🩵 UP Anaesthesia Newsletter

October–November 2025 Edition

“Where science meets soul — one airway at a time.”

✨ From your beloved newsletter team

This is our revival... 😄

Hey team,

We’ve finally hit that sprint toward year-end — the stretch where spring shifts into summer, the exam countdown begins, and the theatre coffee queue somehow gets longer as we approach what usually is taken as the recess of the year.

Between late-night revisions, airway drills, and the occasional existential crisis in the tearoom, it’s easy to forget how far we’ve all come this year. So this issue is a little mix of the serious and the soulful — a chance to catch up on new research, exam pearls, and a few reminders to breathe (and not just through the oxygen mask).

Grab a cup, take five, and enjoy this double-month wrap-up before December sneaks up. Don't forget to help out with each other in our MMed data collections!

Drs: Wong and Schoombie are still busy with their data collection. Please feel free to ask for more details. Dr Wong needs patients undergoing regional anaesthesia within 18 months for a VR distraction assisted questionnaire (both at Kalafong and Steve Biko) and Dr Schoombie is collecting data surrounding orthopaedic patients at Kalafong. Your cooperation will be deeply appreciated and reciprocated.

💜 — The UP Anaesthesia Newsletter Team

🩺 Clinical Updates & Journal Highlights

As RuPaul once said... Reading is vital

🩺 Clinical Updates & Journal Highlights (with DOIs)

1️⃣ Sugammadex vs Neostigmine: Faster Reversal, Fewer Complications?

A recent meta-analysis of 35 randomized controlled trials (4,275 patients + large retrospective cohorts) showed that sugammadex enabled faster recovery to a TOF ratio ≥ 0.9 (SMD –3.45), shorter extubation time (SMD –1.44), and lower rates of residual neuromuscular blockade (RR ~0.18). PubMed
Another meta-analysis (Carron et al. 2016) also found sugammadex to be superior to neostigmine in speed and lower adverse events. DOI: 10.1016/j.jclinane.2016.01.035 PubMed
In addition, a 2025 systematic review explored effects of sugammadex on coagulation, concluding that while it transiently prolongs PT, it does not appear to increase bleeding risk. DOI: 10.1186/s12871-025-03041-x BioMed Central
And with respect to pulmonary complications, one meta-analysis (Wang et al. 2021) showed sugammadex was associated with a lower risk of postoperative pulmonary complications (PPCs) (OR 0.62, 95% CI 0.43–0.89). BioMed Central

💡 Takeaway: Sugammadex continues to show strong advantages in speed and safety, though cost, availability, and institutional protocols often still mediate its adoption. Don't forget ESAIC guidelines on muscle relaxants, monitoring and reversal. 😄

2️⃣ Perioperative Dexmedetomidine: Friend or Foe?

A 2025 meta-analysis in BMC Anesthesiology suggests dexmedetomidine may reduce postoperative delirium in cardiac surgery patients (DOI: 10.1186/s12871-025-03264-y).
In noncardiac settings, a retrospective propensity-matched study in Frontiers in Pharmacology found delirium rates of 8.68% vs 17.80% favoring dexmedetomidine, though with a modest increase in hypotension. DOI: 10.3389/fphar.2025.1578233
✨ Tip: Use dexmedetomidine selectively, especially in high-risk neuro / cardiac / elderly patients, balancing its sedative benefits with hemodynamic monitoring.

3️⃣ Fluid Responsiveness & Passive Leg-Raise (PLR) Revisited

A recent review “Prediction of fluid responsiveness: What’s new?” confirms that the passive leg-raise test remains among the most reliable dynamic predictors of fluid responsiveness, especially in spontaneously breathing patients. PMC
A 2025 MDPI paper “Passive Leg-Raising Test as a Predictor for the Drop in Blood Pressure After a Lumbar Epidural Block” also underscores the value of PLR to predict hemodynamic changes. DOI: 10.3390/jcm14082629 MDPI
However, not all is perfect: a 2022 BJA article warns that in patients with intra-abdominal hypertension, PLR may be less accurate. bjanaesthesia.org.uk
Also, in Anaesthesia, a 2020 trial (Khan et al.) examined fluid optimization before induction using PLR-based goal-directed therapy; it found no significant reduction in hypotension compared to standard therapy. DOI: 10.1111/anae.14984associationofanaesthetists-publications.onlinelibrary.wiley.com

💧 Pearl: PLR is powerful, but context matters — consider abdominal pressure, ventilatory mode, and baseline physiology.

📘 Exam Prep Corner

🔹 Final Exam Countdown: FS 2026 Sitting

If you’re sitting your final in the coming months, remember: pattern recognition and clinical judgement count more than encyclopaedic recall.

• Practise your notes aloud — your thought process matters.
• Don’t forget non-technical skills — communication, situational awareness, and leadership are all assessable.

