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Smith's Medical Symposium on Enhanced Recovery – Part 6 | ASA 2018 Nov 03, 2018

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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 medical affairs at Axia Women's Health, with contributions from Monty Mythen, TopMedTalk Editor in Chief and Smiths Medical Professor of Anaesthesia and Critical Care at University College London.

Go to www.topmedtalk.com and download our full back catalogue now.

Smith's Medical Symposium on Enhanced Recovery – Part 5 | ASA 2018 Nov 02, 2018

Show notes

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 arranging a car seat before they go home? What was the reaction of hospital administation leaders when they realised your plans would reduce length of stay? Do you do ERAS for 'complicated' patients? ERAS generally seems to reduce length of stay; what major/minor procedure specific complications can we tell our patients have also been reduced? What is the mechanism by which a carbohydrate load is supposed to work, what are the essential elements of that load? What do you think about the role of exparel vs bupivacaine?

Go to www.topmedtalk.com and download our full back catalogue now.

Smith's Medical Symposium on Enhanced Recovery part 4 | ASA 2018 Nov 01, 2018

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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 protocol for ERAS for Mums? Desiree Chappell interviews her guest Dr Elizabeth Cherot, Vice President of medical affairs at Axia Women's Health, with contributions from Monty Mythen, TopMedTalk Editor in Chief and Smiths Medical Professor of Anaesthesia and Critical Care at University College London. Go to www.topmedtalk.com and download our full back catalogue now.

Smith's Medical Symposium on Enhanced Recovery part 3 | ASA 2018 Oct 31, 2018

Show notes

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 Chappell continues her conversation with her guest Vincent W. S. Chan, Professor Anesthesia at The University of Toronto with contributions from Monty Mythen, TopMedTalk Editor in Chief and Smiths Medical Professor of Anaesthesia and Critical Care at University College London.

Go to www.topmedtalk.com and download our full back catalogue now.

Smith's Medical Symposium on Enhanced Recovery part 2 | ASA 2018 Oct 30, 2018

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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 Editor in Chief and Smiths Medical Professor of Anaesthesia and Critical Care at University College London. Go to www.topmedtalk.com and download our full back catalogue now.

Smith's Medical Symposium on Enhanced Recovery part 1 | ASA 2018 Oct 29, 2018

Show notes

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, Mobilising and Sleeping (DREAMS). What are the key elements of an ERAS program? This piece features Desiree Chappell in conversation with Monty Mythen. Go to www.topmedtalk.com and download our full back catalogue now.

Frailty and the perioperative patient - enhancing recovery | ASA 2018 Oct 28, 2018

Show notes

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 Perioperative Medicine at Northwestern.

Considerations for the obstetric patient; ERAS for C-section | ASA 2018 Oct 27, 2018

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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, Professor of Anesthesiology, Perioperative and Pain Medicine at Stanford University Medical Center.

Regional anaesthesia associated with improved cancer survival – new data | ASA 2018 Oct 26, 2018

Show notes

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 online audience are addressed such as "can you send knee surgery patients home on the day of surgery, how do you manage pain?"

Presented by Desiree Chappell and Monty Mythen with their guest Professor Stuart Grant, MB ChB, FRCA Director, Medical Student Education, Duke University School of medicine.

Improving outcomes for the perioperative patient | ASA 2018 Oct 25, 2018

Show notes

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 also have contributions from the audience; "What role does the General Practitioner have in promoting smoking cessation, is the pre-operative clinic too late to get the ball rolling?" and "Is perioperative medicine to be understood as a generic provider / management system or as a specific branch of practice?"

Desiree Chappell and Monty Mythen speak with their guest Dr Angela Edwards, Head of Perioperative Medicine at Wake Forest University School of Medicine.

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