Simon Ash Profile picture
May 5 16 tweets 18 min read Twitter logo Read on Twitter
#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
Okay evidence in ICU and #AnyAnes in @NEJM #SOAPAM2023 ImageImageImageImage
More ICU… @SOAPHQ #OBCCMSIG still tuning in, but at risk of losing the pure #OBAnes #SOAPAM2023 ImageImageImage
11 years ago @bscottsegal would have stopped here. However, things have moved forward. Protocolized GDM care decrease morbidity, improved fetal outcomes. #SOAPAM2023 ImageImageImageImage
Just being included in a @cmqcc bundle made a difference. Protocolized oxytocin administration has improved outcomes. But what about the personalized #OBAnes care we could provide? #SOAPAM2023 ImageImageImageImage
Personalized care is not sliced bread. It’s either future, fantasy or fraud. Genetic testing takes too long. Some significant other concerns or challenges.
#SOAPAM2023 ImageImageImage
AI can deal with big numbers but some big concerns. Objections: Can’t protocolize everything, cookbook medicine, skill loss.
A reminder that best chefs keep cookbooks close to start them thinking rather than replace thinking (@Nigella_Lawson may or may not confirm - @GongGasGirltwitter.com/i/web/status/1… ImageImageImage
@HansSviggum starts the CON side of the debate. #SOAPAM2023 ImageImage
How do we treat 2 disparate patients the same way? Scotch sounds like a difficult character. “There is one best way” is an erroneous assumption. Protocols don’t answer every question. #SOAPAM2023 ImageImageImageImage
Do protocols work? Maybe, occasionally, minority. Adherence is important. >2000 years we have known that treating patient is more important than the disease. #SOAPAM2023 ImageImageImage
We are not able to use genetics (yet) #SOAPAM2023 Image
Protocols remove the patient from the equation. Some times individual choice makes a difference. #SOAPAM2023 ImageImageImageImage
Changing protocols is “exciting”. Vince Lombardi (football coach): keep it simple, focus on basics. Personalized care has to actually be “personalized”. Goodhart’s Law. #SOAPAM2023 ImageImageImageImage
And @HansSviggum wraps up the CON argument. Good protocols are rare and need to be living documents. Put patient at centre of care. Cannot assume the protocol will save you.
#SOAPAM2023 ImageImage

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More from @OBsleepmerchant

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
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
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
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
May 5
@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
Read 11 tweets
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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