IV dexamethasone for cesarean delivery: .✅Prolongs duration of analgesia by 2.5 h .✅Reduces opioid consumption by 10 mg morphine.✅BUT optimum dosing and timing unclear.✅Impact on maternal & neonatal glycemia requires study.#SOAPAM2023 #OstheimerLecture #OBAnes

✅Blood patch more likely to fail in patients with history of migraine and if accidental dural puncture occurred higher than L3 level.✅Another argument supporting routine ultrasound guided neuraxial placement.#SOAPAM2023 #OstheimerLecture #OBAnes

✅UK Royal College guidance on L&D staffing .✅US staffing differs with attending presence more common out-of-hours and needed for SOAP Centers Of Excellence status.✅What are minimum acceptable staffing levels in US L&Ds? .#SOAPAM2023 #OstheimerLecture #OBAnes

What is minimum acceptable staffing on US L&Ds?.✅SOAP COE recommends 24/7 anesthesiologist availability but is this broadly achievable?.✅1/3 of anesthesiologist shifts are spent performing procedures or in the OR.A priority area!.#SOAPAM2023 #OstheimerLecture #OBAnes

Studies urgently needed evaluating the impact of abortion laws on:.✅Maternal mortality and morbidity (MMR and SMM) in diverse US populations.✅Healthcare provider hesitancy, training, ability & willingness to perform procedures .#SOAPAM2023 #OstheimerLecture #OBAnes

✅Prospective studies are needed to compare TIVA vs. volatile anesthesia modes for cesarean delivery performed under GA.✅Suggested outcomes are provided below.✅A research priority area.#SOAPAM2023 #OstheimerLecture #OBAnes

Consider using these ASA #obanes quality metrics for: .✅Your L&D dashboard .✅Audit to benchmark and improve your L&D practice (Quality Improvement) .✅Outcome measures in future studies.Metrics cover cesarean delivery and labor analgesia.#SOAPAM2023 #OstheimerLecture

This enhanced recovery core outcome set should be considered for:.✅OB enhanced recovery studies.✅L&D dashboards.✅QI.It includes ObsQoR-10-a validated 10-item composite patient-reported outcome measure of inpatient postpartum recovery.#SOAPAM2023 #OstheimerLecture #OBAnes

✅IV dexamethasone increases odds of neonatal hypoglycemia when given during scheduled cesarean delivery under neuraxial anesthesia to pre-gestational or GDM pts.✅Effects on maternal and neonatal glycemic need prospective study.#SOAPAM2023 #OstheimerLecture #OBAnes

Penicillin allergy testing is safe during pregnancy and recommended by ACOG.It can impact clinical care as: .✅1:3 women have Group B Strep during pregnancy.✅Increases antibiotic stewardship.✅Helps reduce multi-resistant bacteria.#SOAPAM2023 #OstheimerLecture #OBAnes

Ultra-low & low concentration bupivacaine for labor epidural analgesia result in similar outcomes.✅Concentrations >0.1% bupivacaine are not recommended.✅Diminishing returns for bupi concentrations <0.1%.✅Definitive study needed.#SOAPAM2023 #OstheimerLecture #OBAnes

Key take home messages from the 2023 Ostheimer Lecture including some key research and quality improvement priorities - Amazing job @PervezSultanMD #SOAPAM2023 #OstheimerLecture #OBAnes

Optimum therapy for antenatal opioid use disorder is unclear.Compared to methadone, buprenorphine is associated with: .✅Reduced neonatal abstinence syndrome, preterm birth, low birth weight.✅No differences in maternal outcomes.#SOAPAM2023 #OstheimerLecture #OBAnes

✅DPE and epidural result in similar quality of labor analgesia in obese parturients (BMI≥35).✅No significant outcome differences .✅Studies comparing surgical anesthesia onset times between DPE and epidural are eagerly awaited.#SOAPAM2023 #OstheimerLecture #OBAnes

Evidence-based optimal management of intraoperative pain is urgently needed. Unclear:.✅Role of chloroprocaine and dexmedetomidine.✅Prevalence of anxiety & pain .✅Opioid vs. ketamine efficacy.✅Long term psychological outcomes.#SOAPAM2023 #OstheimerLecture #OBAnes

In patients at low risk of PPH, for measured outcomes:.✅Low dose oxy non-inf to high dose (0.5 vs 5 IU).✅Low dose carb non-inf to high dose (20 mcg vs 100 mcg).✅Low dose oxy + infusion non-inf to high dose carb (100 mcg).#SOAPAM2023 @UofTanesthesia #OstheimerLecture #OBAnes

✅#OBAnes is expanding.✅Quality metrics in #OBAnes are important and should be used (see ASA metrics).✅Expanding role of anesthesiologists as peripartum physicians is needed to manage co-morbidities and high-risk pregnancies.#SOAPAM2023 @UofTanesthesia #OstheimerLecture

IT chloroprocaine vs. bupivacaine for cervical cerclage.✅Quicker sensory block resolution.✅Quicker discharge ready time.3% preparation is not FDA approved (safety data needed).Use CSE / bupivacaine if longer surgery likely.#SOAPAM2023 #OstheimerLecture #OBAnes @ruthi_landau

Why would you be nervous 😬?. I’m sure it has nothing to do with delivering the most coveted lecture at the meeting!. You are going to knock it out of the park!!! . #SOAPAM2025 #OBAnes #OstheimerLecture.

今年の ＃OstheimerLecture はスタンフォードの@PervesSultanMD アプリまで公開してくださっています。毎年A&AにWhat's new in OB anesthesia として公開される講演です。すべてのスライド、引用論文まで詳しく解説されてます！！！これが公開されてるなんてすごい！.＃OBAnes #SOAPAM2023 #産科麻酔.