TopMedTalk

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RCoA Conference Highlight: Global views on Perioperative Medicine - real concerns - prisms or schisms? Jun 25, 2018

Show notes

How do we develop a way to teach perioperative medicine and once that's in place, how should it be overseen? What sort of official endorsement might it need?

Developing a broad knowledge of the process is distinct from being a specialist, how do we develop that further - without developing a schism? This complicated topic is discussed alongside more detail regarding the future for this area.

Presented by Monty Mythen and Mike Grocott with their guests; Joel Symmons, Staff Consultant Anaesthetist in the Department of Anaesthesia and Perioperative Medicine at the Alfred Hospital, Perioperative Medicine Short Course Convenor, and a Senior Lecturer in Anaesthesia at Monash University, and Paul Myles, Head of Alfred Health's and Monash University's Department of Anaesthesia and Perioperative Medicine.

This piece is taken from a longer podcast which you can hear here: https://www.topmedtalk.com/rcoh-14-how-should-we-teach-perioperative-medicine/

ISEH Highlight: ERAS what's the 'secret sauce'? Jun 24, 2018

Show notes

This piece starts with the question: Is there a hierarchy amongst the various elements of an enhanced recovery pathway? The conversation that follows tackles some of the essential elements of perioperative care.

This conversation is taken from a longer piece to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-2/

For further expert discussion regarding the Drink, Eat, Mobilise, Sleep (DrEaMS) concept there is another short piece you can find here: https://www.topmedtalk.com/standardised-outcomes-from-surgery-drink-eat-mobilise-dream/

This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

The conversation features questioner Dr Vishal Patil, Consultant Anaesthetist at Cambridge University Hospitals NHS Foundation Trust, alongside Professor Monty Mythen and his two guests; Dr Simeon West, consultant anaethetist at (University College London Hospitals) UCLH who sits on the board at Regional Anaesthesia UK (RAUK) and Mark Harper Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for thearaputic purposes.

Fluid - Matters | Part 4 'The Great American Fluid Debate' Jun 23, 2018

Show notes

This is an excerpt from 'The Great American Fluid Debate' which was hosted at Duke University Medical Centre's "Controversies in Perioperative Medicine" conference of this year. The debate is framed as "restrictive versus liberal" but, as you'll hear, those terms are questioned by panel members. How do the results of 'The Relief Trial' figure in this debate? Is the pendulum of progress swinging too far - from overly liberal to too restrictive? What can the research and detailed data around these questions tell us?

The two pieces Monty mentions in the podcast, featuring Paul Myles, are found here:

"THE RESULTS"

https://www.topmedtalk.com/the-relief-trial-results/

"YOUR ESSENTIAL DEEP DIVE"

https://www.topmedtalk.com/rcoa-11-the-relief-trial-your-essential-deep-dive-into-the-results/

And you can find the other piece here:

"JOURNAL CLUB; BALANCED VERSUS SALINE"

https://www.topmedtalk.com/journal-club-saline-solution/

Presented by Monty Mythen featuring; Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton; Professor Paul Wischmeyer from the Department of Anesthesiology, Duke University; Professor Stuart Grant, MB ChB, FRCA Director, Medical Student Education, Duke University School of medicine and Tim Miller, anaesthsiologist from Duke University Medical Centre.

Send us your feedback: contact@topmedtalk.com

Controversies in perioperative medicine; "is pain the fifth vital sign"? Jun 22, 2018

Show notes

What is 'the morpheus consortium'? What's the current thinking on pain management and the 'opioid crisis'? On reflection were people wrong to emphasise the message that 'pain is the fifth vital sign'? How did 'pain management' instead become 'opioid management'?

The UK has had a slightly different ride to the US in this respect, although not without its problems, could that be due to this 'fifth vital sign' message being less popular on the other side of the atlantic? Is it important to manage expectations and emphasise patient comfort rather than a total absence of any pain whatsoever?

Also here, there's a fascinating discussion of anemia and sex discrimination within its treatment. What is a normal level of hemoglobin in a patient and should this vary depending upon gender?

Presented by Monty Mythen with his guests Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton and a member of The Morpheus Consortium; Dr. Padma Gulur, anesthesiologist and a Pain Medicine Specialist who sees patients at Davis Ambulatory Surgical Center, Duke Pain Medicine and Duke Perioperative Pain Care; Annemarie Thompson, MD, Director, Residency Program, Professor of Anesthesiology at Duke University School of Medicine.

