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Live from Boston ASA 2017 - Perioperative Medicine in USA Oct 21, 2017

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Anaesthesiology has reached a moment of great change, the discipline is evolving rapidly. With change comes opportunity, this conversation explores the transitional situation experts, practitioners and students find themselves in, how can you best fit into the new world? Renumeration is one changing factor but so is the idea that prevention is a clear goal for people who would like to avoid being seen as patients.

The transatlantic side of this debate is useful as a paradigm to think about where things might go but there are further elements which are outside of that picture; the evolution of AI and technology means concepts such as patient optimisation and 'the new economy of healthcare' may take on unpredictable forms in the future. How does a world of limited resources and increased technological capacity fit into the perioperative movement?

'Evidence Based Perioperative Medicine USA' is discussed alongside the intention to get beyond advocacy and into practical realities. How do we apply all these ideas?

Presented by Monty Mythen, Mike Grocott and Joff Lacey; joined by their guest Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

Podcast 3: Live from Boston ASA 2017 – Perioperative Medicine and the Perioperative Surgical Home – are we talking the same language? Oct 21, 2017

Show notes

Discussion about the challenge of delivering patient-centred, value-driven healthcare.

Value based care is discussed, value for the patient is emphasised and discussion is had about how much people trust hospitals and doctors. The difference between the perception of healthcare institutions and practitioners in UK and the US is debated.

Perioperative medicine, perioperative surgical home, enhanced recovery after surgery (ERAS); the terms differ but are they all really the same thing?

Does value based care mean we have to ask our patients what they value? Shared decision making and an awareness of where an individual's priorities lie is becoming an essential part of the picture now.

How does this dovetail into the questions regarding multiple morbidities and pathological health concerns? Prehabilitation may mean modifiable risk factors brought on by lifestyle need to be addressed as part of patient optimisation.

How does this work in a fee for service environment? The answers vary but if there's a significant saving for a hospital can it be funded by the institution itself?

Professor Monty Mythen, Professor Mike Grocott and Dr Joff Lacey presenting with their guest Prof Zeev Kain, Chancellor's Professor of Anaesthesia at University of California at Irvine and President of the American College of Perioperative Medicine.

Podcast 2: Live from Boston ASA 2017 - The big challenge of big trials Oct 21, 2017

Show notes

The challenges facing the anaesthesia community as the need for big trials looms large. Why does it take so long for the anaesthesia community to adopt new techniques? Goal directed fluid therapy, as an example, seems to work but involves a cultural change and huge trials before it can be adopted.

The Optimisation of Peri-operative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is discussed in detail, as is the FLO-ELA (FLuid Optimisation in Emergency LAparotomy) trial.

Could it be that because fluid therapy involves a cultural change within the anaesthesia community there is a difficulty for some to accept the evidence as it is?

Finally Monty asks, as regards big trials, "blood pressure, shouldn't there be more of a focus on that?".

Presenting live from Boston ASA; Professor Monty Mythen, Professor Mike Grocott and Dr Joff Lacey.

Join the debate: contact@topmedtalk.com

Podcast 1: Live from Boston ASA 2017 - Anaesthesia and the Perioperative Medicine movement Oct 21, 2017

Show notes

The largest gathering of anaesthesiologists in the world; feel as if you're there with the TopMedTalk team at ASA 2017.

This discussion covers the birth of anaesthesia, in Boston, and its adoption around the world. The contrast between demonstration and adoption in the 1800's and in the modern world is questioned, are we too cautious in adopting new ideas these days? Also - what has been the impact upon surgery, do patients now have unrealistic expectations as regards pain management as a result of it?

And finally, is perioperative medicine a natural evolution of this history?

Professor Monty Mythen, Professor Mike Grocott and Dr Joff Lacey recorded this piece live in Boston at the ASA 2017.

Join the debate contact@topmedtalk.com

Anesthesiology 2017 intro Oct 17, 2017

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TopMedTalk ASA 2017 mission statement.

The start of our live coverage from Boston.

Urine output | TopMedTalk General Sep 04, 2017

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Should we still measure urine output? How useful is permissive oliguria?

This taken from a longer conversation on the subject of perioperative nephrology to be found here: http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/

Renal Injury Biomarkers Sep 04, 2017

Show notes

How do cell cycle arrest biomarkers offer hope?

Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh and Dr Tim Miller from Duke University Medical Centre. Join in the debate: contact@topmedtalk.com This piece taken from a longer conversation to be found here: http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/

Perioperative Nephrology Fluids and the Kidney Sep 04, 2017

Show notes

Professor John Kellum gives a thumbnail sketch summary of the fluid debate.

Presented by Professor Monty Mythen and Dr Joff Lacey with guest John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh. Join in the debate: contact@topmedtalk.com This conversation taken from a longer piece here: http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/

Intraoperative Hypotension Sep 04, 2017

Show notes

Reactions to one of the big take away points of EBPOM 2017, intraoperative hypotension lower than 65 mmHg appears to show a close correlation to terrible, sometimes fatal, outcomes.

Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests Dr Tim Miller from Duke University Medical Centre and John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh. Join in the debate: contact@topmedtalk.com This piece taken from a longer conversation to be found here: http://www.topmedtalk.com/aser-ebpom-2017-pod-two-live-from-washington-dc/

Risk of Surgery Sep 04, 2017

Show notes

What is a 'micromort'? Even more of a worry, what does ten of them mean? How do we measure and communicate risk to patients? Everyday activities all carry inherent risks, how do we put surgery into a context 'everyday people' can more easily understand?

Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with guests, Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and Dr Mike Irwin, Professor and Head, Department of Anaesthesiology, University of Hong Kong.

Sponsored by EBPOM and Edwards Life Sciences.

Join in the debate: contact@topmedtalk.com

Taken from a longer conversation to be found here: http://www.topmedtalk.com/ebpom-2017-pod-two-live-from-london/

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