TopMedTalk is covering the flagship meeting of the Royal College of Anaesthetists from the British Museum, London. In this piece, discussion is had about the importance of perioperative medicine leading to conversation about the naming of the conference and differences between terminology; are you an 'anaesthetist' or an 'anaesthesiologist'? The contributors emphasise the global perspective as well as telling you some of the things you should be looking forward to as our coverage progresses over...
May 22, 2018•10 min
What motivates an institution to adopt a value based care programme? How do readmission rates react to optimisation? How do you work care coordination into a successful practice? This piece was originally part of our coverage of 'The American College of perioperative medicine interdisciplinary conference on value based care for orthopedics'. Desiree Chappell speaks with Allan Beck Chief Executive Officer of the Baylor Orthopedic and Spine Hospital at Arlington. This is taken from a longer conver...
May 20, 2018•5 min
This piece explains the 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care provision after Surgery (SNAP-2: EpiCCS) SNAP-2: EpiCCS aims to describe the epidemiology of perioperative risk, outcome, critical care referral and admission after inpatient surgery in the UK. It will also examine whether planned postoperative critical care admission is effective as an intervention to reduce postoperative morbidity. http://www.niaa-hsrc.org.uk/SNAP-2-EpiCCS Presented by Monty Mythen w...
May 19, 2018•4 min
Goal directed fluid therapy and enhanced surgical recovery, are there still some battles not yet won? How do you get anaesthetists to curb their fluid? How do you cure the random element of fluid therapy? Dr Joff Lacey interviews his guest Dr Randall Dull, University of Illinois, live from the ASA 2017. This piece taken from a longer conversation, "Physiological Principles of Goal Directed Fluid Therapy": http://www.topmedtalk.com/live-from-boston-asa-2017-physiological-principles-of-goal-direct...
May 18, 2018•3 min
Association between intraoperative opioid administration and 30-day readmission: a pre-specified analysis of registry data from a healthcare network in New England High intraoperative opioid dose is a modifiable anaesthetic factor that varies in the practice of individual anaesthetists and affects postoperative outcomes. Conservative standards for intraoperative opioid dosing may reduce the risk of postoperative readmission, particularly in ambulatory surgery. https://doi.org/10.1016/j.bja.2017....
May 17, 2018•2 min
Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6) N.J.N. Harper et al. Anaphylaxis, a life threatening allergic reaction, is thankfully rare but a very serious complication in the perioperative period, around the time of surgery. The 6th National Audit Project of the Royal College of Anaesthetists (NAP6) collected and reviewed 266 reports of serious anaphylaxis from all UK NHS hospitals over 1 yr. RESULTS? The good new...
May 16, 2018•3 min
The Xtreme Everest project has won numerous awards and received both local, national and international media coverage. Here we have a discussion with some of the key players about oxygen and the Xtreme Everest team's research studies into human adaptation to hypoxia. How can the human body adapt to extreme conditions, we assume it will inevitably cause damage but this is not always the case. How do people who have inherited a tolerance for low levels of oxygen manage? Professor Monty Mythen, Jof...
May 16, 2018•15 min
ASER 2017 and the POET acronym - a truly multidisciplinary Perioperative Enhancement Team; responsible for project managing optimisation programmes. Monty Mythen speaks with Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology. This piece is taken from a longer conversation to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/ Join the debate: contact@topmedtalk.com Also - why not put...
May 15, 2018•5 min
A discussion about the importance of screening and risk mitigation regarding cognitive dysfunction and delirium in the perioperative period, with particular focus on elderly patients. Monty Mythen and Mike Grocott are joined by their guests Dr Liam Brennan, President of the Royal College of Anaesthetists, and Dr Fay Gilder, Addenbrooke’s, Cambridge. This piece taken from a longer piece to be found here: http://www.topmedtalk.com/live-from-boston-asa-2017-perioperative-delirium-2/ - Want to hear ...
May 14, 2018•10 min
Dr Ramani Moonesinghe on Standardised Outcomes from Major Surgery. Dr Joff Lacey and Professor Monty Mythen talk to Dr Ramani Moonesinghe, Director of the Heath Services Research Centre at the Royal College of Anaesthetists and a lead author of the Perioperative Quality Initiative (POQI http://www.poqi.org) guidelines on outcomes from surgery. Simple objective measures such as Drinking, Eating and Mobilising, Sleep (DrEaMS). For further reading see this article in Perioperative Medicine: https:/...
