TopMedTalk

Podcast 10: Monty Mythen, Mike Grocott and Joff Lacey talk to Dr Tim Miller (Duke University Medical Centre) about a recent study investigating the impact of GDFT on postoperative acute kidney injury in the colorectal patient.

Joff Lacey talks to Dr Randall Dull (University of Illinois) to pick apart the physiological principles of intraoperative fluid resuscitation and the need to rethink our approach.

Podcast 8: Joff Lacey is joined by Dr Davinder Ramsingh (Loma Linda University) to discuss the application of ERAS in the cardiac surgical patient.

A discussion regarding the exciting results from the first multicentre, randomised controlled trial into targeted intraoperative blood pressure management. Monty Mythen and Mike Grocott are joined by their guests Dr Dan Sessler, Cleveland Clinic, and Dr Tim Miller, Duke University Medical Centre.

This podcast focuses on the changing role of goal directed fluid therapy in enhanced recovery programmes. There is discussion around the Perioperative Quality Initiative guidelines, assessment of risk and how this relates specifically to laparoscopic surgery. Updates on relevant trials and the importance of risk stratifying patients to ensure goal directed fluid therapy is used on those that stand...

This conversation explores the extended role of the anaesthetist, brought about partly by perioperative care but more widely because of societal changes. Practitioners face a dilemma; how do you best impact value based care, as a specialist, when multidisciplinary approaches are becoming essential? In the UK, The Royal College of Anaesthetists, are working on this very issue; find out how they are...

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...

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, enhance...

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...

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 impac...

TopMedTalk ASA 2017 mission statement. The start of our live coverage from Boston.

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. Join in the debate:  contact@topmedtalk.com This taken from a longer conversation on the subject of periopera...

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.c...

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/

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....

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...

Should we refuse surgery to those who won't change? What about pathological issues, such as smoking, should practitioners become more didactic in their approach? How do we effectively communicate risk, both to the patient and the institution you work for? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with Dr Joff Lacey and guests, Professor Sol Aronson, a tenured professor at...

Fitness for surgery and an understanding of the realities of risk. How important is it for surgery to take place when balanced against the specific health of the patient? How do we encourage patients to alter pathological aspects of their lives in order to minimise the chances of a negative outcome? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with Dr Joff Lacey and guests, P...

ASER 2017 and the POET acronym - a truly multidisciplinary Perioperative Enhancement Team; responsible for project managing optimisation programmes. Monty Mythen speaks with Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology. This piece is taken from a longer conversation to be found here:  http://www.topmedtalk.com/aser-eb...

Pain Relief in Enhanced Surgical Recovery. Monty Mythen asks Dr Joff Lacey and Professor Mike Grocott to reflect on the pain management discussions from day 1 of the American Society of Enhanced Recovery 2017. 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...

Dr Ramani Moonesinghe on Standardised Outcomes from Major Surgery. Dr Joff Lacey and Professor Monty Mythen talk to Dr Ramani Moonesinghe, Director of the Heath Services Research Centre at the Royal College of Anaesthetists and a lead author of the Perioperative Quality Initiative (POQI  http://www.poqi.org ) guidelines on outcomes from surgery. Simple objective measures such as Drinking, Eating a...

Discussion focused on: outcomes, length of stay and DREAMS (Drinking, Eating and Mobilising) within hours after major surgery, all key process and outcome measures. This in depth discussion relates to the recently published consensus paper from the Perioperative Quality Initiative. Monty Mythen and Joff Lacey with Mike Grocott presenting with contributions from Dr Julie Thacker , Colorectal Surgeo...

What is the SNAP-2 project? This piece explains in detail, the 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care provision after Surgery (SNAP-2: EpiCCS) SNAP-2: EpiCCS will describe the epidemiology of perioperative risk, outcome, critical care referral and admission after inpatient surgery in the UK. It also aims to examine whether planned postoperative critical care admissi...

Bowel Prep and Enhanced Recovery After Surgery. Monty Mythen interviewing Dr Julie Thacker, President of the American Society of Enhanced Recovery and a Colorectal Surgeon at Duke, USA. Dr Thacker explains the consensus statement from ASER and the Perioperative Quality Initiative ( http://www.poqi.org ).  Taken from a longer conversation here:  http://www.topmedtalk.com/ebpom-2017-pod-one-live-fro...

"More than half our patients who come to us for surgery with enhanced recovery are malnourished"; nutrition for patients scheduled for major surgery. Monty Mythen and Joff Lacey speak with Dr Paul E Wischmeyer, Professor of Anesthesiology and Surgery at Duke University School of Medicine. Hear more from Dr Wischemeyer on YouTube: https://www.youtube.com/watch?v=XAYrjf1dhJU This piece is taken from...