Rob Fleming
@robjimfleming.bsky.social
Doctor / Academic | Specialist (SAS) Anaesthetist | Clinical Associate Professor | UK | He / him | FRCA | Award winning irreverence | "non-sea lion" | Part of @SAScollective.com | #SASsix | #PERUSEbeforeYouInfuse
Opinions many, all very much mine!
Opinions many, all very much mine!
Reposted by Rob Fleming
Great fun at the @assocanaes.bsky.social #WSM2026 yesterday!
Was a pleasure to also teach with @emarianomd.bsky.social !
Was a pleasure to also teach with @emarianomd.bsky.social !
January 16, 2026 at 10:09 AM
Great fun at the @assocanaes.bsky.social #WSM2026 yesterday!
Was a pleasure to also teach with @emarianomd.bsky.social !
Was a pleasure to also teach with @emarianomd.bsky.social !
Reposted by Rob Fleming
Explore more journal metrics and find out why Anaesthesia should be a trusted home for your research.
@Anaes_Journal #WSM2026
🔗 Learn more: https://ow.ly/ntaH50XXHuB
@Anaes_Journal #WSM2026
🔗 Learn more: https://ow.ly/ntaH50XXHuB
January 16, 2026 at 10:50 AM
Explore more journal metrics and find out why Anaesthesia should be a trusted home for your research.
@Anaes_Journal #WSM2026
🔗 Learn more: https://ow.ly/ntaH50XXHuB
@Anaes_Journal #WSM2026
🔗 Learn more: https://ow.ly/ntaH50XXHuB
Reposted by Rob Fleming
We were delighted to present honours and awards to twelve exceptional individuals and teams yesterday at the 2026 Winter Scientific Meeting.
Learn more about our honours and awards winners here 👉 buff.ly/vww4L6z #WSM2026
Learn more about our honours and awards winners here 👉 buff.ly/vww4L6z #WSM2026
January 16, 2026 at 11:27 AM
We were delighted to present honours and awards to twelve exceptional individuals and teams yesterday at the 2026 Winter Scientific Meeting.
Learn more about our honours and awards winners here 👉 buff.ly/vww4L6z #WSM2026
Learn more about our honours and awards winners here 👉 buff.ly/vww4L6z #WSM2026
Reposted by Rob Fleming
If you're at the ‘New guidelines’ session at #WSM2026, download the new guidelines from our website:
Guidelines for anaesthesia and sedation in patients who are breastfeeding 👉 buff.ly/e1qbBHD
Measurement and management of adult blood pressure in the peri-operative period 👉 buff.ly/lGaIA4k
Guidelines for anaesthesia and sedation in patients who are breastfeeding 👉 buff.ly/e1qbBHD
Measurement and management of adult blood pressure in the peri-operative period 👉 buff.ly/lGaIA4k
January 16, 2026 at 2:30 PM
If you're at the ‘New guidelines’ session at #WSM2026, download the new guidelines from our website:
Guidelines for anaesthesia and sedation in patients who are breastfeeding 👉 buff.ly/e1qbBHD
Measurement and management of adult blood pressure in the peri-operative period 👉 buff.ly/lGaIA4k
Guidelines for anaesthesia and sedation in patients who are breastfeeding 👉 buff.ly/e1qbBHD
Measurement and management of adult blood pressure in the peri-operative period 👉 buff.ly/lGaIA4k
Reposted by Rob Fleming
The final session at today's @assocanaes.bsky.social #WSM2026 is a debate.
"This house believes that TIVA should be used for Rapid Sequence Induction."
Our Hon Sec @chronotrope.bsky.social is speaking on behalf of TIVA.
Dr Barley is delivering a rousing and entertaining talk. He does that!
"This house believes that TIVA should be used for Rapid Sequence Induction."
Our Hon Sec @chronotrope.bsky.social is speaking on behalf of TIVA.
Dr Barley is delivering a rousing and entertaining talk. He does that!
