Also, why am I doing direct laryngoscopy in a <5kg infant anyway? ☺️
BJA and ESAIC joint statement from last year suggests using video as first line in neonates and infants (1B level):
journals.lww.com/ejanaesthesi...
1) Facemask back on
2) igel #1 if spontaneous, or LMA #1 if positive pressure required
3) Send for videolaryngoscope and sugammadex
4) Make sure shoulder roll is in situ, properly placed. Also gel head ring or similar.
5) Before trying laryngoscopy again, ask if intubation really needed at all costs
No worries about replying, I’m just warming up to BlueSky myself ☀️🐛
Top job on the hernias 💪 One has to wonder sometimes (or I do, at least) how many operations can be done (and GAs or even spinals spared) with solid local infiltration + skilful sedation 💭
Wow! Time to revive the TAP blocks and ‘morphine vs diamorphine’ debates? 😬💭
Where did you find this magical colleague 🥲
Regards,
An anaesthesiologist frequently told by cardiology colleagues that patients are “fit for routine GA as long as you avoid hypotension, hypercapnea, Trendelenburg positioning, and any stimuli of anxiety or pain which may cause tachycardia”
Impressive! Genuine question…what’s your setup? Open inguinal hernia repairs, two anaesthetists, spinal anaesthetics, enhanced PACU protocols? 💭
“…what do you mean you want to do a nerve block now? Don’t worry, we can just infiltrate some local at the end!” 😂🤪
Finally sorted my #APAGBI2025 ticket 🗣️ … I haven’t been to an @apagbi.org.uk meeting since Cardiff 2022, but really looking forward to this one! Walks, talks, & ghost tours in #Edinburgh, what more can…oh wait, I forgot the ceilidh dancing 👶 💭 📢 🥾 🕺 😎 Paed anaesth folk…ASSEMBLE 🦸♂️🛡️
#AnSky #PedsAnes
Where do you work again? That’s an amazing looking coffee…. 🤩 ☕️ 👃🏻
#WorldObesityDay 🌏
🧒 Children living with obesity face unique challenges. The Society for Bariatric Anaesthesia (SOBA UK) has recently updated guidance on anaesthesia for children with obesity, ensuring safe & tailored perioperative care. Read more here: 🔗 lnkd.in/dk4bQvrz
#WHOFides #AnSky #PedSky
#WorldHearingDay👂
Hearing loss can make hospital experiences (especially anaesthesia 😷) more frightening.
🔹 Recognise it
🔹 Keep aids in until patient asleep whenever possible
🔹 Prioritise aid reinsertion ASAP or before waking up
Small changes ➡️ huge difference.
#AnSky #WHOFides #PedSky
It’s World Rare Disease Day 🌎
People with rare diseases sometimes (or often!) need anaesthesia too 🧬
Many rare diseases start in childhood 👶
Improving education is good 🔊 📖
Improving research might be even better 🥼 🧪
Improving advocacy might be the best start 💪 💥
#WHOFides #AnSky #PedSky
This was great! 👏 Look up UNICEF-WHO-WB data on nutrition 🥘 , CHAIN Network ⛓️💥 , and WHO guidelines for severe acute malnutrition (SAM) management 💊 if you’re looking for an interesting (and poignant) read 👀 📖
#AnSky #PICUSky #PedSky
Super, thanks for the tip! 🙌
Yep I use the ‘<10kg rule’ for VL with trainees…if they had to intubate such a patient on their own in an emergency, I suspect most would (try to) default to VL anyway
Genuine Qs: how often do you use a stylet in the tube, and what’s your threshold/preference trend for using an LMA instead of an ETT? I also can’t remember last time I used a paed bougie 🤔 But use a lot of supraglottics and can be quite fussy on patient positioning pre-intubation to optimise chances
ABC = Always Bring Coffee ☕️
Or, when an impatient surgeon tries to hurry along an induction, Anaesthesia Before Cutting 🫡 💤
Always ask ‘…over how long?’ when you’re told that a hypotensive referral has ‘already received 2L fluids’ 💧⏰
I mean…you’re not entirely wrong! Those things can be devilishly sticky, particularly when you least need it 🤯
This! 👆 💯 If you mainly want/need an arterial line for haemodynamic monitoring (rather than blood sampling), why not swap for a forehead sticker which assesses the perfusion outcome? Multiple attempts to cannulate a peripheral artery (or even a single U/S pass) are suddenly much less acceptable 🫠
Oh, I hadn’t come across this one yet! Will look into it, thank you 🙏🏼 The intended use is perioperative anxiolysis…either on ward, during IV cannulation, or possibly even facemask induction of anaesthesia 💤
Anybody got any experience of VR headsets in kids as part of their hospital journey? I’m looking to see which devices would be ‘best’ in terms of reasonably damage-resistant, easy to use, and not too heavy for a child’s head. Financial cost of secondary importance 💸 😊
#AnSky #PedSky
Wow! Many years ago while writing an MSc dissertation, I followed up survivors of our adult ICU for 6 months, screening them for anxiety and depression amongst other things. Fascinating to read your paper on PTSD after #PedsICU which reminds us, ‘survival’ is not the only goal of critical care! 😰💭
A deeply fascinating, highly topical, and also slightly daunting topic! Few specialties are as heterogeneously staffed as #PedsICU nowadays…should be a great event 👂🏻 💭 💯
This is great, helping to conceptualise a (relatively) abstract bit of physiology via two cultural icons ... #Lego and #SpiderMan
BUT it could be even better...by inspiring lots more similar infovids about other things! Any #AnSky wizards out there savvy with Lego, animation, etc open to collab? 🧙👥
Anaesthesiologists may be playas of the medical world when it comes to some skills, but aren’t experts at play - that’s a whole different profession. Yet there is soooo much to learn from play specialists 👏 Incorporating even 1% of their skills into our own can make an anaesthetic so much better 👶🎈🧸
…and it definitely wasn’t a subspecialty fellowship in washing dishes, right? 💭
To video or not to video? The more anaesthetic grey hairs I find, the more I realise guidance 🤝 context
If you rarely tube kids, but 💪 at VL in adults, that’s a context
If your paeds expertise is ⬆️ that’s another
If intubation is ⬆️ stakes or ⬆️ complexity, that’s another
@bjajournals.bsky.social
That, sir, makes you a legend. 👑
Nice vid. One of my favourite blocks to perform, in terms of sonographic end point - I use this sagittal approach in all but the smallest of patients, where a transverse probe position allows slightly better needle access sometimes