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!” 😂🤪

Where do you work again? That’s an amazing looking coffee…. 🤩 ☕️ 👃🏻

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 💤

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 👂🏻 💭 💯