Yavor Metodiev 🏳️🌈🏴🇧🇬
@YavorRM
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Dr Dr | Consultant Obstetric and Neuro Anaesthetist | OAA Executive Committee | IJOA Editorial Board | Editor Anaesthesia Reports |👬🏻| 🐶🐶
Wales, United Kingdom
Joined November 2016
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Almost every patient discussed at these MDTs will need an anaesthetic. And yet… anaesthetists are never part of the MDTs. 😞
I wonder when our expertise will be appreciated and the benefit to patient care recognised…
Sitting in our weekly breast cancer MDT meetings:
4 Consultant breast surgeons
2 Consultant oncologists
2 Consultant radiologists
1 Consultant pathologist
2 Breast SAS drs
1 Surgical registrar
1 Radiology registrar
2 Breast care nurses
2 Oncology nurses
MDT coordinator
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Let’s crack some Entonox in Cardiff!
Entonox is not to be taken away from our patients but used safely for staff and the environment!
@CV_UHB
@BPRMedical
@emma_jevons
@Welshenvironet
@brennan_fiona
@fi_pea
@OAAinfo
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Today I lost my mother… and it hurts! 😢
She was the most devoted woman and mother I have ever known. I will miss you forever, mum! ❤️
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The new evidence is poor and does not warrant the recommendations made. Women deserve to be taken seriously and their pain during labour needs to be treated as per high-quality evidence.
And that graphic is for epidural insertion. BMJ have let themselves down!
New evidence has led to changes in advice around intrapartum care.
What are the new recommendations doctors should know about? This article and
#BMJInfographic
presents a summary
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So excited about this appointment! Bring it on!
@Anaes_Reports
🎉
It is with excitement that we introduce our new Editors!
Dr Caroline Thomas
@DrCRThomas
Dr Niamh Barnwell
@BarnwellNiamh
Dr Craig Lyons
Dr Yavor Metodiev
@YavorRM
Welcome to the
@Anaes_Reports
Editorial Board!
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ObsTIVA-UK is finally published in
@Anaes_Reports
!
Thank you to everyone who contributed and helped us get this through!
And so on time for the
@OAAinfo
ASM in Birmingham.
#OAA24ASM
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Someone needs to urgently revisit their airway skills!!! 20% failure is a reason for review of practice in most countries… 🚩
@laing_simon
If you read the post, I said first attempted failed... which is 15-20% of emergency airways
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Very disappointed that
@NICEComms
basically ignored the
@OAAinfo
opinion on this without a good reason.
Obstetric anaesthetists are experts in providing efficient and evidence based pain relief for women and people who birth.
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Dwi’n hapus i fod yn un o’r 33.4%!!! 🏴
👂 Over a third (33.4%) of people in Wales can understand spoken Welsh
🧮 That's 1,013,000 people
🗣 29.7% of people can speak Welsh
🧮 That's 899,500 people
🏴 Cymraeg is *thriving*, bois bach!
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@docib
Absolutely no! This is the only way we are contactable in case of personal life emergencies…
No employer has the right to disconnect you from the world without providing alternative means to be contactable. And let’s be honest, NHS does not!
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I would question how are they ensuring the safety of its LGBTQ+ members who are technically prohibited to attend due to the country’s laws! Has this been even considered?
Very disappointing and frankly inexcusable!
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✅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
#ostheimer2023
@pervezsultanmd
#obanes
#SOAPAM2023
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We are excited to be closer to the launch of OBS-TIVA UK project!!! Many hospitals have expressed interest to take part in this project. DM, comment, retweet, or email me if you’re interested to take part too!
@WAARENgroup
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Can we stop performing surgery without analgesia on pregnant patients?!
No other surgery starts without analgesia! Dogma in obstetric anaesthesia is harmful!
Immediate caesarean needing GA for foetal Brady. Pt well with no medical issues. Opiate for mRSI or not?
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Well, this is what professional person in many respected positions does when you remind them that LGBTQ+ people may choose not to attend a course in Abu Dhabi…
A reminder that we are not surrounded by allies all the time!
@ClevelandClinic
should know about this…
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Well that looks like a pointless exercise… without any contingency plans for prolonged surgery.
