Discover and read the best of Twitter Threads about #OAA3DC2022
Most recents (24)
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…
@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…
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
#OBAnes #CASAM2023
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
Up next: @ValZaph moderates the #OBAnes session on PPH: a focus on coagulation. Dr Karine Doyon and @LorrainechowMD presenting. #CASAM2023
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
Causes of coagulopathy in pregnancy - Dr Doyon won’t be discussing inherited disorders. The focus will be on the acquired hemorrhagic disorders. #OBAnes #CASAM2023
Just off great @dasairway @OAAinfo #OBAnes airway masterclass webinar with @silv24 chairing, @ProfEllenO @noolslucas @Chakladar_A and @DesireOnwochei giving expert opinions - lots of notes taken, tweets to follow twitter.com/i/web/status/1…
Right, let’s get to it. The #OBAnes airway - shifting the paradigm; a @dasairway & @OAAinfo masterclass. Two Profs in the corner… this should be interesting. @noolslucas kicks off the webinar.
What is a difficult airway? @ASALifeline definition: a clinical situation, conventionally trained anesthesiologist, difficult face mask ventilation/ intubation/ both.
Complications - hypoxemia: @MariePierreBon2 et al @BJAJournals 2020, @DavidGray37 @rosshofmeyr and co, SAJAA… twitter.com/i/web/status/1…
Complications - hypoxemia: @MariePierreBon2 et al @BJAJournals 2020, @DavidGray37 @rosshofmeyr and co, SAJAA… twitter.com/i/web/status/1…
@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…
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
@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…
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…
@emirakur presents an update on @NAPs_RCoA NAP7 Perioperative cardiac arrest & #OBAnes at #OAA23ASM.
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
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…
Number 1. @LilianeErnstMD presents The ED90 of Hyoerbaric Bupivacaine for Cesarean Delivery in Super Obese Patients #OBAnes #SOAPAM2023
Background. Pre-pregnancy obesity increasing across racial groups. A large percentage in grade 3 obesity, racial differences. Super Obese patients more likely to have cesarean section. High block was more common in BMI > 50. #SOAPAM2023 #OBAnes
@Ropivacaine introduces @KalagaraHari for @DalAnesthesia grand rounds: Perioperative POCUS (P-POCUS)
@KalagaraHari (@MayoClinic @MayoAnesthesia @ASRA_Society) promises a whistle stop tour of P-POCUS following an alphabetical approach (would make @rosie_hogg #oaa3dc2022 proud) during his @DalAnesthesia grand rounds
How does it help? Can use POCUS to evaluate almost anything, and perhaps soon everything, giving real time information and assistance with decision making. It has evolved over time, culminating in @ASRA_Society recommendations
@euklaas from @asznl presents on PDPH: new perspectives at #OAA3dc2022. (As promised by teaser) August Bier = father of PDPH, a surgeon started it not #OBAnes 😉
Current perspective on PDPH. ICHD-3 definition, tied to CSF pressure & volume as is pathophysiology. #OAA3dc2022
New anatomical perspectives challenge the classic CSF hypothesis. Choroid plexus not main site of production, CSF doesn’t circulate unidirectionally.
Bulat-Kiarica-Orešković hypothesis: osmotic & hydrostatic forces are main determinants of CSF movement, pulsates
#OAA3dc2022
Bulat-Kiarica-Orešković hypothesis: osmotic & hydrostatic forces are main determinants of CSF movement, pulsates
#OAA3dc2022
Everyone needs to be on #Medtwitter @StephenLap! Watching @obstetriciasati talk about Obstetric hemorrhage I notice a trend observed at #OAA3dc2022 continuing: manual external aortic occlusion (a REBOA without surgeons or balloon catheter)
Dr Ove Karlsson and EXAC group have an article in press:
sciencedirect.com/science/articl…
#OAA3dc2022
sciencedirect.com/science/articl…
#OAA3dc2022
Missing Voices: the key messages of @mbrrace #MBRRACE2022 not too late for #OBAnes leaving #OAA3dc2022, food for thought for those planning #SOAPAM2023 (@PervezSultanMD may have 1 slide) @OAAinfo @noolslucas @SOAPHQ @emilysharpe @ruthi_landau @Ron_George @FarberMichaela @kkjaermd
Missing Voices: 229 women. 10.9 per 100,000. 24% HIGHER. @mbrrace @OAAinfo @noolslucas @SOAPHQ @kkjaermd @emilysharpe @Ron_George @ruthi_landau @APSForg @dremilym @AmyPearsonMD @docanaesthetic @rosshofmeyr @brucebicard @GongGasGirl #OAA3dc2022
