇️HR, right?. Interested to hear advice/tips from those that use regularly. #AnSky

I like the sound of this Kevin. I have avoided Prilo for hips so far, because my workflow is to use plain 0.5 Bupi, and immediately lie the patient lateral, operative side up. So Prilo being hyperbaric is an issue. Will give your way a try!

Thanks Sethina - awesome work!