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Simon Ash Profile picture
@OBsleepmerchant
Jun 11 • 11 tweets • 11 min read Twitter logo Read on Twitter
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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
Okay, say there was value in reducing opioids - what’s in a name? Multimodal analgesia does not include complete avoidance of opioids. Removing opioids prolongs recovery. #CASAM2023 ImageImage
An important point - differentiating analgesics from adjuvants, and what is their overall value? Opioid free anesthesia MOVEMENT (sort of like a cult but nicer? 😉) - hype due to contextual interpretation. The puzzle pieces don’t really fit. #CASAM2023 ImageImage
Multiple pathways. Several bundles, which to choose? Recipes raise questions. #CASAM2023 ImageImageImage
Questioning the evidence - no clinically significant difference in PONV despite opioid group not being given antiemetics. Pain itself can cause PONV. Problems with intraoperative pain. Longer recovery. Non-inferiority vs equivalence vs superiority, oh my. Primary outcome similar,… twitter.com/i/web/status/1… ImageImageImageImage
No clinical benefits with OFA. And then we consider postoperative analgesia (where #AnyAnes ceases to have impact?) Procedure specific analgesia requirements, individual variability. 3 cohorts of patient responses postoperatively: pain decreases, pain plateaus and pain increases… twitter.com/i/web/status/1… ImageImageImageImage
Differences between US patients and international groups. It is perceived that OFA will translate to decreased persistent opioid use and lower long term complications. But pre- and intraoperative opioids are not associated with postoperative pain trajectory. Studying prolonged… twitter.com/i/web/status/1… ImageImageImageImage
Postoperative opioid use (where problem lies?) not studied. Short follow-up durations hamstring OFA studies. Surgical opioid prescription-need and issue: barriers to guideline based prescriptions. #CASAM2023 ImageImageImage
Key messages from @harshamd5. #CASAM2023 ImageImage

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More from @OBsleepmerchant

Simon Ash Profile picture
Jun 12
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 10
@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
Simon Ash Profile picture
Jun 10
Up next: @ValZaph moderates the #OBAnes session on PPH: a focus on coagulation. Dr Karine Doyon and @LorrainechowMD presenting. #CASAM2023 Image
PPH: a focus on coagulation is kicked off by Dr Karine Doyon (a hematologist). Objectives. Canada ranked 39th in world in maternal mortality - not sure if that’s good. We’re doing better than USA. #OBAnes #CASAM2023 ImageImageImage
Causes of coagulopathy in pregnancy - Dr Doyon won’t be discussing inherited disorders. The focus will be on the acquired hemorrhagic disorders. #OBAnes #CASAM2023 ImageImage
Read 20 tweets
Simon Ash Profile picture
Jun 10
@DrWesleyEdwards chair of @CAS_OBSection introduces the first #OBAnes session of #CASAM2023.
Speakers: @SusannaStanford @ammunro2 @Ropivacaine Image
@SusannaStanford starts off with the importance of having a talk with the word “failure” in it. #OBAnes #CASAM2023 ImageImage
I have not asked permission to share @SusannaStanford’s whole lecture video today, and it’s 20minutes long. However, see the following links:

oaawebcast.info/susanna

#OBAnes #CASAM2023
Read 29 tweets
Simon Ash Profile picture
Jun 4
Novel Content No.2 at #SOAPAM2023 virtual #OBAnes highlights Day 2: @DoctorStahl speaks on Obstetric Critical Care #OBCritCare ImageImage
@DoctorStahl is an intensive care bear, who loves #OBAnes. QR code to references. #OBCritCare #SOAPAM2023 ImageImageImage
Pregnancy-associated mortality ≈ maternal mortality. #OBAnes 0.2% - doing well (wonder what the denominator is?), so Elmo could ask why are we worried? #SOAPAM2023 ImageImageImage
Read 35 tweets
Simon Ash Profile picture
Jun 4
@matmedicine presents the first NOVEL content session of #SOAPAM2023 virtual #OBAnes highlights: Trauma in Pregnancy for the Non-Obstetric Provider. Objectives. Goals. All live from Italy - somewhat jealous @matmedicine ImageImageImage
Physiological changes during pregnancy (1): Cardiac/ hemodynamic changes. Haematological changes. Are these protective? #OBAnes #SOAPAM2023 ImageImage
Physiological changes during pregnancy (2): Respiratory effects - displacement of diaphragm is key? ABG changes important - lactate the same in pregnant and non-pregnant @matmedicine? #OBAnes #SOAPAM2023 ImageImageImage
Read 18 tweets

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