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RCoA 04 - The Royal College of Anaesthetists, world leading healthcare May 22, 2018

Show notes

How has the Royal College of Anaethestists (RCoA) evolved over the years and why is perioperative medicine so crucial to its agenda? How has this leadership in perioperative medicine become a force for change and improvement worldwide and what are the common themes that emerge as we take a global perspective on the discipline?

The RCoA's global partnership programme is explained, how can perioperative medicine be part of helping less developed healthcare systems? The considerations are different but the principles remain the same.

The birth of the NHS gave parity of esteem to anaesthetists, the benefits of this are felt by us all in the Western world, could it be argued that this visionary decision might actually help other healthcare systems to evolve more rapidly?

Finally - where is the discipline these days? Leadership and the ability to see the bigger picture are part of it, as is communicating to that wider world with various innovations including this podcast which you, as a listener, are a part of.

Presented by Desiree Chappell and Monty Mythen with their guests Dr Liam Brennan, President of The Royal College of Anaesthetists (RCoA) and Professor Paul Myles, Director, Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia.

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RCoA 03 - Adverse outcomes and patient optimisation May 22, 2018

Show notes

Adverse outcomes, we all know they happen but how do we handle them, record them and avoid them in the first place? The discussion then moves to (Patient Recorded Outcome Measures) PROMS.

Patient optimisation is then discussed. Exercise, could it be so effective because it works as an anti inflammatory? A deep dive into the research on that is contained in this conversation.

The RELIEF trial is discussed as the team get into a discussion about what a patient sees as a good outcome. How do we communicate the risks, possible benefits and limitations, of surgery to patients?

Also in this piece, find out about a fascinating community-based multimodal prehabilitation service.

Desiree Chappell and Joff Lacey are presenting with their guests Dr Mark Edwards, Consultant in Anaesthesia and Perioperative Medicine at The University Hospital Southampton NHS Foundation Trust and Professor Gerard Danjoux, Consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust.

Join in the debate: contact@topmedtalk.com

RCoA 02 - Outcomes, universal healthcare and the goals of the RCoA May 22, 2018

Show notes

Recorded live at The British Museum in London this piece contains a lot of discussion about the NHS; how does it rank in terms of outcomes? What does the offer of universal healthcare mean in terms of that? How does it compare to the way things are done in America and around the world?

The team then discuss the shared goals and huge crossoever which exists between perioperative practitioners and The Royal College of Anaesthetists. Particular focus is given to the challenge of public health overall.

Presented by Desiree Chappell with Monty Mythen and Joff Lacey after the first session, on the first day, of the annual meeting of the Royal College of Anaesthetists.

Join in the debate: contact@topmedtalk.com

RCoA 01 - Live from the annual meeting of The Royal College of Anaesthetists May 22, 2018

Show notes

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 the next few days.

Send us your thoughts: contact@topmedtalk.com

Presented by Monty Mythen, Joff Lacey and Desiree Chappell with their guest Mike Grocott, Professor of anasthesia and critical care at the University of Southampton and one of the co-organisers of the meeting.

Why practice value based care? May 20, 2018

Show notes

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 conversation which you can find here: http://www.topmedtalk.com/barriers-and-successes-in-value-based-care/

What is SNAP-2? May 19, 2018

Show notes

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 with his guest Dr Ramani Moonesinghe, Director of the UK National Institute of Academic Anaesthesia Health Services Research Centre. This taken from a longer conversation here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/ Join in the discussion: contact@topmedtalk.com

Curb your fluid? May 18, 2018

Show notes

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-directed-fluid-therapy-fluid-responsiveness-the-stressed-system-and-the-glycocalyx/ Join in the debate: contact@topmedtalk.com

Journal Club Express 17/05/18 May 17, 2018

Show notes

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.2017.12.044

Journal Club Express 21/05/18 May 16, 2018

Show notes

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 news is senior anaesthetists resuscitated all patients.

The rest is a mixed bag; Immediate management was judged to be 'good' in 46% but 'poor' in 15%, recognition of anaphylaxis was prompt in 97% and treatment was prompt in 83% of cases.

Epinephrine (ADRENALINE) was administered i.v. in 76%, i.m. in 14%, both in 6%, and not at all in 11% of cases.

A catecholamine infusion was administered in half of cases.

Cardiac arrests (40 cases; 15%) were promptly treated but cardiac compressions were omitted in half of patients with unrecordable BP.

The surgical procedure was abandoned in most cases.

Very sadly, Ten (3.8%) patents died from anaphylaxis, mostly elderly with cardiovascular disease. Fluid administration was deemed inadequate in 19% of cases. Adverse sequelae, psychological, cognitive, or physical, were reported in one-third of cases.

THE BOTTOM LINE:

The authors suggest management of perioperative anaphylaxis could be improved, especially with respect to administration of epinephrine, cardiac compressions, and i.v. fluid.

https://bjanaesthesia.org/article/S0007-0912(18)30321-0/fulltext

The Xtreme Everest Oxygen Research Consortium | Xtreme Everest May 16, 2018

Show notes

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, Joff Lacey and Mike Grocott, head of The Xtreme Everest Oxygen Research Consortium; are joined by Dr Dan Martin OBE an anaesthetist and critical care doctor from The Royal Free Hospital in London, a consultant in Intensive Care and an Everest summiteer.

The documentary mentioned in this piece is here: https://www.youtube.com/watch?v=ecCJ8sMVeiU

This taken from a longer piece here: http://www.topmedtalk.com/live-from-boston-asa-2017-life-at-the-extremes-trials-on-everest-adapting-to-hypoxia/

And the Xtreme Everest website is here: http://www.xtreme-everest.co.uk/

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