Dr Katie Cornthwaite (virtually) presents on improving fetal outcomes: the ABC approach to managing impacted fetal head at cesarean section. ABC = national programme, more than just impacted fetal head. #OAA3dc2022
What is an impacted fetal head? Ball in flowerpot analogy (even has holes at bottom of the pot). First win was a consensus definition. Complications for both mother and baby. #OAA3dc2022
Impacted fetal head contributes to 10% most expensive claims (see @BogodDavid elsewhere). Complicates 1.5% births and 10% of emergency cesareans. Impacted fetal head complicates 32% of sections at full dilation, 56% in cesarean before full dilation. #OAA3dc2022
Prevention. Probably not #OBAnes directly, hopefully
Why is training required?
No consensus on safest approach, widespread variation, no national guidelines, impacted fetal head may need > 1 approach, may be avoidably harmful care. Training void. #OAA3dc2022
They’ve come a long way since the survey.
Is it important to #OBAnes? Anesthesia & OR team required. Tocolysis. Trying to avoid the middle T-word but height may actually matter.
Pause - uterus relaxation takes a little time (reaching in equates to fundal rub?) & tocolysis has systemic effects. #OAA3dc2022
IFH algorithm 2
Also Pause to PLAN & communicate it!
Would consultant/attending OB NOT be present? Doesn’t call for help imply that? If not, you may want to put that step a little earlier?
Anticipate & prepare for complications #OAA3dc2022
Effective communication during cesarean section- are #OBAnes bad at it? Or only during emergencies?
Key communication messages: concur with all - however, I’ve been “advised” against some - “keep non-verbal comms minimal” “silence professional” “don’t scare patient” #OAA3dc2022
Okay rewritten: to my mind, there appears to be a conflict between key messages of communication & language (as if done by different groups). Keeping it simple may conflict with correct communication, using exact, clear language is essential, earshot is unavoidable. #OAA3dc2022
This is where some #OBAnes prefer partner out of the room, precisely because it may be traumatic. However, they’re inevitably present during emergencies. Adding a potentially conflicting voice to that of parturient is debatable, parturient should be focus? Thoughts? #OAA3dc2022
Practical training is essential. Simulation even more so. #OAA3dc2022
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@SQuashie presents an update on anesthesia for operative delivery. Declarations. Methodology and themes. #OAA24ASM #OBAnes
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
@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
@Jamesocarroll presents an Update on Labour and Delivery. Disclosures #OAA24ASM #OBAnes
How the lecture was put together. Screening. Themes. How to interpret the slides. Very Ostheimer-esque @Jamesocarroll #OAA24ASM #OBAnes
@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
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)
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
Introduction, Methods and the 10 questions. #SOAPAM2024 #OBAnes
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