Replacing physician roles with non-physicians is never the solution. CRNAs work in an American hospital system where volume equates to profit. Doesn’t translate here where we need independent anesthesia practitioners in rural or remote locations to increase access.

Beautiful! Where’s that figurine from? What a wonderful addition to the bookshelf.

One hundred percent. Having someone keep time is important. Furthermore using sufficient opioid also allows for greater depth on induction with less hemo consequence, and likely helps facilitate success alongside paralysis.

So would not use it in everyone, as I think a lot of people who need it will have already been trialed on it (AECHF, AECOPD), and some may find it distressing and certain patients (ie. sepsis) I cannot see its advantages over other techniques (HFNO) which can stay on for the entirety of intubation.

Like the review - agree that in some patients it’ll improve preoxygenating through improving resp. mechanics. However you can give 100% FiO2 through a BVM (the trial used a NRB I believe), and it is difficult to remove the BiPAP mask at times if you need to place the ETT quickly (1/2)

Happy to hear if you use it in conjunction with other agents.

The original study was benchtop using a test lung.

We then did a lesser cited follow up clinical study.

Long story short, FGF 2 suffice for non laparoscopic surgeries. FGF 4-6 for laparoscopic surgeries.
High FiO2 negates any potential environmental benefits.

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

In our shop they also have to go to a monitored bed, which is highly coveted.

Ileus is the main reason we abandoned it. Surgeons want patients up and walking. I’m surprised in my small sample size how well it has worked.

Still looking for the winning combo of blocks for HTOs. Anyone out there have a recipe, our group would love to hear it!

So I’m a trauma anaesthetist and I do a lot of these for rib fractures.

I think people miss the point. The block chosen depends on anticoagualtion, injury pattern, concurrent injuries (e.g. spine), mobility, surgical trajectory etc.

The block you want to do is not always the block you can do.