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…

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 …

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 d…

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 cab…

You are called to review a woman in labour ward. When you arrive you are told her epidural is no longer working. The epidural was placed by a colleague 5 hours ago and was working well. However in the last 20-30 minutes she has developed breakthrough pain despite a top up and pressing the PCEA a few times. You look at her back and the epidural dres…

A maternal death is always a tragic event for the mother, the child, the family and society at large. Unfortunately in some parts of the globe this is still a much too common event. Luckily for those of us living in higher resource countries it has now become relatively rare. This week Matt and I sat down together to discuss the history of maternal…

As the duty anaesthetist you are called down to the antenatal clinic by the obstetric team to see a pregnant woman with achondroplasia who is booked to deliver in your hospital. What are the anaesthetic issues which can arise in this condition? What evidence is there in the literature for the optimal anaesthetic techniques? What will you discuss wi…

You are called to a code blue on the postnatal ward. A 28 yr old female who is 1 day post a non elective caesarean section has just had a witnessed convulsion lasting 1-2 min. She has now regained consciousness but seems a little confused and is complaining that she “has lost vision in both of her eyes”. Her BP is 180/100, and all other vital signs…

Hi everyone, Join us this episode – Declan and I have scoured the literature for a few interesting articles of varying degrees of quality! We had fun discussing these articles and hopefully you will also enjoy our discussion. Hopefully we will make this a regular feature every 3-4 months! Articles Discussed 1 – Effect of Dural-Puncture Epidural vs …

You are called to labour ward to place an epidural in a nulliparous woman who is obviously extremely distressed in pain. After you sit her up to clean her back you notice she has a long scar running down the middle of her back. Between contractions she tells you she had surgery as a teenager to straighten her back…..what does this mean? Hi Everyone…

Hi Everyone,Whole blood, freeze dried plasma, refrigerated or frozen platelets....On Oct 31st - Nov 3 Graeme, Emelyn and I attended the THOR - THUNDER conference hosted here in Perth at the Rendezvous Hotel in Scarborough. Who is THOR? In their own words:The THOR (trauma haemostasis oxygenation resuscitation) organization is a resuscitation and blo…

Hi everyone,Welcome to part 3 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…

Hi everyone,Welcome to part 2 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…

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…

You are phoned and asked to review the venous blood gas from a woman who has just given birth in labour ward. She had a long and difficult labour and eventually required an instrumental delivery. The RMO tells you also that she was very difficult to take blood from and the tourniquet was on her arm for quite a long time. Her results show that she h…

Hi Everyone,"Three minutes after the administration on the spinal anaesthetic they became restless and complained of severe pain in both lower limbs and back. Their heart rate and blood pressure increased to 130bpm and 160/100 mmHg. A rapid survey of previously administered medications revealed tranexamic acid 300mg was accidentally injected into t…

Hi Everyone,Join Siv and I as we sit down to discuss a couple of interesting obstetric related topics. The first is the pharmacology around the choice and strength of local anaesthetics used in epidural analgesia - thanks Siv. The second part we discuss a very large pragmatic study in the New England Journal of Medicine of 11000 women studying the …

Hi Everyone,This week we are joined by Dr Anastazia Keegan an obstetric haematologist and the head of Haematology at our Women's hospital here in Western Australia. Join us as Anastazia educates us about congenital bleeding disorders in pregnancy - the common ones, Von Willebrands disease and haemophilia - and how to approach a woman with one of th…

Hi Everyone,This is part 2 of a discussion (see the previous episode for part 1).We have just returned from the Obstetric Anaesthesia Special Interest Group Satellite meeting held on May 3-4. I sat down two days after the meeting with Dr Matt Rucklidge (the convenor of this meeting and a colleague here at KEMH) and Prof Nuala Lucas one of the keyno…

Hi Everyone,We have just returned from the Obstetric Anaesthesia Special Interest Group Satellite meeting held on May 3-4. I sat down two days after the meeting with Dr Matt Rucklidge (the convenor of this meeting and a colleague here at KEMH) and Prof Nuala Lucas one of the keynote invited speakers from the UK who is the president of the OAA UK (O…

You are called to a code blue medical on labour ward - a previously well nulliparous woman has just had a seizure, and now seems confused. Her observations are normal, she is not hypertensive and the CTG appears fine. She is presumed to have had an eclamptic seizure and is given oxygen, magnesium and has some urgent pre-eclampsia bloods and urine s…

Hi Everyone,In our tertiary women's hospital here in Perth we use remifentanil PCA in labour approximately 15 times a year - and we are told that in Australian terms this is considered a "heavy user" of this labour analgesic technqiue.This week I sit down with Mike Jamison an anaesthetic fellow from Belfast spending a year with us here in Perth. Wh…

You are referred a patient who needs urgent surgery and the obstetrician tells you she has some obscure medical condition which you have never heard of before. Does her condition have any implications for the safe conduct of anaesthesia? How can you find out in a timely manner what the specific anaesthetic issues are and what anaesthetics have been…

Arterial lines - let's face it who doesn't love them? When you have a truly sick patient these humble and often underrated devices bring so much to the table, precise control of the haemodynamics, assessment of gas exchange, blood sampling to assess coagulation, anaemia and many other parameters. There is nothing more frustrating however when these…

(Hypothetical case) You are called to the PACU to review a patient, who despite face mask oxygen has saturations of only 88%. She is a woman in her 50s who has just undergone a 3 hour laparoscopic hysterectomy for endometrial cancer. She has a BMI of 48, has been a smoker for 30 years, and had a chest infection 3 weeks ago. When she walked into the…

Hi everyone,This week three of us sit down to discuss a great review article (and topic) - the use of TIVA (total intravenous anaesthesia) for GA caesarean surgery. For many the classic technique for a GA caesarean has been thio / sux tube then volatile & nitrous oxide. In recent years many aspects of this have started to change with propofol proba…

Hi Everyone,You receive a phone call at 2am from a junior colleague who tells you that they are managing a code blue caesarean section and in the confusion of urgently administering a number of different medications they have just accidentally injected 10ml of cephazolin into the epidural catheter instead of the intravenous tubing. They are underst…

Hi everyone,This week Graeme and I sit down for the first time in nearly a year and do a bit of a deep dive on the use of nitrous oxide as an analgesic in labour. We drop a few dad jokes, discuss the history of inhaled analgesics, nitrous oxide use around the world, the evidence, the environmental concerns and other interesting anecdotes.Do you hav…

Your 76 yr old patient is now two days post her laparotomy for ovarian cancer. She looks well, is starting to eat and keen to get up to the shower as well as have all the "annoying lines and tubes removed from my arms!".Unfortunately she is still on 3ml/hr of a metaraminol infusion and everytime the nurse tries to wean it off her BP drops to 70/45.…

Hi everyone,This week Sneha leads a discussion with both Matt and myself where we take a deep dive into how to actually perform an epidural blood patch. Even though you can't really classify this as an uncommon procedure, as individuals we probably don't do very many and it is hard for most of us to become experienced and "expert" (whatever that is…

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 th…

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 tho…

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!Links097 Obstet…

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 &…

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 pregnancyc…

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 ANAESTHESIAThe “Basics of Obstetric Anaesthesia” is a short series of podcasts, …

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 th…

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 thoug…

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 ANAESTHESIAThe “Basics of Obstetric Anaesthesia” is …

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, whic…

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 podcas…

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 ANAESTHESIAThe “Basics of Obstetric Anaesthesia” is a short series of podcasts, where we aim to discuss in a conversational manner the basic topics you will …

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 …

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…

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 goin…

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 anest…

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 anest…

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. H…

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. Beca…

"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 Kendric…