You are called to review a woman in labour ward. When you arrive you are told her epidural is no longer working. The epidural was placed by a colleague 5 hours ago and was working well. However in the last 20-30 minutes she has developed breakthrough pain despite a top up and pressing the PCEA a few times. You look at her back and the epidural dressing looks fine – no obvious explanation there. Upon further questioning you are told that she had a caesarean in her previous pregnancy and she is attempting a VBAC. She tells you that since you arrived in the room the pain has changed. Now it is c ..read more

A maternal death is always a tragic event for the mother, the child, the family and society at large. Unfortunately in some parts of the globe this is still a much too common event. Luckily for those of us living in higher resource countries it has now become relatively rare. This week Matt and I sat down together to discuss the history of maternal mortality reporting, and all the useful knowledge we have been able to learn over the years from these important resources. What are direct, indirect and coincidental maternal deaths? We touch on some aspects of the recent Australian reports and th ..read more

As the duty anaesthetist you are called down to the antenatal clinic by the obstetric team to see a pregnant woman with achondroplasia who is booked to deliver in your hospital. What are the anaesthetic issues which can arise in this condition? What evidence is there in the literature for the optimal anaesthetic techniques? What will you discuss with this woman and how will you counsel her? Join Declan and I as we discuss the anaesthetic issues of this relatively rare but sometimes challenging condition… References Dumitrascu CI, Eneh PN, Keim AA, Kraus MB, Sharpe EE. Anesthetic management of ..read more

You are called to a code blue on the postnatal ward. A 28 yr old female who is 1 day post a non elective caesarean section has just had a witnessed convulsion lasting 1-2 min. She has now regained consciousness but seems a little confused and is complaining that she “has lost vision in both of her eyes”. Her BP is 180/100, and all other vital signs are normal. What is this most likely to be? What is your differential diagnosis (what things do you not want to miss)? What investigations would you like done? This turns out to be an episode of eclampsia and PRES (posterior reversible encephalopat ..read more

Hi everyone, Join us this episode – Declan and I have scoured the literature for a few interesting articles of varying degrees of quality! We had fun discussing these articles and hopefully you will also enjoy our discussion. Hopefully we will make this a regular feature every 3-4 months! Articles Discussed 1 – Effect of Dural-Puncture Epidural vs Standard Epidural for Epidural Extension on Onset Time of Surgical Anesthesia in Elective Cesarean DeliveryA Randomized Clinical Trial In this RCT published in JAMA – the time to surgical anaesthesia was 4 min faster when topping up a dural puncture ..read more

You are called to labour ward to place an epidural in a nulliparous woman who is obviously extremely distressed in pain. After you sit her up to clean her back you notice she has a long scar running down the middle of her back. Between contractions she tells you she had surgery as a teenager to straighten her back…..what does this mean? Hi Everyone, Graeme regularly teaches this topic to our anaesthesia trainees and I was surprised to realise that we haven’t done a podcast on this already. Join us as we discuss scoliosis, spina bifida, spinal surgery and other assorted spinal issues ..read more

Hi Everyone, Whole blood, freeze dried plasma, refrigerated or frozen platelets…. On Oct 31st – Nov 3 Graeme, Emelyn and I attended the THOR – THUNDER conference hosted here in Perth at the Rendezvous Hotel in Scarborough. Who is THOR? In their own words: The THOR (trauma haemostasis oxygenation resuscitation) organization is a resuscitation and blood network, originating in Norway a decade ago, and now boasting global reach. It has built an avid following of both civilian and military resuscitation clinicians and scientists, covering both pre-hospital and hospital management of crit ..read more

Hi everyone, Welcome to part 3 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia. These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years! We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening ..read more

Hi everyone, Welcome to part 2 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia. These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years! We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening ..read more

Hi everyone, Welcome to part 1 of a 3 part series we have put together – 3 hypothetical cases involving anaemia / patient blood management scenarios. Thanks to the two great colleagues who made these discussions with me, Dr Anastazia Keegan Head of Haematology here at KEMH and Assoc Prof Nolan McDonnell a colleague from our Department of Anaesthesia. These cases might sound familiar to any registrars who have attended the Thursday teaching run here over the last 8-9 years! We had a lot of fun discussing these three cases and I hope there is a lot of great learning for those of you listening ..read more