What started out as a piano of anonymous whispers has morphed into a crescendo of senior doctors
But with the notable absence of past soloists, by which I mean almost the entire executive body of the @RCPhysicians who have had to resign in quiet shame over this issue
#RCPEGM
Nov 22, 2024 • 24 tweets • 8 min read
As a senior clinician I 💯 approve of @wesstreeting announcement of a review into associates
But I am concerned it will be written around a predetermined outcome like so much of this debate has been
Below is material is hope Prof Leng sees and takes into account 🧵
@RoySocMed
I wrote this thread over a year ago when concerns were just starting to be raised about the misuse of associates, tacit doctor substitution and the direction of work force plans
If you don’t know what an associate is it’s a useful catch up (at least for anaesthesia)
This recent article was brought to my attention by sad, angry & senior resident ICU doctors
Adjacent is a reply of what one thought but didn’t want to say in public
They were very happy for a consultant colleague to speak for them though 🧵
I’m writing this because it is quite clear that a lot of medical leadership is not listening to, or indeed worse, stone walling the voices of resident doctors - their soon to be consultant colleagues
Doctors are scared to speak up and when they do they’re ignored
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
Dec 10, 2022 • 13 tweets • 3 min read
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 🎉 🤐
Oct 3, 2022 • 17 tweets • 5 min read
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 🤮
Aug 20, 2022 • 18 tweets • 6 min read
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!
Aug 6, 2022 • 18 tweets • 5 min read
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!
I’m writing this because it is quite clear that a lot of medical leadership is not listening to, or indeed worse, stone walling the voices of resident doctors - their soon to be consultant colleagues 
