137 GLP1 agonists and anaesthesia a discussion with Erin
Obsgynaecritcare
by Roger Browning - Anaesthetist
2w ago
The next patient on your elective list arrives in theatre. She is a 35 year old woman booked for hysteroscopy to investigate her menorrhagia. She has no co-morbidities so wasn't seen preoperatively in a clinic. She tells you that she has no medical problems but did start on Wegovy for weight loss about 4months ago and has now lost about 12kg. She hasn't eaten anything since 9pm last night - it is now 10am. You were planning a general anaesthetic and a supra-glottic device, but now you're not sure what you should do? Hi everyone, This week I am joined by Erin and we discuss in detail the perple ..read more
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135 The EXIT procedure with Lloyd Green
Obsgynaecritcare
by Roger Browning - Anaesthetist
1M ago
What is the EXIT procedure? Who is it used for and how do we do it? In our institution this procedure only occurs on average every 3-4 years. It is an event where a large diverse group of individuals, who often have never met each other, come together for a brief period of time to work as a highly complex team to achieve a great result for both the mother and baby. Join Lloyd and I as we do a deep discussion on this uncommon but challenging multi-disciplinary procedure. References Maternal anesthesia for EXIT procedure: A systematic review of literature. The management of congenital upper airw ..read more
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133 NAP7 a discussion and review with Jacob
Obsgynaecritcare
by Roger Browning - Anaesthetist
3M ago
Hi everyone, This week I sit down with Jacob one of the provisional fellows in our department and we discuss the findings from the latest UK National Audit Project - NAP7 - which this time investigated Perioperative cardiac arrest. REFERENCES NAP7 - Royal College of Anaesthetists ..read more
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132 The soiled airway with Nathan Blakely
Obsgynaecritcare
by Roger Browning - Anaesthetist
4M ago
A woman collapses with abdominal pain in a restaurant & then the initial evaluation in the ED she is diagnosed with suspected ruptured ectopic pregnancy. She is brought straight into your theatre and you perform a rapid sequence induction. You place your video laryngoscope into her mouth and all you see is vomitus and fluid, your yankauer sucker is blocked with food and doing nothing………… Hi everyone, This week I am joined by Dr Nathan Blakely one of our enthusiastic trainees to discuss an area he has taken a personal interest in —- the management of the soiled airway. Thanks Nathan! Useful ..read more
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131 Hyperkalaemia in Pre Eclampsia a discussion with Natalie Smith
Obsgynaecritcare
by Roger Browning - Anaesthetist
5M ago
As the DA you are paged to come to PACU to review a patient with pre-eclampsia who has just had a PPH and a repair of a perineal tear after delivering in labour ward. The O&G team ordered a VBG because she was febrile and they want to assess her lactate and start her on some antibiotics. The O&G registrar is concerned however because her potassium / K has come back as 7.8 mmol/L…. Join Natalie and I as we discuss the issue of hyperkalaemia specifically in the context of women suffering from pre-eclampsia. Why are they at risk of this important electrolyte abnormality and what are the ..read more
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130 Coagulopathy in abruption a discussion with Graeme
Obsgynaecritcare
by Roger Browning - Anaesthetist
5M ago
You receive a page from labour ward. A woman at 35/40 weeks gestation has just arrived in the hospital very distressed in a lot of pain. A quick bedside ultrasound by the obstetric team has unfortunately demonstrated a large abruption and fetal death in utero. She is contracting strongly and beside herself in pain, the team would like you to come down and place an epidural for analgesia. The team are hoping she will deliver vaginally in the next few hours. What is your approach in this situation? Join Graeme and I as we discuss this complex and challenging clinical condition and the coagulopa ..read more
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129 Is there a doctor on the plane – a discussion with Ilan.
Obsgynaecritcare
by Roger Browning - Anaesthetist
6M ago
You recline your seat back, adjust your neck pillow, eye mask and close your eyes. Finally you are about to have that well earned nap. It was exhausting having to get up at 3am to head to the airport for this unpleasantly scheduled early flight. As your mind drifts towards sleep your thoughts are interrupted by a loud announcement by one of the cabin crew. “If anyone with medical experience is onboard can you please make yourselves known to the cabin crew?” You gently pull your mask aside and see two cabin crew applying oxygen and crouching over a passenger lying supine at the front of the air ..read more
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128 Uterine rupture a discussion with Dr David Owen
Obsgynaecritcare
by Roger Browning - Anaesthetist
7M ago
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
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127 Maternal mortality reports with Dr Matt Rucklidge
Obsgynaecritcare
by Roger Browning - Anaesthetist
7M ago
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
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126 Anaesthetic management of the pregnant woman with Achondroplasia with Declan
Obsgynaecritcare
by Roger Browning - Anaesthetist
8M ago
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
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