TopMedTalk

This discussion focuses on the perioperative quality initiative's intense focus this year on total body water and electrolights. How often should we weigh patients to monitor water balance? What can we learn from a real understanding of the circulation of interstitial fluid and lymphatics? What is the role of diuretics for the perioperative practitioner? Also, haemodilution, what should you do if...

How does perioperative care relate to obstetrics? Who does it benefit, the patient, the hospital or both? How does it help to engage pregnant patients through the perioperative process? Furthermore, does the issue of addiction arise in this area? Coming from this summer's Peroperative Quality Initiative (POQI), hosted at Washington Duke University in Durham, this podcast features Monty Mythen and...

Names, titles and definitions were sliced, diced and discussed at the Perioperative Quality Initiative (POQI). This conversation, recorded on the morning of the second day of the meeting and featuring some of the participants, reflects that. "Stress volumes" and "Pre-load" are a couple of examples given in this piece. Everyone involved knew what these words described but once discussions got into...

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 conversation is taken from a longer piece to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-2/ This edition of TopMedTalk was recorded at The I...

Association of Multimodal Pain Management Strategies with Perioperative Outcomes and Resource Utilization: A Population-based Study. Memtsoudis SG1, Poeran J, Zubizarreta N, Cozowicz C, Mörwald EE, Mariano ER, Mazumdar M. BACKGROUND: Multimodal analgesia is increasingly considered routine practice in joint arthroplasties, but supportive large-scale data are scarce. The authors aimed to determine h...

The debate ' Direct laryngoscopes should be consigned to history ' was hosted by The Royal College Of Anaesthetists and carried out by the two guests on this piece. The conversation explores the fact that this skill is a key part of the job of practitioners, are we "de-skilling" the profession in an overly enthusiastic race toward new technology, or are some resisting it simply because it's not wh...

The patient experience can be quite passive and, as a result, people can lose temperature quickly. The consequences can be very negative, this conversation revolves around how you can keep your patients warm. This piece is taken from a longer conversation to be found here:  https://www.topmedtalk.com/live-from-the-iseh-part-1/ This edition of TopMedTalk was recorded at The Institute of Sport Exerc...

This piece focuses on the latest print issue of 'Anesthesia and Analgesia' which is saturated with coverage of the Perioperative Quality Initiative (POQI), the most recent meeting of which was sponsored by the American Society of Enhanced Recovery (ASER). This conversation acts as an update on where some of the latest thinking is as regards perioperative medicine. It includes a deep dive into gast...

Most people are familiar with ultrasound these days, next to the stethoscope and thanks largely to baby photographs, it's one of the most frequent public facing technologies in medicine. New developments in transesophageal echocardiography have brought about huge advancements in its use as a technology; not to mention the incredible images now available from three dimensional echocardiography. As...

What is TopMedTalk and how did it come about? Why is perioperative medicine such an inspiration to us? Why is our Editor in Chief such an advocate? What is the opioid crisis? Broadcaster Nick Margerrison speaks with our Editor in Chief about TopMedTalk and perioperative medicine. We regularly enjoy reading your feedback: contact@topmedtalk.com

The GIRFT (Getting It Right First Time) project. The stated aim is 'to help improve the quality of care within the NHS by reducing unwarranted variations, bringing efficiencies and improving patient outcomes'. This piece gives you the detail from one of the joint clinical leads.   This piece is taken from a longer piece to be found here:  https://www.topmedtalk.com/rcoa-13-the-girft-getting-it-rig...

A Randomized Trial of a Family-Support Intervention in Intensive Care Units Douglas B. White et al. for the PARTNER Investigators Surrogate decision makers (e.g. family and friends) for incapacitated, critically ill patients can understandably find it very difficult to make decisions related to goals of care. Having to make such decisions can cause them psychological distress and  may  lead to tre...

Geriatricians naturally fit into the perioperative sphere. Shared decision making is an obvious aspect of this, as is preoperative assessment and the consideration of the risks and benefits of surgery. Also in this piece; when do you become geriatric? This piece is taken from a longer conversation to be found here:  https://www.topmedtalk.com/rcoa-06-geriatric-care-and-the-value-of-teamwork/ Desir...

How can perioperative medicine be part of helping less developed healthcare systems? The considerations are different but the principles remain the same. The birth of the NHS gave parity of esteem to anaesthetists, the benefits of this are felt by us all in the Western world, could it be argued that this visionary decision might actually help other healthcare systems to evolve more rapidly? This p...

Big data is a complicated topic and here you will find a discussion about the need to balance the rights of the individual against an obligation to explore and unlock the treasures it offers for wider society. How do we hammer home the fact that responsibly recording data is part of a practitioner's duty of care? Taken from day two of our coverage of the Royal College of Anaesthetists' annual conf...

The pressures of being an anaesthetist are difficult to discuss for some, this conversation might be the start of that for you or a colleague. The message is clear; practitioners are human and they must ask for help if they need it. This piece is taken from a longer piece to be found here: https://www.topmedtalk.com/rcoa-05-if-youre-struggling-seek-help/ Presented by Desiree Chappell and Monty Myt...

NAP (National Audit Project) 6 is the largest ever prospective study of anaphylaxis related to anaesthesia and surgery. This conversation deals with the question; when is the best time to administer antibiotics? This piece is taken from a longer conversation to be found here:  https://www.topmedtalk.com/rcoa-8-nap6-perioperative-anaphylaxis/ Joff Lacey presents with his guest Professor Tim Cook, C...

TopMedTalk set itself a target of over 10,000 downloads in the first year. Much to everyone's delight and surprise, we've smashed that target already! This piece is a chance to hear how you can become a bigger part of what we are doing here; it could be as simple as you connecting with us online, sharing some of our content on your social media feed, emailing us your feedback ( contact@topmedtalk....

The NHS has helped to put the UK into a leading position in perioperative medicine, elsewhere there have been pioneers and innovators pushing it forward. How has this leadership in perioperative medicine become a force for change and improvement worldwide and what are the common themes that emerge as we take a global perspective on the discipline? This piece is taken from a longer conversation to...

In this piece Monty Mythen speaks to Professor Paul Wischmeyer from the Department of Anesthesiology, Duke University, about the recently 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, which has just been print published. The link to it is here:   h...

A highlights RCoA's Anaesthesia 2018 A fascinating conversation about the anti-inflammatory effects of exercise. The theory is floated that this could be part of the reason why exercise as a form a prehabilitation might be so effective as part of an enhanced recovery pathway. This is part of a longer piece which you can enjoy in full here: https://www.topmedtalk.com/rcoa-03-adverse-outcomes-and-pa...

Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation Brian E. Driver, MD1; Matthew E. Prekker, MD1,2; Lauren R. Klein, MD1; et al Key Points Question In patients admitted to the emergency department with difficult airway characteristics undergoing orotracheal intubation with a Macintosh l...

How do we develop an agreed curriculum that speaks to what perioperative medicine should be? Once that's in place, how should it be overseen? What sort of official endorsements would it need? Running in parallel to this are the MOOCs - Massive Online Open Courses - that are being developed. Developing a broad knowledge of the process is distinct from being a perioperative specialist, how do we dev...

A special edition of TopMedTalk recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum. 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. The p...

A special edition of TopMedTalk recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum. How can cold water adaption help people deal with medical issues? There's evidence to suggest that cold water adaption reduces inflamation, can open water swimming help with issues such as chrohn's disease? On the other hand how importa...