Simon Ash Profile picture
Nov 8, 2022 12 tweets 14 min read Read on X
@rex_steffen speaks on cardiac disease in #OBAnes at #OAA3dc2022, setting the expectations immediately (we haven’t got all week) - for a complete list, read escardio.org/Guidelines/Cli…. ImageImageImageImage
@rex_steffen starts with a case study… I think the pause was echoed by ALL the #OBAnes in the room at #OAA3dc2022 ImageImageImage
Great Fontan video… cesarean uneventful, patient required reintubation for second GA because of her heart - doing the potentially difficult airway twice? No thanks! #OAA3dc2022 twitter.com/i/web/status/1…
@rex_steffen continues with epidemiology. Cardiac disease 0.2-4% pregnancies & increasing. Acquired/ modifiable factors exist. Adult congenital heart disease = most common heart disease in pregnancy.
#OAA3dc2022 ImageImageImage
Relevance of cardiac disease = leading cause of death.

MOST importantly, while everything else seems to be improving (downward trend), cardiac deaths are INCREASING.

Only 17% women have pre-existing diagnosis - highly level of suspicion required

#OAA3dc2022 ImageImageImageImage
Why is cardiac disease so dangerous in pregnancy? The second heart beat, may topple the first. Pregnancy and labour stress CVS. When do they die? 23-34 weeks and postpartum weeks 1-4. Cardiac disease & standard OB meds are incompatible #OAA3dc2022 ImageImageImageImage
Both oxytocin and carbetocin decrease MAP 25%. Phenylephrine decreases cardiac output - is there any to spare? How dangerous is cardiac disease - lowest risk adverse event = 2.5-5%. Fine tuning risk prediction: CARPREG, ZAHARA, ROPAC - structural & functional issues
#OAA3dc2022 ImageImageImageImage
Who should be in charge of management? Longitudinal multidisciplinary multidimensional team = best. Timing & delivery - most vaginal. Cesarean still OB domain.
The @Eltonchris list - No wrong anesthetic, but many ways to give a bad anesthetic.
How blood flows = NB
#OAA3dc2022 ImageImageImageImage
Key hemodynamic issues - the basics are still the basics.
RA has been used for all cardiovascular disease - low dose, titratable RA preferred. GA patients generally sicker, poorer fetal outcomes. 4 pillars of heart failure Mx contraindicated in pregnancy
#OAA3dc2022 ImageImageImageImage
Therapeutic options when medical management fails - @rex_steffen algorithm. ECMO is much better than its reputation.
We can = we should = we must? It’s complicated, almost invariably bad. Emotions vs reality. Mom > fetus - treat mom first.
#OAA3dc2022 ImageImageImageImage
Excellent conclusion/ summary slide from @rex_steffen on cardiac disease in pregnancy at #OAA3dc2022 ImageImage
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More from @OBsleepmerchant

May 9
@SQuashie presents an update on anesthesia for operative delivery. Declarations. Methodology and themes. #OAA24ASM #OBAnes

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Gastric USS. Oral rehydration has benefits over NPO wrt vasopressor use. #siptilsend safe, noting some patients have increased gastric volumes irrespective of starvation status. #OAA24ASM #OBAnes
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@SQuashie continues at a rapid pace. To DPE or not to DPE remains a question - 16min vs 19 min, is that 3 min clinically relevant? Esketamine for supplemental analgesia - >95% had psych effects, read @rjharrison79 editorial. #OAA24ASM #OBAnes
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Read 16 tweets
May 9
@Jamesocarroll presents an Update on Labour and Delivery. Disclosures #OAA24ASM #OBAnes

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How the lecture was put together. Screening. Themes. How to interpret the slides. Very Ostheimer-esque @Jamesocarroll #OAA24ASM #OBAnes


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@Jamesocarroll Clinical practice theme: intrathecal catheters & ADP. Intrathecal catheters: No decrease in PDPH, but reduction in EBP. 10mL intrathecal saline decreased PDPH & need for EBP. Of note, the percentage of epidurals requiring multiple attempts. #OAA24ASM #OBAnes

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Read 17 tweets
May 5
8am-ish in Denver and time for a much anticipated session: PDPH beyond the guidelines. Moderated by Dr Lisa Leffert, featuring @Ropivacaine, @euklaas, @sharonOzynger and @WouterSchievink at #SOAPAM2024 #OBAnes

(HT: @Ropivacaine, bless his heart, he knows I hate missing out)

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Hot off the Press? August 2023! @JAMANetworkOpen with quite an illustrious team including @Ropivacaine @robin_russell1 @KalagaraHari @LimGrapes @claralexlobo @noolslucas @NarouzeMD (please tag others if you have their handles?) #SOAPAM2024 #OBAnes

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Introduction, Methods and the 10 questions. #SOAPAM2024 #OBAnes

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Read 11 tweets
Jun 12, 2023
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

Bookends the 1st #OBAnes session, on intrapartum pain at cesarean section… twitter.com/i/web/status/1… Image
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 ImageImageImageImage
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 ImageImageImage
Read 9 tweets
Jun 11, 2023
Dr Ning Nan Wang introduces @harshamd5 to open the chronic pain session: Perioperative use of opioid in the context of Opioid Epidemic. #CASAM2023 ImageImageImage
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… ImageImageImage
Opioid use around the time of surgery. Understanding nociception vs pain. Does eliminating opioids during surgery make a difference - no definitive conclusions. #CASAM2023 ImageImageImage
Read 11 tweets
Jun 10, 2023
@DrLucieFilteau introduces @CMA_Docs president @AlikaMD for his keynote address at #CASAM2023 Image
@AlikaMD starts with the state of the 🇨🇦 health system, including a little history. #CASAM2023 ImageImage
The 🇨🇦 health system approach to problems, creating new problems as a result with a dangerous lack of interoperability. #CASAM2023 ImageImageImage
Read 12 tweets

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