Standing up a Preoperative Smoking Cessation Program Moderator: The rationalization; data, outcomes, economics; The practical realities; screening, workflow and workforce, financials and tracking Presented by James Davis, MD, Director Duke Smoking Cessation Program This is taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum" which took place in Atlanta earlier this year.
Nov 19, 2018•17 min
This special four part series explores the fascinating story of Xtreme Everest – the ground-breaking, research programme that has pursued a novel approach to scientific exploration. Over the last decade, this innovative team has performed large scale studies at high altitude to mimic some of the effects of critical illness. The objective is for their findings to be brought “from the mountainside to the bedside” so that the care for our sickest patients may be improved. In this podcast, Chris Imr...
Nov 18, 2018•18 min
Standing up a Preoperative Smoking Cessation Program Moderator: The rationalization; data, outcomes, economics; The practical realities; screening, workflow and workforce, financials and tracking This is taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum" which took place in Atlanta earlier this year. Presented by James Davis, MD, Director Duke Smoking Cessation Program
Nov 17, 2018•21 min
Standing up a Preoperative Smoking Cessation Program Moderator: The rationalization; data, outcomes, economics; The practical realities; screening, workflow and workforce, financials and tracking This is taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum" which took place in Atlanta earlier this year. Presented by James Davis, MD, Director Duke Smoking Cessation Program.
Nov 16, 2018•22 min
Standing up an Obstructive Sleep Apnea (OSA) Clinic. The rationalization; data, outcomes, economics; The practical realities; screening, workflow and workforce, financials and tracking. This is taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum" which took place in Atlanta earlier this year. Presented by Andrew Spector Assistant Professor of Neurology at Duke University Medical Center in Durham, NC USA
Nov 15, 2018•21 min
Standing up an Obstructive Sleep Apnea (OSA) Clinic. The rationalization; data, outcomes, economics; The practical realities; screening, workflow and workforce, financials and tracking. This is taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum" which took place in Atlanta earlier this year. Presented by Andrew Spector Assistant Professor of Neurology at Duke University Medical Center in Durham, NC USA
Nov 14, 2018•20 min
This talk covers heart disease in pregnancy and was taken from the "20th Current Controversies in Anaesthesia & Peri-Operative Medicine" conference which took place in Dingle, Ireland in October 2018. Fiona Walker, Cardiologist, trained in grown-up congenital heart disease (GUCH) and maternal cardiology in Toronto and at UCLH. She is the Service lead for GUCH (2005 – present) and head of the maternal cardiology programme at University College London Hospitals (UCLH).
Nov 13, 2018•20 min
What is "Point of care ultrasound" or POCUS? What is the usefulness of ultrasound? Have the boundaries of this application been reached yet? How do you get started with point of care ultrasound? The websites mentioned in this piece are: https://www.foresightultrasound.com/ and www.POCUSEducation.com Monty Mythen and Desiree Chappell with Mike Grocott and their guest Davinder Ramsingh, M.D. Associate Professor of Anesthesiology, Loma Linda University....
Nov 12, 2018•14 min
This special four part series explores the fascinating story of Xtreme Everest – the ground-breaking, research programme that has pursued a novel approach to scientific exploration. Over the last decade, this innovative team has performed large scale studies at high altitude to mimic some of the effects of critical illness. The objective is for their findings to be brought “from the mountainside to the bedside” so that the care for our sickest patients may be improved. In this podcast, Dan Marti...
Nov 11, 2018•12 min
Where are we with the journey from Enhanced Recovery (ER) to Perioperative Medicine? Is it fair to characterise the latter as "Enhanced Recovery v2.0"? Mike Grocott explains how the Royal College of Anaesthetists (RCoA) have set up a plan for "perioperative care" going forward. Does this terminology, "perioperative care" help? Also - news about the "international board of perioperative medicine", how are the challenges of the global ambition for this movement being met? Monty Mythen and Desiree ...
Nov 10, 2018•14 min
How important is 'expectation management' in pediatrics? What could the usefulness of cannabis be as a way of reducing reliance on opioids? Is research in this area growing? Desiree Chappell and Mike Grocott interview their guest Myron Yaster, Children's Hospital Colorado.
