TopMedTalk

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Optimising the perioperative patient | ASA 2018 Oct 24, 2018

Show notes

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 such treatments require a frailty adjustment and what is the bigger picture as regards delirium?

Questions are taken from the audience; what is the value of lidocaine infusions? How does opioid minimisation fit into this picture? How practical are alternating dosages when it comes to analgesics in the US healthcare system?

Finally, there is an indepth discussion about anemia in the perioperative process.

Presented by Desiree Chappell and Monty Mythen with their guest Michael Scott, Professor and Division Director, Critical Care Anesthesiology- Virginia Commonwealth University

The practical applications of innovation | ASA 2018 Oct 23, 2018

Show notes

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 tie into the issue of early mobilisation? Furthermore - what will the consequences be when facial recognition and monitoring is ubiquitous within institutions?

The website mentioned in the podcast is here: https://www.michardconsulting.com/

Presented by Desiree Chappell with Monty Mythen and their guest Frederic Michard of MiCo Consulting.

Teaching Anaesthesia to Medical Students | ASA 2018 Oct 22, 2018

Show notes

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.

Perioperative Fluid Management to Enhance Recovery After Surgery | ASA 2018 Oct 21, 2018

Show notes

This conversation focuses on perioperative fluid management as part of Enhanced Recovery After Surgery (ERAS). Firstly, the team addresses the online poll - Is Enhanced Recovery (ER) the standard of care where you practice? They then move into a wider discussion about the key elements of ER alongside the main topic of perioperative fluid management.

Presented by Monty Mythen with Desiree Chappell featuring their guests Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton and Tim Miller, Associate Professor of Anaesthesiology from Duke University Medical Centre.

For more on the RELIEF trial: https://www.topmedtalk.com/?s=RELIEF

Massive study of quality shows no benefit; why? | ASA 2018 Oct 20, 2018

Show notes

Lessons learned from the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial. This conversation focuses upon the challenges of quality improvement programmes; how do we keep track of patients and improve follow up questions after surgery? How do we clearly show Quality Improvement Programmes work for the patient? Further discussion encompasses innovation and utilization in practice.

Presented by Monty Mythen and Desiree Chappell with their guest Carole Peden, Professor of Anesthesiology and Exec. Director of the Center for Health System Innovation, University of Southern California, University of Bath and the Institute for Healthcare Improvement (IHI).

For more on EPOCH look here: https://www.topmedtalk.com/?s=EPOCH

Building a sustainable ERAS programme | ASA 2018 Oct 19, 2018

Show notes

This fascinating in-depth conversation about Enhanced Recovery After Surgery, facilitated by questions both from our worldwide online audience and people who were attending the American Society of Anesthesiologists (ASA) conference in San Francisco this year.

Presented by Desiree Chappell and Monty Mythen with Sol Aronson, tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology and Vijaya Gottumukkala, Professor of Anesthesia and Deputy Chair at MD Anderson.

Fluid - Matters; Part 2 Total body water and electrolytes | TopMedTalk Highlight Oct 19, 2018

Show notes

In no particular order we're playing some of the content that listeners have voted for with their downloads. This episode is one of the top ten most downloaded podcasts we've done so far.

This discussion focuses on the perioperative quality initiative's (POQI) intense focus this year on total body water and electrolytes. How often should we weigh patients to monitor water balance? What can we learn from a real understanding of the circulation of interstitial fluid and lymphatics? What is the role of diuretics for the perioperative practitioner? Also, haemodilution, what should you do if you have a patient with a positive post operative fluid balance and a low haemoglobin? Finally, how do we deal with Sodium balance and Chloride?

Coming from this summer's POQI hosted at Duke University in North Carolina, USA this podcast is presented by Monty Mythen and Henry Howe with their guests Tom Woodcock, an independent consultant in patient safety, medical law and ethics, and Manu Malbrain, Professor at the Faculty of Medicine and Pharmacology Vrije University in Brussells.

The website mentioned in this piece is here: https://www.fluidacademy.org/

ERAS working with existing resources | ASA 2018 Oct 18, 2018

Show notes

Despite the fact that a return on investment is a given after 12 months why is it that resources are not available for those of us pushing for Enhanced Recovery After Surgery (ERAS)? How do we convert the conversation down from pure financial terms into a lexicon that institutions can understand?

The 'Council of Nurses' idea advocated in this piece is explored further in a previous podcast on TopMedTalk to be found here: https://www.topmedtalk.com/a-council-of-nurses/

Join the team on the first day of the ASA in San Francisco. Originally streamed live on http://www.topmedtalk.com from the Smith's Medical Booth in the exhibition hall of the conference.

Presented by Monty Mythen and Desiree Chappell with their guest Dr Ruchir Gupta, medical lead for enhanced recovery at Stony Brook University.

RCoA 11 - The RELIEF Trial; your essential 'deep dive' into the results | TopMedTalk Highlight Oct 18, 2018

Show notes

This series is a chance for new listeners to jump on board and for established listeners to catch up with some of our favourite podcasts so far, as voted for by our listeners: "RCoA 11 - The RELIEF Trial; your essential 'deep dive' into the results." The RELIEF (Restrictive versus liberal fluid therapy in major abdominal surgery) trial has been a huge story for us here at TopMedTalk, recorded on the second day of The Royal Collage of Anaesthetists' annual conference at the British Museum this is the moment the team get to pick over the results in detail. One of the biggest trials ever, it has both raised questions and provided answers. Inevitably there has been a huge debate, this piece puts all the major questions and concerns to the organiser of the trial. Send us your thoughts on The RELIEF trial: contact@topmedtalk.com

Presented by the TopMedTalk team; Professor Monty Mythen, Dr Joff Lacey, Desiree Chappell and Professor Mike Grocott, with their guest Paul Myles, Head of Alfred Health's and Monash University's Department of Anaesthesia and Perioperative Medicine and organiser of the RELIEF trial.

Welcome to The ASA | ASA 2018 Oct 17, 2018

Show notes

Join the team on the first day of the ASA in San Francisco. Originally streamed live on http://www.topmedtalk.com from the Smith's Medical Booth in the exhibition hall of the conference.

Presented by Monty Mythen, Desiree Chappell, Mike Grocott and Joff Lacey.