A "PERUSE before you Infuse" poster, resting on top of a stack of pre-packaged bundles of posters, each containing 20 posters and some Blu Tack, for putting them on walls. It is all about incentivising the good, innit?

Ahead of my talk today at #SIVA25, I have packaged up some #PERUSEbeforeYouInfuse posters, for anyone convinced by what I'm saying, who then wants to use the check.

The right things happen more often if you make them easy. Providing posters (and Blu Tack) is very much in the spirit of the talk.

Timetable for the morning of day 2 of SIVA's Annual Scientific Meeting, 2025.

Morning folks!

We hope that those who attended the dinner last night had a splendid time and have woken up bright and refreshed, ready for today's #SIVA25 content!

Those who have registered for the workshop, please note it starts at 0900.

The first session of talks starts at 0915.

See you soon!

Professor Kenny at the lectern, in front of a slide titled "Diprofusor Design Features".

First up in the main session today at #SIVA25 we have Professor Gavin Kenny, one of the key architects of the Diprifusor TCI system.

It is no exaggeration to say modern TCI and TIVA would not exist without him.

In the first of two talks he is giving today, he tells us how Diprifusor was created.

Agenda for the first half of this afternoon's SIVA ASM.

Getting ready for the second start of the day.

To the folks who attended a workshop this morning, hello again!

To the folks just arriving, welcome to Liverpool and #SIVA25!

Our next talks are focussed around some of the practicalities of TIVA, in the "how I do it" session.

Liverpool skyline after dark. The two cathedrals are visible at the horizon, with the Radio City tower to the right.

Nice view of the famous Liverpool skyline from up here! Both cathedrals, and the Radio City tower are visible. Bit chilly right now though.

Liverpool is a brilliant city.

We are looking forward to welcoming our delegates at tomorrow's Annual Scientific Meeting #SIVA25.

See you there!

SIVA - 27th & 28th November, Liverpool.

Hello Bluesky!

Ahead of our Annual Scientific Meeting, which starts tomorrow, we thought we would get this account up and running.

It will be curated by @robjimfleming.bsky.social for the next couple of days at least.

Hopefully we will see some of you in sunny Liverpool!

"... a ‘RSI–TCI’ mode with a pre-programmed manual bolus offers a pragmatic solution for those who wish to preserve an intact pharmacokinetic model for accurate propofol delivery, while allowing the rapid induction clinicians expect from a manual bolus."

#AnSky #MedSky

doi.org/10.1111/anae...

What would you like?
I'll see what we can cobble together!

0.2mg/kg bolus has no EEG effect
(See image)
0.3mg/kg may have an effect but I feel clinically un likely
0.5mg/kg often will induce EEG changes that are associated with an rise in BIS index

If bolusing and concerned about rise in BIS value, give during a period of surgical stability

Likewise have a similar recipe. I am enjoying comparing my bolus infusion technique to intermittent boluses

After modelling do you have any thoughts on how useful TCI ketamine is Vs bolus infusion? Ie any circumstances you might choose TCI first?

Brilliant, thank you.
Caveats noted!

7x more failures!?
Do you have a study I can look at?

Eleveld et al.'s #pharmacokinetic - #pharmacodynamic model of #remimazolam begins to pave the way for its widespread use in #sedation and anaesthesia. #BJA #model #simulation

www.bjanaesthesia.org/article/S000...

If performed by a second
person, the cost isn't their salary. It's the time that could be spent elsewhere. Helping with turnover, prepping for the next case etc

If performed by airway assistant - disagree with this practice - The cost is attention divided between multiple important tasks.

If performed by a second
person, the cost isn't their salary. It's the time that could be spent elsewhere. Helping with turnover, prepping for the next case etc

If performed by airway assistant - disagree with this practice - The cost is attention divided between multiple important tasks.

Completely agree with this point about us not necessarily being great at predicting who has a full stomach, especially in the era of comorbid disease and GLP1s

Aspiration has an incidence of between 1:900 - 1:10,000 (NAP4)
Perioperative cardiac arrest has an incidence of 1:3000 (NAP7) - Arguably equally catastrophic so should every patient have defib pads put on at the start of a case?

a man in a robe is standing in a dark room with the words `` only sith deal in absolutes '' written on the screen . ALT: a man in a robe is standing in a dark room with the words `` only sith deal in absolutes '' written on the screen .

But I think your question is less about having cricoid as an absolute but maybe where are we drawing a line as to who to use it on?

Every intervention in healthcare has an opportunity cost.

Cricoid force should be performed by a team member with no other role.

Cricoid time x No of anaesthetics/ per hosp/ per year = large number

Aspiration low incidence in general anaesthetic pop. Cricoid becomes non cost effective.

That is a great study! One to be kept in the bank of interesting papers.

The Effectiveness of Cricoid Pressure for Occluding the... : Anesthesia & Analgesia al entrance with and without CP in anesthetized and paralyzed adult patients. METHODS: One hundred seven, nonobese ASA physical status I and II patients were recruited for the study. A cricoid forc...

I don’t think anyone considers thio part of RSI anymore but I’m certain most who’ve abandoned cricoid are still using sux/roc & many aren’t FMV. It’s definitely singled out.

Again, I qtn whether the rationale for RSI is sound.

This is my fav evidence FOR cricoid. journals.lww.com/anesthesia-a...

No thats fair. And perhaps RSI is not the answer to making us take more care. But we're not always careful for a variety of human factor-ey reasons...

Fine you've convinced me! But can I replace it with another fun acronym instead?

Interestingly while cricoid pressure gets mocked by those wanting to practice EBM, there’s no more evidence for any other aspect of RSI? Why has cricoid been singled out as the component to ditch when the whole thing is entirely rationale-based & incls many opportunities to cause harm.

Interesting!
So can I gas induce them?
Arguably 8% sevo can be reasonably quick...
I joke of course but I think if you're being really careful in frail patients you can reach an accidental plane of 'excitability'

If I'm honest I don't disagree with your points

Then again, here I am arguing about the term rather than the substance of what an RSI is. Perhaps we do need to be rid of the term...

There were several cases of cardiac arrest in NAP7 related to TIVA use where anaesthetists didn't change their practice in sick patients.

The term RSI serves as a warning 'This patient is sick, Take care'
- Use roc not vec, have the suction under the pillow, think about asking for that NG prior

By your other point do you mean
that our usual practice has changed ie we should preox and sit up every patient?

I'd argue that a lot of the PUMA recommendations we don't do for all Pts - or at the very least we aren't scrupulously careful.
In a patient who 'needs' an RSI We take time to prepare.

Good points!

I would agree, deeply paralysed and anaesthetised pt before instrumentation is key
But I think the 1st part - rapid - is important.

Risk of aspiration is not proportional to length of time without a protected airway, but does this mean I can take as long as I want with my induction?

The only way to be safe 🤣