Tom Lawrence
@leedsmedic.bsky.social
Anaesthetist.
Neuro. Airway. TIVA. pEEG. Education.
Coffee. Aston Villa.
Neuro. Airway. TIVA. pEEG. Education.
Coffee. Aston Villa.
Pinned
Tom Lawrence
@leedsmedic.bsky.social
· Nov 16
I guess we are doing introductions.
I'm a consultant anaesthetist specialising in neuro and the T part of ENT.
I'm a TIVA enthusiast and extremely interested in pEEG, awareness and consciousness, and can often be found boring residents about the above.
I'm a consultant anaesthetist specialising in neuro and the T part of ENT.
I'm a TIVA enthusiast and extremely interested in pEEG, awareness and consciousness, and can often be found boring residents about the above.
Reposted by Tom Lawrence
"Infusulator", first created by Matthew Hart, coming soon to SimTIVA. It allows easy entry of a time series of CE (or CP) targets to generate TCI simulations. The conversion from CET/CPT to dosage (volume infused, or the total dose) over time is made simple. An export module is also provided.
November 21, 2025 at 7:35 AM
"Infusulator", first created by Matthew Hart, coming soon to SimTIVA. It allows easy entry of a time series of CE (or CP) targets to generate TCI simulations. The conversion from CET/CPT to dosage (volume infused, or the total dose) over time is made simple. An export module is also provided.
Reposted by Tom Lawrence
2025 DAS guidelines for the management of unanticipated difficult airway published today in the British Journal of Anaesthesia. #airway #difficultairway #intubation #anaesthesia #anesthesia
https://www.bjanaesthesia.org/article/S0007-0912(25)00693-2/fulltext
https://www.bjanaesthesia.org/article/S0007-0912(25)00693-2/fulltext
November 7, 2025 at 2:15 PM
2025 DAS guidelines for the management of unanticipated difficult airway published today in the British Journal of Anaesthesia. #airway #difficultairway #intubation #anaesthesia #anesthesia
https://www.bjanaesthesia.org/article/S0007-0912(25)00693-2/fulltext
https://www.bjanaesthesia.org/article/S0007-0912(25)00693-2/fulltext
Has anyone implemented the Hannivoort model for Dexmedatomadine? Looking to do this on our TCI pumps and any advice appreciated!
October 14, 2025 at 5:06 PM
Has anyone implemented the Hannivoort model for Dexmedatomadine? Looking to do this on our TCI pumps and any advice appreciated!
Reposted by Tom Lawrence
The UK is one of the few countries with penicillin sensitive streptococcus. This is, in my view, one of the greatest achievements of the NHS model.
1 in 6 bacterial infections now resistant to treatment, says WHO - rising to 1 in 3 in SE Asia on.ft.com/46Zv7Dq
One in six bacterial infections now resistant to treatment, says WHO
Levels of antimicrobial resistance highest in south-east Asia and eastern Mediterranean
on.ft.com
October 14, 2025 at 6:38 AM
The UK is one of the few countries with penicillin sensitive streptococcus. This is, in my view, one of the greatest achievements of the NHS model.
Reposted by Tom Lawrence
In >1,100 high-risk surgical patients, individualized periop BP targets based on pre-op nocturnal MAP were not associated with ↓ kidney or cardiac injury vs routine MAP ≥65 mm Hg
CCR Journal Watch – tracking the critical care literature daily
criticalcarereviews.com/latest-evide...
CCR Journal Watch – tracking the critical care literature daily
criticalcarereviews.com/latest-evide...
October 12, 2025 at 4:24 PM
In >1,100 high-risk surgical patients, individualized periop BP targets based on pre-op nocturnal MAP were not associated with ↓ kidney or cardiac injury vs routine MAP ≥65 mm Hg
CCR Journal Watch – tracking the critical care literature daily
criticalcarereviews.com/latest-evide...
CCR Journal Watch – tracking the critical care literature daily
criticalcarereviews.com/latest-evide...
Reposted by Tom Lawrence
I've never heard of a connection with warming the patient before today - interesting, thanks. www.sciencedirect.com/science/arti...
Comparison of the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain: Randomized, double-blind controlled trial
Lidocaine reduces pain that occurs upon the intravenous injection of propofol. But, there are few non-pharmacological nursing interventions to reduce …
www.sciencedirect.com
September 27, 2025 at 4:01 PM
I've never heard of a connection with warming the patient before today - interesting, thanks. www.sciencedirect.com/science/arti...