Missing Voices: 27 babies died. 366 children left motherless
@mbrrace @OAAinfo @noolslucas @SOAPHQ @kkjaermd @emilysharpe @Ron_George @ruthi_landau @APSForg @dremilym @AmyPearsonMD @docanaesthetic @rosshofmeyr @brucebicard @GongGasGirl #OAA3dc2022
@mbrrace @OAAinfo @noolslucas @SOAPHQ @kkjaermd @emilysharpe @Ron_George @ruthi_landau @APSForg @dremilym @AmyPearsonMD @docanaesthetic @rosshofmeyr @brucebicard @GongGasGirl #OAA3dc2022
@Airwayman1 presents on #HumanFactors in #OBAnes. MedTRiM: medical trauma & resilience management - reminding us of the Declaration of Geneva #OAA3dc2022
The plan for the talk. Your patient - straight after new bag sats drop…
NOT Swiss cheese (@girardDev), Emmental(?) model #OAA3dc2022
NOT Swiss cheese (@girardDev), Emmental(?) model #OAA3dc2022
@ArviPalanisamy presents his philosophy on the Future of #OBAnes Research in this final session of #OAA3DC2022: practical, aspirational, inspirational (skipping the queue to catch a train, @noolslucas & @OAAinfo) very accommodating in view of train/tube strikes affecting London)
#OBAnes research has plateaued, advancing in increments. A change in thinking is required. Several low hanging fruit, #MindTheGap between #OBAnes research and practice - implementation science something for future? #OAA3dc2022
One subject ripe for implementation science study is awareness. DREAMY study factors associated are known, awareness common (perhaps we’re losing a skill?) & linked to PTSD. #BridgeTheGap #OAA3DC2022
@girardDev presents on managing the obese parturient at #OAA3dc2022. He sets the bar high for the future of presentations at #SOAPAM2023, #OAA23, #ASM23SYD: a QR code that links to all his references as well as a pdf of his slide deck - perfect for #OBAnes #SoMe & #FOAMed.
The value of PERI-oxygenation in obesity is not to be ignored. All patients will go blue, perioxygenated ones take 52 seconds longer (how long it feels depends on the sats?). We all remember the troop pillow, but do we remember the stool? Ergonomics of intubation #OAA3dc2022
@mbrrace meeting 10 November. Hope to see some live tweets of key messages @SusannaStanford. “We are ALL part of the solution” #OBAnes and obesity is definitely part of the puzzle, preventing it part of the solution. #OAA3dc2022
Sawubona @DavidGray37! He’s presenting on Tranexamic acid at cesarean section: Drug Error Deaths. An unforeseen result of Woman trial. Potentially life saving in LMIC, deadly in drug error. Disproportionately #OBAnes in district/ rural settings. TXA a new drug there #OAA3dc2022
A recent situation. Warning from @ArviPalanisamy and Dr Kinsella. A characteristic presentation - unfortunately very similar to eclampsia, in an environment used to poor antenatal care & eclampsia. Both bupivacaine & TXA now generic, no control of similar packaging. #OAA3dc2022
And #lookalike vials are a problem, a BIG one. 7 recent cases in SA only from 2 provinces, 5 fatal & 2 major neurological morbidity. Getting worse, under reported. Guidance provided, it’s own complication though #OAA3dc2022
Dr Katie Cornthwaite (virtually) presents on improving fetal outcomes: the ABC approach to managing impacted fetal head at cesarean section. ABC = national programme, more than just impacted fetal head.
#OAA3dc2022
#OAA3dc2022
What is an impacted fetal head? Ball in flowerpot analogy (even has holes at bottom of the pot). First win was a consensus definition. Complications for both mother and baby. #OAA3dc2022
Impacted fetal head contributes to 10% most expensive claims (see @BogodDavid elsewhere). Complicates 1.5% births and 10% of emergency cesareans. Impacted fetal head complicates 32% of sections at full dilation, 56% in cesarean before full dilation. #OAA3dc2022
@FarberMichaela’s 2nd lecture at #OAA3dc2022 - placenta accreta spectrum. A few disclosures. An extensive/ complete objective list. #OBAnes
Why is it important? Entire families’ lives are changed. So many traumatic, physical and psychological impacts. Now several societies for PAS. #OAA3dc2022
@FarberMichaela continues PAS by stressing that terminology is key! FIGO classification = how deep does it invade.Risk factors for PAS primarily related to previous cesarean & placenta previa. Antenatal assessment US/ MRI. NB normal does NOT exclude PAS, prepare!
