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Simon Ash Profile picture
@OBsleepmerchant
May 18, 2023 • 14 tweets • 17 min read • Read on X
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@rjharrison79 opens #OAA23ASM with an update on Labour Analgesia for 2023. Sir James Young Simpson remembered. ImageImage
It reads like an #Ostheimer - @rjharrison79 may be a contender to fill @PervezSultanMD’s shoes? Love the QR codes! #OBAnes at #OAA23ASM has gone state of the art! ImageImage
Analgesia efficacy: to puncture or not to puncture, that may be the question. (Puncture and give something or not?) #DPE studies on surgical onset times required, worrying signal regarding PDPH?#OBAnes #OAA23ASM ImageImageImage
What dose do we need - how low would you go? Should you go?
Well, Ultra low as good as low. BUT definitive RCT required. #OBAnes #OAA23ASM ImageImageImage
Which method of delivery is better (Royal Mail as good and cheaper?) All neuraxials superior to opioid PCA - although I think #OBAnes knew that? PIEB + PCEA is optimal - really shouldn’t still be using CEI. However, are there barriers to PIEB? Yes, pharmacy and therapeutics are… twitter.com/i/web/status/1… ImageImageImage
Complications. Optimising management of EBP? EBP optimal >/= 48-72h. So no to early EBP? #OBAnes #OAA23ASM ImageImageImage
What about epidural-related maternal fever? What we know, what we don’t… and probably some things we don’t know we don’t know. New mechanistic studies - likely multifactorial, with sterile inflammation/ thermoregulatory mechanisms likely. We need studies re: neonatal outcomes.… twitter.com/i/web/status/1… ImageImageImageImage
Severe maternal morbidity: 1 per 100 women, associated with >2000x risk mortality. NAP7 - maternal BMI increasing. #OBAnes #OAA23ASM ImageImageImage
Do epidurals protect against SMM? We need more studies - including postnatal period. Labour epidural may be a potentially modifiable risk factor for SMM - @rjharrison79 can you clarify for those #OBanes playing from home, does epidural reduce risk? The last slide got me.… twitter.com/i/web/status/1… ImageImageImage
Equity of care: #OBAnes = 55% of night workload (NAP7). Adequate data required to assess impact on quality & outcomes. @mbrrace data: ethnicity, socioeconomic disadvantage, multiple = more likely to die. SUICIDE 3x more common - maternal mental health matters! #OAA23ASM ImageImageImageImage
Are we providing equity in our care? @SQuashie had same graphic (same source to be fair) - no, there is inequity in #OBAnes care. Underlying causes unclear. Studies required. Multifactorial #OAA23ASM ImageImageImage
Climate crisis: N2O needs cracking (@noolslucas @Rose_Kearsley @Anaes_Journal) - 81% reduction in ambient N2O #OBAnes #OAA23ASM ImageImageImageImage
Returning to the epic Conclusion slide, tweeted and re-tweeted today at #OAA23ASM Well done, @rjharrison79! Great summary of #OBAnes current affairs! Image
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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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