FrankGitonga

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[AFRICAN & BLACK HISTORY @AfricanArchives]

“The first world was made out of the blood and sweat of the third world.”

—Winnie Mandela

[Kathryn Puxty @KPuxty]

Exceptionally impressed by @CritCareReviews #CCR26 meeting. Several practice changing presentations with de-escalation of frequently adopted practices a common theme. Yet again, less is more.

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

Join us for a webinar: Breaking the habit: Individualised IV fluid prescribing & stewardship
Delivered by @Turningthe_Tide in collaboration with @Fluid_Academy, & sponsored by @baxter_intl

📅 Monday 6 July
🕔 17:00 CET/16:00 UK/Portugal
Register here:
https://t.co/WucxpN8cBT

[Larry Madowo @LarryMadowo]

All he had was a bottle of water

📸 @festolang

[小谷祐樹 Yuki Kotani｜集中治療医 @YukiKotani5]

「ECPRについて、最初に読みたい論文は？」
と聞かれたら、このLancet Resp Medの総説がオススメです。

日本では割とハードルが低いECPR。ただ「どの患者さんにとってメリットか」については不明です。ECPRの現在地を知り、プラクティスを見つめ直す助けになる1本です。
https://t.co/ZBubVtfvZK

[Karun Pal @karunpal]

Give your mind a break. From people. From phones. From the constant hustle of life. Spend some alone time just with yourself. Do nothing. Be bored. Stare at a crack in the wall. Look out the window. Watch how shadows move. Listen to a piece of music that's 300 years old. Read Hegel. Read Aristotle. Read Dostoevsky. The minds that are still relevant today. Slow down enough to experience things deeply again. Don't consume something just because it's trending. Be loyal to your own curiosities. Your own interests. Your own idiosyncrasies. If you want to live a life that feels alive, protect the parts of yourself this world keeps trying to distract you from.

[Anesthesiology Journals @_Anesthesiology]

Remimazolam tosylate has shown effective and safe sedation in mechanically ventilated patients in ICUs in a phase 2 trial. Guan et al. conducted a multicenter, randomized, single-blind, actively controlled, phase 3 trial for further evaluation.

📗 https://t.co/XWphx0YqAA

[Edinburgh Anaesthesia Festival @EAFestival]

We are thrilled to introduce Dr Jonathan Örn Schulz as one of our 20 expert speakers at this year's Edinburgh Anaesthesia Festival!
Dr Schulz will be tackling a vital question for modern healthcare: "Hyperbaric Oxygen Therapy - should we be doing more in the UK?"
Whether you want to network in person or learn from the comfort of your home, we have you covered.
🎟️ Join us in person or virtually! Talks can be accessed for 12 months (where speaker permission has been granted)
🔗 Register here: https://t.co/RCsvZcQkVU
#EAF2026 #Anaesthesia #HyperbaricMedicine #MedicalConference #ContinuingEducation

[Edinburgh Anaesthesia Festival @EAFestival]

We want to give FREE access to this year’s Edinburgh Anaesthesia Festival to anaesthetists and trainees in the lowest-income countries.
Every single repost helps us reach the right hospitals and doctors worldwide.
Please REPOST this to spread the word and support global health equity! 💙#EAF2026 #Anaesthesia #MedEd #GlobalHealth #FOAMed

[Edinburgh Anaesthesia Festival @EAFestival]

🚨 REGISTRATION IS OPEN! The Edinburgh Anaesthesia Festival returns 19–21 August at @RCPEdin — Scotland’s biggest annual meeting for anaesthesia, critical care & pain medicine. 🔗 https://t.co/OUDlhDERJ9
Not in Edinburgh? Join virtually or watch all sessions on‑demand for 12 months.
What’s on at #EAF2026:
• 30 talks from 20 outstanding speakers
• Regional Anaesthesia hands‑on workshop AND Leadership workshop (book fast!)
• 1‑year access to all talks + slides
• Abstract Competition - closing date 30 May
• Scottish Shindig - Drinks Reception following first day of talks - free for delegates
• Family Room + £50/day rate for parents on leave
• Free virtual access for lowest‑income countries
• 50% off Q‑Park Omni
• 18 CPD points applied for

#anaesthesia; #regionalworkshops
@IainMoppett @mathewlyons @isiokolo @drchristurnbull @hartos84 @oldandbaffled @ewenharrison @Wilkinsonjonny @PedsAnesNet @AirwayMxAcademy;
@ewenharrison @DimDamask @Assoc_Anaes @Anaes_Residents @PedsAnesNet @AirwayMxAcademy @EdCriticalCare @DaveOlvera1 @AnaesthesiaScot @IJA_web @Assoc_Anaes @Anaes_Residents @PedsAnesNet @TURYATUNGANICH6 @EdCriticalCare @NaveenEipe @Griffith_DM @AnaesthesiaScot

[AFRICAN & BLACK HISTORY @AfricanArchives]

In 1803, A group of enslaved Africans took over a slave ship and grounded it on an island. But when they realized slavery was still waiting for them, many walked into the ocean together and drowned instead of going back in chains.