Nov 09, 2018•14 min
Recognising and treating pain in children has gone through significant change over the years, this is a trend that looks set to continue. With a focus upon Enhanced Recovery (ER), what are the pathways for the pediatric patient? Should we be looking more at opioid reduction rather than opioid avoidance? How large a part of the problem is the dispensation of opioids and the "bystander risk" - where they go unused but are kept in a drugs cabinet at home, posing a risk to curious teenagers? How muc...
Nov 08, 2018•16 min
The conversation from part 1 continues with questions such as; what specific anaesthesia protocols do you use? Is there room in this context to consider a drug diversion programme? Is phenylephrine a good choice for these procedures? There is also a special mention for The Society for Obstetric Anesthesia and Perinatology (SOAP) - you can find their website here: https://soap.org/ Desiree Chappell and Monty Mythen interview their guest Laurent Bollag, M.D., is UW Medicine's chief of Obstetric An...
Nov 07, 2018•15 min
The conversation begins with some thoughts on Enhanced Recovery (ER) for the obstetric patient. Further discussion covers the "transatlantic" differences between the US, UK and the wider EU. Where does pain management fit into the ceasarian section (c-section) debate? What are the advantages of a drug diversion programme in that respect? The issue of fluid management in the operating room is discussed. What is Evidence Based Obstetric Anaesthesia? Desiree Chappell and Monty Mythen interview thei...
Nov 06, 2018•17 min
This roundtable discussion digs deep into the question of Enhanced Recovery After Surgery (ERAS), how do you obtain buy in and sustainability and what can we learn from the experiences of advocates at the University of Pittsburgh Medical Center (UPMC). Presented by Desiree Chappell with her guests Dr Jennifer Holder-Murray, Vice Chair of Quality Integration, Assistant Professor of Surgery, Division of Colon & Rectal Surgery, University of Pittsburgh Medical Center (UPMC) and Dr Stephen Esper...
Nov 05, 2018•18 min
This special four part series explores the fascinating story of Xtreme Everest – the ground-breaking, research programme that has pursued a novel approach to scientific exploration. Over the last decade, this innovative team has performed large scale studies at high altitude to mimic some of the effects of critical illness. The objective is for their findings to be brought “from the mountainside to the bedside” so that the care for our sickest patients may be improved. In this podcast, Denny Lev...
Nov 04, 2018•23 min
This piece is a quick reminder that we have launched a new series on TopMedTalk "Xtreme Everest Extra". It's in four parts and we're going to be releasing them every Sunday from now on. The link to the first episode is here: https://www.topmedtalk.com/xtreme-everest-extra-the-problem-with-hypoxia-the-inception-of-xtreme-everest/ This series is intended for a broad audience, the more in depth pieces we did earlier in the year are to be found here: https://www.topmedtalk.com/?s=Xtreme+Everest+%7C...
Nov 04, 2018•4 min
Recorded before a live audience and streamed on www.topmedtalk.com The conversation from part 5 continues. More on Caesarian Section plus: should we implement Enhanced Recovery After Surgery (ERAS) training into undergraduate and post-graduate training? Is ERAS similar to perioperative surgical home (PSH)? As new data emerges about ERAS how often will pathways and protocols be changed? What is the future for ERAS? Desiree Chappell interviews her guest Dr Elizabeth Cherot, Vice President of medic...
Nov 03, 2018•17 min
Recorded before a live audience and streamed on www.topmedtalk.com The conversation from part 4 continues, the subject is, Enhanced Recovery After Surgery for obstetrics and cesarian sections (c-section). Questions include: How can ERAS co-habitate with the "baby friendly initiative"? The USA is 16th in the world with OB outcomes can ERAS help with that? As we are trying to impliment ERAS for c-section we are encountering some social issues such as screening neo-nates before they go home and arr...
Nov 02, 2018•16 min
Recorded before a live audience and streamed on www.topmedtalk.com The subject is, Enhanced Recovery After Surgery for obstetrics and Caesarean sections (c-section). Questions include: What's the standard length of stay for an elective Caesarean section (C-section) being done with Enhanced Recovery After Surgery (ERAS) protocols? Do Mums want to go home in a day? Don't C-section practitioners already follow ERAS protocols? What is the role of tap blocks in C-section? What is your hospital's prot...
