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Hans Huitink

@airwaymxacademy.bsky.social

760 followers 1.1K following 140 posts

Anesthesiologist🇳🇱Founder Airway Management Academy non-profit airway teaching #AAF25 | Mobile Critical Care Support😷🚑🩺 | AirAmbulance🛩 @AirwayTriageApp

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Hans Huitink @airwaymxacademy.bsky.social · Jun 5

Airway Triage - goodbye difficult airway #airwaytriage

journals.lww.com/ijaweb/fullt...

Airway Triage: Goodbye, difficult airway! : Indian Journal of Anaesthesia

An abstract is unavailable.

journals.lww.com

Hans Huitink @airwaymxacademy.bsky.social · 2d

CU dere 🍷

Hans Huitink @airwaymxacademy.bsky.social · 4d

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Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · 5d

4/9 The child's head was quite heavy and asymmetrical due to the tumour, and awkward to hold in a good position to maintain the airway. Eventually we got the child deep enough to attempt bronchoscopy.

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Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · 5d

3/9 We decided to breathe the child down with halothane and try an asleep oral fibreoptic intubation. The child was cooperative and we soon got him under, but keeping his airway patent was a challenge, which meant getting him deep was also a struggle.

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Hans Huitink @airwaymxacademy.bsky.social · 4d

Yes, meet you there 🍻

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Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · 5d

2/9 Anil and I were both on one day, and we were presented with a 3yo with a massive craniopharyngioma. I don't recall what the procedure was but the child needed to be intubated, and we thought it would be good to do it together.
(I hope he remembers this the way I do.)

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Hans Huitink @airwaymxacademy.bsky.social · 4d

And the models only work for healthy ASA 1 patients so there is no problem at all…

Reposted by Hans Huitink

Cheery Littlebottom @cherrylittlebottom.bsky.social · 6d

I do a normal RSI then once intubated start my pump low at around Cet 2 and titrate up over the case to BIS.

The effect of the initial bolus on the model being inaccurate becomes decreasingly relevant as the case goes on

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Hans Huitink @airwaymxacademy.bsky.social · 4d

Airway Triage application is a non-profit global patient safety project of the Airway Management Academy.

Triage airways to risk stratify the procedure and prevent complications

#airwaytriageapp

Hans Huitink @airwaymxacademy.bsky.social · Jun 5

Airway Triage - goodbye difficult airway #airwaytriage

journals.lww.com/ijaweb/fullt...

Airway Triage: Goodbye, difficult airway! : Indian Journal of Anaesthesia

An abstract is unavailable.

journals.lww.com

Reposted by Hans Huitink

Anaesthesia @anaesjournal.bsky.social · 7d

"... a ‘RSI–TCI’ mode with a pre-programmed manual bolus offers a pragmatic solution for those who wish to preserve an intact pharmacokinetic model for accurate propofol delivery, while allowing the rapid induction clinicians expect from a manual bolus."

#AnSky #MedSky

doi.org/10.1111/anae...

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Hans Huitink @airwaymxacademy.bsky.social · 9d

There have been reports of micro damage to vocal cords and larynx even after a short period of tracheal intubation. This damage will be more frequent if cords are not paralysed during intubation. I would not recommend intubation of adult patients without muscle paralysis.

Reposted by Hans Huitink

Priya Patel @priyapatei.bsky.social · 9d

Really thoughtful exchange, do you think more research is needed on the long term effects of these techniques?

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Reposted by Hans Huitink

Anaesthesia @anaesjournal.bsky.social · 12d

Oooh, this is interesting!

"Surgical start timing was an independent risk factor for increased short- and long-term postoperative mortality, morbidity and healthcare resource utilisation."

#AnSky

doi.org/10.1111/anae...

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Reposted by Hans Huitink

Anesthesiology Journals @anesthesiology.bsky.social · 21d

An editorial by Matava et al. analyzes the impact of the recent Japan Pediatric Difficult Airway in Anesthesia study and discusses opportunities for future inquiry. Read the article: ow.ly/zwAE50WUaYl

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Reposted by Hans Huitink

Robbie Erskine @drrobbieerskine.bsky.social · 24d

Totally depends on individual patient need.
“Anticoagulated therefore don’t even think about spinal” is to automatically exclude a sometimes better option.
If GA plus block has benefits over spinal plus block then choose GA
OtherwiseSpinal plus block even if anticiagulated(benefit/risk assessment)

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Reposted by Hans Huitink

Anaesthesia @anaesjournal.bsky.social · 26d

Airway POCUS

POCUS was associated with higher odds of first-pass success rates during percutaneous tracheostomy when compared with landmark techniques.

#AnSky #AirwaySky #MedSky

doi.org/10.1111/anae...

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Hans Huitink @airwaymxacademy.bsky.social · 26d

Some things we do look wonderful and simple and easy but only the insider knows that it takes a lot of experience and preparation and skills to execute a complex procedure without complications.

Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · 28d

The differences between the 'what' and the 'how' are the subtle, subliminal changes in assessment, preparation and execution an expert accumulates through reflection upon years of successes and failures.
And not running away from failures btw, but working through them.

A kind of personal kaizen.

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Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · 28d

Stepping back for a moment, one can see that there is always a 'metatechnical' dimension to these discussions. Someone brings up a particular technique or device or drug, and we argue over the technical merits/demerits, but the real meat of the discussion is never in
what we do but *how we do it*

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Hans Huitink @airwaymxacademy.bsky.social · 28d

Fully agree

Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · Sep 8

I know Alf is inferior. The point of my story was that relaxant free intubation is a different technique that comes with different baggage. It's not interchangeable with a relaxant based technique.

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Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · Sep 8

7/7 So my question for this forum would be - those of you who use high-dose remi for relaxant-free intubation, what other parameters/caveats do you need to keep in mind to guide those of use who do not do this routinely?
🙏

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Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · Sep 8

6/7 I was always taught that the window for good intubating conditions with Alf was quite narrow - 90 sec at best - if you didn't get in first go you either had to redose with alf or give a relaxant.

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Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · Sep 8

5/7 Long story short sats dropped to 50 but they got the tube down and pts fine. The point is when you use a different technique other things that you take for granted also change without you knowing.

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Reposted by Hans Huitink

Nose Coloured Glasses @ncglasses.bsky.social · Sep 8

1/7 Interestingly I've was having a debrief recently with a colleague who was supervising an advance trainee. they were introducing them to relaxant-free intubation with alfentanil for a dental case. 🧵👇

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