George Zhong @propofoldreams.bsky.social · 10/06/2026Do you TIVA via manual infusion rate? TCI pump not available or battery died mid case? Can't be bothered using a clumsy yet expensive TCI app? Try pdtci.netlify.app Propofol, remi, dexmed, remimazolam TCI via simple infusion table Sync to real time Free forever #TIVASky #MedSky #AnaeSky 200
George Zhong @propofoldreams.bsky.social · 17/03/2026What 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 individualises - comment system - your request!! 000
George Zhong @propofoldreams.bsky.social · 17/03/2026Do 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 ** proposcroll.propofoldreams.org Why not give it a scroll while waiting for the surgeon today...proposcroll.propofoldreams.orgAnaesthesia Feed 110
George Zhong @propofoldreams.bsky.social · 05/12/2025I think for Infusulator to be an useful research tool, the infusion profile output should mimic what a real world pump would do Currently, the output mimics what SimTIVA would do (approximation) What do you think Terence? 110
George Zhong @propofoldreams.bsky.social · 30/11/2025As aspiration/CVS risks are continuous, I think the real world answer is more grey ... For a large indn bolus and high aspn risk - manual out weight pump +++ For a small indn bolus and relatively lower aspn risk - difference between pump vs manual bolus is much less significant 000
George Zhong @propofoldreams.bsky.social · 30/11/2025US colleagues? Many of my Chinese colleagues. A few German colleagues I know. I think there's wide variation in practice around the world #TIVASky 020
George Zhong @propofoldreams.bsky.social · 30/11/2025@glbryson.bsky.social indeed. TCI is a subset of TIVA, which is indeed the specific scenario that is being discussed. I don't think there is the need to use "pump assisted induction" if maintenance phase is not TIVA (or TCI) Ultimately, it's just semantics ... 100
George Zhong @propofoldreams.bsky.social · 29/11/2025I feel the term "pump assisted TIVA RSI" actually describes all components of a VERY specific scenario Pump assisted = induction method TIVA = iv induction AND maintenance When induction is via hand bolus, or maintenance not TIVA, we don't really have the same challenges 100
George Zhong @propofoldreams.bsky.social · 20/08/2025Do not agree with routine large bore iv insertion, esp awake without local Hope registrar learnt smth to better care for his future pts Power imbalance and would like to hear his side of story (how he truly felt inside, in confidence, to decide if it's truly "consent" and "good friends") 130
George Zhong @propofoldreams.bsky.social · 04/05/2025It's the same as asking a 3-Michelin star Japanese chef and a 3-Michelin star French chef: what's better, sushi or beef bourguignon? I'm sure the Japanese chef would never go to a 3 star French restaurant and force them to make sushi ... 😅😅 #TIVASky #AnSky #ASM25CNS 022
Reposted by George ZhongIain Moppett OBE @iainmoppett.bsky.social · 02/05/2025It’s the start of the Antipodean weekend and that means #AnSkyMedSkyDebate time. Here’s the question: TIVA: bees knees or emperor’s new clothes? What do you think? What would you choose for you? Why? @anzca.bsky.social @rcoanews.bsky.social @assocanaes.bsky.social @maffygirl.medsky.social 15117
George Zhong @propofoldreams.bsky.social · 04/05/2025Both are very valid anaesthetic techniques, it's more about the operator than the tool. For my pt, I prefer to use TIVA. 😁 For myself and my family, I prefer the anaesthetist use what they are best at using and then focus on other more important anaesthesia decisions. 121
George Zhong @propofoldreams.bsky.social · 03/05/2025TIVA w NMBA = always pEEG TIVA w/o NMBA - case by case depending on risk/benefit: If at risk of either awareness or excessive anaesthesia depth = use pEEG If risk is low and outweigh cost then no pEEG 021
George Zhong @propofoldreams.bsky.social · 19/04/2025I suspect when plotting probability of inciting debate vs provocativeness of a comment, it's a (upside down) parabolic relationship The only difference is in the coefficients 😅😅 000
