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Simon Ash Profile picture
@OBsleepmerchant
Jun 12, 2023 • 9 tweets • 12 min read • Read on X
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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
Clinical pharmacology of dexmedetomidine (2): high lipophylicity (crosses BBB readily, entrapped at placenta); inactive metabolites, termination half -life 2h; multiple routes of administration available. #OBAnes #CASAM2023 ImageImageImage
Safety of dexmedetomidine in #OBAnes (1)… first a review of the Health Canada monograph. Remember that this is OFF LABEL use in Canada. Not a lot of data regarding use during pregnancy and breast feeding. #CASAM2023 ImageImageImage
Safety of dexmedetomidine in #OBAnes (2). As noted by Dr Eva Roofthooft @OAAinfo at #OAA3dc2022, most data from China. Meta-analysis of 6 RCT. No significant differences in neonatal Apgars and ABG; lower N&V and shivering in mothers; no difference pruritis, hypotension or… twitter.com/i/web/status/1… ImageImageImageImage
Link to Dr Eva Roofthooft’s talk on new drugs in #OBAnes (including dexmedetomidine) from @OAAinfo’s #OAA3dc2022. #CASAM2023
Use of dexmedetomidine in improving maternal experience and outcomes (1): epidural use during labour - better analgesia vs placebo, similar vs opioids; less N&V; no adverse maternal or fetal effects found. Dr Lamontagne’s personal recipe for EPIDURAL dexmedetomidine use. #OBAnes… twitter.com/i/web/status/1… ImageImageImageImage
Use of dexmedetomidine in improving maternal experience and outcomes (2): intrathecal use during cesarean section - fast onset; prolonged duration; decreased shivering; no significant difference neonatal Apgar or hypotension/ bradycardia/ N&V (what was the trend, I wonder?) Dr… twitter.com/i/web/status/1… 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 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
Simon Ash Profile picture
Jun 10, 2023
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

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