May 13, 2018•4 min
What is a 'micromort'? Even more of a worry, what does ten of them mean? How do we measure and communicate risk to patients? Everyday activities all carry inherent risks, how do we put surgery into a context 'everyday people' can more easily understand? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with guests, Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and Dr Mike Irwin, Professor and Head, ...
May 12, 2018•9 min
Monty Mythen presents the results of the RELIEF (Restrictive versus liberal fluid therapy in major abdominal surgery) trial. Does it answer the questions you hoped? Does this trial put to bed the questions about liberal vs restricted fluid therapy or is it a debate that's set to run and run? Can a trial ever be truly definitive? Send us your thoughts: contact@topmedtalk.com Hear Monty Mythen discuss the first thoughts of Paul Myles, Head of Alfred Health's and Monash University's Department of A...
May 11, 2018•6 min
In this piece find out how renal injury biomarkers can offer practitioners and patients hope. Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh and Dr Tim Miller from Duke University Medical Centre. Join in the debate: contact@topmedtalk.com This piece taken from a longer conversation to be found here: http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/...
May 11, 2018•3 min
Where should sleep apnea be on the perioperative surgeon's priority list? A fascinating introduction to the topic, sleep disorders affect every area of life but in the perioperative sphere it brings significantly higher risks of complications following surgery. How important is it that such conditions are picked up during pre-operative optimisation? Furthermore, why do the evaluation at all - if no action at all is taken as a result? A piece originally streamed live from Atlanta Georgia during T...
May 09, 2018•10 min
A conversation that is now even more relevant, the changing role of the anaesthetist. Matters such as population health, lifestyle choices and a wider sense of social responsibility are discussed as Monty asks his contributors, 'is this really what you signed up for'? Presented by Monty Mythen and Joff Lacey with guests, Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology and Liam Brennan President of The Royal College of Anaestheti...
May 08, 2018•7 min
Standby for the results of The RELIEF Trial; coming soon on TopMedTalk, Professor Monty Mythen will be presenting an exclusive programme here covering the results of the trial and discussing its impact. The REstrictive Versus LIbEral Fluid Therapy in Major Abdominal Surgery: RELIEF trial, will it answer the questions we hoped? Will this trial put to bed the questions about liberal restricted fluid therapy or is it a debate that's set to run and run? Can a trial ever be truly definitive? This pie...
May 05, 2018•14 min
This piece begins with the question, what does Enhanced Recovery mean to you? Here we go for a ground up approach via a 'council of nurses'. Can a 'roundtable' sometimes work better than the traditional hierarchical power structure? Desiree Chappell interviews Dr Ruchir Gupta medical lead for enhanced recovery at Stony Brook University. Taken from a longer conversation to be found here: http://www.topmedtalk.com/what-does-enhanced-recovery-mean-to-you/ Join the debate and tell us your story: con...
May 04, 2018•5 min
How do we bend cost curve to our advantage? How do we assert the irreducible minimum? Is it possible to spend less money and get better outcomes? Is it possible to get people to realise that not 'doing something' is sometimes the right decision? How do 'bundle payments' work in relation to overall health? Featuring Desiree Chappell, Monty Mythen, Dr Lee A. Fleisher Chair of Anesthesiology and Critical Care (University of Pennsylvania) and Vicki Morton DNP and Director of Clinical and Quality Out...
May 03, 2018•10 min
METS trial - exercise tolerance and surgery outcomes. The results of the METS trial were presented at the International Anaesthesia Research Society meeting in Chicago. Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery ( http://bmjopen.bmj.com/content/6/3/e010359 ). The trial design is discussed and excitement shared about the potential impact o...
May 02, 2018•12 min
Opioid addiction can happen to anyone, even world leading Professors like Dr Paul Wischmeyer. Listen to Paul's story and then spread this important message to colleagues, patients and friends; there is help available, the first and most important step is to ask for it. Hosted by Desiree Chappell and Monty Mythen. Featuring Dr Paul Wischmeyer, Professor of Anaesthesiology and Surgery at Duke Anesthesiology and TopMedTalk's Henry Howe, a medical student at Bristol University. Join us on www.topmed...