The Igbo Landing is a historic site at Dunbar Creek on St. Simons Island, Glynn County, Georgia. It is the site of one of the largest mass suicides of enslaved people in history. Historians say Igbo captives from modern-day Nigeria, purchased for an average of $100 each by slave merchants John Couper and Thomas Spalding, arrived in Savannah, Georgia, on the slave ship the Wanderer in 1803.
In May 1803, the Igbo and other West African captives arrived in Savannah, Georgia, on the slave ship the Wanderer. They were purchased for an average of $100 each by slave merchants John Couper and Thomas Spalding to be resold to plantations on nearby St. Simons Island. The chained slaves were packed under deck of a coastal vessel, the York, which would take them to St. Simons. During the voyage, some enslaved men rebelled, took control of the ship, drowned their captors, and grounded the ship.
The sequence of events that occurred next remains unclear. It is known only that they marched ashore, singing, led by their high chief. Then at his direction, they walked into the marshy waters of Dunbar Creek, committing suicide. Roswell King, a white overseer on the nearby Pierce Butler plantation, wrote the first account of the incident. He and another man identified only as Captain Patterson recovered many of the drowned bodies. Apparently only a subset of the 75 Igbo rebels drowned. 13 bodies were recovered, but others remained missing, and some may have survived the suicide episode, making the actual numbers of deaths uncertain.
Regardless of the numbers, the deaths signaled a powerful story of resistance as these captives overwhelmed their captors in a strange land, and many took their own lives rather than remain enslaved in the New World. The Igbo Landing gradually took on enormous symbolic importance in local black folklore. The mutiny and subsequent suicide by the Igbo people was called by many locals the first freedom march in the history of the United States.

[Jason Marshall @__JasonMarshall]

Nairobi - y’all don’t know how to drive. Seriously

[Rashid Abdi @RAbdiAnalyst]

I have stopped going to South Africa for any international conferences for mainly 3 things.

1. Border police rudeness: Some years ago I was invited for a conference on conflicts in the Horn in South Africa. I showed email invite to the border policeman at the desk. He rudely asked: "but why can't you people hold your peace conferences in your homes. Why always come to South Africa?" - I think he had a point. Why must we?

Second time it was worse - "But why are you Zomallis and Ethiopians always here."

I reminded him I was actually Kenyan, and I was only in the country for 2 days for an international conference

Reply: "Sheh, um, eh. But what is the difference"

2. As soon as locals figure out you are a black person, possibly African from another country, the automatic assumption is that you are an illegal migrant. You see immediate hostile reaction. Honestly, I found SA one of the most miserable places on earth in terms of peoples' attitude to foreigners. The visceral hatred towards fellow Africans is unnerving. Still one of the most beautiful geographies in Africa.

3. The state bureaucracy and departments filled with people who actually know very little about the outside world. Most of the best people who made South Africa an outward-looking African power are gone. All remaining are small-time apparatchiks stealing from the state and fat toads serving as diplomats. I feel sorry for South Africa.

[小谷祐樹 Yuki Kotani｜集中治療医 @YukiKotani5]

敗血症性ショックの患者さんでノルアドレナリンとバソプレシンを併用しているときの減量方法、についての私見

①原則：パラレルに減らす→ノルアド 0.1 γ 残してバソプレシン終了→ノルアド終了
（理由）一旦併用を始めたら、違う作用機序の薬剤をできるだけ併用し続けたい派です。相乗効果で血管収縮薬の合計量を減らせると思ってます。バソプレシンを先に終了するのは、ただ単に最後はノルアドレナリン単剤にする方が分かりやすいかなと思ってるからです。

②特にバソプレシンを残したいとき：右心不全・肺高血圧症があるとき、頻脈・不整脈で困ってるとき
（理由）バソプレシンは肺血管抵抗をあげないと言われています。また純粋な血管収縮薬で心臓への直接作用がないので、不整脈で困ってる（AFで血圧低下→頻回にDC要するなど）ときは、バソプレシン残しでいきたいです。

③特にノルアドレナリンを残したいとき：徐脈で困ってるとき、腸管や四肢の虚血がある／懸念があるとき
（理由）②の逆です。ノルアドは弱いながらβ刺激作用があるので、相対的徐脈のようなケース（徐脈で拡張期血圧低下→MAP低くなる）ではHRを上げてくれて助かります（むしろバソプレシンはHRを下げる傾向にあります）。バソプレシンの有害事象には腸管虚血や四肢末端壊死があるので、そうした所見が既にあったり、透析患者さんのように動脈硬化が著しくて虚血の懸念が強い症例では、ノルアドレナリンを残しながらバソプレシンを優先的に減量します。

ぼくはこんな感じで考えてますが、みなさんはどうしてますか？

[Sara Moscatelli @saramoscatelli7]

🫀📊 **Diastolic dysfunction: are we finally making it simpler?**

Assessing left ventricular diastolic function remains one of the most challenging areas in echocardiography. Multiple variables, load dependence, age-related changes, and often discordant findings make interpretation difficult even for experienced imagers.

