Obsgynaecritcare

Hi everyone, This week I am joined again by Dr David Owen an obstetrician here at KEMH. We sit down to discuss uterine inversion - an acute obstetric emergency. Luckily this condition is relatively rare - however because of this there can be challenges in recognising and treating this condition even amongst experienced individuals. Should you be unlucky enough to encounter this rare condition, now having listened to our discussion you will be better prepared and confident you know what is required! Thanks again David for your research and preparation for this episode! References Uterine inversionPararajasingam, S.S. et al.BJA Education, Volume 24, Issue 4, 109 - 112 Unfortunately (as of Feb 2025) this article is not yet open access - but it is very good if you can get it through your hospital or college library.. Uterine Inversion for the layperson - Cleveland Clinic https://youtu.be/bYIPkNfPDUI

Hi Everyone, Welcome to Part Two of our discussion with two of the founding members of the Placenta Accreta Spectrum Team here at KEMH Dr Matt Epee-Bekima and Dr David Owen. This team was conceived in 2017 and began operating in 2018 - and has now cared for over 75 women with PAS - including 24 alone this year (2024). In this episode we continue our initial discussion with a more detailed dive into: Surgical management - team members, techniques and approach Techniques for catastophic bleeding - manual aortic compression, vascular clamping, interventional radiology Postpartum issues Controversies (ICU vs HDU, leaving placenta in -situ) Thoughts for the future Thanks Matt & David for sharing the experiences and knowledge learnt by the PAS team over the last 7 years. References https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Placenta-Accreta.pdf?thn=0

Hi Everyone, This week I had the privilege of sitting down and recording two fascinating episodes with two of the founding members of the Placenta Accreta Spectrum Team from here at KEMH, Dr Matt Epee-Bekima and Dr David Owen. In this first episode we discuss the following: Definitions and pathology of placenta accreta spectrum What is the story behind the formation of the PAS team? Screening / Identification / Diagnosis and referral The optimisation and planning of the patient's journey. References King Edward Memorial Hospital website - The Placenta Accreta Spectrum guideline

Hi Everyone, Join Graeme and I as we discuss two articles chosen from last months edition of IJOA (International Journal of Obstetric Anesthesia). In the first we discuss an article exploring whether the use of intermittent calf compression can reduce hypotension and vasopressor use in women undergoing caesarean section under spinal anaesthesia. The second article looks at the utility of preoperative electrical stimulation of acupressure points prior to caesarean section reduces postoperative pain and improves the quality of maternal recovery. There's a sprinkling of our usual dad jokes at the end. For regular listeners to the show join us again later this month when we hopefully will have a couple of episodes dedicated to the management of placenta accreta spectrum and an interview with the founders of the placenta accreta service setup 7 years ago here at KEMH - see you then! References International Journal of Obstetric Anesthesia Effect of pneumatic leg compression on phenylephrine dose for hypotension prophylaxis via variable rate infusion at cesarean delivery: an unblinded randomized controlled trial Transcutaneous electrical acupuncture point stimulation and quality of recovery following cesarean delivery: A randomized controlled trial

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 perplexing topic of GLP1 receptor agonists. These new wonder weight loss drugs seem to be all the rage and certainly things look rosy if you have shares in Novo Nordisk (the manufacturer). However they are not so great if you provide anaesthesia.... We discuss their relationship with delayed gastric emptying and the risk of aspiration. References ANZCA GLP1 clinical practice recommendation June 2024 ASA consensus based guidance on preoperative management of GLP1 agonists Feb 2024 Gastricultrasound.org. - This is the best resource available (our humble opinion) if you want to upskill yourself to be able to assess the contents of the stomach. ANZCA clinical practice recommendation summary - June 2024 see below

Your patient arrives in the anaesthetic room next to theatre, she's booked for a non elective caesarean for failure to progress. She has an epidural in situ and you decide try to top it up - however after 25ml of lignocaine 2% with adrenaline and around 20min of waiting the block is stuck at the umbilicus and she can still move her legs relatively freely. This is obviously not going to be adequate - she is adamant she wants to be awake to see her baby born. You sit her up, pull out the epidural and do a single shot spinal with 2.1ml of heavy bupivacaine 0.5% + fentanyl 15mcg - after all you don't want this block to fail as well! You clean her back, lie her down and turn to talk to the midwife. When you turn back to the patient 30s later she looks a little purple and isn't breathing....... Hi everyone join Graeme and I this week as we discuss total spinal anaesthesia - a fascinating but somewhat scary rare emergency which can occur when we use regional anaesthesia in obstetric practice. A big shout out to the team from Rotunda Hospital in Dublin who wrote the recent narrative review published in IJOA on this topic! References Total spinal anaesthesia following obstetric neuraxial blockade: a narrative review Radwan, M.A. et al.International Journal of Obstetric Anesthesia, Volume 59, 104208 Sobhy S, Zamora J, Dharmarajah K, Arroyo-Manzano D, Wilson M, Navaratnarajah R, Coomarasamy A, Khan KS, Thangaratinam S. Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health. 2016 May;4(5):e320-7. doi: 10.1016/S2214-109X(16)30003-1. PMID: 27102195.

