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Simon Ash Profile picture
@OBsleepmerchant
May 21, 2023 • 18 tweets • 25 min read • Read on X
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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
Socioeconomic deprivation and ethnicity have impacts on outcomes and equitable care. Why though? Online search results may hold a clue or two: only 7% of images have minority models. #OBAnes #OAA23ASM ImageImageImage
Barriers (2): preferred spoken language is NB, if not English double the number of GA sections. Interpreters used for consent, not procedures. Less likely to use interpreters routinely in OB (? Because out of hours?). @labourpainsOAA = quick easy sustainable way to overcome… twitter.com/i/web/status/1… ImageImageImageImage
Green Anaesthesia: @Assoc_Anaes N2O project - NHS committed to net-zero direct emissions by 2040, specifically includes anaesthetic gases. N2O at least 80% of total anaesthetic footprint. Flatten N2O by minimizing waste, promoting green practice, cracking. NHS actions this far:… twitter.com/i/web/status/1… ImageImageImageImage
A cracking project (sadly unplugging Schroeder valves made no difference). Reducing ethyl chloride spray usage - cold stick. An alternative for testing cold modality (for sacral segments, with consent). @YavorRM and TIVA in #OBAnes - benefits and barriers. Many questions need to… twitter.com/i/web/status/1… ImageImageImageImage
Obesity in pregnancy: a growing problem (worldwide). 2018 @RCObsGyn guidance suggested BMI 40 or over needed to be seen by #OBAnes (sadly locally we’ve had to shift that to a BMI of 50 as we did not have the capacity to see everyone over 40). Granted referral rates are poor.… twitter.com/i/web/status/1… ImageImageImageImage
Pause, it’s not about weight/ habitus. #OBAnes risk review necessary (es during Covid), formal airway exam more thorough - #patientsafety & planning. @RCoANews 2023 guideline stipulate that a mechanism for early assessment should exist, and that duty anaesthetist be informed on… twitter.com/i/web/status/1… ImageImageImage
Risk of cesarean section increased with high BMI - 2-3x in obese - perhaps as high as 52% section rate (How does it look in your institution? Do you keep #OBAnes stats?)
Ooh… interesting question: should ALL increased BMI patients be offered ELECTIVE section?

Especially in… twitter.com/i/web/status/1… ImageImage
Obesity in pregnancy (2)- summary: The upward BMI trend continues. Utility and timing of review - when is optimal? Changes post Covid - possibly for better? Elective section for obese patients? #OBAnes #OAA23ASM Image
Monitoring the block: Dr Felicity Plaat et al’s Prevention & management of intra-operative pain during cesarean section (@SusannaStanford @noolslucas @robin_russell1 @DavidGray37 @BogodDavid @Anaes_Journal) highlighted once more. Consent, Testing, What to do (most importantly… twitter.com/i/web/status/1… ImageImageImage
Is the @OAAinfo standard for testing fit for clinical practice? 76% never achieved the standard - one patient of 25 experienced pain. The authors question whether light touch is necessary? Granted they accepted T9/10, not T5 as per guideline.

Now I have a few questions:
1. How… twitter.com/i/web/status/1… Image
From testing to monitoring blocks, a reminder on Yentis et al’s 2020 safety guideline on neurological monitoring, and a great initiative from @mathers_best (@ObsAnaesNetwork) the #RAAlertBracelet (do see the work by @alice_bunce using audiovisual media for education elsewhere on… twitter.com/i/web/status/1… ImageImage
Artificial Intelligence: evaluating #OBAnes grant proposal written by chatGPT (@UofTanesthesia) - graded by 4 content experts. How did it go? #OAA23ASM ImageImageImageImage
Result: 5 seconds for a proposal with no errors and no plagiarism, 7 conciseness alterations and a 71% content score by assessors.
#OBAnes #OAA23ASM Image
Some concerns re: AI. With great advances come great threats. A PAUSE called! #OBAnes #OAA23ASM ImageImageImageImage
First @OAAinfo abstract on AI (probably not the last) - we shall need to consider what this means. Text generated inn5 seconds with no spelling or grammar errors. Humans sadly unable to compete.

C3PO as nursing staff - I’m conflicted.
#OBAnes #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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