A new review proposes a **simplified, tier-based approach** aligned with the 2025 ASE recommendations, aiming to improve the clinical applicability of diastolic function assessment.

🔑 **Key concepts**

✅ Diastolic dysfunction should not be viewed as a single measurement but as a combination of:

• Impaired LV relaxation
• Increased myocardial stiffness
• Elevated filling pressures.

📈 The 2025 approach starts with what may be the most clinically useful marker:

👉 **e′ velocity**, reflecting myocardial relaxation.

Additional markers such as:
• E/e′ ratio
• Left atrial size and function
• Left ventricular hypertrophy
• Left atrial reservoir strain (LARS)

are then integrated in a stepwise fashion.

💡 One of the major advances is the introduction of a **tiered framework** for estimating filling pressures, reducing the number of "indeterminate" studies that frequently complicated the 2016 algorithm.

🏃 In patients with unexplained exertional dyspnoea, the paper reinforces the value of **diastolic stress echocardiography**, recognising that elevated filling pressures often become apparent only during exercise.

🤖 Perhaps the most exciting perspective is the role of artificial intelligence.

The authors propose that diastolic dysfunction may be better understood as a **latent phenotype**, integrating dozens of clinical and imaging variables rather than relying on a few Doppler measurements alone.

Machine-learning models have already demonstrated:
✅ Improved estimation of filling pressures
✅ Better prognostic stratification
✅ Identification of high-risk phenogroups that traditional algorithms may miss.

🎯 **Take-home message**

Diastolic dysfunction is not a binary diagnosis.

[Anesthesiology Journals @_Anesthesiology]

Infographic in #Anesthesiology - Dream Weaving: How Anesthesiologists Can Encourage Dreaming under Anesthesia 🎨 https://t.co/C6HEyYZjZB

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Can digital phenotyping from three-dimensional face scans help us to identify patients who may be difficult to ventilate via facemask?

#anaesethesia #MedTwitter

https://t.co/xoWOACzOKB

[小谷祐樹 Yuki Kotani｜集中治療医 @YukiKotani5]

My thoughts on how to wean vasopressors in patients with septic shock receiving both norepinephrine and vasopressin:

1. General principle: Taper both agents in parallel → discontinue vasopressin when norepinephrine reaches ~0.1 μg/kg/min → then discontinue norepinephrine.

Why? Once I decide to use combination therapy, I prefer to maintain agents with different mechanisms of action for as long as possible. I believe the synergistic effect helps reduce the total vasopressor requirement. The reason I stop vasopressin first is simply that finishing with norepinephrine monotherapy feels more straightforward.

2. Situations where I prefer to keep vasopressin on board: Right ventricular failure, pulmonary hypertension, or problematic tachyarrhythmias.

Why? Vasopressin is generally thought not to increase pulmonary vascular resistance. It is also a pure vasoconstrictor without direct cardiac effects. So when arrhythmias are causing trouble (e.g., AF with hypotension requiring repeated cardioversion), I tend to favor continuing vasopressin.

3. Situations where I prefer to keep norepinephrine on board: Symptomatic bradycardia, or existing/suspected intestinal or peripheral limb ischemia.

Why? Essentially the opposite of #2. Norepinephrine has mild β-adrenergic activity, which can be helpful in cases of relative bradycardia (e.g., bradycardia causing a drop in diastolic blood pressure and thus MAP), since it may increase the heart rate. In contrast, vasopressin tends to lower heart rate. Vasopressin has also been associated with adverse effects such as mesenteric ischemia and peripheral digital necrosis. Therefore, if ischemic findings are already present—or if the patient is at particularly high risk, such as those with severe atherosclerosis on dialysis—I preferentially reduce vasopressin while maintaining norepinephrine.

This is generally how I approach this clinical scenario. How do you handle vasopressor weaning in these situations?

[Shockdoc @FLShockDoc]

@AirwayMxAcademy What bothers me as a 24 year attending is the kids can’t do direct laryngoscopy anymore. They play a video game instead of having a look.

[Edinburgh Anaesthesia Festival @EAFestival]

"What's that? TIVA doesn't need propofol?! ", How can I give TIVA with no propofol?"
Excited for this year’s Edinburgh Anaesthesia Festival. Whether you’re joining virtually or in person, don’t miss Dr Alice Humphrey’s talk: “A Tale of Two Agents: Ketamine and Dexmedetomidine in TIVA.” Scotland’s biggest anaesthesia event is almost here — come be part of it. https://t.co/RCsvZcQkVU
#anaesthesia