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 airway anomalies and the ex-utero intrapartum treatment (EXIT) procedure

Hi Everyone, This week Matt and I agreed to get together to do another journal club episode (or more accurately I printed out an article, put it in Matt's pigeon hole and told him to make himself available or else!). We went to one of our favourite journals IJOA (International Journal of Obstetric Anesthesia), where we chose an article from the latest edition published in May. The article is entitled "A narrative review of the literature relevant to obstetric anesthesiologists: the 2023 Gerard Ostheimer lecture." The background to this article is that every year the north american Society of Obstetric Anesthesia and Perinatology (SOAP) hold an annual conference. One of the highlights of these annual conferences is this lecture which is researched and then presented by a well respected obstetric anesthesiologist from the north american community. The lecture is a narrative review of the previous years published literature highlighting important papers and discussing their importance and relevance particularly in relation to current north american practice. This year's lecture was presented by Pervez Sultan from Stanford University, and it is drawn from a review of articles published in 2022 from 66 different journals. Over 12 different themes are discussed including (but not limited to) TIVA for GA Caesareans, dexamethasone for post CS analgesia, predicting epidural blood patch success, dural puncture epidurals and a number of other interesting topics. Join Matt and I as we discuss these and muse over what relevance they may have to our current practice here in Western Australia as well as a couple terrible olympic themed dad jokes to close! References / Links A narrative review of the literature relevant to obstetric anesthesiologists: the 2023 Gerard W. Ostheimer lecture  Int J Obstet Anesth 2024 May:58:103973. doi: 10.1016/j.ijoa.2023.103973. Epub 2024 Jan 3.

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

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! Blood in Airway: Useful Links / References https://youtu.be/Jaq-vHbcGi0 https://youtu.be/oMXkGgoRMpE Cook T, Woodall N, Frerk C, Project FNA. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. British journal of anaesthesia. 2011;106(5):617-31. Kei J, Mebust DP. Comparing the effectiveness of a novel suction set-up using an adult endotracheal tube connected to a meconium aspirator vs. a traditional Yankauer suction instrument. The Journal of emergency medicine. 2017;52(4):433-7. Andreae M, Cox R, Shy B, Wong N, Strayer R. 319 Yankauer outperformed by alternative suction devices in evacuation of simulated emesis. Annals of Emergency Medicine. 2016;68(4):S123. Cox R, Andreae M, Shy B, DuCanto J, Strayer R. Yankauer suction catheters with “safety” vent holes may impair safety in emergent airway management. The American Journal of Emergency Medicine. 2017;35(11):1762-3. Nikolla DA, King B, Heslin A, Carlson JN. Comparison of Suction Rates Between a Standard Yankauer, a Commercial Large-Bore Suction Device, and a Makeshift Large-Bore Suction Device. The Journal of Emergency Medicine. 2021;61(3):265-70. Weingart SD, Bhagwan SD. A novel set-up to allow suctioning during direct endotracheal and fiberoptic intubation. Journal of clinical anesthesia. 2011;23(6):518-9. Han S, Fisher JA. Airway Management During Persistent Flooding Of the Oropharyngeal Airway. DuCanto J, Serrano KD, Thompson RJ. Novel airway training tool that simulates vomiting: suction-assisted laryngoscopy assisted decontamination (SALAD) system. Western Journal of Emergency Medicine. 2017;18(1):117. Root CW, Mitchell OJ, Brown R, Evers CB, Boyle J, Griffin C, et al. Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management. Resuscitation Plus. 2020;1:100005. Chrimes N. The Vortex: a universal ‘high-acuity implementation tool'for emergency airway management. BJA: British Journal of Anaesthesia. 2016;117(suppl_1):i20-i7. Finke S-R, Schroeder DC, Ecker H, Böttiger BW, Herff H, Wetsch WA. Comparing suction rates of novel DuCanto catheter against Yankauer and standard suction catheter using liquids of different viscosity—a technical simulation. BMC anesthesiology. 2022;22(1):285.

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 principles of management? We also review a recent paper addressing some of the myths surrounding the treatment of acute hyperkalaemia (thanks to Casey at Broomedocs.com for bringing this paper to our attention). Useful References Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. Am J Emerg Med. 2022 Feb;52:85-91. doi: 10.1016/j.ajem.2021.11.030. PMID: 34890894 LITFL, ECG library, Hyperkalaemia https://litfl.com/hyperkalaemia-ecg-library A case of probable labetalol induced hyperkalaemia in pre-eclampsia. https://pubmed.ncbi.nlm.nih.gov/25370900 Hypocalcaemia and hyperkalaemia during magnesium infusion therapy in a pre-eclamptic patient https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614650 Oh's Intensive Care Manual. 7th Edition. Chapter 93 – Fluid and Electrolyte Therapy. Bersten A, Soni N et al. 2014.

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 coagulopathy that can occasionally occur. Here is a link to cases we have had in the past here at KEMH in the ROTEM Real Cases Discussed section: Case 6 - Abruption and fetal death in utero Case 11 - Abruption and severe coagulopathy References Coagulopathy and placental abruption: changing management with ROTEM-guided fibrinogen concentrate therapy 2015 Liverpool Womens Hospital - this is not open access but available through the ANZCA library or your hospital library. It contains 4 very interesting case reports Fibrinolytic and thrombotic DIC an explanation 2023 - This paper explains how there are two types of DIC one predominantly causing microvascular thrombosis and eventually factor depletion. The second which is possibly the mechanism seen in some abruptions is massive activation of fibrinolysis and fibrinogenolysis. WARNING this paper is highly technical!

