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Simon Ash Profile picture
@OBsleepmerchant
May 5 • 11 tweets • 15 min read Twitter logo Read on Twitter
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@Chronotrope presents on using pEEG for sedation at #RAUK23

Now it only took the first slide (next tweet) to draw my full attention, and mean that I will be catching up with recordings later. This raises VERY important questions for #OBAnes in light of recent #SOAPAM2023 chats ImageImage
Neuraxial anesthesia as a sedative…

Sensory deafferentation dependent sedation - an example of a full stomach being sedated that #OBAnes do routinely @VeenaGraffMD (oh wait it gets better)
#RAUK23 #SOAPAM2023

@GongGasGirl have you heard of this? Anyone at #ASM23SYD? Image
Patient age and sensory block level significantly affect relationship between propofol Ce and sedation (I added the graphs from Roh et al’s study). Regional techniques dynamically reduce neural traffic. #RAUK23 #SOAPAM2023 ImageImageImage
Regional techniques including neuraxial reduce neural traffic such that the brain stem SLOWS DOWN, which in turn has a knock on effect on the effects of sedatives like propofol. (@Chronotrope feel free to contribute - it was 330am and 🤯 as new information to me at least) #RAUK23… twitter.com/i/web/status/1… ImageImageImage
Decreasing neural traffic and decreasing hypnotic dose. When walking a tightrope of consciousness, sedatives can add a light wind. In the setting of regional/ neuraxial, it’s a thunder storm - more likely to fall off! @VeenaGraffMD @HofkampMichael @emilysharpe #RAUK23 #SOAPAM2023 ImageImageImageImage
pEEG calibration is more complex than we like to think. There is NO distinct number separating conscious from unconscious. Significant overlap exists! #RAUK23 ImageImageImageImage
Different drugs do different things. Classic EEG changes with anesthesia and sedation. Some familiar patterns. #RAUK23 ImageImageImageImage
BIS number and EEG morphology disconnect. pEEG identifies anesthesia and suppression. Have you ever had a patient SO suppressed that EEG on reads ECG? (@AnaSjaus and I have seen this at TIVA GA section). pEEG can reduce unintended anesthesia.

Argument for its use in sedating a… twitter.com/i/web/status/1… ImageImageImage
How about adding a safety net? Patient Managed Propfol sedation, a study found definite advantages - particularly applicable to #OBAnes perhaps?

@Chronotrope does this program exist widely in TCI pumps? (And yes, limited TCI in North America, if any)

#RAUK23 #SOAPAM2023 ImageImageImageImage
Of note (especially with recent #OBAnes discussions @VeenaGraffMD) other agents do different things. The anesthesiologist is the integration engine. #RAUK23 ImageImage
Great summary slide from @Chronotrope. Lots of food for thought at #RAUK23 and #SOAPAM2023 Image

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More from @OBsleepmerchant

Simon Ash Profile picture
May 6
@hnixon147 presents a very important topic - Optimizing Intraoperative Anesthesia: What can we do to improve care? #OBAnes #SOAPAM2023 ImageImage
A case: “Jennifer” 37 week primup, for induction. Receives epidural, works well for 10h, then requires top-up which is successful.

She chuffs along but eventually stalls. A section is called.

In OR, pinprick and Alice test passed. However, she quickly becomes +++ anxious.… twitter.com/i/web/status/1… ImageImage
The patient is a physician, in same hospital. Feedback given. 9months post partum STILL having flashbacks, PTSD: #OBAnes #SOAPAM2023 ImageImageImage
Read 30 tweets
Simon Ash Profile picture
May 5
#SolShnider track begins with Dr Tiffany Angelo introducing @bscottsegal to start the protocolization in #OBAnes debate vs @HansSviggum at #SOAPAM2023 Image
@bscottsegal will lead off with the PRO argument for protocolization in #OBAnes #SOAPAM2023 ImageImage
The early years - ICU is where it started, treating critically ill patients (no #OBAnes yet) #SOAPAM2023 ImageImageImage
Read 16 tweets
Simon Ash Profile picture
May 5
Dr Vernon Ross begins Fred Hehre Lecture at #SOAPAM2023
The first African American to do so. ImageImage
The Fred Hehre story 1.
#SOAPAM2023 ImageImageImageImage
The Fred Hehre story 2.
#SOAPAM2023 ImageImageImageImage
Read 40 tweets
Simon Ash Profile picture
May 5
@MedgeOwenMD introduces Dr Vernon Ross for the Fred Hehre Lecture. #SOAPAM2023 #OBAnes Image
Fact 1. Family Man - in person, at @WakeAnesthesia and at @KybeleWorldwide #SOAPAM2023 ImageImageImage
Fact 2. His mom’s uterus endowed him with sports knowledge. #SOAPAM2023 ImageImageImageImage
Read 5 tweets
Simon Ash Profile picture
May 5
Dr Brian Bateman moderates the #SOAPAM2023 Gertie Marx Research Competition. #OBAnes Image
Number 1. @LilianeErnstMD presents The ED90 of Hyoerbaric Bupivacaine for Cesarean Delivery in Super Obese Patients #OBAnes #SOAPAM2023 Image
Background. Pre-pregnancy obesity increasing across racial groups. A large percentage in grade 3 obesity, racial differences. Super Obese patients more likely to have cesarean section. High block was more common in BMI > 50. #SOAPAM2023 #OBAnes ImageImageImageImage
Read 22 tweets
Simon Ash Profile picture
May 5
@LondonAllergy presents on a topic we don’t hear much about (follow her & @LouiseSavic for fascinating insights): LOCAL ANESTHETIC ALLERGY at #RAUK23

Topic equally important to #OBAnes audience (@OAAinfo @noolslucas - #OAA3dc?) and I’m sure #SOAPAM2023 audience will enjoy! ImageImage
The allergist team are ready and waiting for your referral, poised to leap into action with different testing modalities. When would they do a drug challenge? To test cross reactivity, exclude allergy and confirm diagnosis #RAUK23 ImageImageImage
Skin testing (a positive latex allergy) includes a negative spot (saline to rule out dermographia) & a positive histamine spot to check for antihistamines in system)

Intradermal testing uses low dilutions for specific drugs. Here a 1:10,000 dilution of sugammadex illicited a… twitter.com/i/web/status/1… ImageImageImageImage
Read 12 tweets

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