#OAA3dc2022
#OAA3dc2022
@MariePierreBon2 kicks day 3 off with diagnosis of PPH. She reminds us the OB hemorrhage causes both mortality and severe morbidity (2/3 in France). Not to be ignored, PPH and APH precipitate majority of maternal cardiac arrest. #OBAnes “Too little, too late” kills
#OAA3dc2022
#OAA3dc2022
Factors associated with PPH severity, #OBAnes can impact initial care - prevent “too little too late” cycle. Delay of diagnosis is bad. HOW do we diagnose? 3T’s 3 F’s #OAA3dc2022
Graduated blood collection bags do NOT reduce rates of severe PPH. Visual aids only useful if no collection bag. Quantitative measurement may have a positive impact on outcomes. #OAA3dc2022
@euklaas from @asznl is going to be presenting new perspectives on PDPH later this morning at #OAA3dc2022 and she sent a few teaser slides. The QR code gives you all her references (very useful things these codes)
@euklaas promises an interesting lecture at #OAA3dc2022 - poking the bear from the outset! I’m sure @asznl is pleased to have her amongst their #OBAnes specialists
Challenging new hypotheses. How does #OBAnes feel about the new? @FarberMichaela would probably pay some heed given the disease burden of PDPH with chronic headache (58.6% at 18months 🤯) and changing how we view PDPH is maybe how we change outcomes? #OAA3dc2022
Prof Marie Pierre Bonnet = @MariePierreBon2 (yay! for #SoMe) and she presents on anemia in #ObAnes at #OAA3dc2022 (photo better than podium ones). Definition of anemia in pregnancy: 110 or greater (11.0g/dL). Worldwide disparities.
Iron deficiency dominates anemia in pregnancy. Iron deficiency is innocuous, right? Perhaps not in pregnancy. Maternal iron deficiency affects more than just Hb. It is associated with adverse outcomes. #OAA3dc2022
@MariePierreBon2 highlights anemia’s impact on maternal mortality (@BJOGTweets @mbrrace): aOR 3.6! Not just mortality, but morbidity burden as well (@Anaes_Journal). The psychological impact of maternal anemia is acknowledged - postpartum depression & cognition #OAA3dc2022
@rex_steffen speaks on cardiac disease in #OBAnes at #OAA3dc2022, setting the expectations immediately (we haven’t got all week) - for a complete list, read escardio.org/Guidelines/Cli….
@rex_steffen starts with a case study… I think the pause was echoed by ALL the #OBAnes in the room at #OAA3dc2022
Great Fontan video… cesarean uneventful, patient required reintubation for second GA because of her heart - doing the potentially difficult airway twice? No thanks! #OAA3dc2022 twitter.com/i/web/status/1…
@hornerdeborah1 opens up on recognizing Critical Illness in #OBAnes. Is deterioration an issue? Yes. Why does it continue to be a problem? Fix the wrong things, don’t see 🐘 in room, no national standards (anywhere), we don’t study it! #OAA3dc2022
PIER approach to deterioration. 4P study important (slides still embargoed @hornerdeborah1?) - take home messages are key to detecting/ recognizing deterioration #OAA3dc2022
Design ambitions, design processes and it looks like every other early warning chart… #OAA3dc2022
@ProfEllenO pre-recorded lecture (hope she’s okay?) on avoiding oesophageal intubation at #OAA3dc2022. Talk will focus on preventing unrecognized oesophageal intubation & @Anaes_Journal article from @UniversalAirway (PUMA group) - link below #OAA3dc2022
…-publications.onlinelibrary.wiley.com/doi/10.1111/an…
…-publications.onlinelibrary.wiley.com/doi/10.1111/an…
#OBAnes not immune to oesophageal intubation, and at higher risk (historically at very least) of difficult airway. Current findings, although looking at a very niche subset of patients, bear that out. #OAA3dc2022
@peteodor speaks on drugs & technique in GA cesarean (will tweet objectively, discuss later). What #OBAnes risks do we need to discuss - not just induction. DDI may not be the “be all and end all”? #OAA3dc2022
Lower GA rates possible - #COVID19 taught us that. HOWEVER, no data on IV adjuvants (how many GAWA’s were administered - oops already questions) The modified RSI in #OBAnes. Thiopentone is dead (taken less time outside UK) #OAA3dc2022
@peteodor raises the use of opioids during induction - we probably don’t really have the answer (@rosshofmeyr probably didn’t collect this sort of data in #OBAnes airway registry). Propofol not faster, but wins deeper for longer race (no place for thiopentone). #OAA3dc2022
@AraniPillai presents first part of GA for cesarean section session (virtually) - hybrid presenter meeting here at #OAA3dc2022. @LondonSneh @oldandbaffled @R_S_Chaggar @Chakladar_A and other @NorthwickNEO may even tune in after their successful workshop?
Can’t discuss #OBAnes without mentioning work by @maretha_smit @dyk_dominique @rosshofmeyr (handles for others, please tag?) and their excellent article. @BruceBiccard - is SAJAA on twitter? Article here:
journals.co.za/doi/pdf/10.363…
#OAA3dc2022
journals.co.za/doi/pdf/10.363…
#OAA3dc2022
@AraniPillai reviews the @dasairway master algorithm for #OBAnes GA & failed intubation. PERoxygenation with HFNO considered. Gentle bagging encouraged. Apnoeic oxygenation buys time. PERoxygentation may be ideal? #OAA3dc2022
