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Simon Ash Profile picture
@OBsleepmerchant
May 21 • 11 tweets • 16 min read Twitter logo Read on Twitter
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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 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
@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
Read 10 tweets

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