Reposted by Tom Lawrence
Who routinely consents patients for the risk of awareness?
What risks of anaesthesia do you routinely consent for & why? How do you communicate the likelihood of complications? What factors influence whether/how you conduct the consent process?
#MedSkyDebate #MedSky #AnSky
#MedSkyDebate #MedSky #AnSky
This is the weekend #MedSkyDebate.
As usual the flamboyant Nick Chrimes @chrimesy.com describes it perfectly.
Supported as usual by @hypoxicchicken.medsky.social and @maryannturner.bsky.social.
Bravo team it is a wonderful editorial. #MedSky #AnSky
As usual the flamboyant Nick Chrimes @chrimesy.com describes it perfectly.
Supported as usual by @hypoxicchicken.medsky.social and @maryannturner.bsky.social.
Bravo team it is a wonderful editorial. #MedSky #AnSky
August 3, 2025 at 12:57 PM
Who routinely consents patients for the risk of awareness?
Good presentation by @claireswarbrick.bsky.social on delirium and anaesthesia, in my opinion probably the least understood and appreciated post-op complication, and one that as anaesthetists I think we can influence. #Anaesthesia2025
May 22, 2025 at 10:59 AM
Good presentation by @claireswarbrick.bsky.social on delirium and anaesthesia, in my opinion probably the least understood and appreciated post-op complication, and one that as anaesthetists I think we can influence. #Anaesthesia2025
The key points for stroke thrombectomy. I completely agree that it is the neuro equivalent of a cat 1 section and should be treated as such!
#Anaesthesia2025
#Anaesthesia2025
May 20, 2025 at 5:28 PM
The key points for stroke thrombectomy. I completely agree that it is the neuro equivalent of a cat 1 section and should be treated as such!
#Anaesthesia2025
#Anaesthesia2025
Reposted by Tom Lawrence
Your dignity honors the bravery of the Ukrainian people.
Be strong, be brave, be fearless.
You are never alone, dear President Zelenskyy.
We will continue working with you for a just and lasting peace.
Be strong, be brave, be fearless.
You are never alone, dear President Zelenskyy.
We will continue working with you for a just and lasting peace.
February 28, 2025 at 9:06 PM
Your dignity honors the bravery of the Ukrainian people.
Be strong, be brave, be fearless.
You are never alone, dear President Zelenskyy.
We will continue working with you for a just and lasting peace.
Be strong, be brave, be fearless.
You are never alone, dear President Zelenskyy.
We will continue working with you for a just and lasting peace.
Reposted by Tom Lawrence
Arterial trauma is a rare, but potentially life-threatening complication of central venous catheter insertion.
In this interrogation of two national databases of incident reports, outcomes included:
• stroke (10%)
• death (4%)
#AnSky #MedSky
https://doi.org/10.1111/anae.16570
In this interrogation of two national databases of incident reports, outcomes included:
• stroke (10%)
• death (4%)
#AnSky #MedSky
https://doi.org/10.1111/anae.16570
February 21, 2025 at 11:59 AM
Arterial trauma is a rare, but potentially life-threatening complication of central venous catheter insertion.
In this interrogation of two national databases of incident reports, outcomes included:
• stroke (10%)
• death (4%)
#AnSky #MedSky
https://doi.org/10.1111/anae.16570
In this interrogation of two national databases of incident reports, outcomes included:
• stroke (10%)
• death (4%)
#AnSky #MedSky
https://doi.org/10.1111/anae.16570
Reposted by Tom Lawrence
When a central venous catheter-related arterial trauma incidents occurs..
Who is involved? 37% resident doctors
Where is the procedure conducted? 37% critical care
What was the intended insertion site? 54% internal jugular
@intensiveperson.bsky.social #AnSky #MedSky
doi.org/10.1111/anae...
Who is involved? 37% resident doctors
Where is the procedure conducted? 37% critical care
What was the intended insertion site? 54% internal jugular
@intensiveperson.bsky.social #AnSky #MedSky
doi.org/10.1111/anae...
February 21, 2025 at 1:35 PM
When a central venous catheter-related arterial trauma incidents occurs..
Who is involved? 37% resident doctors
Where is the procedure conducted? 37% critical care
What was the intended insertion site? 54% internal jugular
@intensiveperson.bsky.social #AnSky #MedSky
doi.org/10.1111/anae...
