Episodes
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Hi everyone Dexmedetomidine, is both a difficult word to pronounce correctly in casual conversation but also a useful pharmacological tool in many different situations. This week I am joined by one of our fellows Dr Han Lu to discuss dexmedetomidine, it’s history, it’s basic pharmacology and then more specifically it’s use in different clinical situations where it may be useful in obstetrics and gynaecology. Thanks Han for a great Tuesday talk and a very informative podcast! References Han’s powerpoint talk Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a sy
Hypothetical Case: You finish injecting the spinal anaesthetic for your patient who has come for an urgent caesarean section. She has pre-eclampsia and her blood pressure just before you started was 180/100. Just after lying down she starts vomiting and unfortunately the non invasive blood pressure cuff is going up and down but not giving you a number – she is shaking and can’t stop moving around. Is she vomiting because of hypotension, should you give her a bolus of phenylephrine? What if she is actually still hypertensive – you don’t want to push her BP over 200. Wouldn’t it be great if you
Declan and Sarah discuss strategies for obstetric questions in the ANZCA final exam.
Join us as Declan and Roger discuss the evidence for routine table tilt during elective caesarean section. Has this changed your practice? What is your opinion on this topic? We’d love to read your emails. As mentioned in the episode we would love to do a future episode on Q&A so if you have any questions on any topic you would like us to tackle please send them in! Send your comments / questions to: obsgynaecritcare@gmail.com References Hughes EJ, Price AN, McCabe L, Hiscocks S, Waite L, Green E, Hutter J, Pegoretti K, Cordero‐Grande L, Edwards AD, Hajnal JV. The effect of maternal position o
Hypothetical Case: You are called to MFAU to see a woman who has just arrived via RFDS (royal flying doctor service) She is a 23 y.o indigenous woman from the Kimberley in the far north of WA. She is 33/40 G1P0 complex social history and possible substance use disorders She has PPROM (pre term premature rupture of membranes) and suspected early chorioamniotis and has been given antibiotics / nifedipine and a few litres of crystalloid fluid during the flight. The obstetric team have evaluated her – she has small for gestational age baby, and is complaining of dyspnoea. Her observations are: HR
Hypothetical Case: You are called to MFAU to see a woman who has just arrived via RFDS (royal flying doctor service) She is a 23 y.o indigenous woman from the Kimberley in the far north of WA. She is 33/40 G1P0 complex social history and possible substance use disorders She has PPROM (pre term premature rupture of membranes) and suspected early chorioamniotis and has been given antibiotics / nifedipine and a few litres of crystalloid fluid during the flight. The obstetric team have evaluated her – she has small for gestational age baby, and is complaining of dyspnoea. Her observations are: HR
Hi everyone, Pain during caesarean is a very challenging and distressing event – for the patient, their partner, the anaesthetist and all the staff present in theatre. This week we catch up with Matt Rucklidge, who recently gave a presentation on this topic at the obstetric anaesthesia meeting in London. We discuss why this has become a “hot topic” in the anaesthesia world in recent times, what is the true incidence, and many other aspects of this difficult topic. References The following is a first person narrative story from a patient with commentary from an uninvolved obstetric anaesthetist
Hi everyone, Sepsis is an important cause of mortality and morbidity in our patients. It is common but can be difficult to diagnose, challenging to manage and sometimes downright scary. After being inspired by listening to an episode from “The Critical Care Commute Podcast” (with Dr Mervyn Singer a UK intensivist involved in sepsis 3.0), Graeme and I sit down to discuss some of these thought provoking areas of sepsis which are controversial and are still actively being researched. Thanks again Graeme! References The Critical Care Commute Podcast
Hi Everyone, This week I am joined by Dr Jen Kielty to discuss ERAS – Enhanced Recovery After Surgery. Jen has been helping us with the introduction of ERAS here at our hospital and also shares her experience with the introduction of ERAS into obstetrics at two hospitals back in Ireland. What is ERAS? Why is ERAS good for patients and good for the hospital? What are the components of an ERAS program? A big shout out to Dr Chloe Ayres here at KEMH as the champion for this initiative. Chloe has done a huge amount of work to make this a success here in our gynae-oncology patients and without her
Hi everyone, This week Declan and I sit down to discuss a novel non opioid analgesic drug recently approved for use by the FDA, suzetrigine. What is it? How does it work? Why should we be interested in this new class of drugs and most importantly will it live up to it’s hype? References Suzetrigine: First in a New Class of Nonopioid Analgesics for Acute Pain. Anesthesiology 142(6):p 989-991, June 2025. | DOI: 10.1097/ALN.0000000000005465 – Unfortunately this is not a free article but well worth a read if you can get to it through your hospital or college library. The accompanying podcast of th
Hi Everyone, This week I sat down with Declan to discuss a fascinating therapy which is used in many areas of medicine. This podcast has a bit of everything, a quiz, a part one viva, dubious animal experimentation, discussions about laxatives, and even some references to cosmology and the Big Bang. Thanks Declan for another entertaining episode.
