SIVA Trainees

Patients rescued from rubble after the 2023 Kahramanmaraş earthquake signavitae.com/articles/10.22… @MRE_signavitae @giovannilandoni

@simtiva_app This looks great Terence - SimTIVA just is just getting better and better!

Upcoming feature: live preview of bolus/infusion rate change in manual mode. Sometimes, we need to change our infusion rate or give an extra bolus, SimTIVA now plots the curve for the predicted effects of such change dynamically as you enter your values. Below examples show the "live preview feature" of: reduction of propofol inf rate, and giving a bolus of fentanyl. Will be released soon.

Sign up for The EEG Bootcamp @Assoc_Anaes 20th November. International faculty of experts covering what YOU need to know to monitor the target organ of anaesthesia! anaesthetists.org/Events/Event-D…

🧠The second episode of the new season is out!!! 📢 🎙️This time we’re interviewing Prof. Matthias Kreuzer @alohias — a VIP in the world of EEG and anesthesia! 💚open.spotify.com/episode/37IZnm… ♥️youtu.be/2WBH0JLEsv0?si…

Eleveld et al.'s #pharmacokinetic - #pharmacodynamic model of #remimazolam begins to pave the way for its widespread use in #sedation and anaesthesia. #BJA #model #simulation bjanaesthesia.org/article/S0007-…

@doctimcook @cannula_service @cliffreid @Anaes_Journal I fall into the camp of 'RSI still has a place'. Certainly the term prompts a two way check from the ODP - Cricoid? Let's get the suction ready? Perhaps RSI is not as important a term in ICU/ED where a checklist and RSI components are the standard?

RSI is a topic that generates a lot of heat & noise. There’s a fair bit to agree with in this editorial - and despite having great respect for both authors I believe there’s a fair bit to disagree with too. At points the editorial seems to be intent on reductio ad absurdum My major concerns with this are -aspiration of gastric contents remains a core complication of airway management and efforts to reduce this complication are a responsibility of us all -there is too often (including in this editorial) a focus on on the lack of evidence instead of applying what evidence there is -this takes us to a place where potential benefits of evidence based practice are ignored I do agree with the authors that there are multiple components of RSI and they should each be considered carefully. Also RCTs are not the answer. Further I believe RSI is overused. Where I take leave of the authors views is that don’t agree that routine intubation and RSI are so similar as to be indistinguishable (indeed this arguably promotes unsafe practice in which no effort is made to reduce the risk of aspiration in high risk cases), nor that because the evidence base is inconclusive we should simply abandon the debate (and by implication any efforts to explore the topic further). @Anaes_Journal

What do people mean by 'RSI'? How it looks now is quite different from the original description. Rapid sequence induction: a modern-day example of Theseus' Paradox? from @Anaes_Journal …-publications.onlinelibrary.wiley.com/doi/epdf/10.11…

RSI survey link here forms.office.com/Pages/Response…

Very pleased with how our TCI / TIVA RSI is doing but would love a few more responses. Also if anyone from the Republic of Ireland can help me with distribution please message me!

Prefer the 'Trigger's Broom' paradox This is one of the questions we have and why we're surveying anaesthetists about TIVA RSI. forms.office.com/Pages/Response…

@AirwayMxAcademy @propofoldream @simtiva_app @LeylsTurk forms.office.com/Pages/Response… Let me know the answers to my questions!

At what point are airway reflexes considered lost? At the moment of unconsciousness? Before? Does it therefore matter about the speed of the initial bolus? @AirwayMxAcademy @propofoldream @simtiva_app @LeylsTurk @

I guess my other question re: TIVA RSI What is an RSI? Do you still give a fixed dose of drug followed immediately by relaxant or do you wait for unconsciousness? Do patients lose their airway reflexes the moment the propofol enters their vein?

@simtiva_app Love it. Although what are we defining as RSI? We're certainly not in Thio/Sux land anymore...

@SIVATrainees simtiva.blogspot.com/2025/05/rsi-an… The above is a full explanation of why a manual bolus is a better choice, as experimented via simulations on SimTIVA app

SIVA are conducting a TIVA RSI survey! (But all RSIs are TIVA RSIs I hear you say) Well... yes that is true but Specifically we want to know what you do with your TCI and TIVA pumps when doing an RSI.

@propofoldream Got you covered!

@SIVATrainees The 2 issues w RSI using TCI are (a) Pump bolus not fast enough (b) Hand bolus not accounted for during maintenance Using plasma targeting (instead of Ce target) together with hand bolusing induction plasma overshoot "solves" both issues Propofol Dreams now has a RSI mode 👍🏼😁

@AirwayMxAcademy @HouthoffKavita @SIVATrainees @jducanto @DaveOlvera1 @SafeAirway @GongGasGirl @cliffreid @emcrit No to #TIVA, Yes to #RSI! HT: ncbi.nlm.nih.gov/books/NBK56059…

@AirwayMxAcademy @jducanto @DaveOlvera1 @HouthoffKavita @SafeAirway @GongGasGirl @cliffreid @NaveenEipe @emcrit I (personal non SIVA opinion) treat it as a continuum and will use both methods. Using pumps for an RSI might induce a degree of cognitive burden. In sick patients it might pay to keep things as simple as possible In an ASA1 appendix?.. I think using pumps isn't unreasonable

RSI should imo NOT be done with pumps. You want to be 100% in control. Pumps are not always reliable due to technical issues or low battery or high pressure alarms. Lets do a poll @jducanto @DaveOlvera1 @HouthoffKavita @SafeAirway @GongGasGirl @cliffreid @NaveenEipe @emcrit Should rapid sequence induction be done using a TCI pump:

Please share it with your colleagues and we'll post our results when we have them

We're looking at adult (non obstetric) RSIs It's mainly directed at UK practice, but anyone can reply (just pop your country of practice in the survey box). forms.office.com/Pages/Response…