Selvan Ramsamy

@doctimcook @AirwayLegend @ben_cloyd @valeriovalente 4/Point being made : MAC VL gives you superior laryngeal views than DL and superior training can get the ETT into the trachea without an introducer / Stylet.

@_Anesthesiology Interesting

Revisit the February 2026 Image in #Anesthesiology - Choosing Nerve Blocks by Hip Fracture Subtype 📷 ow.ly/boep50YwYm9

@CriticalCareNow pivot to the face mask -bag mask ventilation, then thE SGA.

Slow down to speed up Rushing leads to mistakes. For ultimate success, use a checklist every time. Standard VL + a bougie is your "cheat code." If the view fails, don't force it—pivot to an SGA and prioritize ventilation. 💨 #PatientSafety #FOAMed #AirwayManagement

@CriticalCareNow No , not Sux .

From blind intubations to RSI From jamming tubes down noses to 4K video, medicine has evolved. Modern meds like Sux and a "menu" of VL/DL tools make airway management safer and more humane. Don't take current tech for granted! #MedHistory #FOAMed #AirwayManagement

@amit_pawa Yes , And if you going to do spinal block , you might as well do intrathecal morphine .

This is going to be a great update to the original Plan A paper… I have a controversial take though… If you are gonna do an ESP block, you may as well do an ITP block! #Controversy! #PlanABlocks #RegionalAnaesthesia #RegionalAnesthesia

@doctimcook @BJAJournals but why “the only real interest is in POGO 0%” POGO 0% is also intubatable.

The VCI score isn’t new (2021) and isn’t especially appealing. It is both superficial (what adjunct did you use with your blade, what size, why was intubation difficult and what did you do) and misses essential information about laryngeal views because it uses rubbish tool in that regard. For me POGO = NOGO (“NOt a lot GOing on”) Ok that’s harsh …. But it exclusively categorises laryngeal views that should be intubatable. Yes POGO <10% might be harder than POGO 90% but the only real interest is in POGO 0% I suspect POGO has appeal as it sounds good. There is merit in exploring the extent to which a low POGO is associated with tricky intubation but whether POGO is -0”%, 70%, 55% or 33%…. who cares? @NicholasChrimes

Introducing the #VCIscore: a reliable, standardised tool for reporting #videolaryngoscopy-assisted #trachealintubation. High inter-rater agreement means better data and safer care. Read more: bjanaesthesia.org/article/S0007-…

@NicholasChrimes @selvan_ramsamy @doctimcook @AirwayMxAcademy It's not really a myth else there wouldn't be an industry centered around bougies, stylets and introducers that get round the corner.

@NicholasChrimes @doctimcook @AirwayMxAcademy x.com/selvan_ramsamy…

@selvan_ramsamy @doctimcook @AirwayMxAcademy x.com/doctimcook/sta…

The VCI score adds nothing to airway documentation. Why does everything have to be reduced to an incomprehensible code? Why do we need a different system for documenting direct & indirect view? Why would anyone use POGO to document view when all it does is distinguish (w high inter-rater reliability!) bw degrees of easy view but loses all discriminatory value about anything the next person would actually want to know (CL 2b, 3a, 3b & 4 are all POGO zero).

Yes but what do we then do for airway management….? We know the incidence of a non-empty stomach in all elective patients is around 5-6% (much higher in some series) But the incidence of aspiration is around 1 in 10,000 That’s 600-fold lower If we start doing RSIs or even intubating all these patients then there is a significant risk we’ll cause more harm. So I think identifying who has a full stomach is the easy bit. Working out who is actually at high risk or deciding what to do about it is the complex one! @kariem

@selvan_ramsamy @Anaes_Journal Why no? For all the reasons I’ve reasons I’ve explained, imo,

@doctimcook @Anaes_Journal And will this “ incidence of a non-empty stomach in all elective patients is around 5-6%” include the patients on semaglutide. Put another way , “ all elective patients " include patients on semaglutide?

Semaglutide, fasting and gastric ultrasound Nearly 50% of patients receiving semaglutide treatment had a full stomach on pre-operative gastric ultrasound, regardless of dose, duration, route of administration or withholding time. #anaesthesia #MedTwitter doi.org/10.1111/anae.7…

@dkscheah @dkscheah , sorry missed this post . Are you referring to the high frequency , high power horizontal band . That’s amazing , not seen this with TOF. But I have seen something similar with IONM monitoring but more scattered high frequency spikes.

