In it’s current guise the gov’s work force plan is a disaster & and as a consultant I feel compelled to raise a 🚩

The rapid expansion of anaesthesia associates within the NHS is likely to have severe consequences for patient safety and training

Read on if you want to know why There’s a standing joke within anaesthetics that people don’t know we’re actually doctors!

I can assure you we are!!

It takes a minimum of 14 years to train, some of the hardest PG exams in medicine and a series of increasingly competitive selection steps to progress

Last week I wrote a 🧵 about the old fashioned (thio/sux) RSI and it’s abundantly clear from the comments almost no-one does this anymore!

As someone that avoids gas (🤮) a question I get asked a lot is:

“How do you do a TIVA RSI?”

As follows … … … 💉 Normal disclaimer.

What follows is in the context of a stable patient with a normal airway assessment.

Always remember pre-O2, suction etc

I do normally have better things to do than this on a Saturday but I’m covering a very quiet Labour ward 🎉 🤐

A while ago I wrote a thread about Alfentanil and said “I don’t often geek out about anaesthesia”.

That was probably a total lie!

I’m a huge geek and spend a lot of time thinking “how can I give a better anaesthetic?”

This is a thread about intra-op BP…discussion welcome
🧵 When I started anaesthetics in 2007 we didn’t bother warming patients and hardly anywhere had PSVPro.

Consequently patients would regularly pitch up to recovery with temps <35 and PaCO2>10 kPa (that’s 🆙 if you’re 🇺🇸 and use mmHg)!!

Thankfully that is no longer acceptable 🤮

A while ago I said I’d write a thread on why I attempt to avoid the use of muscle relaxants and that routine use is largely dogmatic.

Here’s why I don’t think there should even be a third pillar of anaesthesia…

(Hopefully this doesn’t upset #anaesthesiatwitter too much!!) Disclaimer:
I’m not a total zealot about this and regarding difficult airways etc relaxants are vital to safe management.
What follows should be contextualised for routine airway management in relatively experienced hands.
I also always keep some red stuff nearby just in case!

I don’t normally geek out about #anaesthesia but given the ongoing Remifentanil shortage in 🇬🇧 I thought I’d post my alfentanil TIVA recipe.
IMHO it’s elegant, precise and allows for absolutely minimal anaesthetic poly pharmacy.
(Very boring for non anaesthetists…..)
1…. Remifentanil is useful but I have never liked it in cases where one is reliant on subsequent IV analgesia.
The transition from a carefully titrated anaesthetic to smashing in 10mg morphine, or the like, towards the end has always irked me. You don’t really know where you are!