January 16, 2026 at 4:20 PM
The final session at today's @assocanaes.bsky.social #WSM2026 is a debate.
"This house believes that TIVA should be used for Rapid Sequence Induction."
Our Hon Sec @chronotrope.bsky.social is speaking on behalf of TIVA.
Dr Barley is delivering a rousing and entertaining talk. He does that!
"This house believes that TIVA should be used for Rapid Sequence Induction."
Our Hon Sec @chronotrope.bsky.social is speaking on behalf of TIVA.
Dr Barley is delivering a rousing and entertaining talk. He does that!
Dr Lyons continues. This is making for a very entertaining debate. This was a brilliant choice for the final session of the conference.
"Here is the slide covering the robust evidence that TIVA is superior for RSI than hand bolus followed by turning on a volatile."
#WSM2026
"Here is the slide covering the robust evidence that TIVA is superior for RSI than hand bolus followed by turning on a volatile."
#WSM2026
January 16, 2026 at 4:51 PM
Dr Lyons continues. This is making for a very entertaining debate. This was a brilliant choice for the final session of the conference.
"Here is the slide covering the robust evidence that TIVA is superior for RSI than hand bolus followed by turning on a volatile."
#WSM2026
"Here is the slide covering the robust evidence that TIVA is superior for RSI than hand bolus followed by turning on a volatile."
#WSM2026
Speaking against TIVA in this afternoon's #WSM2026 debate, Dr Craig Lyons first illustrates the number of ways in which we have also "modified" or allowed variation in practice when it comes to RSI.
There are apparently over 3000 combinations available on this slide alone.
There are apparently over 3000 combinations available on this slide alone.
January 16, 2026 at 4:44 PM
Speaking against TIVA in this afternoon's #WSM2026 debate, Dr Craig Lyons first illustrates the number of ways in which we have also "modified" or allowed variation in practice when it comes to RSI.
There are apparently over 3000 combinations available on this slide alone.
There are apparently over 3000 combinations available on this slide alone.
Mark Barley has a lot of style as a debater.
Talking about speed of onset for induction when using TIVA TCI for RSI, he asks "is it too slow?"
The paper he is quoting from would suggest not. He then adds...
"I know my opponent will agree with me about this paper. He wrote it."
#WSM2026
Talking about speed of onset for induction when using TIVA TCI for RSI, he asks "is it too slow?"
The paper he is quoting from would suggest not. He then adds...
"I know my opponent will agree with me about this paper. He wrote it."
#WSM2026
January 16, 2026 at 4:29 PM
Mark Barley has a lot of style as a debater.
Talking about speed of onset for induction when using TIVA TCI for RSI, he asks "is it too slow?"
The paper he is quoting from would suggest not. He then adds...
"I know my opponent will agree with me about this paper. He wrote it."
#WSM2026
Talking about speed of onset for induction when using TIVA TCI for RSI, he asks "is it too slow?"
The paper he is quoting from would suggest not. He then adds...
"I know my opponent will agree with me about this paper. He wrote it."
#WSM2026
For anyone newly here because of the Twitter outage, many welcomes!
Perhaps use this as an opportunity to reflect on why you were still over there in the first place. It isn't a nice place, and it is run by a dodgy megalomaniac.
Wipe your feet on the way in. Try and keep the place clean.
Perhaps use this as an opportunity to reflect on why you were still over there in the first place. It isn't a nice place, and it is run by a dodgy megalomaniac.
Wipe your feet on the way in. Try and keep the place clean.
January 16, 2026 at 4:14 PM
For anyone newly here because of the Twitter outage, many welcomes!
Perhaps use this as an opportunity to reflect on why you were still over there in the first place. It isn't a nice place, and it is run by a dodgy megalomaniac.
Wipe your feet on the way in. Try and keep the place clean.
Perhaps use this as an opportunity to reflect on why you were still over there in the first place. It isn't a nice place, and it is run by a dodgy megalomaniac.
Wipe your feet on the way in. Try and keep the place clean.
