Dr Simon Ash (OBsleepmerchant)

My third #OBAnes session of #CASAM2025, a @CAS_OBSection and @cas_neuro collaboration, with @antonchau1 moderating @Ron_George, Dr. Ibukunoluwa Adedugbe & Dr. Kan Ma, speaking on Care of the Parturient with a Neurosurgical Condition. @CASUpdate

Second #OBAnes session of #CASAM2025 with Dr Allana Munro moderating Prof Rachel Kearns, Prof Dolores McKeen and Dr Wesley Edwards, speaking on: Code OB: Navigating High-Stakes Emergencies in #OBAnes

First #OBAnes session of #CASAM2025, @ammunro2 moderating Dr Lesley Bautista, Dr Archana Vidyasankar and Rr Ron George, speaking on: Complications in #OBAnes and Birth Trauma. (Ron was presenting everywhere, arrived in the nick of time for his slot to test IT expertise)

Consequences hitting closer to home. #CASAM2025

Why bother? CO2 has natural cycles… and they continue to, just at a higher baseline. World temperatures are rising. #CASAM2025

Speakers to come: Dr Cliff Shelton, Dr Anita Rao and Dr Gwen Morgan #CASAM2025

Moderator Prof Kristopher Schroeder provides an introduction to the session Environment Sustainability session at #CASAM2025

Environmental sustainability and the impact of anesthesia makes a splash as the first plenary session of #CASAM2025 with an excellent group of speakers.

Opportunity knocks? @govnl.bsky.social

Completely disappointing progress! We are already paying out that £ and more in harm to women & babies. And of course the human & lifelong cost of harm is incalculable. We need to do much more & NOW!

The complete Dr Fiona Donald #OAA25ASM Bruce Scott lecture on “The Future of #OBAnes as a Subspecialty” - a 🧵

Dr Fiona Donald completes her #OAA25ASM Bruce Scott lecture with a summary of who #OBAnes (indeed @OAAinfo) are and a vision of the future - and bright it is! (Belfast weather hopefully contagious)

… so! How do we makes this a reality?

#OBAnes as subspecialty: SIA since 2021 (≈ Periop Med), offer post-CCT fellowships (well subscribed), own specialist society ( @oaa-anaes.bsky.social = largest spec society, trusted source of patient information {Labourpains}, official journal { @ijoajournal.bsky.social}) - ideally poised? #OAA25ASM

#AnyAnes & related specialties: PHEM only GMC recognised subspecialty, Pain Medicine now Faculty of @rcoanews.bsky.social, ICM separate CCT. Perioperative Medicine = growing SIA, has @cpoc.bsky.social provides a home with resources partnerships & support for high quality care #OAA25ASM

Dr Fiona Donald begins rounding off the #OAA25ASM Bruce Scott lecture with a look towards the future. AI will come, it isn’t here already: need to embrace opportunities to teach it well so it unlearns human biases embedded in algorithms for #OBAnes - perhaps AI = parity/ equity?

a woman says " are you ready " in front of a pink wall ALT: a woman says " are you ready " in front of a pink wall

The weekly debate is going to happen from Monday this week, from a new location for me for a while.
I will use my location as a topic for the debate.
I have plenty of great topics coming up so get ready for another #ANSkyMedSkyDebate and let’s engage and have fun.
#AnSky #MedSky

The complete CON position “Sterile gowns should NOT be mandatory for spinal #OBAnes” from @ClaireAbeyseke1 at #OAA25ASM - an #OBAnes 🧵.

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The complete PRO position: “Sterile gowns SHOULD be mandatory for spinal #OBAnes” from @lateraltilt.bsky.social at #OAA25ASM - a #OBAnes 🧵

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The complete last session of #OAA25ASM the PRO-CON debate between @lateraltilt.bsky.social and Dr Claire Abeysekera: “Should sterile gowns be mandatory for spinal #OBAnes?”

The take home message from @ClaireAbeyseke1 with thanks. #OAA25ASM

Financial implications: the organic banana rate (Cesarean section costs 12k organic bananas) #OAA25ASM #OBAnes

Now this is more palatable: caffe latte exchange rate - something everyone can do WITHOUT flying somewhere. And perhaps something people WILL do, with less risk to patients? (Estimating risk of decaffeinated #OBAnes aside) #OAA25ASM

Carbon costing. An annual carbon audit cycle, working back from Carbon volumes, also using London-Belfast exchange rate (slightly less carbon & different offset than @ClaireAbeyseke1 numbers). Maybe planes are different? #OAA25ASM #OBAnes

The environmental impact of the #OBAnes spinal gowns in Bristol alone - the equivalent of >1.5k trips to airport! Using @lateraltilt.bsky.social historic data, around 1000round trip flights to Belfast from LHR. #OAA25ASM

Dr Abeysekera gets to meat of her argument: climate change. Environmental burden of sterile gowns ≠ zero. Their life cycle has its own CO2 burden over the gown itself. Reusable gowns not better, esp if laundry remote. 60 cycle limit? (Does someone count?) #OAA25ASM #OBAnes

A solid summary on the risk of CSF infection with NO sterile gown at #OBAnes spinal. Is the possibility of increased risk acceptable? (We don’t put spinals in below 50, hematology do) And, if our central ethos is improved care - avoiding preventable harm- why is it? #OAA25ASM

Here I think @LateralTilt makes a good point - role modelling/social influence - I only stopped gowning once I joined a unit in 🇨🇦. No one else was doing it, except for COVID. I wonder how much the pandemic shapes this debate? We all value asepsis or none do? #OAA25ASM #OBAnes

The case for gloves is interesting… not sure 4. helps the cause for gowns? 2. does though - 1 in 6 spinal needles contaminated despite sterile gloves (although study predates recommended use of masks for spinals?) #OAA25ASM #OBAnes

More maternal deaths post spinal infection. What is an acceptable risk? WHO bears the risk? How low does risk need to be for improving care to be irrelevant? Would this improvement prevent a maternal death? #OAA25ASM #OBAnes

@LateralTilt moves on to infection risk: limitations on evidence base, consequences (15% fatality rate is not innocuous), 95% CI up to 3.5/100k. Both NAP 3 & triennial report missed a case. #OAA25ASM #OBAnes