Attended #OAA25ASM? Want to relive that educational jamboree experience? Visit your My OAA> Event videos www.oaa-anaes.ac.uk
Didn’t attend? Banish FOMO. All @oaa-anaes.bsky.social members can access all OAA events past 5 years up to 6m after the latest event!! Membership with benefits!!!
Sizzling Belfast is where the #OBAnes very cool people came together for the #OAA25ASM gig. Look out for future tour dates
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?
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?”
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
Other societies: @ASALifeline @ASRA_Society don’t require gowning for spinal OR epidural. @CASUpdate quote interesting - not a statement, but @CASUpdate study, no mention of gowns for epidurals. @Assoc_Anaes appears ambivalent (gowns are standard precautions?) #OAA25ASM #OBAnes
There’s no evidence for gowning in terms of reducing the risk of CNS infection post spinal. Looking at other colleagues in the hospital: few wear gowns (however, few wear masks too. At least all wear gloves?) Peer pressure from abroad? #OAA25ASM #OBAnes
There’s a limit to “evidence-based” decision making on consequential issues if there may never be any, where an RCT is impossible. PARACHUTES. Surely “primum non nocere” supersedes? Cognitive dissonance abounds: no spinal below 50-70 as no evidence it’s safe. #OAA25ASM #OBAnes
Now the USA is different, 2017 ASA practice advisory did not recommend gowns (based on lack of evidence base & survey results). But should practice elsewhere be dictated by USA, especially where some experts were also against handwashing? Elbows up, but keep gloves on 🇨🇦) #OAA25ASM #OBAnes
National guidelines: remember gowning guidance only in 2008 ANZCA reaffirmed the same in 2015, as did AAGBI IPAC guidelines in 2020. Why pressure to change? How much of resistance based on tribal tradition/ dogma? Fallout from COVID fatigue? #OAA25ASM #OBAnes
Editorial correction from @fatemah_qasem: PEARLS stands for : Promoting Excellence And Reflective Learning in Simulation. (Google fails me again on acronyms) #OAA25ASM
A broad aetiology reflecting the bio-psycho-social impacts on pain. Literature has tried to establish factors impacting persistence of pain after CHILDBIRTH (PPAC) which itself affects maternal outcomes. We may not be able to mitigate maternal factors but #OBAnes perhaps? #OAA25ASM