George Zhong @propofoldreams.bsky.social · 11/04/2025Spot on! The crux of the problem of performing RSI with a TCI pump is whether the maximum pump rate suffices for the given induction dose For an old frail smaller patient, probably suffices For an young healthy larger patient, grossly inadequate It's about the pt not one size fit all technique. 010
Reposted by George ZhongTerence Luk @simtiva.app · 04/04/2025Feature preview: RSI mode coming soon to simtiva.app! How do you do RSI with TIVA? The algorithm suggests a bolus dose based on user-defined CE target at a specified time point (e.g. 60s). It also predicts a CE overshoot & when to resume infusion. Also testing live preview feature... #ansky 021
Reposted by George ZhongTerence Luk @simtiva.app · 04/04/2025Feature preview: testing dexmedetomidine TCI on simtiva.app - coming soon #ansky 011
George Zhong @propofoldreams.bsky.social · 02/02/2025Thank you for all your interest in our work. Due to popular demand, here's the link to our article behind paywall, free for 50 days authors.elsevier.com/a/1kWpX1dCDy... Thank you @bjajournals.bsky.social #TIVASky #AnSky #TCIauthors.elsevier.com 000
George Zhong @propofoldreams.bsky.social · 02/02/2025Of course, depth of anaesthesia is a 3-way balance between (1) PK (how much propofol) (2) PD (pt sensitivity) (3) how much stimulus It seems from our study that when stimulus is standardised (i.e. minimised), it may be possible to reliably predict wake up time 🤔🤔 010
George Zhong @propofoldreams.bsky.social · 01/02/2025To try our wake up prediction algorithm today, just search for Propofol Dreams in the app store on your phone. Free for the world forever! propofoldreams.org Reference doi: 10.1016/j.bja.2025.01.007 273
George Zhong @propofoldreams.bsky.social · 01/02/2025As a pilot study, we validated our novel prediction algorithm in 2 small cohorts of patients: painful and non-painful surgeries (defined as whether additional analgesics were required in PACU). The predictive value of the algorithm was excellent, esp in the No Pain group. 7/7 100
George Zhong @propofoldreams.bsky.social · 01/02/2025EXPERIMENT: we tested our hypothesis by examining a simplified cohort of patients where external stimuli (pain, verbal, tactile) at the time of emergence were minimised. We built a hybrid regression model that predicts the awakening Cp for from maintenance Cp and SE. 6/7 100
George Zhong @propofoldreams.bsky.social · 01/02/2025HYPOTHESIS: if we solve for the sigmoid Emax model parameters using maintenance phase data (propofol concentration, state entropy) for a given patient, we may then be able to use these to predict their individualised awakening propofol concentration 5/7 100
George Zhong @propofoldreams.bsky.social · 01/02/2025ASSUMPTION: the Hill coefficient and other model parameters quantifying the pharmacodynamic effect of propofol are unchanged between the maintenance phase shortly before emergence and at the time of emergence 4/7 110
George Zhong @propofoldreams.bsky.social · 01/02/2025LEMMA: the sigmoid Emax model relates propofol concentration to its pharmacodynamic effect. 3/7 110
George Zhong @propofoldreams.bsky.social · 01/02/2025We came up with a novel algorithm for predicting individualised wake up Cp during propofol TCI based on: (1) maintenance Cp (2) corresponding state entropy Here's how we did it. 2/7 110
George Zhong @propofoldreams.bsky.social · 01/02/2025When do you switch off propofol #TCI at the end of a case? How do you predict when the patient will spontaneous eye open and emerge from general anaesthesia? We tackled this Q in our latest study published in BJA. Here's a quick summary ... 1/7 #AnSky #TIVASky 372
George Zhong @propofoldreams.bsky.social · 27/01/2025You can also mimic Eleveld infusion regime almost exactly by using Marsh on your existing pump together with an adjusted input weight. 😜😜 propofoldreams.org/elemarsh-mode/propofoldreams.orgEleMarsh Mode – Propofol Dreams 020
George Zhong @propofoldreams.bsky.social · 27/01/2025Have used all 4. BD Nexus and Agilia (Fresenius) are both good daily drivers Don't mind the Braun Not a fan of the Arcomed because it's clunky to exchange syringes (hardware issue) and over the top safety confirmations (litigation avoidant > clinician centred design, easy software fix) 100