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 aircraft. You quietly glance around the aircraft - no one else seems to have volunteered to help........ If you have any medical, nursing or paramedical training and you occasionally fly on an aeroplane then this talk could well be relevant to you! This week I am joined by Ilan, one of our anaesthetic fellows and the current education fellow. Ilan is also a licensed pilot and has an interest in inflight medical emergencies and their management. Join us as we discuss the physiology, epidemiology, legal issues and share some anecdotes on this fascinating topic. Thanks Ilan! References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789915/ - In flight medical emergencies Western J Emerg Medicine 2013 https://jamanetwork.com/journals/jama/article-abstract/2719313 - In flight medical emergencies JAMA 2018 https://onepagericu.com/in-flight-medical?rq=flight - https://www.casa.gov.au/ - Australian Aviation Governing Authority where all the legal requirements for flight operations in Australia can be found https://insightplus.mja.com.au/2017/39/what-is-my-duty-to-assist-in-emergency/ - Duty to Assist in MJA https://www1.racgp.org.au/newsgp/professional/medical-good-samaritans-and-the-law-what-gps-need

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 constant and she has developed pain in her shoulder. Suddenly the CTG deteriorates and within a few minutes the team are calling a code blue caesarean to theatre.....This is recollection of a real case from an evening shift a few years ago. As you can probably guess this week we are discussing the important and somewhat scary topic of uterine rupture. This week we are joined to discuss this topic by Dr David Owen. David is a senior obstetrician, who previous to WA worked at Liverpool Women's Hospital and was a psychiatrist in a previous life. Thanks David! References Uterine Rupture: A Seven Year Review at a Tertiary Care Hospital in New Delhi, India Tocogram characteristics of uterine rupture: a systematic review

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 then go into depth on the long history of the UK reports which have many strengths such as their national funding, compulsory reporting, anonymous nature and very long history. Thanks Matt References Maternal Mortality Report Australia Maternal Mortality World Health Organisation WHO MBRRACE-UK Maternal mortality reports UK Signup to receive email notification of each new episode We don't share email addresses and we don't send spam (function() { window.mc4wp = window.mc4wp || { listeners: [], forms: { on: function(evt, cb) { window.mc4wp.listeners.push( { event : evt, callback: cb } ); } } } })(); First Name Last Name Email address: Leave this field empty if you're human:

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 parturients with achondroplasia: a case series. Proc (Bayl Univ Med Cent). 2023 Dec 20;37(1):63-68. doi: 10.1080/08998280.2023.2261084. PMID: 38173994; PMCID: PMC10761160. Lange, E.M.S., Toledo, P., Stariha, J. et al. Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism. Can J Anesth/J Can Anesth 63, 945–951 (2016). https://doi.org/10.1007/s12630-016-0671-5 15 Ways Pregnancy Is Different For Little People - Good Lay Person Website

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 encephalopathy syndrome). What is PRES? What are it's radiological features and what is the mechanism which leads to this disorder? Join Graeme and I as we discuss this uncommon but fascinating condition. References Gewirtz AN, Gao V, Parauda SC, Robbins MS. Posterior Reversible Encephalopathy Syndrome. Curr Pain Headache Rep. 2021 Feb 25;25(3):19. doi: 10.1007/s11916-020-00932-1. PMID: 33630183; PMCID: PMC7905767. Marcoccia E, Piccioni MG, Schiavi MC, Colagiovanni V, Zannini I, Musella A, Visentin VS, Vena F, Masselli G, Monti M, Perrone G, Panici PB, Brunelli R. Postpartum Posterior Reversible Encephalopathy Syndrome (PRES): Three Case Reports and Literature Review. Case Rep Obstet Gynecol. 2019 Jan 27;2019:9527632. doi: 10.1155/2019/9527632. PMID: 30809401; PMCID: PMC6369475.

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 epidural in comparison to a standard epidural catheter. 2 - Neuraxial buprenorphine for post-cesarean delivery analgesia: a case series This correspondence from the International Journal of Obstetric Anesthesia (IJOA) this year discussed the experience of a small hospital which decided to use neuraxial buprenorphine when there was a morphine shortage. 3 - There's No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment This classic paper from 2006 is a must read for anyone who is involved in debriefing and simulation in healthcare. 4 - Improving blood product management in placenta accreta patients with severe bleeding: institutional experience This short report from IJOA 2023 describes the experience of blood product management in patients with placenta accreta spectrum disorder in a large tertiary referral hospital in Israel. 5 - Incidence of Interstitial Alveolar Syndrome on Point-of-Care Lung Ultrasonography in Pre-eclamptic Women With Severe Features: A Prospective Observational Study This observational study from Analgesia & Anesthesia 2022 examined 70 women with severe PET with lung ultrasound and ECHO to assess diastolic dysfunction.

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.

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 critically unwell patients. The THOR vision is to improve outcomes from traumatic haemorrhagic shock by optimising the acute phase of resuscitation. The mission is to develop and implement the best practices for haemorrhagic shock resuscitation from pre-hospital care right through to the completion of the acute phase of hospital resuscitation. Thor group website: Trauma Hemostasis and Oxygenation Research Network (rdcr.org) We sat down to reflect on the different topics that were presented at this fascinating conference. A big shout out to Tania Rogerson for organising such an amazing bunch of speakers. It was great to hear how resuscitation of major haemorrhage is done in other parts of the globe and to be educated about some different resuscitation products that are not available here in Australia. If you also want to hear a great deep dive into the scientific evidence base for the management of massive haemorrhage then I highly recommend listening to Casey Parker and Justin Morgenstein discussing this topic here (thanks for a great balanced summary of the evidence): Massive Haemorrhage: Science and Practice - Broome Docs - Nov 2023 Massive hemorrhage: a very deep dive - First10EM - Nov 2023 References Evaluation of freeze dried plasma for use in NSW - https://aci.health.nsw.gov.au/networks/trauma/resources/freeze-dried-plasma There has even been a pilot study comparing whole blood for use in accrete spectrum surgery in San Antonio: Whole blood transfusion reduces overall component transfusion in cases of placenta accreta spectrum: a pilot program.J Matern Fetal Neonatal Med 2022 Dec;35(25):6455-6460. The Use of Whole Blood Transfusion in Trauma - Curr Anesthesiol Rep Jan 2022 Warming Up to Cold-stored Platelets Anesthesiology December 2020, Vol. 133, 1161–1163. 

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 – thanks Anastazia and Nolan for giving up a few hours to put these together!

