Great Fontan video… cesarean uneventful, patient required reintubation for second GA because of her heart - doing the potentially difficult airway twice? No thanks! #OAA3dc2022twitter.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
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
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
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
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
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
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
Excellent conclusion/ summary slide from @rex_steffen on cardiac disease in pregnancy at #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