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Simon Ash Profile picture
@OBsleepmerchant
May 21 • 18 tweets • 25 min read Twitter logo Read on Twitter
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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 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
@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
@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
Read 11 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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