Anaesthesia@anaesjournal· 19d Should we be using GWP or GWP* to estimate carbon dioxide equivalents for volatile anaesthesia?
GWP* includes rate terms that change over time.
GWP is a fixed metric.
#AnSky #climate #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 19d For beta blockers + intra-operative dexmedetomidine - how common are major adverse cardiac events post-operatively?
Neither: 8%
Either: 4%
Both: 19%
#AnSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 19d For patients with a low likelihood of survival, admission to ICU may risk a negative dying experience.
A technologically mediated death marked by distress, uncertainty and grief is unlikely to be a good death, regardless of circumstances.
#ICU #MedTwitter
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 20d Combined chronic pre-operative beta blocker therapy + intra-operative dexmedetomidine use might be associated with an increased risk of major adverse cardiac events in older patients undergoing major non-cardiac surgery.
#AnSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 20d ICU and hope
"... hope is not the opposite of accepting death but integral to it, and supporting this reframing aligns closely with the role of palliative care in holistic, goal-oriented care and decision-making at the end of life."
#ICUSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 21d A good death in intensive care
"Increasingly, ICU is recognised not only as a place of rescue, but also as a place where compassion, dignity and comfort can be provided at the end of life."
#AnSky #ICUSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 21d "... external validation should prioritise populations in whom difficult facemask ventilation is both more consequential & more likely to change the airway plan, incl patients with severe obesity or OSA, and those having emergency or obstetric surgery."
#AnSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 26d Value is not unit price.
Value is the whole pathway: quality control; standardisation; safety; time; & the avoidance of rare but devastating failures.
Differentiating between cost & value requires clinical leadership.
#MedSky #AnSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 26d Admission to the ICU involves experiential burdens & a risk of a negative dying experience.
People who have been through ICU treatment can provide useful insights into what it might be like to die in ICU & what chance of survival makes ICU treatment acceptable.
#MedTwitter
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· 26d Intensive care decision-making, survival and dying well: a mixed methods study with people who have been intensive care patients
#AnSky #MedSky #ICUSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 10 ...the discordance observed in this trial reinforces a recurring finding in peri-operative and critical care trials – improvements in physiological variables (e.g. blood pressure, O2 targets, Hb, fluids) do not necessarily translate into improved clinical outcomes...
#AnSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 9 With esketamine:
Is the reduction in delayed behavioural disturbances a secondary benefit of superior pain control or is it driven by an independent neuroprotective mechanism related to neuroinflammation?
#AnSky #MedSky #PharmSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 7 A survey of 45 delegates at the Society for Obesity and Bariatric Anaesthesia (SOBA) 2025 Winter Scientific Meeting on GLP1-RA mx
• Fasting strategies varied wildly! (standard - 48h)
• Airway mx varied wildly! (RSI, gastric US, standard)
Thoughts?
#AnSky #obesity #GLP1
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 7 A step forward for patient-centred fasting guidelines
"As these recommendations are adopted, a little more clarity on higher-risk groups, how advice is communicated.. & how tools such as gastric ultrasound are integrated would likely make the transition smoother."
#AnSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 6 Opioid-free vs. opioid-inclusive anaesthesia with or without regional anaesthesia for postop pain
"We believe that the conclusion supported most firmly by this study is that local/[RA] techniques themselves are associated with improved postoperative outcomes."
#AnSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 6 Here's a good one!
The criteria for excluding oesophageal intubation are different from those for confirming tracheal intubation.
Thoughts?
#AnSky #MedSky
@chrimesy.com
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 6 "Transitivity is a fundamental assumption of network meta-analysis, requiring that the distributions of important effect modifiers are sufficiently similar across the different comparisons in the network for indirect comparisons to be valid."
#AnSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 1 Time to introduce the initial assessment of competence in regional anaesthesia?
#AnSky #RASky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 1 The age illusion: why ASA requires biological recalibration
"We contend that a logical next step for ASA.. is the integration of the brain age gap, a validated neuroimaging metric that quantifies the discrepancy between predicted brain age and chronological age."
#AnSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jul 1 Feasibility study - pulmonary artery catheter vs central venous catheter
Acute kidney injury occurred more frequently in patients allocated to the PAC group.
**BUT interpret with caution - hypothesis-generating only
#AnSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jun 30 Pulmonary artery catheter vs central venous catheter - which monitoring method is safer or better than the other?
#AnSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jun 30 Pulmonary artery catheters are used widely in cardiac surgery despite observed associations with worse outcomes and guidelines that recommend against their routine use. No adequately powered randomised trials are available.
Should we run a randomised trial?
#AnSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jun 29 What are the barriers to the implementation of pre-operative fasting protocols?
From: "A step forward for patient-centred fasting guidelines: a reply"
#AnSky #MedSky
doi.org/10.1111/anae...
Anaesthesia@anaesjournal· Jun 29 "..there is a need to move beyond describing disparities and toward identifying modifiable factors within healthcare systems that contribute to differential access and utilisation. Qualitative research will play a critical role in this process..."
#AnSky #MedSky
doi.org/10.1111/anae...