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 – thanks Anastazia and Nolan for giving up a few hours to put these together!

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 - thanks Anastazia and Nolan for giving up a few hours to put these together! Reference - Fishbane Reaction Safety of Intravenous Iron Following Infusion Reactions Stojanovic et al The Journal of Allergy and Clinical Immunology: In Practice Volume 9, Issue 4, April 2021: 1660-1666 - A great paper discussing the different types of reactions to i.v. including the Fishbane reaction and how they were managed in over 13000 iron infusions at the Alfred Hospital in Melbourne. Unfortunately it is an Elsevier publication and you will need some sort of institutional access to read it in full. Where is the iron in our body?

You are phoned and asked to review the venous blood gas from a woman who has just given birth in labour ward. She had a long and difficult labour and eventually required an instrumental delivery. The RMO tells you also that she was very difficult to take blood from and the tourniquet was on her arm for quite a long time. Her results show that she has a lactate of 2.5. Does this result mean she has maternal bacterial sepsis? Does this mean she is in shock, not perfusing her organs properly and they are using anaerobic metabolism? Unfortunately it's not that simple but these are common misconceptions that we might encounter when interpreting raised lactate levels. What is lactate? How does the body handle it? What are the different conditions which can raise your lactate levels? If you want to know this and more listen in to our fascinating discussion this week. Hi everyone, This week I am joined by two new guests, Tim Marmion one of our talented junior registrars and Declan Sharp the new education fellow here at KEMH. This week Tim kindly agreed to give us a talk he recently wrote whilst working in ICU, on the challenges of lactate interpretation. I cornered him after the talk and he kindly agreed to share it with us on the podcast. Thanks Tim and Declan for a fascinating and educational topic! References How should we interpret lactate in labour? A reference study S.Dockree et al BJOG. 2022 Dec; 129(13): 2150–2156. Blood Lactate Measurements and Analysis during Exercise: A Guide for Clinicians Matthew Goodwin et al J Diabetes Sci Technol. 2007 Jul; 1(4): 558–569. https://resus.me/understanding-elevated-lactate/ https://youtu.be/TuvKcplVQLg

Hi Everyone, "Three minutes after the administration on the spinal anaesthetic they became restless and complained of severe pain in both lower limbs and back. Their heart rate and blood pressure increased to 130bpm and 160/100 mmHg. A rapid survey of previously administered medications revealed tranexamic acid 300mg was accidentally injected into the subarachnoid space instead of 15mg of hyperbaric bupivacaine." - case report 2021 Graeme and I sit down to do a deep dive on the serious topic of accidental neuraxial administration of tranexamic acid which may have up to 50% mortality. We discuss two papers which summarise over 40 published case reports of spinal administration and one case report of accidental epidural administration. Join us as we discuss the pharmacological mechanism of toxicity, proposed treatments and methods to minimise the risk of this occurring in the first place. References Catastrophic drug errors involving tranexamic acid administered during spinal anaesthesia. S. Patel, B. Robertson, I. McConachie Anaesthesia. 2019 Jul;74(7):904-914. - Open access Tranexamic acid-associated intrathecal toxicity during spinal anaesthesia: A narrative review of 22 recent reports. S. Patel Eur J Anesthesiol 2023 May 1;40(5):334-342. - This article is not open access. Accidental administration of tranexamic acid into the epidural space: a case report. C. Pysyk, L Filteau Can J Anaesth 69, pages 1169–1173 (2022) - open access Tranexamic acid-associated seizures: Causes and treatment. I.Lecker et al. Ann Neurol 2016 Jan;79(1):18-26.

Hi Everyone, Join Siv and I as we sit down to discuss a couple of interesting obstetric related topics. The first is the pharmacology around the choice and strength of local anaesthetics used in epidural analgesia - thanks Siv. The second part we discuss a very large pragmatic study in the New England Journal of Medicine of 11000 women studying the use of tranexamic acid as a prophylaxis during caesarean surgery (elective and emergency). Spoiler alert it didn't show any difference (death or transfusion). Thanks Siv! References Tranexamic Acid to Prevent Obstetrical Hemorrhage after Cesarean Delivery Pacheo et al N Engl J Med 2023; 388:1365-1375 Minimum local analgesic concentration of local anaesthetics. Malachy Columb, Iain Gall Continuing Education in Anaesthesia Critical Care & Pain, Volume 10, Issue 4, August 2010, Pages 114–116 Determination of the Minimum Local Analgesic Concentrations of Epidural Bupivacaine and Lidocaine in Labor. Columb, Malachy O. FRCA; Lyons, Gordon FRCA. Anesthesia & Analgesia 81(4):p 833-837, October 1995.

Hi Everyone, This week we are joined by Dr Anastazia Keegan an obstetric haematologist and the head of Haematology at our Women's hospital here in Western Australia. Join us as Anastazia educates us about congenital bleeding disorders in pregnancy - the common ones, Von Willebrands disease and haemophilia - and how to approach a woman with one of the many uncommon ones (which working in a tertiary referral centre are more common than you would expect). Thanks for all the great advice and insights - we look forward to having Anastazia back in the near future for the lowdown on some more really important haematological conditions we encounter in women's health. References Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy. Med J Aust 2019; 210 (7): Online Bleeding Assessment Tool ISTH-BAT