Controversies in perioperative medicine Jun 21, 2018

Show notes

Monty sits down with one of the co-organisers of this year's meeting in Orlando and discusses this year's annual conference, "Controversies in perioperative medicine". The discussion encompasses pain relief, opioids, the increased use of ultrasound and the use of particular blocks during abdominal surgery. As ultrasound improves how is perioperative medicine changing? What are the challenges presented by larger patients? What are the potential problems with an ultrasound guided tap block? Presented by Professor Monty Mythen with his guest Professor Stuart Grant, MB ChB, FRCADirector, Medical Student Education, Duke University School of medicine. Join the debate and email us at contact@topmedtalk.com

Fluid Matters | Part 3 Fluid Responsiveness and venous capacitance Jun 20, 2018

Show notes

This conversation reflects a discussion had at the Perioperative Quality Inititative (POQI). It originally ran under the title, "Intervascular volume and fluid responsiveness" but, as this conversation explains, it was renamed "Fluid Responsiveness and venous capacitance".

With a genuinely multidisciplinary approach on display here this piece gives you a glimpse at the inner workings of the POQI process. How does macro circulation interlock with micro circulation and cellular function? How do people on the ground measure stroke volumes? What do you do when passive leg raising is not appropriate? How do we address hypovolemia? How do you define fluid responsiveness at the bedside?

Presented by Desiree Chappell and Mike Grocott with their guests David Kaufman Associate Professor, Director, Medical Intensive Care Unit at NYU School of Medicine, NYU-Langone Medical Center and Dr Greg Martin Director, Research Network, GaCTSA; Director, Predictive Health Institute; Research Director, Emory Critical Care Center.

Fluid - Matters | Part 2 Total body water and electrolytes Jun 19, 2018

Show notes

This discussion focuses on the perioperative quality initiative's intense focus this year on total body water and electrolights. 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 Peroperative Quality Initiative (POQI) hosted at Washington Duke University in Durham 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 Faculty of Medicine and Pharmacology Vrije University in Brussells.

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

You can email the team via contact@topmedtalk.com

Enhanced recovery for cesarean section patients Jun 18, 2018

Show notes

How does perioperative care relate to obstetrics? Who does it benefit, the patient, the hospital or both? How does it help to engage pregnant patients through the perioperative process? Furthermore, does the issue of addiction arise in this area?

Coming from this summer's Peroperative Quality Initiative (POQI), hosted at Washington Duke University in Durham, this podcast features Monty Mythen and Desiree Chappell interviewing their guests Dr Attila Kett, anaesthesiologist and Chairman at St Peter's University Hospital at New Jersey and Dr. Elizabeth Cherot Medical Doctor/Managing Partner at Brunswick Hills Obstetrics and Gynecology. The team are also joined by Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

Fluid - Matters|Part 1 Definite definitions, fluid physiology Jun 17, 2018

Show notes

Names, titles and definitions were sliced, diced and discussed at the Perioperative Quality Initiative (POQI). This conversation, recorded on the morning of the second day of the meeting and featuring some of the participants, reflects that.

"Stress volumes" and "Pre-load" are a couple of examples given in this piece. Everyone involved knew what these words described but once discussions got into detail it became clear multiple definitions were at play. Part of the point of an initiative like POQI is to bring terms like this, used by different people in different ways, to a concensus. This conversation explores some of the dillemmas which emerged as a result.

'Starling pressures' are discussed as is the role of lymph in the fluid balance of our patient's bodies. Furthermore the topic of fluid responsiveness comes up as does passive leg raising. Also, how does the fact that a patient's blood pressure can be normal, even if they've lost upto 25% of blood volume, impact on our understanding of these things?

Finally, how does this relate to the practitioners at the bedside? How do we translate these debates into practical advice which will make a real difference to patients, this piece goes some way towards answering those questions.

Send us your thoughts and contribute ot the debate: contact@topmedtalk.com

Coming from this summer's Peroperative Quality Initiative (POQI) hosted at Washington Duke University in Durham this podcast is presented by Desiree Chappell with Professor Monty Mythen, Henry Howe and their guest Tim Miller, anaesthsiologist from Duke University Medical Centre and organiser of the POQI meeting.

ISEH Highlight: Getting it right first time (GIRFT) Jun 16, 2018

Show notes

We begin with a question from the audience; 'how do we drive change in our institutions towards enhanced recovery after surgery?'

The GIRFT (Getting It Right First Time) project is explained. The Health Foundation is also mentioned.

This conversation is taken from a longer piece to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-2/

This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

The conversation features questioner Paul Hutchings, Consultant Anaesthetist at Norfolk and Norwich University Hospital, alongside Professor Monty Mythen and his two guests; Dr Simeon West, consultant anaethetist at (University College London Hospitals) UCLH who sits on the board at Regional Anaesthesia UK (RAUK) and Mark Harper Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for thearaputic purposes.

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