Simon Ash Profile picture
Nov 10 11 tweets 18 min read
@girardDev presents on managing the obese parturient at #OAA3dc2022. He sets the bar high for the future of presentations at #SOAPAM2023, #OAA23, #ASM23SYD: a QR code that links to all his references as well as a pdf of his slide deck - perfect for #OBAnes #SoMe & #FOAMed.
The value of PERI-oxygenation in obesity is not to be ignored. All patients will go blue, perioxygenated ones take 52 seconds longer (how long it feels depends on the sats?). We all remember the troop pillow, but do we remember the stool? Ergonomics of intubation #OAA3dc2022
@mbrrace meeting 10 November. Hope to see some live tweets of key messages @SusannaStanford. “We are ALL part of the solution” #OBAnes and obesity is definitely part of the puzzle, preventing it part of the solution. #OAA3dc2022
@NEJM 2022 review on obesity in pregnancy (@FarberMichaela does Brian Bateman have a handle?) Obesity impacts all aspects of peri-delivery #OBAnes - both mom & baby, pregnancy & long term. Risks of adverse outcomes increased! @ashrafhabib5 gives additional insights #OAA3dc2022
Recent #OBAnes review in @BJAJournals (might make @PervezSultanMD’s #SOAPAM2023 Ostheimer?) discusses circulating blood volume and looks at EBL as it relates to weight. #OAA3dc2022
This @IJOA_Journal review on blood pressure measurement in obesity probably worth #OBAnes’ time to read? #OAA3dc2022
Another @IJOA_Journal looked at neuraxial failure rates in BMI >/= 50: pretty high, catheter migration common. @_Anesthesiology found that epidural catheter migration was associated with patient movement, 4.28 cm from sitting to lateral! #OAA3dc2022
The relationship between BMI & PDPH was looked at by @FeycePeralta @CynthiaAWongMD et al: 17% decrease. @CarvalB looked at ED50/95 for intrathecal bupivacaine in obese parturients: higher doses more success? #OAA3dc2022
Panni & Columb @BJAJournals found the opposite for epidural LA requirements. @josecarvalhoyyz et al @Anaes_Journal looked at ED90 of oxytocin for elective cesarean in obesity: 0.75iu (higher than 0.35iu for non-obese) #OAA3dc2022
Remember to dose sugammadex appropriately for morbidly obese patients (@Anaes_Journal) - guided by NMT is best. @IJOA_Journal retrospective study on neuraxial morphine & respiratory depression in obesity: almost 2x higher in obesity (almost 3x in class 3 obesity) #OAA3dc2022
That QR code again. Thank you @girardDev, I’m sure @OAAinfo and all #OBAnes appreciate this resource for references (leading the way for future presenters?) #OAA3dc2022

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More from @OBsleepmerchant

Nov 11
@euklaas from @asznl presents on PDPH: new perspectives at #OAA3dc2022. (As promised by teaser) August Bier = father of PDPH, a surgeon started it not #OBAnes 😉 ImageImageImageImage
Current perspective on PDPH. ICHD-3 definition, tied to CSF pressure & volume as is pathophysiology. #OAA3dc2022 ImageImageImage
New anatomical perspectives challenge the classic CSF hypothesis. Choroid plexus not main site of production, CSF doesn’t circulate unidirectionally.

Bulat-Kiarica-Orešković hypothesis: osmotic & hydrostatic forces are main determinants of CSF movement, pulsates

#OAA3dc2022 ImageImageImage
Read 14 tweets
Nov 10
Everyone needs to be on #Medtwitter @StephenLap! Watching @obstetriciasati talk about Obstetric hemorrhage I notice a trend observed at #OAA3dc2022 continuing: manual external aortic occlusion (a REBOA without surgeons or balloon catheter) Image
Dr Ove Karlsson and EXAC group have an article in press:

sciencedirect.com/science/articl…

#OAA3dc2022
Find out more at:

exac.no/about

#OAA3dc2022 ImageImage
Read 4 tweets
Nov 10
@Airwayman1 presents on #HumanFactors in #OBAnes. MedTRiM: medical trauma & resilience management - reminding us of the Declaration of Geneva #OAA3dc2022 ImageImageImageImage
The Boabab lesson (Zambia) applicable to #OBAnes #OAA3dc2022 Image
The plan for the talk. Your patient - straight after new bag sats drop…
NOT Swiss cheese (@girardDev), Emmental(?) model #OAA3dc2022 ImageImageImageImage
Read 14 tweets
Nov 10
@ArviPalanisamy presents his philosophy on the Future of #OBAnes Research in this final session of #OAA3DC2022: practical, aspirational, inspirational (skipping the queue to catch a train, @noolslucas & @OAAinfo) very accommodating in view of train/tube strikes affecting London) ImageImageImageImage
#OBAnes research has plateaued, advancing in increments. A change in thinking is required. Several low hanging fruit, #MindTheGap between #OBAnes research and practice - implementation science something for future? #OAA3dc2022 ImageImageImageImage
One subject ripe for implementation science study is awareness. DREAMY study factors associated are known, awareness common (perhaps we’re losing a skill?) & linked to PTSD. #BridgeTheGap #OAA3DC2022 ImageImageImageImage
Read 9 tweets
Nov 9
Sawubona @DavidGray37! He’s presenting on Tranexamic acid at cesarean section: Drug Error Deaths. An unforeseen result of Woman trial. Potentially life saving in LMIC, deadly in drug error. Disproportionately #OBAnes in district/ rural settings. TXA a new drug there #OAA3dc2022 ImageImageImageImage
A recent situation. Warning from @ArviPalanisamy and Dr Kinsella. A characteristic presentation - unfortunately very similar to eclampsia, in an environment used to poor antenatal care & eclampsia. Both bupivacaine & TXA now generic, no control of similar packaging. #OAA3dc2022 ImageImageImageImage
And #lookalike vials are a problem, a BIG one. 7 recent cases in SA only from 2 provinces, 5 fatal & 2 major neurological morbidity. Getting worse, under reported. Guidance provided, it’s own complication though #OAA3dc2022 ImageImageImageImage
Read 4 tweets

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