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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 part 1 7 – General anaesthesia for Caesarean Delivery part 2 8 – Obstetric Haemorrhage 9 – Neuraxial anaesthesia for Caesarean Delivery https://www.obsgynaecritcare.org/podcast-series-on-the-basics-of-obstetric-anaesthesia/

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 part 1 7 – General anaesthesia for Caesarean Delivery part 2 8 – Obstetric Haemorrhage 9 – Neuraxial anaesthesia for Caesarean Delivery https://www.obsgynaecritcare.org/podcast-series-on-the-basics-of-obstetric-anaesthesia/embed/#?secret=Ut7cFWuyJp#?secret=NAwEYLzf8U

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 part 1 7 – General anaesthesia for Caesarean Delivery part 2 8 – Obstetric Haemorrhage 9 – Neuraxial anaesthesia for Caesarean Delivery https://www.obsgynaecritcare.org/podcast-series-on-the-basics-of-obstetric-anaesthesia/embed/#?secret=Ut7cFWuyJp#?secret=NAwEYLzf8U

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 – 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 https://www.obsgynaecritcare.org/podcast-series-on-the-basics-of-obstetric-anaesthesia/embed/#?secret=Ut7cFWuyJp#?secret=NAwEYLzf8U

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 – 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 https://www.obsgynaecritcare.org/podcast-series-on-the-basics-of-obstetric-anaesthesia/embed/#?secret=Ut7cFWuyJp#?secret=NAwEYLzf8U

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 – 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 https://www.obsgynaecritcare.org/podcast-series-on-the-basics-of-obstetric-anaesthesia/embed/#?secret=Ut7cFWuyJp#?secret=NAwEYLzf8U

We discuss the basics involved in epidural analgesia for labour. Join us in the next podcast where we will discuss common problems, pitfalls and how to trouble-shoot issues. Thanks 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 – 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 https://www.obsgynaecritcare.org/podcast-series-on-the-basics-of-obstetric-anaesthesia/embed/#?secret=Ut7cFWuyJp#?secret=NAwEYLzf8U

You get called to a code blue medical in the maternofetal assessment unit of your labour ward. A pregnant woman at 35 weeks has presented in severe respiratory distress. Her BP is 220/110, her heart rate 120/min, oxygen sats 88% despite high flow oxygen. She has a history of hypertension, diabetes and amphetamine abuse. You grab the nearby obstetric ultrasound (because it is there) and quickly scan her lungs with the curvilinear probe - all the lung fields are full of B-lines..... Hi everyone join Graeme and I as we discuss the acute management of this condition, variously known as SCAPE (sympathetic crashing acute pulmonary oedema), flash pulmonary oedema, or hypertensive pulmonary oedema. Links Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society of Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group. J Card Fail. 2016 Aug;22(8):618-27 A critical appraisal of the morphine in the acute pulmonary edema: real or real uncertain? J Thorac Dis. 2017 Jul;9(7):1802-1805.  https://emcrit.org/pulmcrit/scape-2/#:~:text=SCAPE%20%28Sympathetic%20Crashing%20Acute%20Pulmonary%20Edema%29%20is%20a,SCAPE%20in%20articles%20and%20chapters%20about%20heart%20failure.

A pregnant woman at 32/40 weeks gestation is rushed into your theatre for a code blue caesarean because of fetal distress. The team tell you that she has been in hospital for the last 6 weeks with Guillain Barre syndrome and has only just got out of ICU where she needed respiratory support for a number of weeks. What sort of anaesthetic are you going to give? Why is the traditional thio / sux / tube likely to go badly? If you inject local anaesthetics into her neuraxium what response will you expect from her already damaged nervous system? Will the drugs cause any further damage? What about breathing and swallowing problems afterwards? Hi everyone, This week I am joined by Dr Shilpa Desai, an anaesthetic consultant colleague and we discuss how to handle this rare but tricky group of patients and share a few dodgy dad jokes on the way! References https://resources.wfsahq.org/atotw/guillain-barre-syndrome/ Guillain Barre Syndrome - BJA Cardiac arrest after succinylcholine administration in a pregnant patient recovered from Guillain-Barré syndrome