Nov 01, 2018•19 min
Recorded before a live audience this piece continues the question and answer session from parts one and two. Epidurals versus plane blocks, what do you choose and why? Is there a potential for decrease in fasting times for clear fluids to further enhance recovery? Where can Enhanced Recovery (ER) protocol templates be found on line? How do we know which parts of Enhanced Recovery work and which parts are less important? Is local anesthesia the secret to avoiding post-operative delerium? Desiree ...
Oct 31, 2018•12 min
What is the balance of risks and benefits related to regional anaesthesia? Does the short term use of opioids really contribute to the opioid crisis? What are the benefits of "opioid sparing" when held against "opioid free"? When it comes to regional anaesthesia, what kind of benefits should we expect beyond pain control and opioid sparing? Desiree Chappell interviews her guest Vincent W. S. Chan, Professor Anesthesia at The University of Toronto with contributions from Monty Mythen, TopMedTalk ...
Oct 30, 2018•12 min
Recorded before a live audience this Q&A session was recorded at the annual meeting of the American Society of Anesthesiologists (ASA) at a specially hosted dinner where both those in attendance and the online audience could submit questions. This discussion is about Enhanced Recovery (ER) and lowering tolerance of poor outcomes after surgery. How do we know practitioners are actually using the principles of Enhanced Recovery After Surgery (ERAS)? Put simply, they should be Drinking, Eating,...
Oct 29, 2018•11 min
Where is perioperative medicine as a specialty in the US? How do frail patients benefit from the perioperative process? Age and physical fitness are important factors when deciding if you're going to put a patient through major surgery, how do these factors allow us to differentiate between those who are likely to have a poor outcome? How common is cardiopulmonary exercise testing (CPET) in the US? Presented by Desiree Chappell and Monty Mythen with their guest Bobbie Jean Sweitzer, Director of ...
Oct 28, 2018•19 min
Obstetrics might seem the natural place for Enhanced Recovery After Surgery (ERAS). Which components of Enhanced Recovery apply the most to a procedure such as a Caesarian section (C-section)? Differences between obstetrics in the UK and the US are discussed. The addictive qualities of oxycodone are discussed in detail. This leads to a discussion about what tablets patients should be leaving the hospital with. Presented by Monty Mythen and Desiree Chappell with their guest Brendan Carvalho, Prof...
Oct 27, 2018•31 min
This piece is a deep dive into regional anaesthesia for Enhancing Recovery. Hear how paravertebral nerve blocks can be used in breast cancer surgery, how does this effect long term outcomes for patients? There is then further discussion regarding regional anaesthesia for Ambulatory Surgery. There is also a long form discussion of electromyographic (EMG) objective monitoring on a neuromuscular blockade. How can this help reduce and discover potential poor outcomes? Further questions from the onli...
Oct 26, 2018•27 min
Enhanced Recovery After Surgery (ERAS) is the focus for the TopMedTalk team at this year's ASA. This piece features discussion regarding; what to do about pre-operative frailty, smoking cessation, patient-centric care and how to manage pre and post operative expectations. How do we ensure the conversations we have before surgery both reflect the needs of the patient and the realities of an operation? Moving beyond that how do we use patient reported outcomes to improve the process overall? We al...
Oct 25, 2018•25 min
This piece is about optimizing the perioperative patient for Enhanced Recovery (ER). Hear from one of the pioneers of ER for laparoscopic colorectal surgery in the UK, over 15 years ago he was sending patients home in less than 24 hours having had laparoscopic right hemicolectomys! This is the story of one of the roots of Enhanced Recovery adoption in the NHS. We also cover issues such as, the importance of pre-operative nutrition, gabapentinoids and, in a similar vein, low dose ketamine. Do suc...
Oct 24, 2018•36 min
How do new technologies impact the postoperative elements of Enhanced Recovery? We discuss ward monitoring 3.0 and the technology available, or in the pipeline, to improve outcomes. How do we best use this information and these innovations? There is also a refreshing conversation about Artificial Intelligence (AI) alongside discussion about "bed sensors" and "facial recognition". Some dementia units are using new technology to monitor patient movement both in and out of their beds, how does this...
Oct 23, 2018•25 min
This fascinating conversation revolves around the experience and need for good teachers in the field of Anaesthesia. How do we encourage professionals and students to pursue this vital and rewarding discipline? Dr Joff Lacey presents with his guest Dr Rob Stephens, Consultant in Anaesthesia, UCLH, Hon Senior Lecturer in Anaesthesia, UCL.
Oct 22, 2018•11 min
