@chrimesy.com
Anaesthetist | Creator Vortex Approach | Co-founder Safe Airway Society | Director Universal Airway (PUMA) Guidelines | ANZCA/ASA/NZSA Airway SIG Executive Member VortexApproach.org UniversalAirway.org SafeAirwaySociety.org EZDrugID.org
New: Guidelines for anaesthesia and sedation in patients who are breastfeeding
Anaesthetic, sedative & analgesic medicines are transferred to breastmilk in only very small amounts. Patients should be advised that discarding of breastmilk after anaesthesia is not necessary
Download: buff.ly/KNnL8gR
Semaglutide, fasting and gastric ultrasound
Nearly 50% of patients receiving semaglutide treatment had a full stomach on pre-operative gastric ultrasound, regardless of dose, duration, route of administration or withholding time.
#AnSky
doi.org/10.1111/anae...
Be interested to know what their starvation time was? Patients on GLP here are now getting 24 hour fast pre-op.
Ping @hypoxicchicken.medsky.social
Some correspondence from a retired academic lawyer on consent!
"... the law, while dynamic, is almost always reactive. Expecting it to change to fit a particular narrative is likely to end in disappointment."
#AnSky #LawSky
doi.org/10.1111/anae...
Come work with us!
Save the date for the @SafeAirway 2026 Annual Meeting.
Held in collaboration with the @anzca.bsky.social @asa-australia.bsky.social @thenzsa.bsky.social Airway Management SIG meeting, our shared theme is 'One Airway, One Team'.
Get alerted when rego opens:
sasevents.eventsair.site/contact-us
Registrations are now open for our Gosford Airway Workshop.
Come learn HAVL, VAFI, Neck Rescue & management of trache/lary emergencies on NSW's sunny Central Coast.
Qualifies for @anzca.bsky.social CICO ERM sign off & for CICM airway CPD recognition.
sasevents.eventsair.site/registration
Should we use fewer arterial catheters in critical care patients?
It may prevent harm from non-infective and infective complications, lower financial and environmental costs and reduce iatrogenic blood loss and blood transfusions in individual patients.
#AnSky #ICUSky
doi.org/10.1111/anae...
Pity they massively overdosed the ketamine arm - significant percentage > 2mg/kg / no ceiling dose ("rule of 1 ampoule") / dose per total body weight / and who gives > 0.5 mg/kg to a "sick" patient - great trial / wrong pharmacology / wrong conclusion = drugs are equivalent at equipotent doses
Hyperangulated videolaryngoscopy: stylet first until benefit of bougie is shown
"...the current challenge for the wider community of anaesthetists ... is not mastery of HAVL but access to devices, routine use, gaining familiarly and developing competence."
#AnSky
ttps://doi.org/10.1111/anae.70062
Registrations are now open for the 1st stop on the Safe Airway Society's 2026 #AirwayWorkshopRoadshow: MELBOURNE!
½ Day workshop Sun 22nd March at Peter Mac
Stations:
Neck Rescue @ANZCA.bsky.social CICO ERM sign off available)
HAVL/VAFI
Trache/Lary Emergencies
Places will sell out fast.
Incidence of peri-operative nerve injuries appears to be decreasing over time - a result of meticulous attention to pressure areas? Increasing use of ultrasound for nerve blocks? What do you think?
@dr-amit-pawa.bsky.social @jeffgadsden.bsky.social
The term ‘TIVA’ is irrelevant to what’s being discussed.
The question is should you deliver the induction meds for RSI through a syringe pump.
The answer is no (until we get pumps that can deliver at 7200ml/hr).
“TIVA RSI” (whether pump assisted or not) is a stupid term.
What makes the anaesthetic TIVA is whether IV agent is used for throughout.
All RSI inductions are IV but many are not TIVA bc a volatile is subsequently given for maintenance.
It’s just pump assisted RSI.
Specifics have evolved. Principles remain the same.
I think the biggest issue w RSI is its binary nature. If someone is ‘at risk’ of aspiration, they get RSI even if elements of the technique (eg. no latency bw IA & NMBA) might cause them harm. Amounts to aspiration trumping all other concerns 🤔
Save the dates for our 2026 #AirwayWorkshopRoadshow & annual meeting.
This year our annual meeting will be held back-to-back with the
@anzca.bsky.social @thenzsa.bsky.social @asa-australia.bsky.social Airway SIG meeting in Noosa Heads, QLD.
Registrations open Jan 2026
More details to follow.
Australasian Anaesthesia 2025 (also known as the Blue Book) has landed! You can read a digital version, or order a hard-copy version, here: bit.ly/49JzoxX
“For clinicians who have abandoned cricoid force… the qtn to be answered is why they employ any element of RSI at all. Rather than selectively abandoning cricoid force as a component, it should perhaps be the only component we retain”
From @chrimesy.com in @anaesjournal.bsky.social
"It is perverse that cricoid force has been abandoned selectively by many clinicians for not representing evidence-based practice when, compared with [other RSI elements], it is cost-free, better reasoned, has less potential for harm & more evidence of efficacy."
#AnSky
doi.org/10.1111/anae...
Though there are plenty of other reasons to intubate head up.
Steep head up decreases the risk of regurgitation but increases the risk of aspiration if regurgitation does occur.
Conversely, steep head down makes regurgitation more likely but aspiration virtually impossible in an apnoeic patient.
It’s a zero sum game. You can argue it either way.
If you’re not going to use cricoid, you shouldn’t be doing RSI at all, just standard intubations on everyone.
No one has shown *in a randomised controlled trial* that it does what they say it will do (which is true of all components of RSI) but there’s lots of other experimental evidence that it blocks passage of material bw stomach & pharynx (whereas no other component of RSI has any evidence at all!).
This one’s for @drmikeclifford.bsky.social
Cricoid pressure has been selectively vilified out of RSI in many settings, yet it has less risks, a better rationale & more evidence for efficacy than any other cited component of RSI
Why aren’t we doing it routinely for all adult tracheal intubations?
More complex graphic showing cross reactivity of different NMBAs following previous allergic reaction.
This is the original graphic before I simplified it. Pale blue lines represent lowest risk of cross reactivity.
Algorithm indicating safest NMBA following prior allergic reaction to NMBA.
Ideally refer for testing to find safe agents. Odd that this was not done during previous skin testing.
Otherwise pancuronium.
Awful. I'm just going to leave this here: yes, bronchospasm can account for a flat capnograph, but no, you can't assume that's the reason and you must take the tube out or (if that's genuinely dangerous) exclude oesophageal intubation using a bronchoscope.
onlinelibrary.wiley.com/share/author...
Had enough of this conversation. See ya.
You seem intent on not revealing the secret meaning of virtue signalling.