George Zhong @propofoldreams.bsky.social · 14/12/2024Or "inadequate trace, check place" But I agree with you, it's a risk-benefit balance of a catchy rhyme that efficiently raises awareness vs inducing cognitive bias 100
George Zhong @propofoldreams.bsky.social · 14/12/2024I feel the problem with "no trace, wrong place" is that there are two negatives (no and wrong) which are easy to mentally flip, which then becomes the unintended message of "yes trace, right place" What about using verbs which cannot be easily flipped like "abnormal trace, check place" 100
Reposted by George ZhongBritish Journal of Anaesthesia @bjajournals.bsky.social · 04/12/2024Check out the new BJA Special Issue on #sustainability in anaesthesia. Guest-edited by Prof Jodi Sherman. #anaesthesia #Ansky #environment www.bjanaesthesia.org/current#Spec... 094
George Zhong @propofoldreams.bsky.social · 01/12/2024The climate crisis is a healthcare crisis! #ThereIsNoPlanetB #AnSky #sustainability 062
George Zhong @propofoldreams.bsky.social · 28/11/2024I think to get a rough estimate, all you need would be (1) Local cost of air, oxygen, soda lime, electricity (2) Local GWP of oxygen and air. The GWP of soda lime is pretty consistent (differ by transport). The duration of canister also quite constant. 010
George Zhong @propofoldreams.bsky.social · 28/11/2024So we deliberately avoided making an utility judgement of the $$$$ vs environmental trade-off in our manuscript and just stuck with the science. Personally, I also wouldn't touch durian but my better half loves it 😁😁 but you get the point 😂😂 010
George Zhong @propofoldreams.bsky.social · 28/11/2024Indeed, when we designed the original study, we hypothesised that there would be both an economic AND environmental benefit. Unfortunately, reality is there's a potential trade off for Sydney, Australia (environmental analysis is v conditional) 210
George Zhong @propofoldreams.bsky.social · 28/11/2024You are right Danny. I guess it depends on the dollar cost you price carbon emission ... How many apples do I need to trade for your durian? 😁😁 120
George Zhong @propofoldreams.bsky.social · 27/11/2024doi.org/10.1016/j.bj... Our follow up clinical study 😁doi.orgRedirecting 100
George Zhong @propofoldreams.bsky.social · 24/11/2024🙏🏼🙏🏼 thank you Daniel for raising awareness of our work!! 030
George Zhong @propofoldreams.bsky.social · 24/11/2024My back of envelope approx 20mL syringe = 60g CO2e 50mL syringe = 120g CO2e 020
George Zhong @propofoldreams.bsky.social · 24/11/2024Economic - high FGF invariably saves $$$ Environmental - v complex!Highly dependent on: FiO2, carbon footprint of electricity production, case mix, trigger for soda lime canister replacement, etc 010
George Zhong @propofoldreams.bsky.social · 24/11/2024The original study was benchtop using a test lung. We then did a lesser cited follow up clinical study. Long story short, FGF 2 suffice for non laparoscopic surgeries. FGF 4-6 for laparoscopic surgeries. High FiO2 negates any potential environmental benefits. doi.org/10.1016/j.bj...doi.orgRedirecting 110
George Zhong @propofoldreams.bsky.social · 24/11/2024The original study was benchtop using a test lung. We then did a lesser cited follow up clinical study. Long story short, FGF 2 suffice for non laparoscopic surgeries. FGF 4-6 for laparoscopic surgeries. High FiO2 negates any potential environmental benefits. www.bjanaesthesia.org/article/S000...bjanaesthesia.orgDEFINE_ME 172
Reposted by George ZhongThorn-Seshold Lab @thornsesholdlab.bsky.social · 22/11/2024Wishing the Elsevier editors who desk-accepted this all the best for their next career moves. doi.org/10.1016/j.ij... 1021492505
George Zhong @propofoldreams.bsky.social · 23/11/2024How did this even get accepted when there's no mention of the anaesthesia technique used ... 😮😮 100
George Zhong @propofoldreams.bsky.social · 19/11/2024Yes!!! 😂😂 how did I forget one of our national icons "Bluey"? 010
George Zhong @propofoldreams.bsky.social · 19/11/2024Redback spider, brown snake, drop bear, rocuronium and now sugammadex ... Just the way we roll Down Under 😜😜 120
