Carolyn Chan Dromgoole

Anaesthetist. Pre-Will&Finn expedition medic and globe trotter. 🇬🇧🇸🇬 🇪🇺LNWUH UK / KKH Singapore

[Dr. Rahul Baxi @baxirahul]

Knowledge doesn’t equal immunity. Doctors face the same metabolic risks as the population with long work hours, stress, poor sleep and inactivity.

#Medtwitter

[Ed Mariano, MD, MAS, FASA, FASRA @EMARIANOMD]

Great summary of current evidence related to mixing local anesthetics from Dr @ESoffin @HSSAnesthesia at #PGA79

She also shared a free app from Johns Hopkins that can help calculate safe local anesthetic dosing when mixing local anesthetics.

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Tired of spending ages going through the STOP-BANG questionnaire to assess the peri-op risk of obstructive sleep apnoea?

Check out the B-APNEIC score - it has only 4 variables:
• BMI > 35 kg/m-2
• BP
• neck circumference > 40 cm
• witnessed breathing interruptions

#AnSky #MedTwitter

https://t.co/YYWBx5kL9Z

[Aravind Palraj @Rheumat_Aravind]

Normal blood pressure does not rule out sepsis.

Lactate ≥2 mmol/L, delayed vasopressors, fluid overload, and missed sources are where outcomes are decided.

A practical 2025 guide to sepsis recognition and early management.

#SepsisCare #MedTwitter #FOAMed @DrAkhilX @IhabFathiSulima #ICU

[MBRRACE UK @mbrrace]

The latest MBRRACE-UK Saving Lives, Improving Mothers’ Care report on women who died during or up to a year after pregnancy between 2020 and 2022 released today.

Read more:https://t.co/fFx5yHMOyk

@marianfknight @npeu_oxford @oxford_ndph

[Tim Cook @doctimcook]

FRAILTY, PERIOPERATIVE RISK & CARDIAC ARREST

Frailty in NAP7 a 🧵

Frailty (ie clinical frailty scale score >4) was a big issue in the aetiology of perioperative cardiac arrest

TL/DR

-a high proportion of cases
-frail patients’ more likely
*to be emergency surgery
*to be major surgery
-increased complications
-insufficient illogical monitoring (IMO)
-low rates of DNACPR recommendations
-insufficient risk assessment & communication
-these patients account for a substantial proportion of cardiac arrests
-risk assessment (& communication) poor
-drug dosing an issue in many
-periop cardiac arrest rate ≈8-fold higher than the young & fit
-successful ROSC rate notably lower
-overall early mortality after periop cardiac arrest 40-fold higher then in the young & fit

Frailty arguably a bigger issue than older age

It is a topic relevant t to
-all anaesthetists,
-all perioperative physicians
-orthogeriatricians
- those planning services
& many more

https://t.co/4i6VeIpVYF

https://t.co/WVm5jr1zVy

@NAPs_RCoA @jas_soar @IainMoppett @AgeAnaesthesia @RCoANews @drrichstrong @emirakur @adk300 @CPOC_News

1/n

[International Journal of Obstetric Anesthesia @IJOA_Journal]

Non-targeted serial epidural blood patching for treatment of intracranial hypotension headache during late pregnancy: a case report
💉Serial blood patches may control symptoms/gain time for fetal maturity
💉Definitive treatment can be done post-delivery

https://t.co/ALivTczUke

[International Journal of Obstetric Anesthesia @IJOA_Journal]

Systematic review of pulmonary hypertension (PH) in pregnancy:
🫁PH severity is an important outcome predictor in pregnancy
🫁Mortality continues to decrease and patients with mild disease have better outcomes
🫁Most studies define PH by echocardiography
https://t.co/TOuDTUVvbT

[International Journal of Obstetric Anesthesia @IJOA_Journal]

