key: cord-0077685-4ltz3mtb
authors: Foley, E.; Cope, S.
title: P.150 Anaesthetic care of women with obesity in pregnancy
date: 2022-05-03
journal: Int J Obstet Anesth
DOI: 10.1016/j.ijoa.2022.103446
sha: a3606d927055c1c92e02efde7cb8ed06bb9033b7
doc_id: 77685
cord_uid: 4ltz3mtb

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Discussion: Proven therapies (such as corticosteroids and tocilizumab) should be offered to pregnant and breast-feeding women as in the non-pregnant population. Women should receive multidisciplinary care with input from senior physicians and early escalation when required. by CS of whom 20% needed their CS expedited due to COVID-19 having a mean gestation of 29 weeks (SD 4.7). Among the patients who had CS, 93% had a regional anaesthetic and 7% had a GA. Discussion: BAME was a significant risk factor for pregnant COVID-19 positive patients to be hospitalised. BAME category patients were more symptomatic and required prolonged hospital stay [1] . BMI>30 was not found to be a significant risk factor. COVID-19 caused a high incidences of CTG abnormalities and hence lead to a higher incidence of CS during this period. Regional anaesthesia was performed safely in these patients. Cross infections in maternity unit paved the establishment of Closed Monitoring Unit (CMU) at our centre. Due to the ongoing pandemic, further study is needed to see impact of vaccination on maternity. Introduction: Obesity in pregnancy is associated with an increased risk of anaesthetic complications, such as failure of airway management, intravenous access and neuraxial blockade [1] . Therefore, the Royal College of Anaesthetists defined a set of standards for the care of obese pregnant women. Our aim was to measure current practice against these standards; 100% of women with a booking BMI (body mass index) of 40 kg/m 2 or greater to have an antenatal consultant anaesthetic review and 100% of these patients to be reviewed by the duty anaesthetist on arrival to delivery suite. Methods: A retrospective audit of 50 sets of patient notes with a BMI 40 kg/m 2 or greater at booking during the period of January-June 2020 at Sunderland Royal Hospital. It was identified whether the patient had been referred to anaesthetics, the outcome of this referral (either no action required or an appointment in the high-risk clinic) and whether an assessment was made by anaesthetics on the delivery suite. Ethics approval was not required for this audit as advised by the trust's clinical effectiveness department.

Results: A total of 54% of eligible patients were referred to anaesthetics; 100% of these patients were screened by an obstetric anaesthetist with 41% of those patients being seen in the high-risk clinic. Only 6% of all patients were assessed by a member of the anaesthetic team on arrival to delivery suite with a plan documented in the notes. Discussion: There must be a more robust system for the referral of high BMI patients to anaesthetics both antenatally and on delivery suite in order to plan early for the management of predicted difficult airway, intravenous access and neuraxial blockade as well as the early involvement of senior anaesthetic help. We have now written a guideline to ensure the above standards are met in future and this will be re-audited after the guideline is implemented. is not yet universally embraced in current UK obstetric anaesthetic practice. This is despite well documented benefits and support for its use from recent systematic reviews and meta-analysis [1] . One reason for this may be the perceived difficulty in achieving competence in the technique, with up to 40 scans suggested as necessary to achieve competence [2] . We aimed to assess the ease with which the technique can be taught to anaesthetic trainees with limited experience of it. Methods: As part of a wider quality improvement initiative to improve uptake of pre-procedural US for CNB in our institution, a targeted teaching session was held for 13 trainees which encompassed both didactic theory and hands-on scanning practice on live models. Discussion: We found a surprisingly high accuracy of first scans following a short teaching session. Scans were directly supervised and candidates could not be deemed independently competent following this. However, this suggests the technique is easy to learn and should encourage further efforts at improving its uptake. This will benefit both practitioners already experienced in CNB as it may facilitate improved success and reduced complications, as well as flattening the learning curve for trainees learning CNB for the first time [2] .

Introduction: The initial obstetric anaesthesia module can be a technically and emotionally challenging period for trainees. This additional psychological burden is faced by doctors who already feel training negatively affects their mental health [1] . "Near peer teaching" is teaching carried out by a trainee one or more years senior to another trainee on the same education programme. This approach is established within General Practice with demonstrable benefits to both parties [2] . To support trainees in their first obstetric anaesthesia placement, a peer to peer support group "Learning through challenges" was developed. The aim was to use a near pear teaching approach to reassure and inspire confidence in trainees and ultimately allow trainees to work safely as they begin the obstetric anaesthesia journey.

Methods: Learning through challenges is a peer to peer trainee network with monthly sessions to share difficult or 'grey' scenarios they've encountered. Sessions are facilitated by one or more experienced trainees with an enthusiasm for obstetric anaesthesia. It is an online format open to all trainees in in the North West Deanery. Trainee feedback was collected after each session and continually used to optimise the format to best meet trainee needs. The feedback questionnaire consisted of a mix of rating questions and free text responses.

Results: To date, this session has occurred five times, with an average of eight trainees per session reaching a total of 23 trainees in total. Feedback responses were collected from 65% of attendees and was overwhelmingly positive. All students believed the session was extremely relevant to their learning needs and found the format helpful. Themes in the free text comments suggested the session provided a safe learning environment, reassurance that experiences were shared with fellow trainees and a greater confidence to ask for clinical support. Suggestions for improvement centred around the timing and frequency of sessions and having a theme for each meeting. Discussion: Learning through challenges has successfully utilised a near peer teaching programme to support trainees in the North West Deanery. It has gained the full support of the school executive board and has been timetabled into the regional teaching programme. As the programme continues, the aims are to increase reach, improve feedback response rate and also to explore the impact the session has on those facilitating.

Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics-a systematic review and meta-analysis with trial sequential analyses

Ultrasound-facilitated neuraxial anaesthesia in obstetrics

Learning through challenges: a near pear teaching approach for UK anaesthetic trainees

Health Education North West

Lancashire Teaching Hospitals