George Zhong

love . death . anaesthesia 🌏♻️🌳💉

[George Zhong @propofoldream]

Propofol Dreams is a free app that empowers clinicians and assists with all aspects of TIVA workflow.

It's now available as a web app!!
https://t.co/gibEIwAVPi

Here are the key functionalities and how it can make your TIVA more precise, efficient and reduce waste... 1/8

[George Zhong @propofoldream]

@NicholasChrimes @DrNatBroughton @DrHuw @Anaes_Journal @Cartouchelechat Anaesthesia choice should not be equated to the trolley problem

We need to focus on non zero-sum win-win solutions for BOTH best patient care AND environment

[George Zhong @propofoldream]

@doctimcook @maffygirl Answer depends on how much you value your time.

Anything you write, whether hardcopy or electronic, any medium, will all be used to train AI models and thus inform or educate.

The decision of personal gain vs time investment/opportunity cost is subjective

[George Zhong @propofoldream]

❤️❤️ Our cardiology friends asked, so we answered!!

PropoScroll now has the latest cardiology literature too!

Give it a scroll to keep updated with the latest studies today!

https://t.co/eQk48YQk4m

[George Zhong @propofoldream]

What PropoScroll does:
- abstracts from top anaesthesia journals summarized

- key take home messages in a scrollable format

- link to full abstracts on Pubmed

Features to come:
- filter by topic
- learns your interests and individualized
- comment system
- your request!!

[George Zhong @propofoldream]

Do you want to keep up with anaesthesia literature but find it "too hard"?
Do you find doomscrolling "too easy"?
What happens when the two meet?

Introducing my new pet project
** PropoScroll **

https://t.co/eQk48YQk4m

Why not give it a scroll while waiting for the surgeon...

[George Zhong @propofoldream]

@maffygirl @NicholasChrimes @noolslucas And ANZCA PG18 ... Open to interpretation ... Our amazing anaesthetic nurses usually put dots on back and side to facilitate skin to skin 🤜🏼🤛🏻

[George Zhong @propofoldream]

@NicholasChrimes Amount of CO2 presented to soda lime probably same if there's no scavenging/FGF/exit and it's a true closed circuit

Again, you might be right, but it's hard to know without performing some calculations/simulations. @grok

Just my gut feeling circuit matters ...

[George Zhong @propofoldream]

@NicholasChrimes Thought experiment of extreme cases:
Zero circuit volume, all expired CO2 instantly meets canister, no buffer, huge peak flux

Infinite circuit volume, all exhaled CO2 buffered by circuit, canister not needed

Real life, depends on factors I previously mentioned. It's complex

[George Zhong @propofoldream]

@NicholasChrimes Of course, the balance is complex

Multiple factors govern the balance: CO2 production, MV, I:E ratio, FGF, exact circuit volume, channeling of CO2 through canister/soda lime design etc

Net effect is economic/environmental of paed circuit gains vs canister replacement cost

[George Zhong @propofoldream]

@NicholasChrimes Adult w high MV (esp. laparoscopy) + smaller circuit volume = greater peak flux of CO2 through canister.

If canister cannot efficiently absorb peak flux = FiCO2 elevation

FiCO2 elevation interpreted as exhaustion = early replacement

Sorry I can't answer Q2 for you.

[George Zhong @propofoldream]

@DocMattHart @MichiIntrona Lemme know if you want to extend ethics to next door and I can help you recruit at the adult hospital 😜 we share the same ethics committee anyway

[George Zhong @propofoldream]

@MichiIntrona Until we have that evidence, it's like medicolegal prisoner's dilemma ...

2 x 2 payoff matrix
Pump bolus fast enough vs not
Vs
Bolus by pump vs manual

Given, RSI is primarily intended to address increased aspiration risk, the equilibrium solution based on current evidence is ..

[George Zhong @propofoldream]

@MichiIntrona So we desperately need a clinical study designed to find:
(1) Time to LOC
(2) Time to onset of NMB
(3) Range/variance of (1) and (2)

For pump vs manual bolus
For a clinically useful range of pts

[George Zhong @propofoldream]

@NicholasChrimes @easypocus @TheSnoozeDoctor Agree w you.

Currently, there are already full self driving cars (with a failure rate), yet most people still choose to learn how to drive.

Follow up question, if we plot failure rate on the X-axis and %learn to drive on the Y-axis, what will that curve look like?

[George Zhong @propofoldream]

@easypocus @NicholasChrimes @TheSnoozeDoctor I think the horses example is a bit extreme

Rather along the same line, if we readily have access to automatic cars, should we still learn to drive manual?

And in the same line of argument, in the future when we have self driving cars, should we still learn to even drive?

[George Zhong @propofoldream]

@NicholasChrimes Agree, that's the scientific method.

You can have the best model, the best simulation methodology, but it just takes one real life counterexample to disprove it

Pragmatism

[George Zhong @propofoldream]

@TheSnoozeDoctor @maffygirl Truth is environmental science is so insanely complex and there's so much we don't know ...

Comparing carbon footprint and ecological impact is like apples vs oranges

The only certainty is REDUCING waste. If we use less and achieve same pt outcome, then it MUST be greener.

[George Zhong @propofoldream]

@maffygirl https://t.co/ZUoaiNqXho

TIVA vs sevo
Real cases, real workflow, real data

At end of day, both sevo/TIVA are good anaesthesia techniques.

Much can still be achieved by reducing wastage for each (e.g. low flow sevo, prudent drawing up of propofol, etc) #ThereIsNoPlanetB

[George Zhong @propofoldream]

@maffygirl The problem with these modelling studies is always the "model"/"assumptions", which often deviate very far from real world.

E.g. the mandatory use of remifentanil, "quad" fusor, pEEG only for TIVA, no use of TCI, etc etc

A better (real world) study is by Bernat BJA 2025.