Simon Ash Profile picture
Passionate about #OBAnes and #patientsafety (#OBcritcare special interest). Father of 2 future Jedi. Views my own. he/his #heforshe 🇿🇦🇮🇪🇨🇦

May 18, 2023, 11 tweets

Dr Neel Desai provides an Update on Anesthesia for Cesarean Delivery at #OAA23ASM #OBAnes

Starting with the mainstays: choice of local anaesthetic and intrathecal morphine. Prilocaine 2% has compared favourably with bupivacaine 0.5%. However, there are caveats: if prilocaine is to be considered for routine #OBAnes it is recommended a CSE be used. ITM does NOT prevent… twitter.com/i/web/status/1…

The very topical: inadequate neuraxial anaesthesia for cesarean section. See lectures from @hnixon147 and @PervezSultanMD from recent @SOAPHQ annual meeting elsewhere on my timeline - this is a widespread concern. @Jamesocarroll has initiated a large multicentre trial through the… twitter.com/i/web/status/1…

Excellent guidelines on testing blocks and approaches to inadequate #OBanes in @Anaes_Journal from Dr Felicity Plaat, @SusannaStanford @noolslucas et al. Keystone = multimodal testing. Upper and lower limits should be assessed (lower is more tricky) #OAA23ASM

Regarding GA for cesarean section: PERIoxygenation. TIVA for cesarean section- do we know enough? Are models we have for TCI applicable in pregnant population? @YavorRM has lots of research questions. Risk factors for #OBAnes difficult intubation similar to non-pregnant… twitter.com/i/web/status/1…

Carbetocin non-inferior to oxytocin (not necessarily equivalent, not superior), does have advantages but at a price? IV dexamethasone has analgesic benefits- is it safe for all #OBAnes? Is there an optimal NSAID for post cesarean section analgesia? #OAA23ASM

TAP block superior to wound infiltration wrt pain score at rest at 2h, but no other differences (this is not simple subdermal infiltration mind you - @MarcVandeVelde6 has an impressive video not for #SoMe). ESP block for cesarean section - I have some concerns about this in… twitter.com/i/web/status/1…

ESP has been included in PROSPECT guideline for elective cesarean section. Premature? #OBAnes #OAA23ASM

Ethnic disparities in #OBAnes care. @SQuashie covered this extensively at #Anaesthesia2023 - her lecture is elsewhere on my timeline. More likely to receive GA, less likely to have a neauraxial for assisted delivery - worrying. The why’s abound, definitely an area for more… twitter.com/i/web/status/1…

Conclusions from Dr Neel Desai. Multimodal testing. PERIoxygenation. Single shot LA infiltration? #OBAnes #OAA23ASM

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