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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 22/06/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 21/06/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 21/06/2025

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)

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 21/06/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 21/06/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 21/06/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 21/06/2025

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

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Reposted by Dr Simon Ash (OBsleepmerchant)

Donna Ockenden FRSA, Hon DLitt Hon DSci @dockendenltd.bsky.social · 30/05/2025

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!

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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?

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

#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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

#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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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?

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Reposted by Dr Simon Ash (OBsleepmerchant)

Dr Mary-Ann Fox BMBS FANZCA GChPOM @maffygirl.medsky.social · 18/05/2025

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

media.tenor.com

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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?”

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

@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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

Editorial correction from @fatemah_qasem: PEARLS stands for : Promoting Excellence And Reflective Learning in Simulation. (Google fails me again on acronyms) #OAA25ASM

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 18/05/2025

@ClaireAbeyseke1 asks what the gown adds? While not linked to infections, a liberal dusting of “skin squames” may not be ideal for the sterile field - but in a #OBAnes spinal the field is upright and certainly not beneath one’s arms #OAA25AM

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

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

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

Sex differences regarding pain are not insignificant - from pK/pD, altered processing, different mechanisms of hypersensitivity. Women marginalized. 5 P’s a rough ride, then add massive physiological changes in pregnancy = complex milieu in which to manage pain! #OAA25ASM #OBAnes

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

Background on Peripartum pain. Why is it important? Disparities, the focus on the newborn. Distinct pain entities result in gap in education - for both patient and providers. Sex /Gender biases in Pain research (not small men), amplified in peripartum setting. #OAA25ASM #OBAnes

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

@athmathottungal.bsky.social that’s an entire alphabet of qualifications, which explains the disclosures. Is there such a thing as overqualified? Not at #OAA25ASM! “Beyond opioids for obstetric pain conundrums” = peripartum pain in the OB population (“small” topic, expansive agenda) #OBAnes

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

So what are the pro’s and con’s of wearing a gown according to @lateraltilt.bsky.social? My concern at this point is that the pro’s relate to something anaesthesia “don’t believe in” - it’s like having a pain at cesarean discussion. #OAA25ASM #OBAnes

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

In the auditorium, you can sense an element of moral injury in this debate. What is so hard about putting a gown on? We cancel patients because there’s 1 in 250k risk of complication, but putting on a gown for a more frequent complication is a bridge too far? #OAA25ASM #OBAnes

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

Anaesthetists seem to have a history of deep seated aversion to asepsis. Each decade seems to have an anti-asepsis “champion” - even gloves seem challenging. Here anaesthesia seeks evidence-base, where elsewhere intuitive decisions are acceptable. #OAA25ASM #OBAnes

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

@lateraltilt.bsky.social begins by pointing out that we only recently learned to gown. Handwashing only started in 1847. Wearing a mask & gown as optimal asepsis for spinal = 2008. Yet 2024 saw a movement to stop gowning for environmental reasons. #OAA25ASM #OBAnes

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

Now compare rates in #OBAnes spinals with background SPONTANEOUS neuraxial infections. Bugs are commendable of nose and oropharynx. Genotypic matching has linked anesthesiologist to infection. Not masking more problematic? #OAA25ASM

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

What do the numbers really say? NAP3 looked at major complications of neuraxial anesthesia: spinals associated with only 4 infective complications (20% of total), 4 in 325000, NONE in #OBAnes. Internationally, 1/100k ALL spinals, 0.4/100k in OB - 🇯🇵0.96/100k (>3M) #OAA25ASM

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

Providing context @anaesjournal.bsky.social poll found 77% of #AnyAnes respondents felt we should STOP gowning; @oaa-anaes.bsky.social survey 8% of #OBAnes already don’t routinely wear a gown, 79% would stop gowning if supported by guidelines. An overview of the CON position! #OAA25ASM

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

To ensure fairness, both sides of the debate have provided their slides, may the #OBAnes odds ever be in their favour. Dr Abeysekera takes the CON, stressing that the discussion is about single shot spinal NOT an epidural. #OAA25ASM

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Dr Simon Ash (OBsleepmerchant) @obsleepmerchant.bsky.social · 17/05/2025

The complete Dr Fatemah Qasem “From Gaps to Gains: Enhancing Maternal Care through System Integration Simulation” lecture at #OAA25ASM - an #OBAnes thread

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