Anaesthetist, perioperative physician, prehabilitation enthusiast. Honorary secretary iPOETTS, POM Lead for Devon ICB/NHSE.

South West, England
Joined February 2012
A single 5-mg preoperative dose of olanzapine improved quality-of-recovery scores in women undergoing ambulatory surgery under general anesthesia, a randomized trial of 384 women found. Day-1 median QoR-40: 183 vs 174 with placebo. f.mtr.cool/0jiqjql69z #PONV #Anesthesiology
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💨 Does high-flow nasal oxygen increase the risk of gastric insufflation? Across 4 randomized trials involving 375 patients, high-flow nasal oxygen (HFNO) was associated with less gastric insufflation than face-mask ventilation during elective peri-intubation (RR, 0.32; 95% CI, 0.19–0.52). The analysis also found no significant difference in gastric antral cross-sectional area. 🔎 Moderate-certainty evidence supports the gastric safety of HFNO in most elective and procedural settings. However, evidence remains limited at higher flow rates and in critically ill patients—areas where further research is needed. buff.ly/5yHMknp
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Walking more is good. But if you already walk regularly and want better fitness, glucose control or stronger legs, simply adding more minutes may not be the most effective next step. Human trials suggest that changing the intensity inside the walk can produce adaptations that steady walking of similar duration does not. You may have seen this recently called "Japanese interval walking." The name comes from a research program developed and extensively tested by scientists in Japan. In the studies it is usually called interval walking training: repeated periods of fast walking separated by slower recovery walking. The basic protocol is simple: 3 minutes of brisk walking followed by 3 minutes of easier walking, repeated for several rounds. The fast portion should feel distinctly demanding, roughly the point where speaking in full sentences becomes difficult, while the recovery pace should let comfortable conversation return. WHAT THE FAST MINUTES CHANGE When interval walking has been compared with continuous walking of similar duration or energy expenditure, the difference is surprisingly consistent: - Aerobic fitness: in people with type 2 diabetes, four months of interval walking increased peak oxygen uptake by 16.1%. Continuous walking produced no significant improvement. - Body composition: body mass, fat mass and visceral fat decreased with interval walking, while the matched continuous program produced no significant changes. - Glucose handling: two weeks of interval walking improved glucose effectiveness, meaning the body disposed of glucose more effectively without a measurable increase in insulin sensitivity. Continuous walking did not. - Same-day glucose: a single interval session increased glucose clearance during a meal test and lowered average glucose for the rest of that day compared with continuous walking. - Leg strength: in middle-aged and older adults, interval walking increased knee-extension strength by 13% and knee-flexion strength by 17%. Continuous walking did not significantly improve either. - Weekly dose: in a larger older-adult cohort, fast walking time was the main predictor of improved aerobic capacity, with gains increasing up to roughly 50 minutes of fast walking per week. The glucose experiments were small and conducted in people with type 2 diabetes, so they should not be turned into universal effect sizes for healthy people. The acute glucose benefit also faded by the following day. But across different populations and outcomes, the recurring signal is that the faster portions appear to provide much of the training stimulus. WHY INTERVALS CAN DO MORE Walking faster raises the muscular and energetic demand of each step. Higher contraction demands recruit muscle fibers that easy walking may rarely challenge, while muscle contraction also moves GLUT4 glucose transporters toward the cell surface through pathways that do not depend on insulin. The slow intervals then reduce the workload without stopping movement completely. They give the muscles a recovery period before the next harder bout. That combination lets walking become a training stimulus without turning the entire session into continuous hard cardio. It also does not require turning every walk into a structured workout. In everyday life, the same principle can be applied by deliberately picking up the pace for a stretch, walking a hill quickly or using stairs to create a brief period of much higher effort. WHERE STEADY WALKING STILL FITS None of this makes ordinary walking useless. Higher daily step counts remain strongly associated with lower mortality and better cardiovascular health. And interval walking is not superior for every outcome or every population. In people with diabetes who already had significant lower-extremity weakness, interval walking did not outperform continuous walking for static knee-extension strength, although walking ability and physical quality of life improved more. So the useful distinction is simple. For general movement and baseline health, keep walking. If you want the walk itself to build more aerobic capacity, challenge the legs or improve glucose disposal, adding periods that are genuinely brisk appears to provide a stronger stimulus than simply accumulating the same amount of comfortable walking. The goal is repeatable hard walking, not exhaustion. People with existing health conditions should talk with their doctor before substantially increasing walking intensity. General information, not medical advice. Practical details are in Part 2, with a quick checklist in Part 3.