Vice president at @assocanaes.bsky.social, generally splendid person Dr Robert Self ends this mornings wellbeing session at #WSM2026, with a talk on mentoring.
Learning relationships help individuals achieve their potential. We all need this from time to time.
Learning relationships help individuals achieve their potential. We all need this from time to time.
January 16, 2026 at 12:45 PM
Vice president at @assocanaes.bsky.social, generally splendid person Dr Robert Self ends this mornings wellbeing session at #WSM2026, with a talk on mentoring.
Learning relationships help individuals achieve their potential. We all need this from time to time.
Learning relationships help individuals achieve their potential. We all need this from time to time.
Resilience has become a bit of a dirty word in recent years, placing the emphasis on the individual rather than the system that is stretching them.
However, it is still useful to talk about it.
Definitions of resilience often come down to elasticity and flexibility, as here.
#WSM2026
However, it is still useful to talk about it.
Definitions of resilience often come down to elasticity and flexibility, as here.
#WSM2026
January 16, 2026 at 12:05 PM
Resilience has become a bit of a dirty word in recent years, placing the emphasis on the individual rather than the system that is stretching them.
However, it is still useful to talk about it.
Definitions of resilience often come down to elasticity and flexibility, as here.
#WSM2026
However, it is still useful to talk about it.
Definitions of resilience often come down to elasticity and flexibility, as here.
#WSM2026
Question to Alan McEwen after his excellent talk on safety and air traffic control.
"Will AI ever replace human beings in air traffic control?"
"Since the 1980s there has been a joke that in the future, air traffic control will be a computer, a man and a dog."
...continued...
"Will AI ever replace human beings in air traffic control?"
"Since the 1980s there has been a joke that in the future, air traffic control will be a computer, a man and a dog."
...continued...
January 16, 2026 at 11:40 AM
Question to Alan McEwen after his excellent talk on safety and air traffic control.
"Will AI ever replace human beings in air traffic control?"
"Since the 1980s there has been a joke that in the future, air traffic control will be a computer, a man and a dog."
...continued...
"Will AI ever replace human beings in air traffic control?"
"Since the 1980s there has been a joke that in the future, air traffic control will be a computer, a man and a dog."
...continued...
Alan McEwen, international air traffic controller, talks about how to avoid error when the perceived risk is low, but the results of getting it wrong are catastrophic.
The first lesson is that it is really hard to "solve" the problem. It requires constant reinforcement and cultural shift.
#WSM2026
The first lesson is that it is really hard to "solve" the problem. It requires constant reinforcement and cultural shift.
#WSM2026
January 16, 2026 at 11:03 AM
Alan McEwen, international air traffic controller, talks about how to avoid error when the perceived risk is low, but the results of getting it wrong are catastrophic.
The first lesson is that it is really hard to "solve" the problem. It requires constant reinforcement and cultural shift.
#WSM2026
The first lesson is that it is really hard to "solve" the problem. It requires constant reinforcement and cultural shift.
#WSM2026
First question to the panel asks if there are plans for widespread distribution of military guidelines to civilian anaesthetists / intensivists, IF there is an expectation of more military patients in NHS hospitals?
The answer is that THIS session is the first step in doing exactly that.
Blimey.
The answer is that THIS session is the first step in doing exactly that.
Blimey.
Day 2 of @assocanaes.bsky.social #WSM2026, and I have opted for stream B, titled "WAR" and delivered by the military.
Talk 1 is "The civilian Anaesthetist's role in treating the casualties of a multi-national mass casualty event".
As this is the military session, it is starting at 0900 precisely.
Talk 1 is "The civilian Anaesthetist's role in treating the casualties of a multi-national mass casualty event".
As this is the military session, it is starting at 0900 precisely.
January 16, 2026 at 10:15 AM
First question to the panel asks if there are plans for widespread distribution of military guidelines to civilian anaesthetists / intensivists, IF there is an expectation of more military patients in NHS hospitals?
The answer is that THIS session is the first step in doing exactly that.
Blimey.
