Out of interest, were there any to vecuronium in your institution?

Critically think using what you’re taught and use the same terminology as others in the room.

In regards to VL, my go to VL for predicted difficult airway (both anatomical and physiological) is with a hyperangulated blade and a stylet. I’ve refined my teaching over the years using Nic’s videos

Having immersed in Vortex workshops in the last 12 months, I can see its value in a system where everyone understands it/and its terminology.

However, when DAS algorithms are taught and executed right, it brings about the same outcome.

A bit of tongue in cheek but an opinion from an old boss, “the key to a good block is sedation”

I agree with the alfentanil sentiment but I also don’t understand why only 100mcg of fentanyl is ever given on induction! I routinely given between 2-3mcg/kg

iGel for anyone with teeth. Always size up, 4 for females and 5 for males.

Ambu otherwise. Always size down, 3 for females and 4 for males.

Although I agree that is largely true, there are instances where the risks of anaesthesia aren’t acceptable to the patient relative to the nature of surgery they’re having.

But yes, what we are really doing is offering alternatives and allowing pts to choose the risks that are acceptable to them

IMO, consenting on the morning of surgery can hardly be considered informed consent. We are protecting ourselves rather than a true autonomous process.

Imagine a patient having traveled over 200km, paid for accommodation for the time around admission, has waited a year and is first on the list..

Was a standard in most NHS hospitals I’d worked. I think it potentially useful in overstretched PACU units where staff vigilance can be suboptimal (granted that’s papering cracks, which unfortunately is a problem in some units in the NHS)

We still did a fair bit of PACU extubations in a place I was practising in Brum 12 months ago. Can’t say we had any higher rate of complications than the norm.

As usual it all boils down to patient selection and skillset. When done well it inevitably improves efficiency

I’ve worked in a large tertiary orthopedic center that didn’t use probe covers for SS blocks - not a single incident of infection.

A clean no touch technique is probably of greater importance.

Disclaimer: I use tegaderm for SS blocks myself

Made the change when I started doing vascular, and now it is my first choice regardless of the patient in front of me. Almost fool proof and takes away the uncertainty with long cases/awkward positioning.