TopMedTalk

Where are we with the journey from Enhanced Recovery (ER) to Perioperative Medicine? Is it fair to characterise the latter as "Enhanced Recovery v2.0"? Mike Grocott explains how the Royal College of Anaesthetists (RCoA) have set up a plan for "perioperative care" going forward. Does this terminology, "perioperative care" help? Also - news about the "international board of perioperative medicine",...

How important is 'expectation management' in pediatrics? What could the usefulness of cannabis be as a way of reducing reliance on opioids? Is research in this area growing? Desiree Chappell and Mike Grocott interview their guest Myron Yaster, Children's Hospital Colorado.

Recognising and treating pain in children has gone through significant change over the years, this is a trend that looks set to continue. With a focus upon Enhanced Recovery (ER), what are the pathways for the pediatric patient? Should we be looking more at opioid reduction rather than opioid avoidance? How large a part of the problem is the dispensation of opioids and the "bystander risk" - where...

The conversation from part 1 continues with questions such as; what specific anaesthesia protocols do you use? Is there room in this context to consider a drug diversion programme? Is phenylephrine a good choice for these procedures? There is also a special mention for The Society for Obstetric Anesthesia and Perinatology (SOAP) - you can find their website here: https://soap.org/ Desiree Chappell...

The conversation begins with some thoughts on Enhanced Recovery (ER) for the obstetric patient. Further discussion covers the "transatlantic" differences between the US, UK and the wider EU. Where does pain management fit into the ceasarian section (c-section) debate? What are the advantages of a drug diversion programme in that respect? The issue of fluid management in the operating room is discu...

This roundtable discussion digs deep into the question of Enhanced Recovery After Surgery (ERAS), how do you obtain buy in and sustainability and what can we learn from the experiences of advocates at the University of Pittsburgh Medical Center (UPMC). Presented by Desiree Chappell with her guests Dr Jennifer Holder-Murray , Vice Chair of Quality Integration, Assistant Professor of Surgery, Divisi...

This piece is a quick reminder that we have launched a new series on TopMedTalk "Xtreme Everest Extra". It's in four parts and we're going to be releasing them every Sunday from now on. The link to the first episode is here: https://www.topmedtalk.com/xtreme-everest-extra-the-problem-with-hypoxia-the-inception-of-xtreme-everest/ This series is intended for a broad audience, the more in depth piece...

This special four part series explores the fascinating story of Xtreme Everest – the ground-breaking, research programme that has pursued a novel approach to scientific exploration. Over the last decade, this innovative team has performed large scale studies at high altitude to mimic some of the effects of critical illness. The objective is for their findings to be brought "from the mountainside t...

Recorded before a live audience and streamed on www.topmedtalk.com The conversation from part 5 continues. More on Caesarian Section plus: should we implement Enhanced Recovery After Surgery (ERAS) training into undergraduate and post-graduate training? Is ERAS similar to perioperative surgical home (PSH)? As new data emerges about ERAS how often will pathways and protocols be changed? What is the...

Recorded before a live audience and streamed on www.topmedtalk.com The conversation from part 4 continues, the subject is, Enhanced Recovery After Surgery for obstetrics and cesarian sections (c-section). Questions include: How can ERAS co-habitate with the "baby friendly initiative"? The USA is 16th in the world with OB outcomes can ERAS help with that? As we are trying to impliment ERAS for c-se...

Recorded before a live audience and streamed on www.topmedtalk.com   The subject is, Enhanced Recovery After Surgery for obstetrics and Caesarean sections (c-section). Questions include: What's the standard length of stay for an elective Caesarean section (C-section) being done with Enhanced Recovery After Surgery (ERAS) protocols? Do Mums want to go home in a day? Don't C-section practitioners al...

Recorded before a live audience this piece continues the question and answer session from parts one and two. Epidurals versus plane blocks, what do you choose and why? Is there a potential for decrease in fasting times for clear fluids to further enhance recovery? Where can Enhanced Recovery (ER) protocol templates be found on line? How do we know which parts of Enhanced Recovery work and which pa...

