In this piece you will hear more discussion regarding the POQI papers, a growing concensus on goal directed fluid therapy and the move away from opioids. One of the big stories, The American College of Surgeons's announcement that ERAS is to be rolled out to more than 750 hospitals, is also discussed.

The POQI (Perioperative Quality Initiative) papers on outcomes and fluid management are discussed.

The outcomes paper offers a framework for how data on ERAS might be collected. How quickly are people drinking eating and mobilising? What are the lengths of stay and readmission rates? How should these numbers be coallated? How can outcomes continue to be improved beyond the initial adoption of enhanced recovery after surgery (ERAS)? The importance of DREAMS (Drinking Eating Mobilising and Sleep) is emphasised in the discussion.

The fluid management paper is said to offer a general concensus. The key message regarding shortening the gap between the time a patient stops, and then resumes, taking fluid orally is empahasised in the discussion. The importance of getting the IV down and minimising maintainence fluid is also discussed.

Shouldn't all fluid therapy be goal directed? What about fluid restriction?

Finally there's discussion about some of the sessions at ASER 2017; prehabilitation and rehabilitation, dealing with patients on chemotherapy who are less physically fit than average and the possible improvement in cancer tumour regressions brought about by physical exercise.

The link mentioned in the podcast is here: https://ebpom.org/ASER-EBPOM-2017

Sponsored by EBPOM and Edwards Life Sciences

Featuring Dr Tim Miller anaesthesiologist at Duke Medical Centre and Vice President of ASER and presented by Monty Mythen, live from London, with Joff Lacey and Mike Grocott in Washington.

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