@AraniPillai reviews the @dasairway master algorithm for #OBAnes GA & failed intubation. PERoxygenation with HFNO considered. Gentle bagging encouraged. Apnoeic oxygenation buys time. PERoxygentation may be ideal? #OAA3dc2022
HFNO in pregnant women has been studied, BUT does NOT meet @OAAinfo/ @dasairway preoxygenation standards, less effective than FMO2. May increase PaO2 though.
HOWEVER, does benefit of apnoeic oxygenation outweigh loss of preoxygenation? HFNO out performs LFNO (sorta) #OAA3dc2022
Optiflow “switch” offers possibilities but needs evaluation. The DL-VL debate continues. First attempt should be your best, that may be VL. But remember glottic impersonation - VL alone doesn’t prevent oesophageal intubation (may -> false security) DL has pro’s too #OAA3dc2022
In @AraniPillai’s practice: 1. HFNO - accepting mods & no ETO2 > 90 (achievable or not) & NOT for emergency #OBAnes GA. 2. VL - standardized type across hospital, available everywhere. Accessible = in reach.
Rotation = VL changes = problem @UniversalAirway guidelines #OAA3dc2022
Next up at #CASAM2023 - fittingly keeping the most important academic session to last: #OBAnes @ValZaph moderating the Maternal Experience and Outcomes: Improving the care we provide. @DrWesleyEdwards
Dr Christina Lamontagne kicks off the session with: Use of Dexmedetomidine in improving maternal experience and outcomes. Nothing to disclose. Then an important disclosure: All indications discussed are OFF LABEL in Canada. Objectives. #OBAnes#CASAM2023
Why does Dr Lamontagne use a lot of dexmedetomidine (not only in #OBAnes mind)? Clinical pharmacology of dexmedetomidine (1): highly selective alpha-2 agonist; sedation WITHOUT amnesia at locus coeruleus. #CASAM2023
Dr Ning Nan Wang introduces @harshamd5 to open the chronic pain session: Perioperative use of opioid in the context of Opioid Epidemic. #CASAM2023
The opioid crisis isn’t new - China probably remembers the Opium wars that helped establish a British foothold on the continent. Opioids and OUR crisis. Is what we fear the real crisis? Are opioid-related deaths due to surgical prescriptions? No, mostly due to street fentanyl.… twitter.com/i/web/status/1…
Opioid use around the time of surgery. Understanding nociception vs pain. Does eliminating opioids during surgery make a difference - no definitive conclusions. #CASAM2023
PPH: a focus on coagulation is kicked off by Dr Karine Doyon (a hematologist). Objectives. Canada ranked 39th in world in maternal mortality - not sure if that’s good. We’re doing better than USA. #OBAnes#CASAM2023
Causes of coagulopathy in pregnancy - Dr Doyon won’t be discussing inherited disorders. The focus will be on the acquired hemorrhagic disorders. #OBAnes#CASAM2023
Pregnancy-associated mortality ≈ maternal mortality. #OBAnes 0.2% - doing well (wonder what the denominator is?), so Elmo could ask why are we worried? #SOAPAM2023