Tom Lawrence
@leedsmedic.bsky.social
Anaesthetist.
Neuro. Airway. TIVA. pEEG. Education.
Coffee. Aston Villa.
Neuro. Airway. TIVA. pEEG. Education.
Coffee. Aston Villa.
Potentially high spinal injuries.
I guess as the relaxant goes in you could sit/tilt them up but I've had them desaturated on sitting up for AFOI due to the respiratory mechanics before even with binders on.
But yes, mostly agree, just being that awkward person point out the 0.1% exception.
I guess as the relaxant goes in you could sit/tilt them up but I've had them desaturated on sitting up for AFOI due to the respiratory mechanics before even with binders on.
But yes, mostly agree, just being that awkward person point out the 0.1% exception.
October 22, 2025 at 10:37 AM
Potentially high spinal injuries.
I guess as the relaxant goes in you could sit/tilt them up but I've had them desaturated on sitting up for AFOI due to the respiratory mechanics before even with binders on.
But yes, mostly agree, just being that awkward person point out the 0.1% exception.
I guess as the relaxant goes in you could sit/tilt them up but I've had them desaturated on sitting up for AFOI due to the respiratory mechanics before even with binders on.
But yes, mostly agree, just being that awkward person point out the 0.1% exception.
I've been trying this the last week or so.
No pain so far.
Also no pain when I've forgotten.
Please click follow for more high quality studies like this.
No pain so far.
Also no pain when I've forgotten.
Please click follow for more high quality studies like this.
October 7, 2025 at 3:30 PM
I've been trying this the last week or so.
No pain so far.
Also no pain when I've forgotten.
Please click follow for more high quality studies like this.
No pain so far.
Also no pain when I've forgotten.
Please click follow for more high quality studies like this.
BUT most of the time I don't think there is enough benefit for the extra complication at a crucial point, so this is one of the few times I don't use TIVA.
The proposed pump changes would simplify it though so I would consider it more if it became available.
The proposed pump changes would simplify it though so I would consider it more if it became available.
October 2, 2025 at 10:10 PM
BUT most of the time I don't think there is enough benefit for the extra complication at a crucial point, so this is one of the few times I don't use TIVA.
The proposed pump changes would simplify it though so I would consider it more if it became available.
The proposed pump changes would simplify it though so I would consider it more if it became available.
If there are massive benefits to TIVA I would either
1) Have the pump deliver the bolus into a syringe via a 3 way tap then deliver this by hand
2)have the pump deliver the pre calculated dose into an empty syringe, deliver the induction dose by hand then put propofol into the pump for maintenance
1) Have the pump deliver the bolus into a syringe via a 3 way tap then deliver this by hand
2)have the pump deliver the pre calculated dose into an empty syringe, deliver the induction dose by hand then put propofol into the pump for maintenance
October 2, 2025 at 10:10 PM
If there are massive benefits to TIVA I would either
1) Have the pump deliver the bolus into a syringe via a 3 way tap then deliver this by hand
2)have the pump deliver the pre calculated dose into an empty syringe, deliver the induction dose by hand then put propofol into the pump for maintenance
1) Have the pump deliver the bolus into a syringe via a 3 way tap then deliver this by hand
2)have the pump deliver the pre calculated dose into an empty syringe, deliver the induction dose by hand then put propofol into the pump for maintenance
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...
I use IV bolus doses to attenuate the pressor response to intubation in cranial aneurysms but don't use infusions. SALG specifically raised safety concerns with them so I'd be cautious using them.
September 27, 2025 at 7:30 PM
I use IV bolus doses to attenuate the pressor response to intubation in cranial aneurysms but don't use infusions. SALG specifically raised safety concerns with them so I'd be cautious using them.
I was going to suggest exactly this debate but @intensiveperson.bsky.social has beaten me to it. My response will test this short form platform somewhat but I'll try later to form a succinct answer 😂
September 6, 2025 at 10:18 AM
I was going to suggest exactly this debate but @intensiveperson.bsky.social has beaten me to it. My response will test this short form platform somewhat but I'll try later to form a succinct answer 😂
I don't really do hypotension. There has to be a very good reason for it, of which there are very few.
The problem is there are so many factors in play, most of which we can't measure so if you do have significant hypotension for long periods of time you are playing russian roulette.
The problem is there are so many factors in play, most of which we can't measure so if you do have significant hypotension for long periods of time you are playing russian roulette.
August 16, 2025 at 8:11 PM
I don't really do hypotension. There has to be a very good reason for it, of which there are very few.
The problem is there are so many factors in play, most of which we can't measure so if you do have significant hypotension for long periods of time you are playing russian roulette.
The problem is there are so many factors in play, most of which we can't measure so if you do have significant hypotension for long periods of time you are playing russian roulette.
Same in the UK generally.
August 14, 2025 at 6:39 PM
Same in the UK generally.
Agree with midazolam close to induction.
I have quite a bit of unease with using a drug that primarily causes amnesia rather than loss of consciousness. Feels like covering your tracks rather than doing the job properly in the first place.
I have quite a bit of unease with using a drug that primarily causes amnesia rather than loss of consciousness. Feels like covering your tracks rather than doing the job properly in the first place.
