TopMedTalk

This piece deals with the prediction of opioid induced respiratory depression for our inpatients on hospital wards, could a change in monitoring practices help? The postoperative period seems to be critical, the thirty day period immediately after anesthesia being a key area. 7.7% of postoperative deaths are in this period, according to The Lancet here; https://www.thelancet.com/journals/lancet/ar...

"Maybe it's time to evolve our practice" Many believe ultrasound is an essential bedside tool which should be as common as the archetypal Doctor's stethoscope, with training made mandatory for all acute medicine specialists. This piece is structured as a debate where this point of view is advocated and debated. Presented by Mark Edwards , Consultant in Anaesthesia and Perioperative Medicine at The...

This piece starts with the challenges faced by non-consultant hospital doctors (NCHD's) in this pandemic environment and the challenges of teaching novice anesthesiologists during COVID19. What insights can be gained from this high stress high demand environment where correct and comprehensive training is essential? The conversation is then thrown out to a panel and questions are considered; what...

"There is some great literature out there that has been shared ... great data, especially in cardiac surgery, which is where we are using it and I would like to expand it out to other service lines as well..." Methadone has had something of a resurgence recently, thanks in part to the work of some of our contributors in this piece. Could it be that this "opioid sparing opioid" could be a way to ac...

This piece, part 2 of 2, is a series of questions related to part 1; "Monitoring and management of neuromuscular blockade | EBPOM Chicago". This piece gets into the detail regarding one of the stand out moments of EBPOM Chicago 2020; questions from the online audience facilitate the discussion. Given the fact that our methods of monitoring residual neuromuscular blockade are often inadequate do yo...

This piece is an informative conversation about "the Perioperative Care Team"; who is essential to the team and how do we make sure everyone feels included? What elements do you need to make up such a team, how do you keep people energized and excited about it over the long term? How do we ensure, in this context, that a fee for service system interlocks with the needs of both the institution and...

"If you want to take population based data, and define hypotension, you'll be right for the majority of our average patients, but not for all patients and it appears that the amount of time we spend below the lower limit of autoregulation has meaning for patient outcomes" Starting from the origins of blood pressure monitoring, via the father of neurosurgery endocrinology, Harvey Cushing, through t...

"It was successful early on within the National Health Service.. [because] you could eliminate the cost of some unhelpful, unnecessary tests... referrals to other "-ologists"... in our system that works, because more work is just more work. It's not more money." Is the business case for prehabilitation a "slam dunk", as some enthusiasts claim? If so how do you measure value versus volume, is value...

What do we mean by "nutritionally fit" and why does it matter? How do we identify those most at risk in terms of screening and assessment and what's the difference between these two processes? How can we use screening and assessment to triage patients into care? Also, in the time of COVID19, are there ways we can perform some tasks related to these processes remotely? Presented by Steve Wooton , S...

"Studies suggest that even three fourths of patients may be anemic when they present for surgery and many of these patients are previously undiagnosed" This common problem is known to cause issues both within the perioperative period and beyond. How can we manage this condition and where does the latest data lead us? Following a presentation there is a panel discussion featuring questions from the...

This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers now. This piece i...

This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers. This piece gets...

"Cognitive testing has been in the news ... there are recommendations for keeping pets mentally sound by implementing nutritional modifications, regular exercise and mental stimulation, we should certainly think about providing the same support to our geriatric patients." What does the latest research say about this vital issue? How is frailty defined? What's the clinical impact of preoperative co...

This talk examines the rationale for using methadone in our surgical patient population, reviews clinical trials that assess the effect of intraoperative methadone on post operative outcomes and discusses some unanswered questions related to the administration of this long acting opioid in the perioperative period. Presented by Glenn Murphy , Jeffery S. Vender Chair of Anesthesiology Research and...

"The main challenge around the variability in the perioperative period is nomenclature, definitions and standardized endpoints. Well designed and well conducted randomized control trials determine effectiveness to an unbiased comparison of outcomes, events, or endpoints between intervention groups". If data is destiny it is to this that we must look if we want to understand what the future may hol...

"In this session, we're going to talk about the importance of fitness, frailty, function and perioperative medicine." Fitness, frailty and function are overlapping concepts. In the UK, about quarter of patients will be over the age of 65 by 2034. As patients age they may develop comorbidities. These factors combine to present a unique opportunity for the perioperative physician; fitness increases...

"Perhaps assessing functional performance is something that we've overlooked in medicine" This piece is about the role of functional assessment and status in perioperative medicine. The Duke Activity Status Index (DASI) can be found here: https://www.mdcalc.com/duke-activity-status-index-dasi The Mini Cog assessment is here: http://mini-cog.com/wp-content/uploads/2015/12/Mini-Cog-Form-010816.pdf T...

"I hope to impress upon you that this is a topic that we can and must do better at ... no malnourished patient should ever have elective surgery without having a nutrition assessment done" This piece is presented in two parts; this is part 2. Using perioperative nutrition to optimize our patients outcomes; data shows us that nutrition therapy or nutrition optimization is literally life saving. Any...

"I hope to impress upon you that this is a topic that we can and must do better at ... no malnourished patient should ever have elective surgery without having a nutrition assessment done" This piece is presented in two parts; this is part 1. Using perioperative nutrition to optimize our patients outcomes; data shows us that nutrition therapy or nutrition optimization is literally life saving. Any...

It's widely understood that high value care during, before and immediately after surgery is optimal whereas poor quality care in the perioperative period produces long term difficulties which are compounded by the acute stresses produced during and immediately after a procedure. This talk covers three main areas; surgical care for patients in Greater Manchester, "ERAS+"; prehabilitation for cancer...

This piece looks at some of the advantages to having a perioperative interdisciplinary team reducing complications, understanding and discussing risk, facilitating better shared decision making and increased patient satisfaction, even among those who - as part of this process - decide not to go ahead with an operation. It also incorporates evidence regarding what we know about COVID-19; "The risks...

This piece is essential listening for any medical practitioner. The pathophysiology of COVID 19 is now being understood, although there are still a number of outstanding questions. This piece attempts to answer those questions; where does it come from, what do we know about it now, what would we like to know about it in the future? Why is the disease more pronounced in men, how come obesity seems...

"More than 300 million patients have surgery annually worldwide and an increasing proportion of them are elderly and at risk of perioperative adverse events. There's very few proven primary or secondary prevention measures, and the resources for monitoring and trading complications are inadequate. So - more action is required". This piece looks at the evidence as regards perioperative outcomes for...

This panel discussion covers essential ground for any institution that is trying to make real and lasting change. What do we need to know? What do our patients need to know? Who is responsible for questions of safety? How important are checklists? What about "patient advocates"? Presented by Sol Aronson with Mike Ramsey , Chair of the department of Anesthesia and pain management at the Baylor Univ...

  How have we adapted in our views on the use of video laryngoscopy during the Covid-19 pandemic? Who is best suited to intubate? Are we seeing "a poorly managed first wave"? How are practitioners changing their approach in light of the possibility of infections? What lessons are being learned by practitioners in the midst of the COVID crisis? This piece was generously supported by Medtronic.com P...