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Turmeric / Curcumin can help with arthritis related pain. A randomized controlled trial compared turmeric extract 1500mg/day with ibuprofen 1200mg/day for 4 weeks. Both groups had similar levels of pain and functional improvement. However, turmeric / curcumin had much better side effect profile. pubmed.ncbi.nlm.nih.gov/2467…
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Beyond survival: understanding postoperative disability in peri-operative care "...disability has emerged as an important outcome that may better reflect the lived experience of patients after surgery compared with conventional endpoints alone." #anaesthesia #MedX #MedTwitter #surgery doi.org/10.1111/anae.70420
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In a US cohort of 128,121 bariatric surgery patients, prescriptions for GLP-1 receptor agonists in the year before surgery increased from 3.6% in 2017 to 22% in 2025. ovid.com/10.1097/SLA.0000000…
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#Review by Bornemann-Cimenti et al reporting the anaesthetic core items consistently present in #ERAS guidelines: temperature, PONV, fluid therapy, neuromuscular block management, airway management and analgesia. bjanaesthesia.org/article/S0…
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In a large, multicenter, randomized phase 4 trial published in The Lancet Respiratory Medicine, sugammadex reduced the risk of postoperative pulmonary complications compared to neostigmine. Read a summary in the October 2026 SM&A: ow.ly/3Fe250ZVauW
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Time to ask a different question: setting new goals for oncoanaesthesia What should the new goals be? • facilitating postoperative return to intended oncologic treatment • optimising surgical conditions • prehabilitation #anaesthesia #MedTwitter #MedX #oncology doi.org/10.1111/anae.70424
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For readers interested in GLP-1 receptor-based therapies for diabetes, obesity and beyond, here's a comprehensive review nature.com/articles/s41573-0… rdcu.be/WP9YfmRxmena
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As federal dietary guidelines shift and influencers hawk endless supplements, Stanford Medicine nutrition experts help separate protein hype from medical science. stan.md/4sBpQvt
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Helen retweeted
Large Language Model Chatbots Cannot Reliably Calculate Clinical Risk Scores: A Comparative Accuracy Study mdpi.com/1664-204X/29/3/31
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The organellar biology of aging: A mitochondrial vantage link.springer.com/article/10…
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In a large, multicenter randomized trial in the New England Journal of Medicine, routine tranexemic acid use for high-risk noncardiac surgery led to fewer transfusions without increasing venous thromboembolism risk. Read a full summary in the SEP26 SM&A: ow.ly/26Qw50ZHVQB
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The Health Benefits of Exercise: Molecular and Cellular Mechanisms onlinelibrary.wiley.com/doi/…
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New perioperative management strategy for #SGLT2 inhibitors proposed by the #SPAQI. In this #BJA Editorial, Garcia and coworkers present this balanced and risk-stratified approach between metabolic events and cardiac benefits. bjanaesthesia.org.uk/article…
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Beyond the gut—dietary fiber mediated interorgan crosstalk and systemic health: Mechanistic insights and human evidence doi.org/10.1016/j.nut.2026.1…
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Exercise-induced mitochondrial remodeling in energy-demanding organs during aging cell.com/iscience/fulltext/S…
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🚨 Cambio de paradigma en sarcopenia 🧠💪 ¿Y si no fuera solo una enfermedad muscular? 👉Proponen entenderla como una enfermedad del sistema motor envejecido: cerebro, médula, nervios y músculo 🎯No basta preservar masa: fuerza y función importan más doi.org/10.1016/j.lanhl.2026…
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