@rjharrison79 opens #OAA23ASM with an update on Labour Analgesia for 2023. Sir James Young Simpson remembered.
It reads like an #Ostheimer - @rjharrison79 may be a contender to fill @PervezSultanMD’s shoes? Love the QR codes! #OBAnes at #OAA23ASM has gone state of the art!
Analgesia efficacy: to puncture or not to puncture, that may be the question. (Puncture and give something or not?) #DPE studies on surgical onset times required, worrying signal regarding PDPH?#OBAnes #OAA23ASM
What dose do we need - how low would you go? Should you go?
Well, Ultra low as good as low. BUT definitive RCT required. #OBAnes #OAA23ASM
Which method of delivery is better (Royal Mail as good and cheaper?) All neuraxials superior to opioid PCA - although I think #OBAnes knew that? PIEB + PCEA is optimal - really shouldn’t still be using CEI. However, are there barriers to PIEB? Yes, pharmacy and therapeutics are… twitter.com/i/web/status/1…
Complications. Optimising management of EBP? EBP optimal >/= 48-72h. So no to early EBP? #OBAnes #OAA23ASM
What about epidural-related maternal fever? What we know, what we don’t… and probably some things we don’t know we don’t know. New mechanistic studies - likely multifactorial, with sterile inflammation/ thermoregulatory mechanisms likely. We need studies re: neonatal outcomes.… twitter.com/i/web/status/1…
Severe maternal morbidity: 1 per 100 women, associated with >2000x risk mortality. NAP7 - maternal BMI increasing. #OBAnes #OAA23ASM
Do epidurals protect against SMM? We need more studies - including postnatal period. Labour epidural may be a potentially modifiable risk factor for SMM - @rjharrison79 can you clarify for those #OBanes playing from home, does epidural reduce risk? The last slide got me.… twitter.com/i/web/status/1…
Equity of care: #OBAnes = 55% of night workload (NAP7). Adequate data required to assess impact on quality & outcomes. @mbrrace data: ethnicity, socioeconomic disadvantage, multiple = more likely to die. SUICIDE 3x more common - maternal mental health matters! #OAA23ASM
Are we providing equity in our care? @SQuashie had same graphic (same source to be fair) - no, there is inequity in #OBAnes care. Underlying causes unclear. Studies required. Multifactorial #OAA23ASM
Climate crisis: N2O needs cracking (@noolslucas @Rose_Kearsley @Anaes_Journal) - 81% reduction in ambient N2O #OBAnes #OAA23ASM
Returning to the epic Conclusion slide, tweeted and re-tweeted today at #OAA23ASM Well done, @rjharrison79! Great summary of #OBAnes current affairs!
@threadreaderapp unroll please
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