The answer is that THIS session is the first step in doing exactly that.
Blimey.
Wg Cdr Samantha Jones also reminds the room of the fatal triad of trauma.
Coagulopathy, hypothermia and acidosis each worsen outcomes, especially in combination with one another.
#WSM2026
Coagulopathy, hypothermia and acidosis each worsen outcomes, especially in combination with one another.
#WSM2026
January 16, 2026 at 10:09 AM
Wg Cdr Samantha Jones also reminds the room of the fatal triad of trauma.
Coagulopathy, hypothermia and acidosis each worsen outcomes, especially in combination with one another.
#WSM2026
Coagulopathy, hypothermia and acidosis each worsen outcomes, especially in combination with one another.
#WSM2026
Wg Cdr Samantha Jones ends this #WSM2026 session on war with a talk on critical care in the context of mass casualties.
In a mass casualty setting there are those who can't be saved, and those who will survive.
The outcomes for everyone else are dependent on the care we are able to provide.
In a mass casualty setting there are those who can't be saved, and those who will survive.
The outcomes for everyone else are dependent on the care we are able to provide.
January 16, 2026 at 9:57 AM
Wg Cdr Samantha Jones ends this #WSM2026 session on war with a talk on critical care in the context of mass casualties.
In a mass casualty setting there are those who can't be saved, and those who will survive.
The outcomes for everyone else are dependent on the care we are able to provide.
In a mass casualty setting there are those who can't be saved, and those who will survive.
The outcomes for everyone else are dependent on the care we are able to provide.
Lt Col Alex Kumar opens the war pain management talk at #WSM2026 with a quote attributed to Julius Caesar.
"It is easier to find people who will volunteer to die, than to find those who are willing to endure pain with patience"
Early opioids and continuous regional analgesia are the norm.
"It is easier to find people who will volunteer to die, than to find those who are willing to endure pain with patience"
Early opioids and continuous regional analgesia are the norm.
January 16, 2026 at 9:40 AM
Lt Col Alex Kumar opens the war pain management talk at #WSM2026 with a quote attributed to Julius Caesar.
"It is easier to find people who will volunteer to die, than to find those who are willing to endure pain with patience"
Early opioids and continuous regional analgesia are the norm.
"It is easier to find people who will volunteer to die, than to find those who are willing to endure pain with patience"
Early opioids and continuous regional analgesia are the norm.
Starting his talk at #WSM2026, Col James Ralph, a military representative to @assocanaes.bsky.social, talks about echelons of care.
Role 2 is usually a military orthopaedic surgeon, general surgeon, multiples anaesthetists and ODPs. This is stabilising only.
Role 4 is "us" i.e. the NHS.
Role 2 is usually a military orthopaedic surgeon, general surgeon, multiples anaesthetists and ODPs. This is stabilising only.
Role 4 is "us" i.e. the NHS.
January 16, 2026 at 9:10 AM
Starting his talk at #WSM2026, Col James Ralph, a military representative to @assocanaes.bsky.social, talks about echelons of care.
Role 2 is usually a military orthopaedic surgeon, general surgeon, multiples anaesthetists and ODPs. This is stabilising only.
Role 4 is "us" i.e. the NHS.
Role 2 is usually a military orthopaedic surgeon, general surgeon, multiples anaesthetists and ODPs. This is stabilising only.
Role 4 is "us" i.e. the NHS.
Day 2 of @assocanaes.bsky.social #WSM2026, and I have opted for stream B, titled "WAR" and delivered by the military.
Talk 1 is "The civilian Anaesthetist's role in treating the casualties of a multi-national mass casualty event".
As this is the military session, it is starting at 0900 precisely.
Talk 1 is "The civilian Anaesthetist's role in treating the casualties of a multi-national mass casualty event".
As this is the military session, it is starting at 0900 precisely.
January 16, 2026 at 9:00 AM
Day 2 of @assocanaes.bsky.social #WSM2026, and I have opted for stream B, titled "WAR" and delivered by the military.