Who is involved? 37% resident doctors
Where is the procedure conducted? 37% critical care
What was the intended insertion site? 54% internal jugular
@intensiveperson.bsky.social #AnSky #MedSky
doi.org/10.1111/anae...
Reposted by Tom Lawrence
Propofol vs inhalational anaesthesia and cancer-related outcomes
Preclinical investigation & retrospective studies suggest propofol:
• inhibits tumourigenesis & metastasis
• is not immunosuppressive
• blocks angiogenesis
• ⬇️ recurrence
BUT no large RCT supports this #AnSky
buff.ly/4aIWRh3
Preclinical investigation & retrospective studies suggest propofol:
• inhibits tumourigenesis & metastasis
• is not immunosuppressive
• blocks angiogenesis
• ⬇️ recurrence
BUT no large RCT supports this #AnSky
buff.ly/4aIWRh3
February 5, 2025 at 6:18 PM
Propofol vs inhalational anaesthesia and cancer-related outcomes
Preclinical investigation & retrospective studies suggest propofol:
• inhibits tumourigenesis & metastasis
• is not immunosuppressive
• blocks angiogenesis
• ⬇️ recurrence
BUT no large RCT supports this #AnSky
buff.ly/4aIWRh3
Preclinical investigation & retrospective studies suggest propofol:
• inhibits tumourigenesis & metastasis
• is not immunosuppressive
• blocks angiogenesis
• ⬇️ recurrence
BUT no large RCT supports this #AnSky
buff.ly/4aIWRh3
Reposted by Tom Lawrence
Reposted by Tom Lawrence
Leeds leading
January 23, 2025 at 10:47 AM
Leeds leading
I'm interested in people's opinions on BP targets in ICH. Let's use an example.
Gentleman in his mid 50s.
Unknown PMHx.
BP 220/100 o/a
GCS 7 (M4)
I+V to facilitate scan which shows ICH with hydrocephalus.
Going to theatre for an EVD.
What are your BP target, and upper and lower limits.
Gentleman in his mid 50s.
Unknown PMHx.
BP 220/100 o/a
GCS 7 (M4)
I+V to facilitate scan which shows ICH with hydrocephalus.
Going to theatre for an EVD.
What are your BP target, and upper and lower limits.
January 4, 2025 at 7:30 PM
I'm interested in people's opinions on BP targets in ICH. Let's use an example.
Gentleman in his mid 50s.
Unknown PMHx.
BP 220/100 o/a
GCS 7 (M4)
I+V to facilitate scan which shows ICH with hydrocephalus.
Going to theatre for an EVD.
What are your BP target, and upper and lower limits.
Gentleman in his mid 50s.
Unknown PMHx.
BP 220/100 o/a
GCS 7 (M4)
I+V to facilitate scan which shows ICH with hydrocephalus.
Going to theatre for an EVD.
What are your BP target, and upper and lower limits.
This is really nice for showing how inaccurate Schnider is at induction, and why you should take the numerical figure the patient goes to sleep at with a huge pinch of salt.
Ce 90s after the same bolus (75mg propofol)
Schnider: 4.3
Eleveld: 1.3
...and this is coming from a Schnider user.
Ce 90s after the same bolus (75mg propofol)
Schnider: 4.3
Eleveld: 1.3
...and this is coming from a Schnider user.
2024 Recap (4)
Do you prefer to use Schnider or Marsh model in TCI? SimTIVA.app has an “Eleveld emulation tool” that converts a Marsh/Schnider TCI infusion scheme into CP, CE & estimated BIS values as predicted by the Eleveld model. This helps to compare older models with the Eleveld model.
#ansky
Do you prefer to use Schnider or Marsh model in TCI? SimTIVA.app has an “Eleveld emulation tool” that converts a Marsh/Schnider TCI infusion scheme into CP, CE & estimated BIS values as predicted by the Eleveld model. This helps to compare older models with the Eleveld model.
#ansky
December 14, 2024 at 1:48 PM
This is really nice for showing how inaccurate Schnider is at induction, and why you should take the numerical figure the patient goes to sleep at with a huge pinch of salt.
Ce 90s after the same bolus (75mg propofol)
Schnider: 4.3
Eleveld: 1.3
...and this is coming from a Schnider user.
Ce 90s after the same bolus (75mg propofol)
Schnider: 4.3
Eleveld: 1.3
...and this is coming from a Schnider user.