You are called to assess a pregnant woman who presents to your hospital complaining of shortness of breath. She is 36 weeks pregnant with twins and tells you she had been getting progressively short of breath over the last month but put it down to the physical effects of the twin pregnancy in her abdomen. However last night she couldn't get her breath lying flat, had to sleep sitting up on 3-4 pillows and feels that "it is much worse". On examination she has a respiratory rate of 24/min, SpO2 = 92%, HR 105/min, BP 95/45 and you can hear crepitations in both lung fields. Her initial blood tests
Hi everyone, This week I am joined again by Dr David Owen an obstetrician here at KEMH. We sit down to discuss uterine inversion - an acute obstetric emergency. Luckily this condition is relatively rare - however because of this there can be challenges in recognising and treating this condition even amongst experienced individuals. Should you be unlucky enough to encounter this rare condition, now having listened to our discussion you will be better prepared and confident you know what is required! Thanks again David for your research and preparation for this episode! References Uterine invers
Hi Everyone, Welcome to Part Two of our discussion with two of the founding members of the Placenta Accreta Spectrum Team here at KEMH Dr Matt Epee-Bekima and Dr David Owen. This team was conceived in 2017 and began operating in 2018 - and has now cared for over 75 women with PAS - including 24 alone this year (2024). In this episode we continue our initial discussion with a more detailed dive into: Surgical management - team members, techniques and approach Techniques for catastophic bleeding - manual aortic compression, vascular clamping, interventional radiology Postpartum issues Controvers
Hi Everyone, This week I had the privilege of sitting down and recording two fascinating episodes with two of the founding members of the Placenta Accreta Spectrum Team from here at KEMH, Dr Matt Epee-Bekima and Dr David Owen. In this first episode we discuss the following: Definitions and pathology of placenta accreta spectrum What is the story behind the formation of the PAS team? Screening / Identification / Diagnosis and referral The optimisation and planning of the patient's journey. References King Edward Memorial Hospital website - The Placenta Accreta Spectrum guideline
Hi Everyone, Join Graeme and I as we discuss two articles chosen from last months edition of IJOA (International Journal of Obstetric Anesthesia). In the first we discuss an article exploring whether the use of intermittent calf compression can reduce hypotension and vasopressor use in women undergoing caesarean section under spinal anaesthesia. The second article looks at the utility of preoperative electrical stimulation of acupressure points prior to caesarean section reduces postoperative pain and improves the quality of maternal recovery. There's a sprinkling of our usual dad jokes at the
The next patient on your elective list arrives in theatre. She is a 35 year old woman booked for hysteroscopy to investigate her menorrhagia. She has no co-morbidities so wasn't seen preoperatively in a clinic. She tells you that she has no medical problems but did start on Wegovy for weight loss about 4months ago and has now lost about 12kg. She hasn't eaten anything since 9pm last night - it is now 10am. You were planning a general anaesthetic and a supra-glottic device, but now you're not sure what you should do? Hi everyone, This week I am joined by Erin and we discuss in detail the perple
Your patient arrives in the anaesthetic room next to theatre, she's booked for a non elective caesarean for failure to progress. She has an epidural in situ and you decide try to top it up - however after 25ml of lignocaine 2% with adrenaline and around 20min of waiting the block is stuck at the umbilicus and she can still move her legs relatively freely. This is obviously not going to be adequate - she is adamant she wants to be awake to see her baby born. You sit her up, pull out the epidural and do a single shot spinal with 2.1ml of heavy bupivacaine 0.5% + fentanyl 15mcg - after all you do