Did the pt go home 2 hrs earlier? Is that an outcome that is significant?
Just give people proper anaesthesia.
First case report of intrathecal chloroprocaine and dexmedetomidine for cesarean section!
#OBanes
@AJOG_thegray
@SOAPHQ
@Ron_George
@ruthi_landau
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The bestest boys in Wales are two years old! Penblwydd hapus Dewi a Dylan! ❤️
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Obstetric GA can be safely administered when indicated or desired by patient! Avoiding it at al cost may have more detrimental consequences.
@bruceppdl
@bobfunn
@DrRobbieErskine
@glauncel
@Anaes_Journal
@SQuashie
@Marianfknight
I think we need to de-mystify obstetric GA - I think the anxiety around potential complications is affecting performance when GA is required. That said, there is evidence that avoidable GA for CS is assoc with a higher risk of complications
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@doctorhelgi
So what do you suggest? I agree 6 days unpaid is a lot… but there is no alternative.
Doctors are in trouble and regulators, Colleges and NHS are destroying the profession. You know that well…
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This is amazing! The ObsTIVA-UK team is truly excited to close 5 months earlier than predicted!
Curious about the results… 😝
#obsTIVAUK
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Clearly obstetric anaesthesia is still to come… 😜
I've put in 500 cannulas since starting anaesthetics training. Of these, 9.8% were under ultrasound guidance. I wonder how that compares to others? I feel I have a relatively low threshold for using US (to minimise number of attempts), but I may be wrong.
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Not excited about the future of our specialty at all… 😔
In the latest issue of the Bulletin...
How successfully integrating AAs into the anaesthetic team can help alleviate the post-pandemic backlog.
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First 100% GF coffee shop in Cardiff! There goes my diet…
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Why do we (anaesthetists) discuss labels on syringes? It.does.not.matter!!! 😒
I drew up half these drugs, the trainee the other. One of us isn’t leaving the anaesthetic room alive
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Amazing resource! Worth having in every theatre where pregnant patients may be cared for!
@OAAinfo
announces launch of the QRH for Obstetric Emergencies to assist all
#OBAnes
and colleagues providing best emergency obstetric EBM care. Visit
@RCoANews
@Assoc_Anaes
@BAPM_Official
@M0MSuk
@ResusCouncilUK
@BMFMSNews
@BICSoc
@CollegeODP
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Amazing how much interest and enthusiasm there is about TIVA in obstetrics.
#ObsTIVAUK
is going strongly and hopefully will provide some valuable insight.
#OAA23ASM
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@SAS_gas_Thomas
@OBsleepmerchant
@HofkampMichael
@LimGrapes
That stems from the previous generation of obs anaesthetists who battled the high incidence of anaesthesia-related maternal morbidity and mortality. And they did a great job.
Now it’s our job to fix the overshoot.
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The best day of my life!
@ArwelDa
Tra bo dau 🎶
‘While there’s two of us’ 🖤🖤
Iafor+Arwel
25.3.22
💐💐💐
Am ffordd i ddechrau seremoni priodas.
What a beautiful way to begin a wedding ceremony.
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More than happy to talk about our project and the future direction of research
#ObsTIVAUK
In the mean time here is a link to our paper (it’s open access):
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@julian_donovan
I think it has something to do with inappropriate intubations and expectations of the other team to take over after that and secure bed, provide care, etc when they may have managed differently from the outset.
Or we are just possessive for no good reason… 🤷🏻♂️
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Whoever authored this one should not be proud of it (not putting their name to it is a red flag)… It is not a case study, it is poorly written, and is severely biased without and COI disclosure…
Misleading and serving an agenda.
This is a case study documenting a few examples of how AA's are being utilised, complementing departments and providing much needed services for patients.
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@TheRealDude78
@Autismstoke
@Bushra1Shaikh
@toryboypierce
You can choose your religion… do you still not see the difference?
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I can’t really agree with the routine use of a bougie… most intubations are not difficult and using a bougie is not without risks.
But this is what happens when airway recommendations are made by non-anaesthetists.
