Andy Downs

@Anaes_Journal Alkalinised lidocaine intra-cuff

What strategies can be used to reduce the incidence of post operative sore throat? • Cuff pressure ≤ 30 cmH2O • IV/topical corticosteroids • Nebulised/topical ketamine • Topical NSAIDs • Smaller tube: 7.0 mm (male); 6.0 mm female • Use a SAD instead #anaesthsia #MedTwitter doi.org/10.1111/anae.7…

@alifia_tameem @CrossCountryUK Not at all!

@CrossCountryUK why does the 15:56 from Sheffield to Plymouth only have 4 coaches?! It is absolutely rammed on this train - probably dangerously so. The PA system isn’t working. The smell is bad. What a total joke.

…and just found out the only toilet that I can feasibly get to (due to overcrowding) is out of order.

@Dr_BellaR MacBook Air

@ann_barron1 We used to. But now we've moved to 400mg Teicoplanin + 160mg Gent for joint replacements.

@andrewjdowns Thanks Andy - do you use 1g fluclox for your joint replacements too?

Interested in finding out about antibiotic prophylaxis for fractured NOF pts. In our trust we use 2g fluclox and 160mg gent but this combination is more likely to cause an AKI. What does your trust use and (if possible) why?

@isitsleepytime I wouldn't even get into medical school these days, let alone onto a specialty training programme.

@Dr_BellaR Stayed in Taksim in July, and this was a good location to explore the city. We did a cookery lesson with a local family which was the highlight of our trip ( @lokalbond on Instagram). Avoid the Bosphorus cruises, they are tourist traps. Take a ferry instead!

I see membership of @TheBMA as essential & don’t resent these subs I also think the 190,000 members won’t resent £2 of their annual fee being donated to @AnaesUnited legal case against @gmcuk attempting to ensure proper, safe regulation of associates’ scope RT if you agree🙏

@Dr_BellaR I would exercise caution. Once you click “send” there’s no taking it back. If the placement is that bad, as others have said, they may retaliate. I would speak informally the foundation programme director. Email is bad for nuance, so F2F or phone call best.

@nosecglasses Very well written. Completely agree. @NicholasChrimes - having read a lot of your online content, I have a great deal of respect for your knowledge and expertise, but @nosecglasses has hit the nail on the head here.

13/ I've written and deleted some so many versions of this last paragraph that I'll just say this: Nick I value your genuinely stellar contribution to the field of complex airway management, but perhaps there is merit in at least pretending you value opinions other than your own.

4/ Aviation had in recent years experienced a number of 'black swan events' - rare catastrophic events that were completely unexpected - and Qantas was worried that their checklist-based training was not preparing pilots for IRL crises esp. in new fly-by-wire cockpit env'ts.

@Whitehouse_ICU Similar constraints for us Tony, needs to have a water reservoir as will be impractical to have it plumbed in.

@andrewjdowns Let me know how you get on! We are doing the same. Capsules aren't environmentally sound (and the coffee isn't nice) but managing the pucks for a bean to cup and reducing mess is a challenge. Also we have to have a machine with a water reservoir as no mains water in the office.

I have the v responsible task of buying a new bean-to-cup coffee machine for our anaesthetic department. Anybody got any recommendations? Criteria include: no fresh milk container (it'll end up disgusting), easy to clean, robust, makes nice coffee. #MedTwitter #CoffeeLovers

@BluntingStress If we get a really fancy machine, maybe that would tempt you back to the Uk? 😉

@andrewjdowns I’m a keen observer of this thread..

@johncampbell01 @SIVAnaesthesia @SIVATrainees Hi John, weirdly it’s not much of problem after a full TIVA GA. But I do quite a bit of procedural sedation with prop + remi TCI, and these ones shiver quite markedly in recovery for 15mins or so. Can’t figure out why!

@andrewjdowns @SIVAnaesthesia @SIVATrainees Oops I've been blissfully ignorant of this being a TIVA problem

#TIVA users: any magic recipes to reduce post op shivering? Basic things are being done already: warming mattress, warm fluids, etc. Tympanic temps being monitored and within normal limits. #MedTwitter #anaesthetists @SIVAnaesthesia @SIVATrainees

@Dr_Mrs_Mama 😂 Obvs!

@andrewjdowns With a sudoku book in your hand?

@Dr_Mrs_Mama It could possibly have even more anaesthetisty, if I had written it whilst wearing full lycra?

@andrewjdowns Literally the most anaesthetisty post ever. And it’s not even about anaesthetics