What is the EXIT procedure? Who is it used for and how do we do it? In our institution this procedure only occurs on average every 3-4 years. It is an event where a large diverse group of individuals, who often have never met each other, come together for a brief period of time to work as a highly complex team to achieve a great result for both the mother and baby. Join Lloyd and I as we do a deep discussion on this uncommon but challenging multi-disciplinary procedure. References Maternal anesthesia for EXIT procedure: A systematic review of literature. The management of congenital upper airw
Hi Everyone, This week Matt and I agreed to get together to do another journal club episode (or more accurately I printed out an article, put it in Matt's pigeon hole and told him to make himself available or else!). We went to one of our favourite journals IJOA (International Journal of Obstetric Anesthesia), where we chose an article from the latest edition published in May. The article is entitled "A narrative review of the literature relevant to obstetric anesthesiologists: the 2023 Gerard Ostheimer lecture." The background to this article is that every year the north american Society of O
Hi everyone, This week I sit down with Jacob one of the provisional fellows in our department and we discuss the findings from the latest UK National Audit Project - NAP7 - which this time investigated Perioperative cardiac arrest. REFERENCES NAP7 - Royal College of Anaesthetists
A woman collapses with abdominal pain in a restaurant & then the initial evaluation in the ED she is diagnosed with suspected ruptured ectopic pregnancy. She is brought straight into your theatre and you perform a rapid sequence induction. You place your video laryngoscope into her mouth and all you see is vomitus and fluid, your yankauer sucker is blocked with food and doing nothing............ Hi everyone, This week I am joined by Dr Nathan Blakely one of our enthusiastic trainees to discuss an area he has taken a personal interest in ---- the management of the soiled airway. Thanks Nathan!
As the DA you are paged to come to PACU to review a patient with pre-eclampsia who has just had a PPH and a repair of a perineal tear after delivering in labour ward. The O&G team ordered a VBG because she was febrile and they want to assess her lactate and start her on some antibiotics. The O&G registrar is concerned however because her potassium / K has come back as 7.8 mmol/L.... Join Natalie and I as we discuss the issue of hyperkalaemia specifically in the context of women suffering from pre-eclampsia. Why are they at risk of this important electrolyte abnormality and what are the princip
You receive a page from labour ward. A woman at 35/40 weeks gestation has just arrived in the hospital very distressed in a lot of pain. A quick bedside ultrasound by the obstetric team has unfortunately demonstrated a large abruption and fetal death in utero. She is contracting strongly and beside herself in pain, the team would like you to come down and place an epidural for analgesia. The team are hoping she will deliver vaginally in the next few hours. What is your approach in this situation? Join Graeme and I as we discuss this complex and challenging clinical condition and the coagulopat
You recline your seat back, adjust your neck pillow, eye mask and close your eyes. Finally you are about to have that well earned nap. It was exhausting having to get up at 3am to head to the airport for this unpleasantly scheduled early flight. As your mind drifts towards sleep your thoughts are interrupted by a loud announcement by one of the cabin crew. "If anyone with medical experience is onboard can you please make yourselves known to the cabin crew?" You gently pull your mask aside and see two cabin crew applying oxygen and crouching over a passenger lying supine at the front of the air
