TopMedTalk

This podcast covers the physiological principles of goal directed fluid therapy, fluid responsiveness, the stressed system and the glycocalyx. Originally streamed live on www.topmedtalk.com Presented by Dr Joff Lacey with his guest Dr Randall Dull of the University of Illinois, live from the ASA in 2017.

What can practitioners do to preoperatively screen for signs that their patients may have issues with post operative delirium? How do we get patients fit for surgery, particularly as regards delirium? Can you build up mental resilience in the run up to an operation, do suggestions that puzzles and mental activity such as sudoku and a good crossword help have any evidence behind them? This piece features Monty Mythen and Desiree Chappell in conversation with Dan Cole, professor of clinical anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles and former president of the American Society of Anesthesiologists (ASA).

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.

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 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.

This piece, originally streamed live on www.topmedtalk.com features a conversation about the implementation of enhanced recovery protocols and the results practitioners report. The discussion starts with the observation that just implementing the ERAS intraoperative protocols drove outstanding outcomes in practice. The wider discussion focuses on the importance of putting into practice a bigger plan. Presented by Desiree Chappell with her guests Raul Castillo, Anesthesia Medical Director at the University of Missouri Hospital, Jennifer Clark, Staff Nurse Anesthetist at the University of Missouri Hospital Department of Anesthesiology, and Kay Smith, pain nurse coordinator University of Missouri Hospital.  

What are the results if you apply Enhanced Recovery to obstetrics? This podcast features Desiree Chappell interviewing Dr Attila Kett, anaesthesiologist and Chairman at St Peter’s University Hospital at New Jersey. Join in the debate: contact@topmedtalk.com

In short; Post-Op recovery in less than 3 days with over 90% mobilised on day 1. This in depth discussion relates to the consensus paper from the Perioperative Quality Initiative, see link below. It focuses on: outcomes, length of stay and DREAMS (Drinking, Eating and Mobilising) within hours after major surgery- all key measures of compliance and success in an Enhanced Recovery Program. Monty Mythen and Joff Lacey with Mike Grocott presenting with contributions from Dr Julie Thacker, Colorectal Surgeon from Duke University and President of the American Society of Enhanced Recovery and Dr Tim Miller, Anesthesiologist from Duke University. POQI website is here: http://www.poqi.org For further CME read the paper in Perioperative Medicine: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0062-7 Attend our next meeting: http://www.ebpom.org/EBPOM-USA This piece is taken from a longer discussion here: http://www.topmedtalk.com/aser-ebpom-2017-pod-two-live-from-washington-dc/

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

This episode of The Perioperative Coach reflects on the pain management discussions being had by the American Society of Enhanced Recovery (ASER) and its members. For further reading see the articles in Perioperative Medicine Journal: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0064-5 This conversation taken from a longer piece to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/ Presented by Monty Mythen with Dr Joff Lacey and Professor Mike Grocott.

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/

A discussion about fluid management in an enhanced surgical recovery pathway in relation to the guidelines from ASER and the work of The Perioperative Quality Initiative (POQI http://www.poqi.org). Presented by Monty Mythen with his guest Dr Tim Miller, anaesthesiologist at Duke Medical Centre and Vice President of ASER. For more come to our meetings: http://www.ebpom.org/EBPOM-USA This highlight clip is taken from a longer conversation to be found here: http://www.topmedtalk.com/aser-ebpom-2017-pod-two-live-from-washington-dc/

Implementing better practice and "ERAS 2.0". The ground up approach of a 'council of nurses' sparks some fascinating debate and discussion. Can a roundtable approach sometimes work better than the traditional hierarchical power structure? Presented by Desiree Chappell with her guests Dr Ruchir Gupta, medical lead for enhanced recovery at Stony Brook University and Joni Brady, Perianesthesia, Pain Management Nursing Consultant Alexandria, Virginia.