The EuSEM document is just two pages but contains a wealth of common sense and good practice
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Da iawn!!! Full support for our colleagues!
#payrestoration
Approximately 500 junior doctors outside the Senedd today chanting ‘claps won’t pay the bills’
#payrestorationnow
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It’s astonishing how fragile some masculinities are…
He will never be great by virtue of refusing to reflect… 💅
Based on the astonishing number of people commenting about the wrecklessness NPAs, I decided to test this **dangerous** $4 plastic tube out on myself. Thus far, I've reached none of the endpoints I was promised:
-Hemorrhage from an anterior nose bleed (or any bleed)
-Sheering
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We want to hear from our patients!
If you or your partner had caesarean birth under general anaesthesia, we want to hear from you!
Help us shape the future of research into the effects of different types of general anaesthesia on mothers and babies.
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@EmergMedDr
@thesecondshelf
@SpeakingSatan
Yeah… doesn’t look like it’s really middle class suburbia… 😂
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What an amazing day hosted by the West of Scotland Obstetric Anaesthesia Society
@WoSOA
!!! Met some lovely people 🏴! And got to talk about ObsTIVA-UK!
@WAARENgroup
@ArcBroom
@rjharrison79
(Here is also a swanky chandelier from the bar 😉)
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Our very own
@SarahEMHarries
is so deserving of this recognition! I am honoured to be working alongside people like her!
@Welshanaesthes
Two recipients of the College Medal today.
Dr Jo Budd, a stalwart contributor to anaesthetics training as a College Tutor, Regional Adviser and FRCA examiner.
Dr Sarah Harries for the leadership she has shown with the Welsh Training Board.
Congratulations both.
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Important message!
And if you giving QR codes for access, please, check if they open the correct website.
@OAAinfo
@labourpainsOAA
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So, I went… Hopefully gave two good talks…
Met some awesome people who I only knew as Tweeps! See you next year in Glasgow!
#EA22
#EA23
@cmdelgadou
@ruthi_landau
@caitlindsutton
@CarolynWeiniger
@emiliaguasch
@aioscovich
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A massive congratulations to the impressive multidisciplinary team at Cardiff for recruiting the first participant to
@iHOLDSTrial
Amazing effort all round! Everyone came together to make this happen. Thank you so much.
@CV_Pharmacy
@OGResearchTeam1
@ResearchBWC
@Bethan_Jones89
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Exciting times ahead!
@noolslucas
@Eltonchris
@loafnbread
@LiverpoolWomens
@Ggar82
@DrCliffShelton
@drsas27
@DrNFreeman
@elboghdadly
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@morefluids
We most likely should not… unless it is someone we are directly looking after and the prescription is related to our job…
I wouldn’t prescribe syntocinon despite being able to.
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Finally! Medic is a doctor or a medical student…
Find your own words for the professions you do.
Communication matters.
A medic, in court, is defined as a doctor or medical student.
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@HofkampMichael
@OBsleepmerchant
@emilysharpe
@ruthi_landau
Substituting one dogma with another is not the way forward…
Only epidurals that had been working well should be activated.
Instead of subjecting patients to another procedure, clinicians should focus on better monitoring epidurals and act early on the suboptimal ones.
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Gutted to have missed it!!! I am not sleeping tonight and hoping…
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Proud to see Cardiff making a change! Looking forward to seeing it shared at the
#OAA23ASM
!
@Welshanaesthes
@CV_UHB
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Absolutely smashed the PhD,
@LucyHalliday7
!!! Congratulations!
It was a great honour to examine you alongside
@ArcBroom
!
Proud moment for supervisor moment for
@rjharrison79
!
This is what a successful viva defence looks like! Congratulations
@LucyHalliday7
on your excellent performance. Thank you to
@ArcBroom
and
@YavorRM
for their examining expertise &
@rjharrison79
@profscottnelson
for sterling supervision.
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We are so deeply grateful to all contributors! This month marks 6 months of
#ObsTIVAUK
running…
Let’s do another 6 months!
Congrats to
@DesireOnwochei
@GSTTresearch
and
@OxfordPeriop
@OUHospitals
and their teams who were our joint top case submitters to
#ObsTIVA
for April! Fantastic work from all of our collaborators - thank you all!
