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Simon Ash Profile picture
@OBsleepmerchant
May 21, 2023 • 11 tweets • 16 min read • Read on X
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@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
The ever topical Remifentanil PCA - always a source of debate. (See excellent @damien_hug261 lecture 🧵 from #OAA3dc2022 for a balanced update). Recognizing the risk and ameliorating by design (1:1 nursing, monitoring, etc) may address the same? But it’s not ONLY remifentanil in… twitter.com/i/web/status/1… ImageImageImage
#NAP7 inclusion criteria, inclusion period and structure. 3 parts: baseline survey, case reporting and activity survey. #OBAnes #OAA23ASM ImageImageImageImage
Baseline survey (1): 72% response rate (NHS hospitals). Three quarters of anaesthesia departments have #OBAnes. ~33% OB units are remote location (cf. main OR/ theatre). 1 in 2 units offer remifentanyl PCA. 71% of all UK anaesthetists represented. #OAA23ASM ImageImageImageImage
A continuum. @IARS_Journals #patientsafety article on impacts of Perioperative catastrophes found: > 70% experienced guilt/ anxiety/ reliving. 1 in 5 never recovered. Ability to work compromised - 70% first 4 hrs, 50% first 24h. ~45% anaesthetists involved in management of 1 or… twitter.com/i/web/status/1… ImageImageImage
Psychological impact on anaesthetists. ~5% anaesthetists affected - impacting patient care delivery after recent cardiac arrest. #OBAnes only a small proportion thankfully. #OAA23ASM ImageImage
Activity survey: been covered at #OAA23ASM on several occasions, so a brief recap - #OBAnes accounts for 13 % of ALL anaesthetic workload, but SEVENTY percent of anaesthesia workload 00h00 to 07h00. Other finding covered before - median BMI of OB patients increasing (3,7kg/m2)… twitter.com/i/web/status/1… ImageImageImageImage
Case registry: #OBAnes ~3% of perioperative cardiac arrests, more are overweight/ obese. Top 3 causes: hemorrhage, high neuraxial block & bradyarrythmias. ~1 in 10 associated with epidural for analgesia. ~80% women survived. Arrests & anaesthesia care - disconcerting large piece… twitter.com/i/web/status/1… ImageImageImage
NAP7 #OBAnes summary. @emirakur acknowledges local coordinators, collaboration of all UK anaesthetists. #OAA23ASM ImageImageImageImage

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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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