Simon Ash Profile picture
May 19, 2023 14 tweets 15 min read Read on X
ERAC at #OAA23ASM, expertly managed by #OBAnes @LimGrapes from @OBAnesUPMC Image
@LimGrapes lays out the objectives of her talk and highlights the model for improvement applicable to #AnyAnes. Great quote! #OBAnes #OAA23ASM ImageImage
What is ERAC? Well, let’s start at the very beginning (seems like a good place to start): enhanced recovery is about quicker recovery and improving outcomes. Most of all it is an APPROACH! #OBAnes #OAA23ASM ImageImageImage
Is enhanced recovery for cesarean different? It is still an approach, with similar ERAS components #OBAnes #OAA23ASM ImageImageImage
However, there are some modifications to the ERAS components. It’s all in the name. #OBAnes #OAA23ASM ImageImageImage
Prenatal: limit NPO, Education/ engagement, discharge planning. Intraoperative:preventing hypotension, golden hour, medication optimization. Postpartum: early oral/ mobilization, support breastfeeding, treat anemia. #OBAnes #OAA23ASM ImageImageImage
What is the evidence? The protocol. GI outcomes? Satisfaction achieved - maybe? #OBAnes #OAA23ASM ImageImageImageImage
Discharge may not be parturient but passenger related. ERAC improves postoperative LoS, patient satisfaction, breastfeeding rates (maybe a few others). Emphasis placed on 4 interventions, QI initiative implementations successfully met. #OBAnes #OAA23ASM ImageImageImage
Pain and opioid outcomes good (filled scripts is tricky - that may happen without the opioids being taken?) Similarly nutrition and ambulation. #OBAnes #OAA23ASM ImageImageImage
Research opportunities for ERAC. How to get clinician “buy in”? Many ERAS protocols have not yet been implemented for cesarean delivery. #OBAnes #OAA23ASM ImageImageImage
Negative outcomes: best process/ approach? LoS requires further work as not independently related to perioperative #OBAnes or surgery factors. What are CORE outcomes for ERAC? #OAA23ASM ImageImageImage
ERAC editorial in @IARS_Journals encourages further studies to identify interventions to improve outcomes, discern best treatment strategies based on real world data, specific populations while engaging different stakeholders. #OBAnes #OAA23ASM ImageImage
A Benjamin Franklin quote to segway to @LimGrapes’ conclusions - ask her a question (on Twitter if you’re brave)? #OBAnes #OAA23ASM ImageImageImage
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More from @OBsleepmerchant

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
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
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
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
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
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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