A nulliparous woman is admitted to labour ward in established labour, she is in a lot of pain and asks for an epidural. The team note that a full blood count taken 2 days ago showed a platelet count of 48. Is this a real thrombocytopenia? What are the causes of thrombocytopenia in pregnancy? How are they treated? What about epidural or spinal anesthesia? Will she bleed? What if it falls further and she needs platelets? Hi everyone, Welcome to part 2 of our discussion on thrombocytopenia and platelets in pregnancy with Dr Simon Kavanagh a consultant haematologist. As this is a conversation split into two - if you haven't already please listen to part 1 first (see link below): Thanks Simon! https://www.obsgynaecritcare.org/thrombocytopenia-in-pregnancy/

A nulliparous woman is admitted to labour ward in established labour, she is in a lot of pain and asks for an epidural. The team note that a full blood count taken 2 days ago showed a platelet count of 48. Is this a real thrombocytopenia? What are the causes of thrombocytopenia in pregnancy? How are they treated? What about epidural or spinal anesthesia? Will she bleed? What if it falls further and she needs platelets? Hi everyone, This week I have a new guest on the show Dr Simon Kavanagh a consultant haematologist and we do a two part deep dive into thrombocytopenia in pregnancy, what are the causes, what to do and who to call! (hint they specialise in diseases of the blood…..) Thanks Simon! References HOW Collaborative position paper on the management of thrombocytopenia in pregnancy – ANZJOG Jan 2021 This is published by Wiley and you may need to access it via your institution / library

You are called to see a 31 yr old woman on the ward who is 8 hours postop after a diagnostic laparoscopy to investigate her longterm chronic pelvic pain. The nurse treating her is concerned because she is still complaining of pain despite many analgesics, however she is more concerned by the patient’s increasingly erratic behaviour and agitation. Her heart rate is 108/min, NIBP 155/95, she appears sweaty, temp = 38.9C, appears restless and has some noticeable tremor. When you examine her she has very brisk reflexes and three beats of clonus in her ankles. Glancing at her med chart you see she is usually on desvenlafaxine 50mg/day, tramadol 100mg BD, and admits to using methamphetamine recreationally. Join Graeme and I as we discuss a rational approach to this sort of scenario, share some real life anecdotes and trade a few more dodgy dad jokes. Differential diagnoses (don’t miss these) Deeper dive into SS syndrome, and NLMS References Tutorial of the Week 2010 Serotonergic Syndrome Serotonin Syndrome in the Perioperative Period BJA Education 2020

You are called to review a 35yr old woman at 36 weeks in labour ward who has had a couple of “funny turns” in the last 15 minutes where she became unresponsive and then seemed confused for a few minutes after. When you get there they tell you she is being induced with cervidil for premature rupture of membranes but she is not in active labour. Because of the PROM she has been started on erythromycin. She has also been unwell with hyperemesis most of the pregnancy but has been vomiting a lot over the last 2 days and has received a lot of medications to try and get on top of it including, ondansetron, droperidol, famotidine and maxalon – with only limited effect. She looks pretty thin and she says she has had a lot of trouble with her weight / nutrition because of her chronic nausea. The team have done some observations on her – she has a heart rate of 57/min, BP 100/55, she is afebrile and not tachypneic. At this stage the team thinks maybe she is fainting because she is a bit dehydrated but decide to send off some bloods and to do an ECG “to make sure there is nothing else going on”. Her bloods come back and her potassium is only 2.2 and she is anaemic Hb 95. The ECG shows the following – what’s wrong? (Image borrowed from LITFL – Hypokalaemia ECG changes • LITFL • ECG Library) Suddenly she passes out again whilst the ECG is attached, what are you going to do? Image borrowed from LITFL – Polymorphic VT and Torsades de Pointes (TdP) • LITFL Join Graeme and I as we discuss another fascinating topic after having a couple of patients recently with this challenging but fascinating syndrome…..

“Doctor did you know your next patient is a micro alert ?” What does this mean? Do we have to suit up as if there has been an outbreak of Ebola? Will Cefazolin 2g suffice? I just pushed in the vancomycin as recommended – why is the patient now on noradrenaline????? This week I am joined by Jodie Jamieson – an anaesthetic colleague and Claire Kendrick a pharmacist here at KEMH. We discuss the most commonly encountered microbiology alerts, especially MRSA and important safety points concerning some of the less commonly encountered antibiotics. Thanks Jodie and Claire! Note these are the microbiology alerts used in Western Australia – they will not be the same in other parts of the world! USEFUL LINKS Therapeutic Guidelines – https://www.tg.org.au KEMH Clinical Guidelines for health professionals – https://www.kemh.health.wa.gov.au/For-health-professionals/Clinical-guidelines/OG