If this can be replicated it would probably improve list turnover, be more sustainable and most importantly, make TIVA much less of a faff.
#ansky
#ansky
Are you interested in #Sustainability in #Anesthesiology and how reusing TIVA lines could help reduce greenhouse gas emissions? Per Werner Moller, originally an expert in #AppliedPhysiology and #VenousReturn, discusses their environmental paper on the #EJA podcast.
open.spotify.com/episode/2RCa...
open.spotify.com/episode/2RCa...
December 4, 2024 at 11:55 PM
If this can be replicated it would probably improve list turnover, be more sustainable and most importantly, make TIVA much less of a faff.
#ansky
#ansky
December 4, 2024 at 5:54 PM
Reposted by Tom Lawrence
Until I was a young I adult, I thought that a general anaesthetic was one that was used all over the country. And a local one was one that was just used where I lived.
December 2, 2024 at 8:25 AM
Until I was a young I adult, I thought that a general anaesthetic was one that was used all over the country. And a local one was one that was just used where I lived.
This is almost identical to my recipe for extubating neuro and head & neck cases, esp. pituitaries.
Only stimulation being their name I think is the most important aspect.
Main difference is I leave the remi running, and I admit I've never heard of lidocaine in the cuff. I'll be giving it a go!
Only stimulation being their name I think is the most important aspect.
Main difference is I leave the remi running, and I admit I've never heard of lidocaine in the cuff. I'll be giving it a go!
November 28, 2024 at 6:54 PM
This is almost identical to my recipe for extubating neuro and head & neck cases, esp. pituitaries.
Only stimulation being their name I think is the most important aspect.
Main difference is I leave the remi running, and I admit I've never heard of lidocaine in the cuff. I'll be giving it a go!
Only stimulation being their name I think is the most important aspect.
Main difference is I leave the remi running, and I admit I've never heard of lidocaine in the cuff. I'll be giving it a go!
School books indoctrinating our kids with NIMBYism. No wonder we couldn't get HS2 done 😂
November 25, 2024 at 7:11 PM
School books indoctrinating our kids with NIMBYism. No wonder we couldn't get HS2 done 😂
Reposted by Tom Lawrence
Supporting slide set for my talk at the @RCoANews Winter Symposium "Pick of the Papers 2024"
My (biased) choice of the most interesting papers relating to anaesthesia/ICM that people may have missed.
wordpress.com/post/sthjour...
My (biased) choice of the most interesting papers relating to anaesthesia/ICM that people may have missed.
wordpress.com/post/sthjour...
WordPress.com
wordpress.com
November 22, 2024 at 2:12 PM
Supporting slide set for my talk at the @RCoANews Winter Symposium "Pick of the Papers 2024"
My (biased) choice of the most interesting papers relating to anaesthesia/ICM that people may have missed.
wordpress.com/post/sthjour...
My (biased) choice of the most interesting papers relating to anaesthesia/ICM that people may have missed.
wordpress.com/post/sthjour...
The @rcoanews.bsky.social State of the Nation 2024 report is out.
No huge surprises, still a massive shortfall in Anaesthetists.
This is a political decision, so now is a great time to email your MP and point out this huge barrier to NHS recovery.
#ansky #medsky
www.rcoa.ac.uk/policy/polic...
No huge surprises, still a massive shortfall in Anaesthetists.
This is a political decision, so now is a great time to email your MP and point out this huge barrier to NHS recovery.
#ansky #medsky
www.rcoa.ac.uk/policy/polic...
The Anaesthetic Workforce: UK State of the Nation Report 2024
This report sets out that while anaesthetist numbers have increased, the shortfall has increased even more. As such, the NHS remains in urgent need of more anaesthetists.
www.rcoa.ac.uk
November 20, 2024 at 1:30 PM
The @rcoanews.bsky.social State of the Nation 2024 report is out.
No huge surprises, still a massive shortfall in Anaesthetists.
This is a political decision, so now is a great time to email your MP and point out this huge barrier to NHS recovery.
#ansky #medsky
www.rcoa.ac.uk/policy/polic...
No huge surprises, still a massive shortfall in Anaesthetists.
This is a political decision, so now is a great time to email your MP and point out this huge barrier to NHS recovery.
#ansky #medsky
www.rcoa.ac.uk/policy/polic...
Starting to feel like home.
Ed Balls
November 18, 2024 at 6:58 PM
Starting to feel like home.