The 10pm call: why anaesthetists belong at ISAH

It is 10pm. The neurosurgical registrar wants a WFNS grade 5 patient in theatre for an EVD before anyone has done a DSA. Andy Lindberg, neuroanaesthetist at Royal North Shore Hospital and Vancouver General fellowship graduate, takes that patient all the way through: the induction that must not swing the blood pressure, the case for rocuronium over sux, thiopentone and adenosine when the aneurysm goes on the table, and the decision about who gets the tube out.

His argument for the meeting is simple. Anaesthetists see this disease at every point on the pathway, at the ED airway, in the angio suite, in theatre, in ICU, and back for repeat DSAs, and are usually the only specialty in the room at all of them. A shared mental model across craft groups is not a nice-to-have.

Worth listening for

• Why smooth induction is not mythology: the swing, not the number, is what threatens transmural pressure.

• The rate of change rule: a systolic that drops 20 mmHg quickly is assumed to keep dropping.

• Adenosine as a communication event. The surgeon has to know exactly when it goes in.

• “This is not a case for Sudoku.” What separates elite operators is that they are watching the field and one step ahead.

Where this shows up in the program

Andy runs Neuroanaesthesia 101 on the workshop day, Tuesday 17 November: a half-day for anaesthetists and trainees with three sessions. A simulated cardiac arrest during a SAH case, run as an ANZCA emergency-response scenario. A side-by-side TCI showdown, Eleveld versus Schnider versus Minto, on what actually changes at the bedside. And EEG as a monitor in SAH patients, another set of eyes on someone who cannot tell you what is wrong.

In the main program, Hemant Bhagat presents on neuroanaesthesia and delayed cerebral ischaemia on Thursday afternoon, the Wednesday breakout on autoregulation and physiological targets during and after surgery picks up the blood pressure questions from this episode, and a randomised trial on the effect of anaesthetic agents on cerebral oxygenation during clipping is among the Wednesday rapid-fire abstracts.

Listen above, or go to the full episode and transcript on NeuroResus.

ISAH 2026 runs 17–20 November at the Sheraton Grand Hyde Park, Sydney. See the program or register here.