@YavorRM
@elboghdadly
@bsharif
@iliff_helen
@Welshanaesthes
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Hmmm… not what
#DoctorsDay
is about!
We do not need this reminder today!
Enough doctors on this platform I work with & we all need a reminder to appreciate the professionals (medical, non medical, managers around us who make us the doctors we are! couldn’t really celebrate
#NationalDoctorsDay
without acknowledging them🙌🏾
You all kick ass🫡✊
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No one should be excited to publish this! The EiC should reconsider allowing this to stay published.
Midwives should not be the centre of peripartum care! Pregnant people must be in the centre!
Excited to publish this commentary on how midwives are the answer to the ‘wicked problems’ in the 🌍 in the Lancet today with
@FrankaCadee
@neel_shah
@DanielaDrandic
@AddressMalata
Supporting midwifery is the answer to the wicked problems in maternity care
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@MariaSheikhMD
@Drdrowsy
@kyra_bernstein
@emilysharpe
@PervezSultanMD
@WaseemAtharMD
Rarely, if ever, needed CVL. Large bore peripheral lines more than enough. (Unless difficult veins).
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Another excellent work undertaken by
@Welshanaesthes
trainees! Da iawn!!!
#OAA24ASM
@Fionafionakel
@doctimcook
@Airwayman1
@Anaes_Journal
@dasairway
@Assoc_Anaes
@OAAinfo
@maypiansmith
@mbrrace
@LateralTilt
@noolslucas
@SQuashie
@Marianfknight
@LucyHalliday7
@rjharrison79
@Jamesocarroll
@PervezSultanMD
Associations between ethnicity and
#OBAnes
in Wales: common theme, GA more likely. Really DO need to start looking at the why…
#OAA24ASM
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Excellent choice! Definitely a reason to consider doing my first SOAP ASM…
@emilysharpe
@SOAPHQ
Congratulations to Emily Sharpe, MD! Dr. Sharpe has been selected to present the Ostheimer Lecture at the 2025 SOAP Annual Meeting, to be held April 30 - May 4, 2025, at the Hilton Portland Downtown Hotel, Portland, Oregon.
#SOAP
#SOAPAM25
#Ostheimer
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@DrChrisHingston
@UCAirCareDoc
@DrPetDetective
@AMPAdocs
You’re being very kind by calling it “not a great approach”! It’s barbaric, unnecessary, and demonstrates poor clinical knowledge and skill! That’s what it is.
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Such an honour to see my name on a slide during the
#Ostheimer2023
!!!
#SOAPAM2023
@noolslucas
@IJOA_Journal
21. TIVA vs volatile:
✅Prospective studies are needed comparing these anesthesia modes for cesarean delivery performed under GA
✅Suggested outcomes are provided below
✅A research priority!
#ostheimer2023
@YavorRM
#OBAnes
#SOAPAM2023
@IJOA_Journal
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One way you improve women’s health is by ensuring there are highly trained doctors they see.
You have the opportunity to improve that but you choose not to. No slogan will help you until you pay doctors their worth.
A woman’s sex matters.
Our Women’s Health Strategy is getting results but there is more to do. Looking forward to today’s Women’s Health Summit, and setting out next steps to make women’s access to healthcare faster, simpler and fairer.
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Randomising patients between epidural and non-epidural analgesia is a bit ethically questionable in my opinion.
We know that satisfaction from labour analgesia was highest in patients who received what they asked for… I can’t help but feel the results of this study may be flawed
🔓This new RCT found no significant difference in the risk of postpartum depression between patients who received epidural labour analgesia and those who utilised non-epidural analgesic modalities.
🔗
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The little man wins!!!
Moral of the story - take the extra time to appeal when you know you’re in the right.
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Maybe, they should look into the difference of awareness when an anaesthesiologist is responsible for the RSI vs when an ED doctor is… 🤔 I wonder if it will be a roc issue…
Another day, another patient RSI’d in the ED with rocc who experienced post-intubation hypotension and had the propofol turned down to 5mcg/min with no opiods or amnestics.
