TopMedTalk

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Heated discussions - exponential rise in babies born addicted to opiodes Mar 16, 2018

Show notes

Joff Lacey, Monty Mythen and Patrick Shanahan get stuck into an informative discussion about yesterday's 'heated' and controversial debate regarding the opiode crisis.

Joff Lacey reports he heard one clinician say "over 25% of total knee replacements are still on opiodes 6 months after their operation".

Patrick Shanahan pleads with the public "don't connect discomfort with a need for a narcotic to take care of it, there are many other avenues to take care of pain; that message is not out there enough!"

Monty Mythen and the team agree it's important not to "demonise narcotics" but all agree these discussions are essential.

How has enhanced recovery changed your practice? Mar 15, 2018

Show notes

Desiree Chappell, Dr Vijaya Gottumukkala and Dr George Nassif discuss the changes enhanched recovery has brought into their world, the conversation then moves to narcotics and the opiode epidemic.

What is ASER's vision for 2018 Mar 15, 2018

Show notes

The Roundtable Blog on TopMedTalk, live from ASER 2018.

Dr Julie Thacker takes some time with Desiree Chappell to discuss ASER's vision for this year.

Meet the TopMedTalk team for ASER 2018 Mar 15, 2018

Show notes

Monty Mythen, Joff Lacey and Mike Grocott chat with Desiree Chappell about the plan for the TopMedTalk team at ASER 2018.

Joff Lacey will be out and about with his roving mic getting on the spot interviews with attendees, gathering late breaking news as it happens.

Mike Grocott will be doing Journal Club, a deep dive into some of thre big papers of the last 12 months or so.

And finally, Desiree Chappell, will be returning to her popular Round Table Blog podcasts; bringing people from diverse backgrounds to the conversation so they can explain how they apply the perioperative process to their work.

The Opiate crisis - TOPMEDTALK live from ASER 2018 Mar 15, 2018

Show notes

Monty Mythen, Joff Lacey and Mike Grocott look ahead to this years conference and look back over the meeting last year in Washington.

The team discuss the association between low blood pressure and outcomes and the first interventional trial related to that.

They are then joined by Dr Patrick Shanahan who discusses, amongst other things, the issues related to opiode and narcotic use which can be reduced by the perioperative process.

"My Pre-op". Empowering patients before surgery. Mar 14, 2018

Show notes

Techno Talk Broadcaster Nick Margerrison presents Techno Talk; joined by Professor Monty Mythen, editor in Chief of TopMedTalk and Pete Paterson, a sports psychology master. On this episode Dr Paul Upton explains My Preop. For more information go to: www.ultramed.co

Are you ready for ASER 2018? Mar 14, 2018

Show notes

Desiree Chappell, Monty Mythen, Tim Miller and Stefan Holubar discuss some of the big issues at ASER 2018.

The team discuss whether or not we're at the point of mass adoption for enhanced surgical recovery? Where next with post operative opitate prescriptions? And finally what to expect this year from ASER 2018.

Optimal analgesia within an enhanced recovery pathway Mar 13, 2018

Show notes

Mike Grocott, Joff Lacey, Monty Mythen and Julie Thacker react to the American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery.

What is "optimal analgesia" and how rapidly should a patient "return to normal"?

The links to the papers are here:

Part 1:

https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0064-5

Part 2:

https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0063-6

Journal Club Xpress: After non-cardiac surgery myocardial injury is common and dangerous. Mar 12, 2018

Show notes

Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing DiagnosticCriteria, Characteristics, Predictors, and 30-day Outcomes

TheVascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION)Writing Group, on behalf of The Vascular events In noncardiac Surgery patIentscOhort evaluatioN (VISION) Investigators. Anesthesiology 03 2014,Vol.120, 564-578.

International,prospective cohort study of 15,065 patients > 45 yr, having noncardiac surgery.

TroponinT was measured first 3 postoperative days. Diagnosticcriterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judgeddue to myocardial ischemia.

MINSwas an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87;95% CI, 2.96–5.08) and had the highest population-attributable risk (34.0%, 95%CI, 26.6–41.5) of the perioperative complications.

1,200 patients (8.0%) suffered MINS, and over half (58.2%) of these patients would nothave fulfilled the universal definition of myocardial infarction. Fewer than one in five (15.8%) patients with MINS experienced an ischemic symptom.

Among adults undergoing noncardiacsurgery, MINS is common and associated with substantial mortality.

For original paper click here:

http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1917890

Journal Club: Multi-centre trial in BJA: Goal Directed Therapy improves outcomes Mar 10, 2018

Show notes

Effect of goal-directed haemodynamic therapy on postoperative complications in low–moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial)

Randomised Controlled Multicentre trial; n=420; GDHT vs Control

Conclusions:

"Oesophageal Doppler monitor-guided GDHT reduced postoperative complications and hospital length of stay in low–moderate risk patients undergoing intermediate risk surgery, with no difference in mortality at 180 days."

Click here for full text.

http://bjanaesthesia.org/article/S0007-0912(17)54207-5/fulltext

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