leedsmedic.bsky.social
Anaesthetist.
Neuro. Airway. TIVA. pEEG. Education.
Coffee. Aston Villa.
Ça Ira.
50 posts
633 followers
128 following
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You may be right that there is a subgroup that will benefit, but all the last few studies I've seen have been equivocal. Given we do precious few high quality studies in anaesthesia I feel we should probably use those resources elsewhere.
Maybe yet another GA Vs spinal in NOF study.
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I think the main thing that made me suspicious was the size of the effect in Wigmore 2016, which is probably the paper that really increased mass interest in this.
The split in mortality immediately from time of surgery didn't fit with metastasis, and the size of the effect stretched my credulity.
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Hi Pete. Firstly sorry for the late reply, I never had a notification of your post!
I admit I was probably a little flippant about the science, and as an ardent TIVA user I would love to be proved wrong.
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I think most of the physiological mechanisms hypothesised came as a result of the initial trials rather than the other way round.
Like the many attempts to explain why THRIVE reduced CO2, when in reality it didn't.
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I'm a huge TIVA advocate, but I think the cancer outcomes argument was always a stretch. It didn't pass the "does that sound plausible?" test for me, and whilst we definitely needed to look into it, I think the evidence has convincingly put it to bed now.
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To be fair those initial studies' numbers were so dramatic (too dramatic?) and the potential benefits so great I think it was worth a few studies to explore it.
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Yeah, I think mean is the figure to use for estimatingcerebral perfusion, but sBP is likely the better marker / driver for rebleeds of haematoma expansion
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That's very similar to my practice, agree there is a paucity of evidence.
I was talking with a trainee about this as we had two ICHs in theatre at different stages of their presentation which triggered the question.
I'll post my current thinking with working in a day or so!
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And would you have an upper limit?
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Let me know if there is anything else you would want to know to make a decision.
#ansky #neurosky #neuroicu
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...and just found this table.
Looks fantastic.
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Or would if I had my glasses on.
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Time to go TIVA?
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Excellent.
Great to be able to stop saying "I don't think it makes a difference but I have nothing to back that up"
#ansky
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Biggest attrition rate of training programmes.
Worrying there is such a huge pool of potential dictators out there.
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I think it's great. Using Bitcoin to allow those from the Mississippi to the South Seas to enjoy tulips.
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Surely the only time we would see clinical significance is if a patient was difficult to intubate, which is the series of 50 patients none were.
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HFNO performed better in all the metrics you would expect to help you if you were unfortunate enough to have a difficult intubation.
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I'm not sure that's the headline I would be using.
The study wasn't powered to look at clinical outcomes and as all but one patient was intubated on first pass you wouldn't expect to see change in clinical outcomes.
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Do you get halfway through the talk and suddenly think "I've looked at that audience member way too much, it's getting weird" then assiduously avoid any eye contact with them for the rest of the talk?
No?
Me neither.
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(I completely agree)
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Completely agree.
To the excellent article I would add that SpO2 is a much more significant determinant of blood oxygen content than PaO2.
An ABG only estimates this whilst a pulse oximeter measures it. Which would you rather know?
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I have a Samsung S9FE+ which I use for reading and drawing, and would recommend.
It has an IPS screen which is a bonus if you struggle with LED screens with PWM as I do.
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Interesting. I asked for a cost list of our drugs last week from pharmacy so hopefully will find out soon.
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Which patients do you see the bladder dysfunction in?
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I also don't have any major opinions on the matter so I'd be interested on the opinions.
The main use at our institution is for awake craniotomies where I can see the benefit in the anxiolysis without sedation.
For pure analgesia I am less convinced at present but happy to have my mind changed!
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Devils advocate, given the extra cost, and extra pump and line, how much better than clonidine is it?
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Completely agree.
Won't pay until you hit ~£3m for most, then only pay half the general public pay, and you can spread it over 10 years.
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Heavily involved in education, with a particular interest in digital learning.
I was probably a bit too passive on the old place, I'll try and post more educational content and fewer sarcastic comments.
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Has it had a resurgence in the US or did it never go out of fashion?
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There may be a tiny element of do as I say not as I do about the above post 😬