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Simon Ash Profile picture
@OBsleepmerchant
May 19 • 10 tweets • 11 min read Twitter logo Read on Twitter
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@DevroeSarah presents on Anaesthesia in Pregnancy and Neurodevelopment at #OAA23ASM. Quite an outline! #OBAnes ImageImage
@DevroeSarah begins with epidemiology - 0.4-1% pregnant women will have non-OB surgery during their pregnancy. Fetus = innocent bystander. Complicated question. What is the pathobiology of normal brain development? Is there a link between anaesthesia and impaired brain… twitter.com/i/web/status/1… ImageImageImageImage
Mechanisms? Drug-induced vs multifactorial. Preclinical evidence of consistent association. Clinical evidence inconclusive. Preclinical findings certainly headline grabbing, which prompted a systematic review and meta-analysis from Bleeser et al (incl. @DevroeSarah @rex_steffen… twitter.com/i/web/status/1… ImageImageImageImage
Why the sense of urgency? 2016 FDA safety announcement: repeated or lengthy GA/ sedation under 3years or in pregnant women during third trimester MAY affect the developing brain (making GA section more scary - albeit questionable evidence). Sadly, most models lacked clinical… twitter.com/i/web/status/1… ImageImage
Enter the Bleeser et al propensity-score weighted bidirectional cohort study. BRIEF global executive composite. Ranked comparison of effect size - anaesthesia highlighted. #OBAnes #OAA23ASM ImageImageImage
Neurodevelopmental effects of prenatal exposure to anaesthesia comparable to “innocent” risk factors. Case closed? Maybe. Some subgroups demonstrated differences - worthy of further focussed study? #OBAnes #OAA23ASM ImageImage
Future perspectives: can we do better? Alternative anaesthetics & physiologic neuro protection have been suggested. Targets for alternative anaesthetics include inflammation, neurotoxicity and immature vascularisation. Dexmedetomidine may be neuroprotective, over & above reducing… twitter.com/i/web/status/1… ImageImageImageImage
Physiologic neuroprotection: maternal hemodynamic management; maternal ventilation/ oxygenation management; and depth of anaesthesia management have all been proposed to play a role. #OBAnes #OAA23ASM ImageImageImage
Practical approach and recommendations from @DevroeSarah. And it’s not only #OBAnes opinion, @acog committee opinion as well. Consider alternative anaesthetics, provide physiologic neuroprotection. #OAA23ASM ImageImageImageImage
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More from @OBsleepmerchant

Simon Ash Profile picture
May 23
@TasPirani presents of Liver disease in pregnancy. A lot to cover! #OBAnes #OAA23ASM ImageImage
Physiological changes in pregnancy. Normal LFT/ laboratory changes. #OBAnes #OAA23ASM ImageImage
Causes of liver derangement in pregnancy: flare of pre-existing liver disease (known or unknown). Incidence of pregnancy in people with chronic liver disease at King’s College Hospital. Historically, cirrhotic patients have been infertile d/t anovulation. Population based data… twitter.com/i/web/status/1… ImageImageImageImage
Read 18 tweets
Simon Ash Profile picture
May 22
@ICULone presents on Severe Maternal Morbidity (SMM) and its consequences at #OAA23ASM. #OBAnes Image
Definition of acute SMM: severe, life threatening event during pregnancy & within 6 weeks of delivery. @NPEU_UKOSS provides UK wide high quality obstetric surveillance. Deaths, while uncommon, investigated in depth.

Study Aims: operationalise definition of SMM; report incidence… twitter.com/i/web/status/1… ImageImageImage
SMM at a population level. Study population derivation. #OBAnes #OAA23ASM ImageImage
Read 11 tweets
Simon Ash Profile picture
May 22
Prof Donald Peebles on Embedding Maternal Medicine Networks at #OAA23ASM. Knowing who to call is half the solution to any problem? (Touched on by @elsmere_g during #OBAnes session at #Anaesthesia2023) Image
Direct maternal mortality rate per 100,000 maternities had been decreasing over the last 2 decades, but should a remarkable upswing since 2018, not all accounted for by #COVID19. @mbrrace outlined a case for change: most parts of UK have MDT, but make up variable most without… twitter.com/i/web/status/1… ImageImage
The Maternal Medicine Network (MMN) mandate: ensure timely access to specialist advice and care at all stages of pregnancy. Development of Maternal Medicine specialist centres as regional hub & spoke model = urgent national priority (@DOckendenLtd report)

MMN Ambition and… twitter.com/i/web/status/1… ImageImage
Read 5 tweets
Simon Ash Profile picture
May 21
Dr Katy Sheehan and @ArcBroom present the pick of the posters at #OAA23ASM. 4 criteria for selection of #OBAnes abstracts. ImageImage
A positive start, with the power of positive communication on patient satisfaction, morale & culture, and #patientsafety #OBAnes #OAA23ASM ImageImageImageImage
Barriers to care. Ethnicity, Language and Socioeconomic deprivation. @mbrrace, @TheLancet, and most recently @Anaes_Journal (@LateralTilt @noolslucas @SQuashie @Marianfknight) set the stage. #OBAnes #OAA23ASM ImageImageImageImage
Read 18 tweets
Simon Ash Profile picture
May 21
@NoelleHealy (another 🇮🇪 representative - @ISOA_Ireland well represented!) presents on #OBAnes as a team sport - how do we perform better? at #OAA23ASM. Quite an inspiring quote, then setting the stage with @Fionafionakel et al #humanfactors guidelines in @Anaes_Journal… twitter.com/i/web/status/1… ImageImageImage
Why is teamwork important in OB/ #OBAnes? @mbrrace suggests some lessons to be learned. Prompt action is arguably reliant on good communication, within & between teams. Involving consultant/ specialist care early has been a theme for over a decade. #OAA23ASM ImageImageImage
@DOckendenLtd’ final report highlighted “conflicting agendas and poor teamwork” contribute to adverse maternal & neonatal outcomes? So how do we create good teams?

The @JulieAndrews approach may have the hills alive, but for #OBAnes we may need to start at the very beginning,… twitter.com/i/web/status/1… ImageImage
Read 10 tweets
Simon Ash Profile picture
May 21
@emirakur presents an update on @NAPs_RCoA NAP7 Perioperative cardiac arrest & #OBAnes at #OAA23ASM. ImageImage
The history of @NAPs_RCoA projects and key findings for #OBAnes over the years (failed intubation NAP4 1:390, recent US data 1:808 - gotten better or different methodology?) #OAA23ASM ImageImage
Cardiac arrest in pregnancy. CAPS study @BJOGTweets (I see @Marianfknight?) looked at incidence, management & outcomes in UK. #OBAnes have a significant slice of the pie. @SOAPHQ serious complication repository project (incl. @RichSmileyMD @bscottsegal) provide US data: cardiac… twitter.com/i/web/status/1… ImageImageImageImage
Read 11 tweets

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