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Simon Ash Profile picture
@OBsleepmerchant
May 16, 2023 • 11 tweets • 13 min read • Read on X
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@elsmere_g presents on Maternal Medicine at #Anaesthesia2023. Pregnancy is stressful - it will unmask disease. Pick up the phone. Why are we worried? #OBAnes #OAA23ASM ImageImageImageImage
When looking at @mbrrace reports the UK has shown some improvements in maternal mortality, however, there has been an uptick since 2018. While this is partly accounted for by a changing maternal population (older, more obese, more comorbidities, etc), start inequalities related… twitter.com/i/web/status/1… ImageImageImage
Majority are indirect deaths. #OBAnes contributes only a small amount (not to be ignored though). Everyone has a role to play in improving maternity care and reducing mortality & morbidity. Remember majority of deaths occur AFTER delivery - recent pregnancy history shouldn’t be… twitter.com/i/web/status/1… ImageImageImage
Common myths in pregnancy. Imaging is not bad, especially when indicated (delayed diagnosis is deadly). Avoid gadolinium, unless required. Resources. Making a (the) diagnosis is essential. Patients CAN decline imaging, but at least allowed adequate informed consent.… twitter.com/i/web/status/1… ImageImageImage
Drugs are not necessarily bad, context important. Risk-benefit resource = uktis.org. Stopping anti-epileptics can have significant consequences (get expert advice). Coamoxiclav should be avoided in third trimester. Key message: de-prescribing, balancing choices is… twitter.com/i/web/status/1… ImageImageImage
Sick women DO get pregnant. Cancer, renal disease, interstitial lung disease, oh my. Reinforce/ direct contraception and/or pre-pregnancy counselling when you see systemic illness. #Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImage
Odd symptoms are NOT due to pregnancy, until proven otherwise. Think heart - older patients, more heart disease. Majority do NOT know they have heart disease. Chest pain is NEVER normal. Pain should be explained, when there’s more call for advice/ look deeper. MEWS are important… twitter.com/i/web/status/1… ImageImageImageImage
NOT everything gets better with delivery. Especially important is preeclampsia - often postnatal presentation of eclampsia or HELLP. @mbrrace has recommendations specific to preeclampsia (in bold). #Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImageImage
Where do we look after the sick parturient (pre/ postnatally)? Depends - pro’s and con’s. May not always be a simple yes/ no answer. Principles of management - MDT MDT MDT. Optimise devastating situations with compassionate care.
#Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImageImageImage
Networks and MDT’s - knowing WHO to call is important. Important resources with QR codes. #Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImage
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More from @OBsleepmerchant

Simon Ash Profile picture
May 9
@SQuashie presents an update on anesthesia for operative delivery. Declarations. Methodology and themes. #OAA24ASM #OBAnes

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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
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@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
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Read 16 tweets
Simon Ash Profile picture
May 9
@Jamesocarroll presents an Update on Labour and Delivery. Disclosures #OAA24ASM #OBAnes

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How the lecture was put together. Screening. Themes. How to interpret the slides. Very Ostheimer-esque @Jamesocarroll #OAA24ASM #OBAnes


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@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

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Read 17 tweets
Simon Ash Profile picture
May 5
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)

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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

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Introduction, Methods and the 10 questions. #SOAPAM2024 #OBAnes

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Read 11 tweets
Simon Ash Profile picture
Jun 12, 2023
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

Bookends the 1st #OBAnes session, on intrapartum pain at cesarean section… twitter.com/i/web/status/1… Image
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 ImageImageImageImage
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 ImageImageImage
Read 9 tweets
Simon Ash Profile picture
Jun 11, 2023
Dr Ning Nan Wang introduces @harshamd5 to open the chronic pain session: Perioperative use of opioid in the context of Opioid Epidemic. #CASAM2023 ImageImageImage
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… ImageImageImage
Opioid use around the time of surgery. Understanding nociception vs pain. Does eliminating opioids during surgery make a difference - no definitive conclusions. #CASAM2023 ImageImageImage
Read 11 tweets
Simon Ash Profile picture
Jun 10, 2023
@DrLucieFilteau introduces @CMA_Docs president @AlikaMD for his keynote address at #CASAM2023 Image
@AlikaMD starts with the state of the 🇨🇦 health system, including a little history. #CASAM2023 ImageImage
The 🇨🇦 health system approach to problems, creating new problems as a result with a dangerous lack of interoperability. #CASAM2023 ImageImageImage
Read 12 tweets

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