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Simon Ash Profile picture
@OBsleepmerchant
May 19, 2023 • 13 tweets • 15 min read • Read on X
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@AliciaTDennis starts day 2 of #OAA23ASM with an update on the management of preeclampsia. #OBAnes ImageImage
The problem of preeclampsia and maternal morbidity & mortality is not new (1933 - 33.3% with eclampsia DIED) Nor is it a UK/ US problem. #OBAnes #OAA23ASM ImageImage
Cardiac disease and preeclampsia feature as leading causes of maternal mortality in @mbrrace reports. Complications of preeclampsia are multiple. Preeclampsia and heart disease are included in key messaging. It’s a @WHO problem: international comparisons. #OBAnes #OAA23ASM ImageImageImageImage
Health equity is very topical, and management of preeclampsia is no exception. Definitions. A multisystem disease with multiple threats. Important KEY MESSAGE: preeclampsia IS heart disease. #OBAnes #OAA23ASM ImageImageImageImage
The first step is eliminating magical language. Know the hypertensive emergencies. Know the impact of hypertension in perioperative period. #OBAnes #OAA23ASM ImageImageImageImage
Diagnostic aids are important - hypertension in pregnancy is potentially a continuum. Hypertension should be treated with antihypertensives. #OBAnes #OAA23ASM ImageImageImage
Additional symptoms/signs - time for magnesium AS WELL. Magnesium has been in our armamentarium for long time. Do NOT use benzodiazepines as first line for seizure treatment. #OBAnes #OAA23ASM ImageImageImageImage
#OBAnes goal is a safe birth. Neuraxial is preferred. Ablate hypertensive response of GA. Careful fluids. NO ergot. MONITOR. On neuraxials: 70 is the new 100 for platelets. #OAA23ASM ImageImageImage
Regarding #OBAnes: preoperative, intraoperative and postoperative interventions. Ensure SBP>160mmHg is treated. Avoid ergometrine/ ergot. Allow as much time as possible (even in face of fetal distress, to avoid hypertensive effects of intubation during GA. Consider A-line.… twitter.com/i/web/status/1… ImageImageImageImage
Dealing with diagnostic uncertainty. POCUS - echo (@AnaSjaus @KalagaraHari). Healthy pregnant patient views. TTE has a role to play. #OBAnes #OAA23ASM ImageImageImageImage
Diagnostic tool for important differential diagnoses. #OBAnes #OAA23ASM Image
World Hyoertension Day was 17 May 2023. New recommendations to improve care. Critical hypertension no longer exists - manage as a continuum. #OBAnes #OAA23ASM ImageImageImage
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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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