Hi Everyone, This is part 2 of a discussion (see the previous episode for part 1). We have just returned from the Obstetric Anaesthesia Special Interest Group Satellite meeting held on May 3-4. I sat down two days after the meeting with Dr Matt Rucklidge (the convenor of this meeting and a colleague here at KEMH) and Prof Nuala Lucas one of the keynote invited speakers from the UK who is the president of the OAA UK (Obstetric Anaesthesia Association). We discuss the highlights of this two day meeting and some of the takeaway learning points. Thanks to Matt Rucklidge and Jane Brown who organised the speakers – an absolutely amazing line up of compelling speakers and topics! Apologies for the audio quality – we didn't have the usual microphones and had to record in a side room at the Sydney Convention centre at were unable to get away from the background elevator music…… Nuala flew straight from Sydney back to the OAA annual meeting this year being held in Edinburgh. If anyone is interested in attending any excellent Obstetric Anaesthesia meetings the OAA hold two very well regarded meetings held every year – see the links below: References Challenges and Choices in Obstetric Anaesthesia – Sydney Convention centre May 3-4 2023 Obstetric Anaesthetist's Association OAA-UK – see links to their annual meetings Handbook of Communication in Anaesthesia & Critical Care: A Practical Guide to Exploring the Art Illustrated Edition. Dr Allan Cyna

Hi Everyone, We have just returned from the Obstetric Anaesthesia Special Interest Group Satellite meeting held on May 3-4. I sat down two days after the meeting with Dr Matt Rucklidge (the convenor of this meeting and a colleague here at KEMH) and Prof Nuala Lucas one of the keynote invited speakers from the UK who is the president of the OAA UK (Obstetric Anaesthesia Association). We discuss the highlights of this two day meeting and some of the takeaway learning points. Thanks to Matt Rucklidge and Jane Brown who organised the speakers - an absolutely amazing line up of compelling speakers and topics! Apologies for the audio quality - we didn't have the usual microphones and had to record in a side room at the Sydney Convention centre at were unable to get away from the background elevator music...... Nuala flew straight from Sydney back to the OAA annual meeting this year being held in Edinburgh. If anyone is interested in attending any excellent Obstetric Anaesthesia meetings the OAA hold two very well regarded meetings held every year - see the links below: References Challenges and Choices in Obstetric Anaesthesia - Sydney Convention centre May 3-4 2023 Obstetric Anaesthetist's Association OAA-UK - see links to their annual meetings Moran, NF, Bishop, DG, Fawcus, S, Morris, E, Shakur-Still, H, Devall, AJ, et al. Tranexamic acid at cesarean delivery: drug-error deaths. BJOG. 2023; 130(1): 114– 117. https://doi.org/10.1111/1471-0528.17292

You are called to a code blue medical on labour ward - a previously well nulliparous woman has just had a seizure, and now seems confused. Her observations are normal, she is not hypertensive and the CTG appears fine. She is presumed to have had an eclamptic seizure and is given oxygen, magnesium and has some urgent pre-eclampsia bloods and urine sent. The midwife states she has been trying to stay well hydrated with lots of coconut water and has been on oxytocin to augment her labour for a number of hours. Her results are all normal except for a sodium of 111. She suddenly starts to begin seizing again....... Hi everyone, This week I am joined by two guests - Siv our current education fellow and Jess who is a senior ICU trainee working in our department to discuss a very important but perhaps somewhat often overlooked condition - peripartum hyponatraemia. As we acknowledge in the podcast hyponatraemia is a huge topic and in order to make this podcast more manageable and practical we have chosen to focus specifically on peripartum hyponatraemia, it's common causes, recognition & diagnosis, practical management and how to avoid the harms associated with excessively rapid correction. Thanks Jess! References Guideline for the Prevention, Diagnosis and Management of Hyponatraemia in Labour and the Immediate Postpartum Period - GAIN Northern Ireland March 2017

Hi Everyone, In our tertiary women's hospital here in Perth we use remifentanil PCA in labour approximately 15 times a year - and we are told that in Australian terms this is considered a "heavy user" of this labour analgesic technqiue. This week I sit down with Mike Jamison an anaesthetic fellow from Belfast spending a year with us here in Perth. When he arrived in WA we quickly learned from him that remifentanil PCA is commonly used for labour analgesia in Northern Ireland with one unit he worked in having prescribed this technique for more than 11,000 women. We sit down to have a deep dive into the use of remifentanil PCA in labour in Northern Ireland. What aspects of their approach have led it to become such a commonly utilised technique? What is their recipe? How do they prescribe it, how do they monitor the women and how is this technique now viewed amongst the obstetric, midwifery and wider Northern Irish community! If you are attending the upcoming Obstetric Anaesthesia satellite meeting in Sydney in a few weeks - come along to hear Mike talk on this in person! References Intravenous remifentanil patient-controlled analgesia versus intramuscular pethidine for pain relief in labour (RESPITE): an open-label, multicentre, randomised controlled trial. The Lancet volume 392, p662-672, AUGUST 25, 2018 Remifentanil patient-controlled intravenous analgesia during labour: a retrospective observational study of 10 years' experience. H Murray, P Hodgkinson, D Hughes. Int J Obstet Anesth 2019 Aug;39:29-39

You are referred a patient who needs urgent surgery and the obstetrician tells you she has some obscure medical condition which you have never heard of before. Does her condition have any implications for the safe conduct of anaesthesia? How can you find out in a timely manner what the specific anaesthetic issues are and what anaesthetics have been used safely by others in these patients before? Hi everyone, This week I am joined by Siv and Sarah to discuss this tricky situation and to give a free plug for the website orphananesthesia.eu a site started by the German society of anaesthesiology and now contributed to by anaesthesia providers from all over the world to help with these difficult patients. Correction: In the podcast we referred to Stoelting's textbook - this text is actually titled "Anesthesia and co-existing disease" - but not dedicated specifically to rare or uncommon disorders. A more relevant text would have been Fleischer et al "Anaesthesia and uncommon diseases". References https://www.orphananesthesia.eu/en/