August 12, 2025 at 10:07 PM
Agree with midazolam close to induction.
I have quite a bit of unease with using a drug that primarily causes amnesia rather than loss of consciousness. Feels like covering your tracks rather than doing the job properly in the first place.
I have quite a bit of unease with using a drug that primarily causes amnesia rather than loss of consciousness. Feels like covering your tracks rather than doing the job properly in the first place.
No, although I have no strong opinions on their use.
If I'm using TIVA, I use remi. The case mentioned before was during the last remi shortage where I was trying various alternatives (in that case propfol only induction and block) out and non were as good.
If I'm using TIVA, I use remi. The case mentioned before was during the last remi shortage where I was trying various alternatives (in that case propfol only induction and block) out and non were as good.
August 12, 2025 at 9:57 PM
No, although I have no strong opinions on their use.
If I'm using TIVA, I use remi. The case mentioned before was during the last remi shortage where I was trying various alternatives (in that case propfol only induction and block) out and non were as good.
If I'm using TIVA, I use remi. The case mentioned before was during the last remi shortage where I was trying various alternatives (in that case propfol only induction and block) out and non were as good.
Yep, you either need opioid or a block as propfol does very little to spinal reflexes at normal concentrations. The equivalent "MAC" of propfol is 15mcg/ml.
I once had an adequately anaesthetised parient on propfol twitching at just spraying his leg with chorhexadine for a block.
I once had an adequately anaesthetised parient on propfol twitching at just spraying his leg with chorhexadine for a block.
August 12, 2025 at 9:06 PM
Yep, you either need opioid or a block as propfol does very little to spinal reflexes at normal concentrations. The equivalent "MAC" of propfol is 15mcg/ml.
I once had an adequately anaesthetised parient on propfol twitching at just spraying his leg with chorhexadine for a block.
I once had an adequately anaesthetised parient on propfol twitching at just spraying his leg with chorhexadine for a block.
Yes, whenever I put BIS on patients when someone is using volatile, especially if they are frail they are usually significantly burst suppressed.
The problem is MAC is hinerently a measure of spinal reflexes not level of consciousness.
The problem is MAC is hinerently a measure of spinal reflexes not level of consciousness.
August 9, 2025 at 8:02 AM
Yes, whenever I put BIS on patients when someone is using volatile, especially if they are frail they are usually significantly burst suppressed.
The problem is MAC is hinerently a measure of spinal reflexes not level of consciousness.
The problem is MAC is hinerently a measure of spinal reflexes not level of consciousness.
Largely agree, I teach our residents that the number isn't particularly accurate but it a point to calibrate from using pEEG and physiological parameters. Also feel there isn't much between Marsh and Schnider, however Eleveld when we finally get it should be a step up.
August 8, 2025 at 4:51 PM
Largely agree, I teach our residents that the number isn't particularly accurate but it a point to calibrate from using pEEG and physiological parameters. Also feel there isn't much between Marsh and Schnider, however Eleveld when we finally get it should be a step up.
It means I have probably hid behind the statistical rarity, when in actually fact if asked I suspect most patient would say they would want to be warned about it.
August 4, 2025 at 9:05 AM
It means I have probably hid behind the statistical rarity, when in actually fact if asked I suspect most patient would say they would want to be warned about it.
This is why it has been on my mind recently.
I think the problem is what you have already articulated, the timing constraints of the pre anaesthetic visit have made me reticent to being up a rare complication that can (arguably) unduly frighten a patient just before surgery.
I think the problem is what you have already articulated, the timing constraints of the pre anaesthetic visit have made me reticent to being up a rare complication that can (arguably) unduly frighten a patient just before surgery.
August 4, 2025 at 9:05 AM
This is why it has been on my mind recently.
I think the problem is what you have already articulated, the timing constraints of the pre anaesthetic visit have made me reticent to being up a rare complication that can (arguably) unduly frighten a patient just before surgery.
I think the problem is what you have already articulated, the timing constraints of the pre anaesthetic visit have made me reticent to being up a rare complication that can (arguably) unduly frighten a patient just before surgery.
Also all discussion on BlueSky will be oversimplified, I was more expecting to be pulled up on it being recall rather than consciousness, but then that's a whole other debate to try and squeeze into 300 character snippets.
August 4, 2025 at 8:59 AM
Also all discussion on BlueSky will be oversimplified, I was more expecting to be pulled up on it being recall rather than consciousness, but then that's a whole other debate to try and squeeze into 300 character snippets.
As I think you have said consent is a two way process where what the patients' expectstions are is as important as our medical categorisation of harm and it's likelihood. I think the central nature of awareness in the perception of anaesthesia makes it slightly different to other risks.
August 4, 2025 at 8:59 AM
As I think you have said consent is a two way process where what the patients' expectstions are is as important as our medical categorisation of harm and it's likelihood. I think the central nature of awareness in the perception of anaesthesia makes it slightly different to other risks.
Surgery has been performed for thousands of years but it's only since the birth of our specialty 175 years ago that people expect not the remember it, and in the popular mind that is our primary job.
August 4, 2025 at 8:59 AM
Surgery has been performed for thousands of years but it's only since the birth of our specialty 175 years ago that people expect not the remember it, and in the popular mind that is our primary job.