Cricoid has been selectively vilified out of RSI in some settings but has more evidence, less risks and a better rationale than any other cited component. So why not do it routinely for all tracheal intubations? Let the games begin. In @Anaes_Journal https://t.co/DeDP4hNpJY

@doctimcook @NicholasChrimes @Anaes_Journal

"Do that thing Nick Chrimes made up, I can't remember what it's called" has to be the best recommendation @dasairway has ever made! 😂 I couldn't be more chuffed.

"Paradox of informed consent" by @NicholasChrimes et al

I accidentally deleted the PUMA Twitter account, so please re-follow. The rest of the guidelines REALLY are coming out in 2026.

@NicholasChrimes @Anaes_Journal

@loes_bruijstens @NicholasChrimes @Anaes_Journal In NAP4 & NAP7 more related to intubation than SGA use In famous Warner paper (prevSGA) 60% of aspirations occurred during laryngoscopy or extubation, though I guess confounding is likely

@NicholasChrimes @Anaes_Journal I agree regarding vilification of cricoid and lack of evidence for (m)any of the other elements of RSI -said as much in a lecture last week There are significant downsides to -predefined induction dose -lack of delay between drugs -early intubation -even use or not of NGT

@AirwayMxAcademy @NicholasChrimes @Anaes_Journal Rather than reserve Cricoid Pressure (CP) only for RSI, CP, when indicated, will reduce gastric insufflation during BMV! #CricoidParadox https://t.co/ZTBhzil1i1

Did some rough maths. There a 4 million anaesthetics given in Australia annually. If 20% of these involve administration of NMBA then using roc vs atrac (or vec) would result in an additional 200 episodes of anaphylaxis per year. Not insignificant.

@NicholasChrimes @DrRJWebb @AirwayMxAcademy Pholcodine banned in UK March 2023 …..but immunologists I’ve spoken to are far from convinced of its relevance to NMB allergy

Interesting paper. REBOA outcomes not as good as heading straight to theatre. Will this paper change practice?

Emergency Medicine Registrar teaching today: 2 hours of airway sim then 2 hrs advanced airway classroom and practical including hands on practice with airway visualisation using the aScope in our ”live cadaver lab” Like with kids - you want them to have the things you never had.

In Australia & NZ you should only be using rocuronium if there’s a benefit to the patient from its rapid onset. That doesn’t necessarily require it to be RSI, could just be challenging FMV, short safe apnoea time, etc. If you just want to reverse w sugammadex, use vecuronium.

Come join us for an airway fellowship in 2026 at Gosford Hospital on the NSW Central Coast. DM me for more details.

@Anaes_Journal Fascinating Quite a different NMBD rate from the UK NAP6 (which only captured grade 3+ (ie life threatening anaphylaxis cases) Reported UK rates -rocuronium 1:17,000 -atracurium 1:24,000 -suxamethonium 1:9,000 They had differing relative -severities and -phenotype of

The chance of having an allergic reaction to a neuromuscular blocking drug is: • suxamethonium: ~1 in 1500 people • rocuronium: ~1 in 3300 people • atracurium: ~1 in 15,000 people Women were up to eight times more likely to have a reaction than men. #anaesthesia #MedTwitter

• There is a significant difference between the rates of peri-operative hypersensitivity reactions with rocuronium and suxamethonium vs. atracurium. • Females may be higher risk than males of reacting to neuromuscular blocking drugs. #anaesthesia #allergy #MedTwitter

https://t.co/wMz5RS1npt

@Dr__Yield @BJAJournals @dasairway Guidelines do not mandate care, but they do de facto establish standards -these guidelines based on evidence -they recommend default VL -the strength of recommendation evidence is grade A (the highest possible) -the rationale for use of a VL is safety -our standard-setting