Arterial lines - let's face it who doesn't love them? When you have a truly sick patient these humble and often underrated devices bring so much to the table, precise control of the haemodynamics, assessment of gas exchange, blood sampling to assess coagulation, anaemia and many other parameters. There is nothing more frustrating however when these lines don't go in easily, malfunction or stop working altogether..... Hi everyone, This week I sit down with Graeme and Siv to dissect & discuss a great review article. The authors do a great job performing a deep dive into almost every imaginable aspect of their use, including insertion techniques, ultrasound, angle of insertion, length, size, site, construction, securement, and more. Join us and no matter what your level of experience I am sure you will learn something new - I know I certainly did! References Preventing radial arterial catheter failure in critical care - Factoring updated clinical strategies and techniques. Anaesth Crit Care Pain Med 2022 Aug;41(4):101096. *Unfortunately this is an article in a journal owned by Elsevier (in my humble opinion a company not very supportive of open access) and is behind a pay-wall. You can access this through the ANZCA library or your own institutions library in some cases.

(Hypothetical case) You are called to the PACU to review a patient, who despite face mask oxygen has saturations of only 88%. She is a woman in her 50s who has just undergone a 3 hour laparoscopic hysterectomy for endometrial cancer. She has a BMI of 48, has been a smoker for 30 years, and had a chest infection 3 weeks ago. When she walked into the hospital earlier this morning she was breathing relatively normally. She had a long period of time when we she was steeply head down, there was a pneumoperitoneum of gas pushing on her lung bases and we were positively ventilating her with the anaesthetist choosing what gas mixture, pressures and ventilation modes they used. What has happened during this operation and anaesthetic that now she has serious respiratory dysfunction here only a few hours later in PACU? Are there any strategies that we could have employed intraoperatively to try and minimise or avoid postoperative respiratory problems like this? Join Lloyd and I as we discuss this thorny issue which is not uncommon in gynaecological patients having laparoscopic and open abdominal surgery. Part 1: We discuss post pulmonary dysfunction and consensus statements on the topic. Part 2: We talk about practical intraoperative & postoperative strategies you might consider to try and protect the lungs and prevent any problems. "Lloyd's Recipe" Check the patient's oxygen sats whilst supine - pre induction (use to plan target sats intra & post) Individualise FiO2 for pre-oxygenation and not necessarily 100% for most (usually 80%) Have the APL valve at around 5cm H20 when preoxygenating Head-up / ramped (to maintain FRC) Recruitment manoeuvre after intubation and before pneumoperitoneum - use a machine technique not hand recruitment. Start with a PEEP 5-8cm H20, individualise during the case - may need higher whilst head down and pneumoperitoneum. Small Tidal Volumes (TV) 5-8ml/kg of ideal body weight - (obese patients don't get bigger TV's) Keep FiO2 < 0.4 I:E ratio 1:1 If disconnection - repeat recruitment maneouvre At emergence / extubation - sitting upright, don't disconnect to suction ETT, recruit again if laparoscopic procedure or obese. Routinely use NM monitoring - ensure TOFR >0.95 Don't use 100% O2, Aim FiO2 < 0.8 If breathing on manual ventilation setting have APL valve at 5-10 to maintain PEEP Squeeze bag as extubating Immediately post extubation place face mask with APL still at 5-10 Be cautious / avoid excessive opioids that will suppress respiratory drive in PACU References A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications BJA 2018 May 120(5) Postoperative pulmonary complications BJA: British Journal of Anaesthesia, Volume 118, Issue 3, March 2017, Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis BMJ 2020; 368 Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations BJA 2019 Dec;123(6)

Hi everyone, This week three of us sit down to discuss a great review article (and topic) - the use of TIVA (total intravenous anaesthesia) for GA caesarean surgery. For many the classic technique for a GA caesarean has been thio / sux tube then volatile & nitrous oxide. In recent years many aspects of this have started to change with propofol probably more commonly used as the i.v. induction agent and now in many cases rocuronium is used in preference to suxamethonium. Now with the much increased use of TIVA across anaesthesia practice there is a renewed interest in it's role for women having caesarean surgery and GA for management of postpartum haemorrhage. Join us as we discuss this article. What do we mean by TIVA? What are the potential benefits? (uterine tone, recovery, PONV) and are there risks? (awareness, fetal depression, over sedation). It is fair to say there has not been a lot of high quality research done on this topic and there are more questions than definitive answers, but this article does well to summarise the issues and what we do know. Informal Twitter Poll result from Parita!: References The role of total intravenous anaesthesia for caesarean delivery. Y. Metodiev, D.N. Lucas IJOA April 08, 2022 Comments on above article - M.Paech IJOA June 28, 2022

Hi Everyone, You receive a phone call at 2am from a junior colleague who tells you that they are managing a code blue caesarean section and in the confusion of urgently administering a number of different medications they have just accidentally injected 10ml of cephazolin into the epidural catheter instead of the intravenous tubing. They are understandably upset and worried. (* This is a hypothetical scenario). What are wrong route errors? How common are they? How do they happen? Article from 2012 - "The US Pharmacopeia, the largest information source of tube misconnection related errors, has received 1600 reports of epidural to central or peripheral intravenous misconnections since 1999." What is NRFIT and how will this help improve patient safety? When is it coming? - It is already here and will probably coming to your health service soon. Many hospitals around the world including all of Japan have already changed over and a few sites in Australia / NZ have also now introduced NRFIT. Join Graeme and I as we discuss the issue of wrong route errors, and what you need to know about NRFIT, as well of course a few bad Xmas jokes! LINKS Reducing Risk of Epidural-Intravenous Misconnections - APSF Newsletter Winter 2012 Challenges when introducing NRFit™ at a tertiary hospital in Japan International Journal of Obstetric Anesthesia, 2022-02-01, Volume 49, Article 103244 . This article is behind Elseviers firewall but you should be able to access it through the ANZCA library or your own hospitals if you are lucky enough to have these available. NRFIT Pajunk Stay connected GEDSA NRFIT website

