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Simon Ash Profile picture
@OBsleepmerchant
May 21, 2023 • 10 tweets • 13 min read • Read on X
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@Rose_Kearsley (@RotundaHospital - my fellowship alma mater) speaks on #OBAnes in the 4th trimester at #OAA23ASM. ImageImage
At the outset, @Rose_Kearsley addresses the definition of trimester (3 months, not only “a third of”). It’s not a novel concept - in lay, academic and anesthesia literature - which makes sense when one thinks of how many pregnancy-associated disease extend beyond delivery (not… twitter.com/i/web/status/1… ImageImageImageImage
#OBAnes workload. 33.3% time on procedures. NB average workload does NOT reflect ebbs & flows, more so surges of activity. @NAPs_RCoA NAP7 data: majority of labour analgesia 1800-0800; #OBAnes accounts for majority of single speciality #AnyAnes work 1800-0800; increasing obesity… twitter.com/i/web/status/1… ImageImageImageImage
The patient experience is central to our practice in #OBAnes.

@SusannaStanford’s @Anaes_Journal editorials and Dr Felicity Plaat et al guidelines on prevention & management of intra-operative pain during cesarean section has been very topical in #OBAnes community as well as the… twitter.com/i/web/status/1… ImageImage
A reminder of @DOckendenLtd’s final report (see 🧵 from #Anaesthesia23 #OBAnes session elsewhere on time line, as well as Bill Kirkup’s). 15 IEA’s including postnatal follow up (4th trimester!) #OAA23ASM Image
Why does anaesthesia follow up in the 4th trimester?: clinical, psychological and when things go awry. Clinical: follow-up of PDPH. At 3 months, 1 in 10 patients were receiving medication for either HA or LBP. At 18months: 58.4% of ADP group had persistent HA. #OBAnes #OAA23ASM ImageImageImage
Clinical: maternal health - preeclampsia up to 3x increased risk of MACE; GDM 50% chance DM2 in 5-10 years.

Psychological: parturients - difficult/ traumatic birth for varied reasons; feel weren’t listened to/ treated with respect; some need time to mourn.

Same experience but… twitter.com/i/web/status/1… ImageImageImage
Hot debrief vs Cold debrief - advantages and disadvantages to both. #OBAnes #OAA23ASM ImageImageImageImage
Is just right… lukewarm? (Better not be porridge). Hot debrief whilst inpatient.

Postnatal Post-Anaesthesia Clinic (POPAC) held monthly at @RotundaHospital. Clinical follow up: PDPH, EBP, other. Referrals from Birth reflection service.

Before POPAC, looks like what exists in… twitter.com/i/web/status/1… ImageImageImageImage
The future of POPAC begins with PDSA cycle of audit and compare. Review themes arising from birth reflections. Patient perspectives to improve patient experiences and outcomes of #OBAnes. Closing with an appropriate Maya Angelou. #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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