GA and block.
But if GA too high risk from Resp Compromise then spinal with small needle to minimise risk.
Consent including spinal heamatoma & consequences.
I also add in the Regional alert bracelet to pick up delayed resolution of block.

But surely the phenomena wouldn’t be limited to those who are paralysed 🤷🏼‍♀️

But how would that work for any anaesthetic lasting longer than a couple of hours? That poor arm…..

Given that responsiveness without recall cannot be measured at the time nor identified retrospectively with any certainty & we cannot define specific risk factors then we cannot act logically & safely to prevent it. It is essentially unavoidable with today’s knowledge & therefore must be acceptable.

But is responsiveness without recall avoidable? If it’s undetected & undetectable during an anaesthetic what could or should we do to avoid this possibility & at what cost? The risk is greater known harm. Deeper anaesthetic, more cvs instability, renal impact, more brain suppression, more pocd 🤷🏼‍♀️

I think Starmer has the yips - now he’s there he’s too scared to do anything meaningful. I’m hoping someone shakes him out of it….

I have done this - it’s awful. The sad heartbreaking jobs will be over soon. Keep going

Maybe & I’ll keep an eye on what’s happening locally….

I live in a Labour constituency, used to be strongly so. Not so much now. Recently the nastiness of reform has taken hold. I worry that a free vote in my area will open the door to Reform. However, a shift to PR would change that & I would vote green as they most accurately represent my views.

But what if the disabled person had a different skin colour & looked like a migrant?!?! 😱😱😱

🙄🤦🏼‍♀️

The sad state of the world - everyone angry at the wrong things

I usually say to patients that anaesthesia is like pressing pause on the recording part of their brain… their brain will still be working in the background but they won’t remember it. When they wake up the will start recording again from where they left off.

I don’t think there’s any way to reliably assess responsiveness without recall by patient or anaesthetist. Is it real? If so, is it harmful? If there is harm why are awake craniotomy’s or even “sedation” on ITU acceptable.

It’s not the same as implicit memory drugs change the brain chemistry.