A single Train-of-four twitch on orbicularis oris will generate a persistent falsely high Psi and high power DSA, until the TOF electrodes removed from skin from 3:00-3:06. The TOF remains 'live' and produce EMI to Sedline. Have you encountered this @selvan_ramsamy ?

@doctimcook @Anaes_Journal Why not take a step back and manage all the patients on the drug as full stomach if gastric ultrasound is not practical . If elective ,can postpone administration of the drug and postpone surgery if the indications for both allow . If cannot postpone either , then it’s RSI .

Older surgical patients are at risk because of age-related physiologic decline and comorbidities. In a new article, Zhou et al. analyze the effectiveness of a widely used monitoring device in improving outcomes. Read the article: ow.ly/MsSn50Y5642

@AirwayMxAcademy When the SAD works , it works well , when it doesn’t , it just does not . This device may just be one other intervention before the ETT?

💡 Has anyone of you already used Larynxlock device to fix supraglottic airway device leakage? I have used it now in 5 clinical patients with Intersurgical Igel or Comepa SAD with airway leakage 50 - 150 ml during short anaesthesia procedures (< 60 min) and it was succesfull in all. I opine that this device could be very useful in the prehospital setting as well during CPR 🚑 where teams are often shorthanded. It now has CE mark so it is available in Europe. Larynxlock is made from potatoe 🥔 starch so it seems a smart green solution as well. Made in 🇳🇱 the Netherlands. It can prevent tracheal intubation or the need for replacement with another model or size SAD. Studies are needed to find out how effective this is. It looks very promising and simple. @jducanto @Asiritrauma1 @maffygirl @ProtectedAirway @airwayGladiator @cliffreid @emcrit @elboghdadly @ProfEllenO @NaveenEipe @NicholasChrimes @dasairway @AirwayHub @doctimcook @DaveOlvera1 #larynxlock #airwayleakage

@doctimcook For the lay public , the terms convey that it’s temporary and the patient will “ wake up”

Answer me this Why when a patient is anaesthetised…..almost always full unconscious, often paralysed are they popularly described as ‘asleep’ Yet when sedated in ICU the term ‘put into an induced coma’ is most often used. These patients are usually sedated, non fully unconscious and very rarely paralysed. Both basically wrong and potentially misleading. One seemingly trivialising anaesthesia and the other dramatising ICU sedation. Anyone explain it to me?

@AirwayMxAcademy @NicholasChrimes @Nitrousman75 @Anaes_Journal @AAGBI I agree , if you have one , use it . If you don’t have one , it’s not really needed , unless you plan on intubating en route from theatre 😜

@NicholasChrimes @Nitrousman75 @Anaes_Journal @AAGBI Its not really needed Nick

Another death involving unrecognised oesophageal intubation. Misinterpretation of chest impedence trace as ETCO2 trace. PUMA guidelines address the need for monitoring displays to be standardised and ETCO2 trace to be distinctive. Free full text in @Anaes_Journal sbs.com.au/nitv/article/n… …-publications.onlinelibrary.wiley.com/doi/10.1111/an…

My comments regarding the new DAS2025 guidelines for management of the unanticipated difficult tracheal intubation. 📖 kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F%2… @BJAJournals @NicholasChrimes @NaveenEipe @dasairway @navarroguillej @dr_imranahmad @maffygirl @DaveOlvera1 @PedsAnesNet @NightShiftMD

@NicholasChrimes @dasairway If I were intubating outside theatre , with no availability of capnography, then it wound be ideal to see ETT between the cords.

Some ambiguity about criteria for confirming tracheal intubation in the @dasairway 2025 Guidelines. Statements about *ideally* having both sustained exhaled CO2 & seeing tube bw cords might be interpreted as suggesting that in *non-ideal* circumstances only one of these will suffice. No explicit statement that sustained exhaled CO2 is mandatory to exclude oesophageal intubation. Perhaps too much emphasis on confirming tracheal intubation (which SECO2 + tube through cords doesn't do anyway as tube could still be bronchial or even mediastinal …-publications.onlinelibrary.wiley.com/doi/10.1002/an…) rather than excluding oesophageal intubation. @dr_imranahmad @doctimcook @AndyHiggsGAA

@NicholasChrimes @dasairway Grade 3 view , C&L, successful intubation with SEC02. This is where the "non IDEAL "circumstance comes into play as you were not able to see the tube between the cords .