A conversation about ASER fluid management; NPO; preop drinks and keeping the i.v down. Monty Mythen is presenting with his guest Dr Scott Brudney, Professor, Departments of Anaesthesiology and Internal Medicine, University of Manitoba, Winnipeg, Canada. Click here for the American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-016-0049-9 This conversation is taken from a longer piece to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/

A conversation about enhanced recovery implementation. Dr Joff Lacey catches up with Mike Scott, Virginia Commonwealth University and Ross Kerridge, John Hunter Hospital, Newcastle, Australia.

"An operation is like a marathon, nobody prepares for that by starving themselves" Monty Mythen talks to Professor Paul Wischmeyer from the Department of Anesthesiology, Duke University, USA about the e.published American Society of Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on Nutrition and Screening Therapy within an Surgical Enhanced Program. Click on this link to access the full paper: https://journals.lww.com/anesthesia-analgesia/Abstract/publishahead/American_Society_for_Enhanced_Recovery_and.96950.aspx Furthermore, you can listen to one of Paul's excellent talks here: http://topmedtalk.libsyn.com/website/ebpom-2018-perioperative-nutrition-should-be-a-key-part-of-enhanced-recovery

How does the treatment of anemia fit into the perioperative process? How far should patient optimisation extend to treatment of this condition? Live from the hugely successful EBPOM USA conference, directly after their presentation Desiree Chappell talks with her guests; Dr Lori Heller, Cardiac Anesthesiologist, Swedish Medical Center, through US anaesthesia partners and acting instructor at the University of Washington, Seattle and Dr Bobbie Jean Sweitzer, Associate Professor and Director of pre-operative medicine at the University of Chicago.

Discussion begins with a hugely successful Enhanced Recovery program at a large community hospital, continued improvements and service line expansion. Learn about both the advantages and the challenges of a perioperative practice here. Presented by Desiree Chappell and Monty Mythen with their guests Kim Duggan, Perioperative Surgical Home (PSH) - Enhanced Recovery After Surgery (ERAS) Manager, New Hanover Medical Centre and Robin Davis, Clinical Education Specialist II at New Hanover Regional Medical Center.

How do we best negotiate working in a multidisciplinary team? Generalisations regarding surgeons and anaesthetists only ever work generally, the specifics of each practitioner and their priorities inevitably contrast. How do we keep sight of these broad differences without falling foul of stereotypes? The conversation evolves; how does the surgical journey fully utilise the team based perioperative approach? With specific focus on geriatric care there is further discussion regarding shared decision making, something which has been part of that discipline for many years. The debate regarding when a patient becomes geriatric is explored. Is it age which defines that or do symptoms and comorbidities qualify the term? Recorded on the first day of the Royal College of Anaesthetists' annual conference at The British Museum. Desiree Chappell and Monty Mythen interview their guests Professor Jenifer Weller, Head of the Centre for Medical and Health Sciences Education, University of Auckland and Dr Jugdeep Dhesi, Clinical Lead, POPS and Consultant Geriatrician, Guys and St Thomas' NHS Trust.

This piece focuses on the article "The malnourished surgery patient, a silent epidemic in perioperative outcomes?" which you can find here: https://journals.lww.com/co-anesthesiology/Abstract/2019/06000/The_malnourished_surgery_patient__a_silent.23.aspx The Perioperative Quality Initiative is here: www.poqi.org Presented by Desiree Chappell with Monty Mythen and their guests Jeroen Molinger, Clinical Medical Exercise Physiologist at Duke University Medical Center, Department of Anesthesiology & ICU and John Whittle, assistant Professor at Duke University Medical Centre.

The Hypotension Prediction Index (HPI) Monitor takes 2.6 million features from a single waveform which it then applies to 150 million different wave forms looking for factors which can predict hypotension. It's the first fully approved foray into predictive analyitics for the world of anaesthesia. This conversation looks at how it works and how it is being adopted in detail. Presented by Desiree Chappell with Monty Mythen and Feras Hatib Phd, Director, Research and Development, Algorithms and Signal Processing at Edwards Lifesciences and Dr Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust.