\n
![\"\"](\"https:\/\/i0.wp.com\/accordingtokirsty.com\/wp-content\/uploads\/2026\/09\/IMG_7537.jpeg?resize=525%2C394&ssl=1\")
\nAs pressures on us increase, we tend to cut back on the very things that are helping to sustain us.<\/p>\n
OK, maybe there\u2019s very little interest amongst you in the latest developments in anaesthesia, particularly for the Russian bots I\u2019m guessing. On the other hand, it\u2019s your taxes that have helped fund my trip, so you deserve a report whether you want it or not.<\/p>\n
I\u2019ll just discuss a few of the highlights before I forget them.<\/p>\n
There\u2019s been a move to use propofol for end of life care instead of benzodiazepines and opioids, because doctors seem at times unwilling to escalate doses appropriately. Patients on a propofol infusion (AKA Jackson Juice or milk of amnesia), tend to look quite serene. However, it\u2019s widely used for sedation in ICU, and it turns out that ICU survivors will tell you of awful experiences they have while on it, with very real seeming hallucinations and nightmares. So, best to just teach the doctors to be more generous with the other drugs that we know are at least pleasant, for when they\u2019re looking after your old gran in her final days.<\/p>\n
There was another session by some young anaesthetists called \u201coff the beaten path\u201d which was inspiring although also rather intimidating. They are all doing extra curricular things like starring on TV shows, being expedition doctors, or looking after famous football teams. They argued that anaesthetic training gives us a huge amount of transferrable skills that help us thrive in difficult situations. I\u2019d like to think it\u2019s true.<\/p>\n
The session on brains was also fascinating, and is my particular area of interest. The brainwave monitor (EEG) we use nowadays to make sure people are getting enough anaesthetic can also tell us a lot about how healthy the brain is or isn\u2019t, and how it\u2019s coping with an acute insult such as a head injury or brain bleed. It\u2019s just a matter of pattern recognition which is something we\u2019re very good at.<\/p>\n
The talk on functional disorders, meaning illnesses that don\u2019t have an organic basis, was really interesting. This includes things like functional seizures that aren\u2019t epilepsy. Of note, the patients definitely aren\u2019t just \u201cputting it on\u201d. We used to say it was a diagnosis of exclusion, that you had to make sure they weren\u2019t having \u201creal\u201d seizures, \u00a0but actually that approach can be quite risky, because the drugs that you give can make it worse and are dangerous in their own right. It turns out functional seizures are quite characteristic and easy to spot if you have experience. I had a patient with it last year, and in retrospect we could have done a better job of managing it, mostly with de escalation measures.<\/p>\n
The last talk in that section was about clot retrievals in acute stroke. This is when you Hoover out the blood clot from an artery in a patients brain that\u2019s causing the blockage to blood flow. They have way more centres doing it over here than at home, which fits with their higher population, but they still have inequality in access, leading to a postcode lottery for timely care. Unfortunately time is brain so your chances of a good outcome are way better in central London than rural Wales. We have the same problem in NZ.<\/p>\n
The peri operative medicine section was the classical sort of thing you expect from medical conferences. They presented a paper that was published on the day they were giving the talk – you can\u2019t be more hot off the press than that! It was on the very effective new weight loss drugs, the GLP-1 agonists like Wegovy. Due to poor stomach emptying it does seem to increase the risk of vomiting under anaesthetic. Perhaps of more interest, less than half of patients who were on them had them prescribed by their GP or hospital doctor. Most just \u201cgot them off the internet\u201d somehow. The presenter talked about the last patient she had who was on them, she\u2019d got them from the lady who did her eyebrows. Yikes.<\/p>\n
The \u201coutcomes that matter\u201d talk essentially said that what people care about after their surgery and anaesthetic isn\u2019t necessarily what we might expect. Success could look very different to a patient or a doctor. Hence the importance of good communication about expectations, ahead of time.<\/p>\n
A talk on caring for autistic patients was a real eye opener too. So much of what we might think is good care is essentially an assault on the senses of an autistic patient. Calmer, quieter, less stimulating environments are important. It\u2019s not a \u201cone size fits all\u201d situation, but rather \u201chorses for courses\u201d, and incidentally that sort of figurative language is also surprisingly unhelpful for concrete thinkers. All adults hate surprises, \u00a0but this population in particular, so full explanations of the peri operative journey, or even better, a visit of the theatre suite in the days before hand, can be very useful. Premeds such as clonidine are also helpful (that note is for me).<\/p>\n
This morning the session on research included some very thorough work debunking the myth that labour epidurals are associated with learning difficulties in children. I\u2019d never even heard of this idea I must say, but I\u2019m pleased to hear it\u2019s all rubbish since I had epidurals for both labours.<\/p>\n
The last session was on burnout, which was terrific. I was very pleased to hear it\u2019s not a personal failing, which of course we\u2019re all afraid that it is.
\n
\nAs pressures on us increase, we tend to cut back on the very things that are helping to sustain us.<\/p>\n
![\"\"](\"https:\/\/i0.wp.com\/accordingtokirsty.com\/wp-content\/uploads\/2026\/09\/IMG_7542.jpeg?resize=525%2C394&ssl=1\")
The presenter had very useful tips on what to do if we recognise the signs in ourselves or in colleagues, and how to prevent it happening in the first place. Surprisingly, the Americans are way ahead in recognising the important role that workplaces provide, and the benefits that accrue not just to staff but to the organisation as a whole when people are thriving. I suspect NZ is way behind in this.<\/p>\n
Well, I think that\u2019s about it. Sorry to bore you.<\/p>\n","protected":false},"excerpt":{"rendered":"
OK, maybe there\u2019s very little interest amongst you in the latest developments in anaesthesia, particularly for the Russian bots I\u2019m guessing. On the other hand, it\u2019s your taxes that have helped fund my trip, so you deserve a report whether you want it or not.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[1],"tags":[],"class_list":["post-13382","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pa8Ukf-3tQ","jetpack-related-posts":[{"id":6501,"url":"https:\/\/accordingtokirsty.com\/index.php\/2021\/05\/21\/payback\/","url_meta":{"origin":13382,"position":0},"title":"Payback","author":"Interloper11","date":"May 21, 2021","format":false,"excerpt":"I mentioned in my work newsletter editorial last week that one of the senior doctors in ICU had shouted at me during a patient handover. It was only to ask me to speak up so that everyone could hear, but it still felt a bit awkward. I didn\u2019t say his\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":4737,"url":"https:\/\/accordingtokirsty.com\/index.php\/2020\/05\/11\/poultry-2\/","url_meta":{"origin":13382,"position":1},"title":"Poultry","author":"Interloper11","date":"May 11, 2020","format":false,"excerpt":"Now that COVID 19 has fallen off our radar at work, at least temporarily, the riskiest thing I did all weekend was to eat several chicken meals from the hospital staff cafeteria. You may laugh but one of the junior doctors I was working with yesterday told me about the\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":391,"url":"https:\/\/accordingtokirsty.com\/index.php\/2018\/09\/14\/sad\/","url_meta":{"origin":13382,"position":2},"title":"Sad","author":"Interloper11","date":"September 14, 2018","format":false,"excerpt":"Was hoping to post my best received work email of all time, which was actually one written by my daughter Samantha in her last year at school: \u201cSam\u2019s Agony Aunt or whatever replies\u201d, September 2015. \u00a0I got so many emails and comments from colleagues \u201cshe\u2019s so clever\/witty\/funny\/charming\/talented\u201d - far more\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":4980,"url":"https:\/\/accordingtokirsty.com\/index.php\/2020\/06\/19\/old-scheduling-email-early-june-2016\/","url_meta":{"origin":13382,"position":3},"title":"Old scheduling email – early June 2016","author":"Interloper11","date":"June 19, 2020","format":false,"excerpt":"I haven\u2019t got a photo yet of the new tattoo, so in the meantime, here\u2019s another old scheduling email. I was sure I\u2019d got into trouble after the previous email, and it seems I was right. Obviously the hurt is still very fresh. From: Kirsty Jordan Sent: Friday, 10 June\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":9096,"url":"https:\/\/accordingtokirsty.com\/index.php\/2023\/07\/05\/break\/","url_meta":{"origin":13382,"position":4},"title":"Break","author":"Interloper11","date":"July 5, 2023","format":false,"excerpt":"I\u2019ve been very quiet this week because my first case on my return to work after my holiday went badly. I put my frail little old lady patient off to sleep for her routine minor surgery, and she suffered a major medical event and never woke up. Ghastly for everyone\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/accordingtokirsty.com\/wp-content\/uploads\/2023\/07\/IMG_2747-669x1024.jpeg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/accordingtokirsty.com\/wp-content\/uploads\/2023\/07\/IMG_2747-669x1024.jpeg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/accordingtokirsty.com\/wp-content\/uploads\/2023\/07\/IMG_2747-669x1024.jpeg?resize=525%2C300&ssl=1 1.5x"},"classes":[]},{"id":3863,"url":"https:\/\/accordingtokirsty.com\/index.php\/2019\/12\/23\/christmas-eve-a-report-from-the-trenches\/","url_meta":{"origin":13382,"position":5},"title":"Christmas Eve – a report from the trenches","author":"Interloper11","date":"December 23, 2019","format":false,"excerpt":"Live stream! Well, I plan to add to this post during the day unless things really go pear shaped and it gets busy. Am on till 10pm. 0815 - am onto my third coffee. Is this a good idea? Am meant to be in the neurosurgery theatre today, but they\u2026","rel":"","context":"Similar post","block_context":{"text":"Similar post","link":""},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/accordingtokirsty.com\/wp-content\/uploads\/2019\/12\/BF812800-0209-4707-846C-285A56B484D2.jpeg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/accordingtokirsty.com\/wp-content\/uploads\/2019\/12\/BF812800-0209-4707-846C-285A56B484D2.jpeg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/accordingtokirsty.com\/wp-content\/uploads\/2019\/12\/BF812800-0209-4707-846C-285A56B484D2.jpeg?resize=525%2C300&ssl=1 1.5x"},"classes":[]}],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/posts\/13382","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/comments?post=13382"}],"version-history":[{"count":0,"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/posts\/13382\/revisions"}],"wp:attachment":[{"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/media?parent=13382"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/categories?post=13382"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/accordingtokirsty.com\/index.php\/wp-json\/wp\/v2\/tags?post=13382"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}