AnaesthesiaVault

Three papers from June 2026, one through-line: the short-term signal you react to is often not the outcome that matters.

RELIEF's restrictive fluid arm showed more acute kidney injury in hospital. At four years, no excess chronic kidney disease — filtration-rate trajectories were superimposable. The acute creatinine rise was a poor proxy for lasting harm.

Pure oxygen at washout measurably collapses lung volume at extubation, a 643 mL greater reduction in end-expiratory volume one minute after extubation. But the effect clears within an hour, and 70 per cent oxygen gave the best post-extubation oxygenation.

Sugammadex beat neostigmine on extubation failure across 15,730 endoscopy patients, and the benefit held even in patients without chronic pulmonary disease.

Each recalibrates a default. None settles it. Weight a signal by the outcome that follows it, not the one in front of you.

Each paper carries its own evidence tier on the slide — seven slides walk through the study, the caveat, and the practice implication for each.

The full breakdown connects to Fluid Therapy, Renal Protection, Lung-Protective Ventilation, Emergence and Extubation, and Neuromuscular Reversal in AnaesthesiaVault, alongside question bank entries and flashcards on each topic.

Save this for your next journal club. Link in bio for the full breakdown.

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For the first time in adult guidance, a consensus endorses clear liquids inside the two-hour window.

Solids and milk are unchanged. What shifts is the clear-liquid story.

Median fasts still run to nine to twelve hours against a two-hour target. The new international, multidisciplinary consensus reframes the rigid two-hour rule as a barrier to short fasting rather than an aspiration safeguard.

The onus moves to institutions: bring fasting close to two hours, or to drinking until called, under local protocol. Gastric ultrasound is reserved for genuine uncertainty. GLP-1 agonists are judged case by case.

Eight slides cover what changed, what held, the milk-versus-clear-liquid physiology, and how to read the evidence.

The full evidence-based topic, linked to Pulmonary aspiration · Gastric ultrasound · GLP-1 receptor agonists, sits in AnaesthesiaVault alongside question bank entries and flashcards on this area.

Foundation is free. Save for your next pre-assessment round.

Comment VAULT for the link.

You should not have to revise the whole of anaesthesia to pass one exam.

AnaesthesiaVault has been rebuilt from the ground up around that idea. One referenced library, now delivered through two purpose-built modes: Clinical for point-of-care decisions in theatre, Educational for exam preparation at your desk. Same underlying content, different lens depending on what you need in the moment.

Pick your exam and the vault filters to your syllabus, not the entire knowledge base. Seven major curricula are fully mapped — FCA Part 1, FCA Part 2, DA(SA), FRCA Primary, FRCA Final, EDAIC Part I, FANZCA Final — with the study planner tracking against the one you are actually sitting.

Every note traces back to its primary source, with study design and journal shown up front. A referenced companion for fast decisions and revision, never a replacement for clinical judgement or your local protocols.

Swipe through for how the two modes work.

The Founding Member programme closes 31 July 2026 — referral-only, limited places.

Save this. Link in bio to pick your exam and explore the rebuilt vault.

MedEd FRCA FCA Medicine AnaesthesiaVault

Passing your final FCA earns you the right to register as a specialist. It does not register you.

Between your result and your name in the register sits one packet. It registers three things at once: your MMed and your fellowship as additional qualifications, and you as a specialist. Four signatures, three institutional stamps, and a short list of rules that bounce non-compliant applications straight back — unforgiving of a single wrong date or a missing stamp.

The most useful thing I can tell a finishing registrar: start the Form 57 signature chain the week you finish. The forms take an afternoon. The signatures take weeks, because they depend on busy people in separate offices who are not waiting for you.

The full step-by-step guide sits in the AnaesthesiaVault library — the specialist registration roadmap, from final exam to your name in the register. Every form, fee, signature, and address, in the order to do them in.

Save this for the week you finish. Link in bio for the full guide.

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Knowing the syllabus is one thing. Performing under exam conditions is another.

AnaesthesiaVault now carries dedicated question banks for all three South African anaesthetic examinations — Diploma, FCA Part 1 and FCA Part 2. More than 1,150 SAQs, data interpretation questions and clinical cases, every one with an integrated model answer.

Each session can be sat timed and to mark allocation, then self-marked part by part — full, partial or missed — with progress tracked across the bank, so practice mirrors the real paper.

New physics notes complete the FCA Part 1 syllabus. And because the SAQ, data interpretation and clinical-case formats are shared, the banks translate directly to FRCA, EDAIC and FANZCA preparation.

Swipe through all five slides for the coverage, the exam mechanics, and the international fit.