Total spinal anaesthesia in #ObAnes: a narrative review
🧠Spinal after epidural most common precipitant reported recently
🧠Good outcome when treated promptly
🧠Poor outcomes associated with delayed recognition and inadequate resuscitation

https://t.co/uawQMc0ZAu

[British Journal of Anaesthesia @BJAJournals]

#BJAEd - The difficult #spinal anaesthetic: the key to success? Dr Poots & Prof Chin elegantly describe the #paraspinous approach, why it could work well, and how to do it. An article which could change your every day practice. Read the full article at: https://t.co/JjOI78U4gp

[International Journal of Obstetric Anesthesia @IJOA_Journal]

Total spinal anaesthesia in #ObAnes: a narrative review
🧠Spinal after epidural most common precipitant reported recently
🧠Good outcome when treated promptly
🧠Poor outcomes associated with delayed recognition and inadequate resuscitation

https://t.co/uawQMc0rKW

[International Journal of Obstetric Anesthesia @IJOA_Journal]

Total spinal anaesthesia in #ObAnes: a narrative review
🧠Spinal after epidural most common precipitant reported recently
🧠Good outcome when treated promptly
🧠Poor outcomes associated with delayed recognition and inadequate resuscitation
#SOAPAM2024
https://t.co/uawQMc0rKW

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Medication errors are potentially avoidable & can affect maternal/neonatal outcomes & costs

NAP7 found errors caused cardiac arrest in 2 obstetric patients

Tageldin asks - can we have more details?

@doctimcook @noolslucas

🔗https://t.co/YUyDnO0lZt

https://t.co/H2hH2L0gpv

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Why don't people receive epidural analgesia in labour?

Delay in:

➡️receiving information about epidural analgesia prior to hospital

➡️seeking epidural analgesia in hospital

➡️receiving epidural analgesia

@AliciaTDennis @nsheridan123

🔗https://t.co/po96sDUFoJ

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Why is obstetric haemorrhage under-recognised & under-treated?

➡️relative preservation of haemodynamic vital signs during the early stages of bleeding

➡️estimate of blood loss unavailable until the end of the operation

@DavidTMonks @ArviPalanisamy

🔗https://t.co/8xDR8bI8Kt

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

⚠️Attention obstetric anaesthetists!⚠️

Outcomes from the @RCoANews NAP7 study

➡️Haemorrhage was the single leading cause of peri-operative cardiac arrest in obstetric patients

➡️Underestimated severity & inadequate early resuscitation contributed

🔗https://t.co/Cexp2FV7aj

[Cardio-Obstetrics @CardioOb]

Opportunities in Postpartum Period to Reduce CVD Risk After Adverse Pregnancy Outcomes:
A Scientific Statement From @AHAScience

@jennlewey @GarimaVSharmaMD @DrLaxmiMehta @HeartDocSadiya @ElizaMillerMD
#CardioObstetrics
https://t.co/d5cIcpNYt1

[Tim Cook @doctimcook]

I think a key message is that
-at the point of intubation
-for most non theatre settings
-including in neonatology

CAPNOGRAPHY is not a respiratory monitor.

CAPNOGRAPHY is an AIRWAY MONITOR

A positive upstroke on the capnograph shows we have alveolar ventilation (ie exhalation from alveoli engage in gas exchange). This requires a patent airway & gas flow.

It’s that simple.

For non anaesthetists
Don’t worry about the phases of the CO2 trace.
Do understand hats and caps

[International Journal of Obstetric Anesthesia @IJOA_Journal]

Is crystalloid co-loading necessary to prevent spinal hypotension during elective cesarean delivery?

• Crystalloid co-loading = ⬇️phenylephrine dose to maintain BP
• Cardiac output can be reduced despite normal BP

@girardDev #ObAnes

https://t.co/4mmnxhs9T8

[MBRRACE UK @mbrrace]

Please take a look at the programme for the virtual conference presenting the @mbrrace Perinatal Confidential Enquiry Reports 2023
Anyone with an interest in maternity care and safety is welcome to attend
Book here: https://t.co/L1tvoPE0d8