Hi everyone, This week Graeme and I sit down for the first time in nearly a year and do a bit of a deep dive on the use of nitrous oxide as an analgesic in labour. We drop a few dad jokes, discuss the history of inhaled analgesics, nitrous oxide use around the world, the evidence, the environmental concerns and other interesting anecdotes. Do you have nitrous oxide on labour ward in your part of the world? Send us a comment and let us know! Enjoy LINKS ANZCA Blue Book 2021 (Australasian Anaesthesia) - go to page 183 Developments in labour analgesia and their use in Australia 2015 Safety and Utility of Nitrous Oxide for Labor Analgesia APSF Journal June 2020

Your 76 yr old patient is now two days post her laparotomy for ovarian cancer. She looks well, is starting to eat and keen to get up to the shower as well as have all the "annoying lines and tubes removed from my arms!". Unfortunately she is still on 3ml/hr of a metaraminol infusion and everytime the nurse tries to wean it off her BP drops to 70/45..... Is there anything you can do? Hi everyone, This week Rheily and I discuss the pharmacology of oral midodrine a alpha adrenergic agonist useful as an oral systemic vasoconstrictor. Join us as we discuss the ins and outs of using oral midodrine - please leave us a comment if you have some experience or tips to share! USEFUL LINKS Australasian Anaesthesia 2019 (Blue Book) Article - go to page 101

Hi everyone, This week Sneha leads a discussion with both Matt and myself where we take a deep dive into how to actually perform an epidural blood patch. Even though you can't really classify this as an uncommon procedure, as individuals we probably don't do very many and it is hard for most of us to become experienced and "expert" (whatever that is defined as). We discuss the evidence, the effectiveness, the practical considerations and some of the common problems / difficulties which may be encountered. Thanks Sneha (for organising and leading this episode) and of course you too Matt! LINKS Epidural blood patch: A narrative review - Anaesthesia Critical Care & Pain Medicine October 2022 Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch International Journal of Obstetric Anesthesia 2019

Welcome to this podcast, the tenth in our series of obstetric anaesthesia basics. Join us for this the second part of a conversation where we discuss all things relating to neuraxial anaesthesia for Caesarean section. Due to it's length we have split this discussion into two parts – who would have thought we could talk for so long about this! (I thought it would only be one episode and was surprised what we teased out). Thanks Shilpa, Matt & Roger! BASICS OF OBSTETRIC ANAESTHESIA The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 – Epidural analgesia in labour part 1 2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 – Accidental dural puncture and intrathecal catheters 4 – Post-dural puncture headaches and management 5 – Pre-eclampsia, eclampsia and hypertensive disorders 6 – General anaesthesia for Caesarean Delivery part 1 7 – General anaesthesia for Caesarean Delivery part 2 8 – Obstetric Haemorrhage 9 – Neuraxial anaesthesia for Caesarean Delivery part 1 10 - Neuraxial anaesthesia for Caesarean Delivery part 2

Welcome to this podcast, the ninth in our series of obstetric anaesthesia basics. Join us for this the first part of a conversation where we discuss all things relating to neuraxial anaesthesia for Caesarean section. Due to it's length we have split this discussion into two parts – who would have thought we could talk for so long about this! (I thought it would only be one episode and was surprised what we teased out). Thanks Shilpa, Matt & Roger! BASICS OF OBSTETRIC ANAESTHESIA The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 – Epidural analgesia in labour part 1 2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 – Accidental dural puncture and intrathecal catheters 4 – Post-dural puncture headaches and management 5 – Pre-eclampsia, eclampsia and hypertensive disorders 6 – General anaesthesia for Caesarean Delivery part 1 7 – General anaesthesia for Caesarean Delivery part 2 8 – Obstetric Haemorrhage 9 – Neuraxial anaesthesia for Caesarean Delivery part 1 10 - Neuraxial anaesthesia for Caesarean Delivery part 2 https://www.obsgynaecritcare.org/podcast-series-on-the-basics-of-obstetric-anaesthesia/

Hi everyone, Join us this week as we briefly celebrate the 100th episode - almost exactly 5 years after the first episodes aired. Then we sit down to discuss some real haemorrhage cases - a follow up on our promise from the earlier episode 97 where we discuss the basics of managing obstetric haemorrhage. Thanks Graeme, Shilpa and Matt! Links 097 Obstetric haemorrhage https://youtu.be/rc9BYcIhamA MBRRACE-UK - Maternal mortality and morbidity reports UK https://youtu.be/nqRBbXxzX6Q

Hi everyone, This is the second episode of two, where I sit down with my anaesthetic colleague Sneha and senior ICU trainee Jess to discuss the important and sometimes scary topic of maternal sepsis. Join us as in this second episode where we discuss amongst many things. antibioticsfluids & vasopressorsmulti-organ dysfunctionsource controlanecdotes & tips Thanks Sneha & Jess! If you haven't already listen to episode one first: https://www.obsgynaecritcare.org/098-maternal-sepsis-with-jess-and-sneha-part-1/?preview=true LINKS “Sepsis in Pregnancy” Burlinson et al – International Journal of Obstetric Anaesthesia 2018 “Maternal sepsis” Filetici et al – Best Pract Res Clin Anaesthesiol 2022

Hi everyone, This is the first episode of two, where I sit down with my anaesthetic colleague Sneha and senior ICU trainee Jess to discuss the important and sometimes scary topic of maternal sepsis. Join us as in this first episode where we discuss amongst many things the recent changes in how sepsis is defineddetection and recognition in pregnancycommon micro-organisms Thanks Sneha & Jess! LINKS "Sepsis in Pregnancy" Burlinson et al - International Journal of Obstetric Anaesthesia 2018 "Maternal sepsis" Filetici et al - Best Pract Res Clin Anaesthesiol 2022