What is the balance of risks and benefits related to regional anaesthesia? Does the short term use of opioids really contribute to the opioid crisis? What are the benefits of "opioid sparing" when held against "opioid free"? When it comes to regional anaesthesia, what kind of benefits should we expect beyond pain control and opioid sparing?   Desiree Chappell  interviews her guest  Vincent W. S. C...

Recorded before a live audience this Q&A session was recorded at the annual meeting of the American Society of Anesthesiologists (ASA) at a specially hosted dinner where both those in attendance and the online audience could submit questions.   This discussion is about Enhanced Recovery (ER) and lowering tolerance of poor outcomes after surgery. How do we know practitioners are actually using the...

Where is perioperative medicine as a specialty in the US? How do frail patients benefit from the perioperative process? Age and physical fitness are important factors when deciding if you're going to put a patient through major surgery, how do these factors allow us to differentiate between those who are likely to have a poor outcome? How common is cardiopulmonary exercise testing (CPET) in the US...

Obstetrics might seem the natural place for Enhanced Recovery After Surgery (ERAS). Which components of Enhanced Recovery apply the most to a procedure such as a Caesarian section (C-section)?   Differences between obstetrics in the UK and the US are discussed. The addictive qualities of oxycodone are discussed in detail. This leads to a discussion about what tablets patients should be leaving the...

This piece is a deep dive into regional anaesthesia for Enhancing Recovery. Hear how paravertebral nerve blocks can be used in breast cancer surgery, how does this effect long term outcomes for patients? There is then further discussion regarding regional anaesthesia for Ambulatory Surgery. There is also a long form discussion of electromyographic (EMG) objective monitoring on a neuromuscular bloc...

Enhanced Recovery After Surgery (ERAS) is the focus for the TopMedTalk team at this year's ASA. This piece features discussion regarding; what to do about pre-operative frailty, smoking cessation, patient-centric care and how to manage pre and post operative expectations. How do we ensure the conversations we have before surgery both reflect the needs of the patient and the realities of an operati...

This piece is about optimizing the perioperative patient for Enhanced Recovery (ER). Hear from one of the pioneers of ER for laparoscopic colorectal surgery in the UK, over 15 years ago he was sending patients home in less than 24 hours having had laparoscopic right hemicolectomys! This is the story of one of the roots of Enhanced Recovery adoption in the NHS. We also cover issues such as, the imp...

How do new technologies impact the postoperative elements of Enhanced Recovery? We discuss ward monitoring 3.0 and the technology available, or in the pipeline, to improve outcomes. How do we best use this information and these innovations? There is also a refreshing conversation about Artificial Intelligence (AI) alongside discussion about "bed sensors" and "facial recognition". Some dementia uni...

This fascinating conversation revolves around the experience and need for good teachers in the field of Anaesthesia. How do we encourage professionals and students to pursue this vital and rewarding discipline?   Dr Joff Lacey  presents with his guest  Dr Rob Stephens , Consultant in Anaesthesia, UCLH, Hon Senior Lecturer in Anaesthesia, UCL.

This conversation focuses on perioperative fluid management as part of Enhanced Recovery After Surgery (ERAS). Firstly, the team addresses the online poll - Is Enhanced Recovery (ER) the standard of care where you practice? They then move into a wider discussion about the key elements of ER alongside the main topic of perioperative fluid management. Presented by Monty Mythen with Desiree Chappell...

Lessons learned from the  Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial. This conversation focuses upon the challenges of quality improvement programmes; how do we keep track of patients and improve follow up questions after surgery? How do we clearly show Quality Improvement Programmes work for the patient? Further discussion encompasses innovation and utilization in practice....

This fascinating in-depth conversation about Enhanced Recovery After Surgery, facilitated by questions both from our worldwide online audience and people who were attending the American Society of Anesthesiologists (ASA) conference in San Francisco this year. Presented by  Desiree Chappell and Monty Mythen with Sol Aronson , tenured professor at Duke University and Executive Vice Chairman in the D...

In no particular order we're playing some of the content that listeners have voted for with their downloads. This episode is one of the top ten most downloaded podcasts we've done so far. This discussion focuses on the perioperative quality initiative's (POQI) intense focus this year on total body water and electrolytes. How often should we weigh patients to monitor water balance? What can we lear...