May 01, 2018•13 min
Dr Attilla Kett explains how he applies Enhanced Recovery after Surgery to obstetrics. This podcast features Desiree Chappell interviewing Dr Attila Kett, anaesthesiologist and Chairman at St Peter’s University Hospital at New Jersey. Join in the debate: contact@topmedtalk.com Want to come see us live in London? http://www.ebpom.org/
Apr 30, 2018•4 min
Steroids in cardiac surgery: a systematic review and meta-analysis BJA April 2018, Volume 120, Pages 657-667. See full article here: https://www.ncbi.nlm.nih.gov/pubmed/29576107 Join in the debate: contact@topmedtalk.com Don't forget to come and meet the TopMedTalk team at one of the EBPOM events, details on the forthcoming London meeting can be found here: https://ebpom.org/EBPOM2018...
Apr 27, 2018•2 min
The first conference highlight from EBPOM USA 2018: How do you best work a pre-op clinic? Should they be places where you get your problems documented or where you get your problems 'fixed'? How do you convince your practice to optimise patients for life and not just 90 days? How do we encourage population health? How do we get round the fact that we're still in a 'fee for service world'? What is "PBPM"? Featuring Desiree Chappell, Monty Mythen, Dr Lee A. Fleisher Chair of Anesthesiology and Cri...
Apr 26, 2018•9 min
How important is it to screen patients for anaemia before surgery? Has anaemia fallen off the health care agenda? We begin with a conversation about patients who are anaemic and then turn to why this is sometimes not checked enough. Monty Mythen mentions UK University students appear to suffer from the condition more these days and Lori Heller points out that treating the condition, as part of patient optimisation, is something of a revelation for some, even occasionally removing the need for su...
Apr 26, 2018•21 min
Treating patients as people rather than 'jobs to be done' and 'boxes to be ticked' is the focus of this piece. What can Doctors do better when it comes to treating patients? Find out what happened when a perioperative care doctor became a patient. A fascinating conversation streamed live from Atlanta Georgia during the second day of TopMedTalk's coverage of "EBPOM-USA Masters Course, A Perioperative Care Practicum". Hosted by Desiree Chappell and Monty Mythen. Featuring Dr Paul Wischmeyer, Profe...
Apr 25, 2018•23 min
This piece discusses how the contributors are driving better perioperative care in their clinics; the importance of getting patient records in advance; ERAS for obstetrics; challenging opioid use with the multimodal pain management; shared decision making in pain management; the importance of clear communication pathways and patient literacy. This podcast features Desiree Chappell interviewing; Dr Ellen Flanagan, anaesthesiologist and medical director at the Duke preoperative assessment testing ...
Apr 24, 2018•18 min
Marc Koch President & CEO of Somnia Inc reviews the conference with Desiree Chappell. What should you expect at an EBPOM meeting? How useful is the practical advice given? How important is the networking side of an event like this? Hosted by Desiree Chappell. Join us on www.topmedtalk.com sign up for our email updates and never miss a live streamed conference again.
Apr 23, 2018•5 min
When it comes to breathlessness how do we better diagnose and apply treatment earlier? How do we overcome the fact that referring to a specialist can sometimes take a patient 'down the wrong route' with a condition that might not be just heart or lung related? Ronan Astin, clinical consultant in respiratory medicine at UCL Hospital, explains his more holistic approach to treatment and diagnosis. "Nick the patient" asks a few questions and demonstrates the misunderstanding that many sufferers mig...
Apr 21, 2018•30 min
Professor Monty Mythen presents Journal Club Express. Postoperative delirium in total knee and hip arthroplasty patients: a study of perioperative modifiable risk factors DOI: 10.1016/j.bja.2017.12.046 -- S. M. Weinstein et al. Br J Anaesth 2018; 120(5): 999-1008 This is an American single center retrospective study with 41,766 patients undergoing hip and knee arthroplasties over a seven year period. They showed that 22.1% patients developed post operative delirium according to the ICD 9 definit...
Apr 20, 2018•2 min
This podcast concerns sleep apnea as part of pre-operative patient optimisation. How important is it to evaluate patients for sleep disorders before surgery? Are patients with sleep apnea aware of their condition and are they using some form of treatment? What are the health problems associated with sleep disorders? How do you build a financial case for including this in your practice? A piece originally streamed live from Atlanta Georgia during TopMedTalk's coverage of "EBPOM-USA Masters Course...
Apr 20, 2018•17 min
