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!

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.

The post 119 PBM case discussion with Anastazia and Nolan part 1 preop anaemia appeared first on obsgynaecritcare.

Hi Everyone,

This week is part two of a series where Dr Mark Johnson and I discuss the emerging field of onco-anaesthesia.

An increasingly enormous number of people every year undergo anaesthesia in order to have cancer surgery. Many different aspects of their surgical, anaesthetic and post surgical analgesic care are known to have effects on the immune system, the inflammatory response to surgery and some drugs act directly on receptors on cancer cells themselves. Is it possible or even probable that there are aspects of the techniques and drugs we use that could effect our patients long term cancer outcomes?

How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676329/

Influence of perioperative anaesthetic and analgesic interventions on oncological outcomes: a narrative review

The post 057 – Part Two Ten Commandments of Oncoanaesthesia with Dr Mark Johnson appeared first on obsgynaecritcare.

Hi Everyone,

This week I am joined by Dr Mark Johnson for part 1 of a two part series where we discuss the emerging field of onco-anaesthesia.

An increasingly enormous number of people every year undergo anaesthesia in order to have cancer surgery. Many different aspects of their surgical, anaesthetic and post surgical analgesic care are known to have effects on the immune system, the inflammatory response to surgery and some drugs act directly on receptors on cancer cells themselves. Is it possible or even probable that there are aspects of the techniques and drugs we use that could effect our patients long term cancer outcomes?

How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676329/

Influence of perioperative anaesthetic and analgesic interventions on oncological outcomes: a narrative review

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563034/

The post 056 – Part One – Ten Commandments of Oncoanaesthesia with Dr Mark Johnson appeared first on obsgynaecritcare.

Hi Everyone,

This week we have a great four person discussion around the importance of assembling the right team when confronted with a high risk complex case in the after hours period. Interesting points covered include still doing the team huddle and introducing everyone even at midnight, a detailed discussion around manual aortic compression – the IVC, and how to monitor effectiveness – and also using a posterior hysterotomy to deliver the fetus when everywhere else looks bad!

Thanks to IKEA for their contribution to our high tech podcast studio!

Thanks also Parvesh, Matt Epee-Bekima & Matt Rucklidge for this great discussion.

(* The patient discussed in this podcast gave us explicit written consent for her case to be used in this deidentified discussion)

The post 048 – After hours critical cases discussion about assembling a good team and communication. appeared first on obsgynaecritcare.

Hi Everyone,

Welcome to part 1 of a two part series on the use of cell salvage in obstetrics & gynaecology!

This week Part 1 focuses on the basics of how cell salvage works and what the staff in the surgical field (nursing and surgical) need to know to do it properly!

Next week we hear from Dr Matt Rucklidge who discusses all the latest controversies and developments in the arena of cell salvage during obstetrics – can we use a single suction, what about amniotic fluid in the collection system, do we always need a leukodepletion filter and how can we organise our practice so that we utilise cell salvage during those unexpected emergency cases?

These two episodes are audio extracts taken from a great combined presentation given at our local department meeting here in August. The audio from these presentations are great but for those of you who are interested in viewing a video version of this talk where you can also see the slides and images referred to in the talk feel free to watch using the link below:

https://www.dropbox.com/s/x19ximgn0d814rn/Cell%20Salvage%20update%20August%202018.mp4?dl=0

National Blood Authority guidelines for intraoperative cell salvage: https://www.blood.gov.au/ics

Great resource from the UK pdfs and free slides on all the various aspects of cell salvage: https://www.transfusionguidelines.org/transfusion-practice/uk-cell-salvage-action-group/intraoperative-cell-salvage-education

If you want to revise the benefits of autologous blood (i.e. the patient’s own blood) then listen to this earlier episode:

023 – Stored blood versus fresh salvaged blood

The post 040 – Cell salvage basics for the person holding the sucker – with Cheryl Dane Stewart appeared first on obsgynaecritcare.

Case scenario:

Mrs A Nonymous is a 67 yr old woman with a diagnosis of probable ovarian cancer who is booked for a midline laparotomy and debulking cancer surgery. She is a smoker, has a BMI of 50 and weighs 115kg. She was diagnosed with OSA 5 years ago but doesn’t use CPAP because she couldn’t tolerate it. She has had longstanding back pain for many years which she blames on an epidural which she had during childbirth 30 years ago. She has had 2 previous back operations “which didn’t help” and now takes 3 analgesics for this pain which include moderately high dose oxycodone, pregabalin, and tramadol. She tells you that she definitely will not consent to any spinal or epidural because of all of her previous back issues…

She is opioid tolerant and at high risk of serious opioid related respiratory adverse effects – how are you going to manage her pain, get her mobilising and avoid any technique that involves a needle in the back!

Hi everyone,

This week we have an interview with Dr Matt Rucklidge, a colleague and good friend who is also a consultant anaesthetist practicing here in Western Australia. Matt trained in the UK and worked in southern England, one of the pioneering regions, where he first became acquainted with the use of rectus sheath catheters for postoperative analgesia after midline laparotomy. He has helped us successfully introduce this very effective technique into our institution where it has now become the default analgesic technique for the majority of our patients undergoing major intra-abdominal surgery with a midline incision.

https://bjaed.org/article/S2058-5349(18)30033-7/abstract

Unfortunately contrary to my comments on the podcast – this article does not appear to be open access and when I tried to access it today it requires an institutional subscription or an individual payment. If you are an employee of a health service / university or a member of a college you may be able to access the article through these channels.

Want to know more about the open access debate? See our previous podcast on this here:

036 – Sci hub, earthquakes, listener mail, pirate jokes and another quiz!

The post 039 – Rectus sheath catheters for analgesia with Dr Matt Rucklidge appeared first on obsgynaecritcare.

Hi everyone,

Join us on the podcast where this week we have part 2 of the discussion with Dr Sonya Ting on tips for management of acute perioperative pain. We explore some advice on how to manage a tricky obstetric patient with post caesarean pain issues.

I also failed dismally to entice any responses to last weeks quiz entitled “Anaesthetist or serial killer”. In one final last ditch attempt to rescue this quiz from abject failure I have now rebranded it. I have supplied you with a small crossword which can be used to get some hints as to the name of the individual who is pictured – and then I am guessing using the power of  the internet someone should be able to figure out who this is!

The post 032 – Part 2 perioperative acute pain management tips with Sonya Ting and a second attempt at quiz 4 appeared first on obsgynaecritcare.

Hi everyone,

This week I am joined again by my colleague Dr Sonya Ting – where I attempt to pick her brains for some useful advice in managing difficult perioperative pain issues. Sonya’s first episode on the opioid epidemic has already taken first place on the podcast download list as the most popular episode so far!

Hypothetical Patient

A 50yr old woman is on your list and scheduled to undergo a laparascopic hysterectomy. You see her in the preoperative area:

Q – What issues / history should you explore to identify if this patient is at risk of perioperative pain issues?

Q – How are you going to explain to her the plan for her perioperative pain management, what are the goals and what strategies fo you use to manage her expectations?

Q – What communication strategies can you use, what about non-verbal and verbal communication?

Listen to Sonya and I discuss these issues on the podcast – and finally have a crack at the latest instalment of our quiz below:

Is the following person an anaesthetist or is he a serial killer (or perhaps is he both!) Massive bonus points available if you can actually name this individual!

The post 031 – Perioperative acute pain management advice part 1 with Dr Sonya Ting appeared first on obsgynaecritcare.