Welcome to this podcast, the eighth in our series of obstetric anaesthesia basics. Join us for this conversation where we discuss all things relating to obstetric haemorrhage, a much feared and common obstetric emergency. Thanks Shilpa, Matt & Roger! BASICS OF OBSTETRIC ANAESTHESIA The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 – Epidural analgesia in labour part 1 2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 – Accidental dural puncture and intrathecal catheters 4 – Post-dural puncture headaches and management 5 – Pre-eclampsia, eclampsia and hypertensive disorders 6 – General anaesthesia for Caesarean Delivery part 1 7 – General anaesthesia for Caesarean Delivery part 2 8 – Obstetric Haemorrhage 9 - Neuraxial anaesthesia for Caesarean Delivery Useful Links https://youtu.be/rc9BYcIhamA https://www.obsgynaecritcare.org/rotem/

Welcome to this podcast, the seventh in our series of obstetric anaesthesia basics. Join us for this the second part of a conversation where we discuss all things relating to general anaesthesia for Caesarean section. Due to it's length we have split this discussion into two parts – who would have thought we could talk for so long about this! (I thought it would only be one episode and was surprised what we teased out). It makes easier listening if you listen to episode one first! Thanks Laura, Matt & Roger! BASICS OF OBSTETRIC ANAESTHESIA The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 – Epidural analgesia in labour part 1 2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 – Accidental dural puncture and intrathecal catheters 4 – Post-dural puncture headaches and management 5 – Pre-eclampsia, eclampsia and hypertensive disorders 6 – General anaesthesia for Caesarean Delivery 7 – Neuraxial anaesthesia for caesarean delivery 8 – Postpartum haemorrhage

Welcome to this podcast, the sixth in our series of obstetric anaesthesia basics. Join us for this the first part of a conversation where we discuss all things relating to general anaesthesia for Caesarean section. Due to it's length we have split this discussion into two parts - who would have thought we could talk for so long about this! (I thought it would only be one episode and was surprised what we teased out). Thanks Laura, Matt & Roger! BASICS OF OBSTETRIC ANAESTHESIA The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 – Epidural analgesia in labour part 1 2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 – Accidental dural puncture and intrathecal catheters 4 – Post-dural puncture headaches and management 5 – Pre-eclampsia, eclampsia and hypertensive disorders 6 – General anaesthesia for Caesarean Delivery 7 – Neuraxial anaesthesia for caesarean delivery 8 – Postpartum haemorrhage

Welcome to this podcast, the fifth in our series of obstetric anaesthesia basics. Join us for this conversation where we discuss eclampsia, pre-eclampsia, hypertensive disorders and the specific issues relating to provision of obstetric anaesthesia. Thanks Laura, Graeme & Roger! BASICS OF OBSTETRIC ANAESTHESIA The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 – Epidural analgesia in labour part 1 2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 – Accidental dural puncture and intrathecal catheters 4 – Post-dural puncture headaches and management 5 – Pre-eclampsia, eclampsia and hypertensive disorders 6 – General anaesthesia for Caesarean Delivery 7 – Neuraxial anaesthesia for caesarean delivery 8 – Postpartum haemorrhage

Welcome to this podcast, the four in our series of obstetric anaesthesia basics. Join us for this conversation where we discuss the approach to a woman with a suspected or known post dural puncture headache. This follows our previous discussion of the incidence, significance and management of accidental dural punctures & intrathecal catheters, which you may want to listen to prior to this episode. Thanks Laura, Matt & Roger! BASICS OF OBSTETRIC ANAESTHESIA The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 – Epidural analgesia in labour part 1 2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 – Accidental dural puncture and intrathecal catheters 4 – Post-dural puncture headaches and management 5 – General anaesthesia for Caesarean Delivery 6 – Pre-eclampsia, eclampsia and hypertensive disorders 7 – Neuraxial anaesthesia for caesarean delivery 8 – Postpartum haemorrhage

Welcome to this podcast, the third in our series of obstetric anaesthesia basics. Join us for this conversation where we discuss the incidence, significance and management of accidental dural punctures & intrathecal catheters. Thanks Laura, Matt & Roger! BASICS OF OBSTETRIC ANAESTHESIA The "Basics of Obstetric Anaesthesia" is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 - Epidural analgesia in labour part 1 2 - Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 - Accidental dural puncture and intrathecal catheters 4 - Post-dural puncture headaches and management 5 - General anaesthesia for Caesarean Delivery 6 - Pre-eclampsia, eclampsia and hypertensive disorders 7 - Neuraxial anaesthesia for caesarean delivery 8 - Postpartum haemorrhage

In Part 2 of epidural analgesia in labour we discuss common problems, difficulties and how to troubleshoot issues in our epidurals on labour ward. Thanks again Matt & Shilpa! BASICS OF OBSTETRIC ANAESTHESIA The “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will need to understand if you wish to practice obstetric anaesthesia. These will be especially useful to anaesthesia trainees new to obstetric anaesthesia but also may appeal to experienced practitioners wanting a refresher of the basics in this subspecialty area. 1 – Epidural analgesia in labour part 1 2 – Epidural analgesia in labour part 2, pitfalls and troubleshooting 3 – Accidental dural puncture and intrathecal catheters 4 – Post-dural puncture headaches and management 5 – General anaesthesia for Caesarean Delivery 6 – Pre-eclampsia, eclampsia and hypertensive disorders 7 – Neuraxial anaesthesia for caesarean delivery 8 – Postpartum haemorrhage