🔹 Quick Reads for Trainees

• “Anaesthesia for Laparoscopic Surgery” – Focus on insufflation physiology.
• “Crisis Resource Management” – Team dynamics and cognitive load.
• “Vascular Access and Ultrasound Guidance” – Fast-review visual summaries.

(Available via the ANZCA Library & UP Shared Drive)

🌿 Wellness & Growth

💭 “The Pause Between Cases”

Wellness isn’t about spa days or slogans. It’s the small moments — that quiet breath before induction, or the smile when a junior nails their first IV.
Consider taking one deliberate pause each day: step outside theatre, stretch, or simply sip your coffee without your phone. Micro-recovery adds up.

🧩 Professional Reflection: “What I Wish I Knew as a Junior”

“You don’t have to know everything. You just need to know what to do next.”

If you’ve ever doubted yourself mid-call, remember: experience grows in hindsight but confidence grows in small wins. Share yours — mentoring someone often teaches you twice.

🥗 Recipe Inspiration: The Rainbow Anaesthetist Bowl

The Sunshine Chicken Bento Box
This recipe is all about bright colors and balanced flavors. It's packed in a bento-style container to keep everything fresh, organized, and looking delicious when you open it for lunch.
Yields: 4 meals
Prep Time: 20 minutes
Cook Time: 25 minutes

Ingredients

For the Lemon Herb Chicken:

• 4 boneless, skinless chicken breasts (about 150g or 5oz each)
• 2 Tbsp olive oil
• Juice and zest of 1 large lemon
• 1 tsp dried oregano
• 1/2 tsp garlic powder
• Salt and black pepper to taste

For the Rainbow Quinoa Salad:

• 1 cup dry quinoa, rinsed
• 2 cups water or vegetable broth
• 1 cup frozen or canned corn, thawed/drained
• 1 cup canned black beans, rinsed and drained
• 1/2 red bell pepper, finely diced
• 1/4 cup chopped fresh cilantro or parsley
• Juice of 1 lime
  For the Sides:
• 2 cups broccoli florets, steamed until tender-crisp
• 1 cup cherry tomatoes, halved
• 1 cup cucumber slices
• 1/2 cup hummus (for dipping)
  Instructions
• Prepare the Chicken: In a bowl, whisk together the olive oil, lemon juice and zest, oregano, garlic powder, salt, and pepper. Add the chicken breasts and toss to coat. You can let this marinate for 15 minutes (or up to 4 hours in the fridge).
• Cook the Chicken: Heat a large skillet over medium-high heat. Cook the chicken for 6-8 minutes per side, or until golden brown and cooked through (internal temperature reaches 74°C or 165°F). Let it rest for 5 minutes before dicing into bite-sized cubes.
• Cook the Quinoa: While the chicken is cooking, bring the 2 cups of water or broth to a boil in a medium saucepan. Add the rinsed quinoa, reduce heat to a simmer, cover, and cook for about 15 minutes, or until all the liquid is absorbed. Fluff with a fork.
• Make the Rainbow Salad: Transfer the cooked quinoa to a large bowl. Add the corn, black beans, diced red bell pepper, cilantro, and lime juice. Mix gently to combine. Season with a pinch of salt if needed.
• Steam the Broccoli: While everything else is cooking, lightly steam the broccoli florets for 3-4 minutes until they are bright green and slightly tender. Immediately rinse with cold water to stop the cooking process and keep them crisp.
• Assemble Your Bento Boxes:
  • Divide the cubed Lemon Herb Chicken evenly among 4 meal prep containers.
  • Add a serving of the Rainbow Quinoa Salad next to the chicken.
  • Fill another compartment with the steamed broccoli and cherry tomatoes.
  • In a small, separate container or compartment, add 2 tablespoons of hummus and the cucumber slices for dipping.
  • Seal the containers and store them in the refrigerator for up to 4 days.
    Here are the approximate macros for one Sunshine Chicken Bento Box:
• Calories: 515 kcal
• Protein: 46g
• Carbohydrates: 42g
• Fat: 19g
  You can sub in shirataki rice or low fat hummus to lower the calories. You can also use Woolies marinated chicken breast to lower the prep work 💃
  Enjoy your delicious and healthy lunches!

📅 Save the Date — Year-End Celebration 🎉

🗓️ Saturday, 6 December 2025
📍 Venue: To be announced soon (but expect good music, bad dancing, and a few familiar airway jokes).

A night to celebrate the wins, the lessons, and the people who make this department what it is.
More details coming in late November — watch your inbox!

💬 Final Thoughts

“Medicine is learnt in silence, but practised in noise.”

May the next few weeks bring both — quiet study and noisy laughter.

Stay safe, stay curious, and see you all at the year-end!

💜 — UP Anaesthesia Newsletter Team