The banks sit alongside the vault notes, flashcards and study planner, so question practice and revision live in one place.

Save this for your next study block. Link in bio.

Lidocaine plus bicarbonate reaches grade 5 crystallisation in vitro. The same grade as injectable triamcinolone.

That is the finding from three Hoerner crystallisation studies, consolidated in a 2026 Anesthesiology narrative review. The mechanism we taught trainees — that low pKa equals safe to alkalinise — was incomplete. Lidocaine (pKa 7.8) plus 8.4 percent bicarbonate in the standard 9:1 ratio precipitates heavily within 30 minutes.

Ropivacaine is worse. It reaches grade 5 with bicarbonate, dexamethasone, or any short-acting co-injectate. The obstetric sequence — ropivacaine labour epidural topped up with alkalinised lidocaine — places two grade-5 combinations in the epidural space sequentially.
The clinical outcome data are thin: one published case of transient bilateral lower-limb weakness in a parturient. But the in vitro picture is striking enough to change habits now, before outcome data accumulate the way they always do.

The practice reset is straightforward. Stop mixing ropivacaine with adjuvants or short-acting agents. Give dexamethasone IV. Consider chloroprocaine for epidural extension — fastest onset of any agent, no alkalinisation required.
Swipe through for the chemistry, the crystallisation matrix, and the full practice recommendations.

The full topic, linked to LA Pharmacology & pKa · Epidural Top-up · Brachial Plexus Block · Spinal Adjuvants · LAST & Toxic Dosing, is in AnaesthesiaVault alongside question bank entries and flashcards on this area.

Save for your next regional list. Link in bio for the full topic.
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FCA(SA) Part II — passed, with distinction.

I'll be honest about how. The only resource I used was a knowledge vault I built myself: every topic, every guideline, every past paper, structured the way I actually revise. The hardest part of this exam isn't any single topic — it's doubting you've covered everything. Trusting one complete source kept me steady through a challenging process.

That vault is now AnaesthesiaVault, used by more than 700 anaesthetists across the FCA, FRCA, EDAIC and FANZCA.

The clinical tools — drug references, emergency protocols, calculators — weren't built for the exam. They were built for day-to-day practice, on the content that already lived in the vault. So it works twice: revision when you're sitting fellowship, a clinical guide when you're in theatre.

Whether you're preparing for fellowship or already in practice, start at the link below. To everyone who carried me through this — thank you.

anaesthesiavault.com

Mechanical power has moved from the ICU baby lung into routine theatre — and the signal is large.

The Müller-Wirtz post hoc analysis (Anesthesiology, May 2026) takes a number we have argued about in ventilated ICU patients for years and tests it in the operating room.

In 2,860 orthopaedic cases, each 0.1 J/min/kg increase in intraoperative mechanical power normalised to predicted body weight carried 55 per cent higher odds of postoperative pulmonary complications — alongside impaired oxygenation in PACU and on the ward.

Eight years after the Serpa Neto 17 J/min ICU threshold, the evidence is converging: the energy load the ventilator delivers matters across the whole perioperative airway course, not only in established ARDS. No randomised trial has yet targeted mechanical power directly.

Swipe through for the equation, the two simplified bedside formulae that work from numbers already on every ventilator screen, the ICU and theatre evidence, and the open questions.

The full topic, linked to Acute Respiratory Distress Syndrome · Ventilation and Weaning · Driving Pressure · Postoperative Pulmonary Complications, sits in AnaesthesiaVault alongside question bank entries and flashcards on this area.

Save for your next general anaesthetic list. Link in bio for the full topic.

A 15 kg child needs high-dose AOM cover. Five Augmentin formulations on the shelf. Which one keeps clavulanate under 10 mg/kg/day at 90 mg/kg/day amoxicillin?

Most prescribers cannot answer without checking. Now they do not have to.
The Discharge Prescribing Guide is the newest module in the AnaesthesiaVault Clinical Guide — 57 source-verified entries across two modules.
The adult module brings brand-by-brand clarity to the SA combination analgesics. Stopayne, Synap, Genpayne, Mybulen — every brand, every composition, side by side. Because the brand names overlap but the formulations do not.
The paediatric module is a reactive weight-driven calculator with hard-stop architecture. Floor refusal. Ceiling redirect. Codeine-under-12 blocked. Augmentin clavulanate cap enforced with a formulation-switch recommendation when the maths fails the patient.

Cross-referenced to SAMF, BNF, BNFc, RXH Formulary, ERAS and Surviving Sepsis 2026.
Save for your next discharge round. Link in bio.
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