This is not a physician issue. This is a system issue and a rocc issue.
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@HofkampMichael
@TheBlondeRN
I would say most patients can sip clear fluids until coming to theatres (depending on surgery type and Hx).
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Then do something to stop the strikes… hint: start by paying doctors what they’re worth!
NHS waiting lists fell by nearly 100,000 in November.
The biggest fall since 2010 outside of the pandemic.
The evidence is clear. When we don’t have strikes our plans are delivering for patients.
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Now onto the technical stage! Thank you to all who contributed to
#ObsTIVAUK
!
Site leads, don’t forget to fill out the closing survey (check your emails).
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@emilysharpe
2.5% failure rate is very high for single shot spinals. 🤔 Maybe changing the way they do spinals would’ve led to the same reduction in GA conversions?
Doing CSE for all CDs is a step towards the past in the UK… it is unnecessary and higher risk procedure when done for everyone.
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@OBsleepmerchant
@HofkampMichael
@LimGrapes
Sometimes I am baffled by what gets published in highly-regarded journals… 🙄
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Aren’t I a lucky one… 🥰
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Excellent article and a bit 🤯 when I read it!!! Good to see
@iliff_helen
authoring this!
@Welshanaesthes
Is this the future of difficult airway management?!
To 3D print a 'scope-able' patient specific model directly from their CT images?!
@iliff_helen
@dr_imranahmad
@cwbwoody
@grees34
@jas_ingham
Read more here:
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@emilysharpe
@BrighamOBAnes
@FarberMichaela
@ClinicalAnesCME
@CurReviewsCRNA
Too much FFP imho… FFP is seldom needed even in the biggest of bleeds… especially after correcting with fibrinogen.
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@DrJSherrington
Same for secondary care, especially surgical specialties…
How is the public not understanding this?
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Now every time I have a Balkan lunch, I think of
@LeylsTurk
! Your lunch/supper photos inspire me to eat more like I’m in my mother’s home…
(Luckily,
@ArwelDa
is fully on for lunch like this one!)
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I am so proud of the team I work with for just allowing me to be in the same room! Amazing work!
#OAA3dc2022
Breaking news. Congratulations to OAA Executive Committee member Prof Rachel Collis and colleagues on being awarded £3.5M NIHR grant for ObsUK study. More on this to come! All happening at
#OAA3dc2022
!
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@doctorhelgi
I’d say careful with comparing the two. Very little in common between the two contrary to what we thought a decade ago.
PPH should be managed very differently from trauma… OBSCymru has demonstrated this.
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Unless you’re an anaesthetist. We help very few people get better but the ones that we help most certainly would not get better without us…
Most patients would've gotten better anyway without our help
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Does anyone still care about the ASA? Means absolutely nothing nowadays… Change my mind… 😜
Completely fit and well? They don't need an operation then.
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@DrRobbieErskine
GA should be routinely offered. It is a valid and safe technique.
We have moved to discussing regional and general anaesthesia for caesareans. I haven’t seen an increase in GA as a result.
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pEEG in pregnant patients is another poorly understood monitor potentially limiting the use of TIVA in this population.
Better understanding and robust evidence are urgently needed! Hopeful that
#ObsTIVAUK
will provide the basis for building this evidence…
#OBanes
@noolslucas
The use of processed electroencephalography (pEEG) in obstetric anaesthesia: a narrative review
🧠 pEEG may differ in pregnant population
🧠 More robust evidence required for its use in
#obanaes
🧠 Direction of practice moving towards greater usage
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Thr state of affairs is just laughable at this point!
Eau doctor of the week, Hannah, our physician associate. Extremely competent, good independent decision making, dependable and very well respected
@NTeesHpoolNHSFT
@MADEinHEENE
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@DrNeenaJha
Oncology management frequently involves surgery… hence, anaesthesia. Day of surgery cancellations and poor postoperative outcomes can be reduced by early involvement of anaesthesia team.
Some pathology more than others, I agree.
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@BrynKemp
@EmergMedDr
If you have made your mind up after reading that trial, it is you who need learn how to interpret evidence…
Obstetric anaesthetists are the experts in labour analgesia (a reminder)…
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