Talk 1 is "The civilian Anaesthetist's role in treating the casualties of a multi-national mass casualty event".
As this is the military session, it is starting at 0900 precisely.
Talk 1 is "The civilian Anaesthetist's role in treating the casualties of a multi-national mass casualty event".
As this is the military session, it is starting at 0900 precisely.
Some of my favourite folks winning honours and awards at the end of today's @assocanaes.bsky.social #WSM2026.
A lot of work goes on nationally, by volunteers trying to make the world a better place.
I always like this bit.
A lot of work goes on nationally, by volunteers trying to make the world a better place.
I always like this bit.
January 15, 2026 at 8:23 PM
Some of my favourite folks winning honours and awards at the end of today's @assocanaes.bsky.social #WSM2026.
A lot of work goes on nationally, by volunteers trying to make the world a better place.
I always like this bit.
A lot of work goes on nationally, by volunteers trying to make the world a better place.
I always like this bit.
Dr Suzanne Farrell is quoting authors, poets, and Ghostbusters in her excellent talk about shared decision-making. I'm thoroughly enjoying it.
Also, I do love a slide with a forking path on it.
#WSM2026
Also, I do love a slide with a forking path on it.
#WSM2026
January 15, 2026 at 3:32 PM
Dr Suzanne Farrell is quoting authors, poets, and Ghostbusters in her excellent talk about shared decision-making. I'm thoroughly enjoying it.
Also, I do love a slide with a forking path on it.
#WSM2026
Also, I do love a slide with a forking path on it.
#WSM2026
Representing SOBA, Dr Eleanor Warwick talks about patients living with obesity, and how damaging stigma is for outcomes.
Where patients are made to feel shame, or judged, they will present late, and have more advanced disease at presentation.
This is not just true of obesity.
#WSM2026
Where patients are made to feel shame, or judged, they will present late, and have more advanced disease at presentation.
This is not just true of obesity.
#WSM2026
January 15, 2026 at 3:12 PM
Representing SOBA, Dr Eleanor Warwick talks about patients living with obesity, and how damaging stigma is for outcomes.
Where patients are made to feel shame, or judged, they will present late, and have more advanced disease at presentation.
This is not just true of obesity.
#WSM2026
Where patients are made to feel shame, or judged, they will present late, and have more advanced disease at presentation.
This is not just true of obesity.
#WSM2026
Previous @assocanaes.bsky.social Featherstone Professor @elboghdadly.bsky.social opens the afternoon session in the main hall, talking about the DAS guidance.
He talks about "peroxygenation" throughout rather than "preoxygenation". The oxygen you gave before induction won't last forever.
#WSM2026
He talks about "peroxygenation" throughout rather than "preoxygenation". The oxygen you gave before induction won't last forever.
#WSM2026
January 15, 2026 at 2:53 PM
Previous @assocanaes.bsky.social Featherstone Professor @elboghdadly.bsky.social opens the afternoon session in the main hall, talking about the DAS guidance.
He talks about "peroxygenation" throughout rather than "preoxygenation". The oxygen you gave before induction won't last forever.
#WSM2026
He talks about "peroxygenation" throughout rather than "preoxygenation". The oxygen you gave before induction won't last forever.
#WSM2026
Summing up, Dr @sallyelghazali.bsky.social says that Goldilocks was mostly right. Too low or too high can both be harmful in a lot of contexts.
Overall:
Oxygen is good.
Blood pressure is good.
Use the drugs you are familiar with.
#WSM2026
Overall:
Oxygen is good.
Blood pressure is good.
Use the drugs you are familiar with.
#WSM2026
January 15, 2026 at 1:21 PM
Summing up, Dr @sallyelghazali.bsky.social says that Goldilocks was mostly right. Too low or too high can both be harmful in a lot of contexts.
Overall:
Oxygen is good.
Blood pressure is good.
Use the drugs you are familiar with.
#WSM2026
Overall:
Oxygen is good.
Blood pressure is good.
Use the drugs you are familiar with.
#WSM2026