Need some advice/ideas on OB anesthesia presentation relevant to OB residents and medical students

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IkeBoy18

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I am currently on my OB rotation and the attending went around asking what specialty we are interested in. Then he said we should do a 10-15min presentation related to OB in our field of interest.

I would love some ideas on what I should present that will be very useful and relevant to medical students, OB residents and even attendings?

thank you!

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Pain management during labour.

Useful for everyone.
 
Pain management during labour.

Useful for everyone.

Thank you for the suggestion. I have decided on pain management during labour. epidural vs spinal vs combo vs PCA.

Since this talk will be for medical students as well as residents/attendings, anyone have any clinical pearls for this topic that I might not find in literature? Or something I should mention that youve noticed over the years and wish the OB res/attendings knew?

Thanks again!
 
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anyone have any clinical pearls for this topic that I might not find in literature? Or something I should mention that youve noticed over the years and wish the OB res/attendings knew?

Off the top of my head.

CSEs may provide better analgesia even after the intrathecal dose is gone. Cappiello 2008 in A&A published an article about dural puncture epidurals showing generally better results compared to plain epidurals. I don't really buy all the conclusions, but there's some good foot for thought in the article.

What I like best about CSEs, other than the patient's instant gratification, is that you can safely start the pump and walk away from the patient. An opiate-tilted intrathecal dose won't cause hypotension. You can chop an easy 10 minutes off the whole encounter by not having to stick around to bolus the epidural.

PCAs for labor are fundamentally different than PCAs for every other purpose. You need a fast onset drug, and there needs to be minimum lag time between button hit and drug in bloodstream - this means a Y at the angiocath, with a briskly moving carrier fluid in one arm and the drug in the other. The usual PCA setup with the drug going into an IV port 12" away from the patient isn't going to work. I favor remifentanil with a .02 mcg/kg/min basal and and 0.2 mcg/kg bolus with a 1 min lockout, and you have to sit there and sit there and sit there and adjust until it's tuned right. It's a PITA but it works for people who can't get epidurals.
 
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Off the top of my head.

CSEs may provide better analgesia even after the intrathecal dose is gone. Cappiello 2008 in A&A published an article about dural puncture epidurals showing generally better results compared to plain epidurals. I don't really buy all the conclusions, but there's some good foot for thought in the article.

What I like best about CSEs, other than the patient's instant gratification, is that you can safely start the pump and walk away from the patient. An opiate-tilted intrathecal dose won't cause hypotension. You can chop an easy 10 minutes off the whole encounter by not having to stick around to bolus the epidural.

PCAs for labor are fundamentally different than PCAs for every other purpose. You need a fast onset drug, and there needs to be minimum lag time between button hit and drug in bloodstream - this means a Y at the angiocath, with a briskly moving carrier fluid in one arm and the drug in the other. The usual PCA setup with the drug going into an IV port 12" away from the patient isn't going to work. I favor remifentanil with a .02 mcg/kg/min basal and and 0.2 mcg/kg bolus with a 1 min lockout, and you have to sit there and sit there and sit there and adjust until it's tuned right. It's a PITA but it works for people who can't get epidurals.

Thank you for the response. I really appreciate the information!
 
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