TopMedTalk

Extended periods of intraoperative hypotension are firmly associated with harm. This piece looks into the detail behind concerns regarding hypotension. Are we now in a position where we can eliminate it entirely?

The paper mentioned in this piece, "Ability of an Arterial Waveform Analysis–Derived Hypotension Prediction Index to Predict Future Hypotensive Events in Surgical Patients", is here: https://journals.lww.com/anesthesia-analgesia/Abstract/publishahead/Ability_of_an_Arterial_Waveform_Analysis_Derived.96240.aspx

Presented by Desiree Chappell and Monty Mythen with their guest Thomas Scheeren, Chair Cardiovascular Dynamics Section at European Society of Intensive Care Medicine (ESICM).

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Our work regarding hypotension is here: https://www.topmedtalk.com/?s=Hypotension

In this piece we look at how Australia is dealing with the COVID 19 crisis. What restrictions are being placed upon people and how strict are they? How does "the father of perioperative medicine" see the world which is now being asked to face one of its most urgent medical emergencies? Has the time come to honour 'the whole team' in the institutions where we work? How can medics help to rebuild our societies after the already devastating consequences of a global pandemic?

Presented by Desiree Chappell with her guest Ross Kerridge, Senior Staff Specialist Anaesthetist Clinician at the John Hunter Hospital, Newcastle, Australia and Associate Professor at the University of Newcastle.

The article mentioned is here: https://www.newcastleherald.com.au/story/6699930/honouring-our-courageous-frontline-force-in-the-fight-against-covid-19/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

Preoperative risk stratification; what is are the risks and controversies behind preoperative exercise testing and the six minute walk test? This piece looks at the evidence behind both and some practical guidance for informing clinical care.

Does the six minute walk test predict complications? What is the true value for cardiopulminary exercise testing (CPET)?

For more on the METS study go here: https://www.topmedtalk.com/the-measurement-of-exercise-tolerance-before-surgery-mets-trial/

Presented by Duminda Wijeysundera, Professor in the Department of Anaesthesia and the Institute of Health Policy Management and Evaluation at the University of Toronto, and a Staff Anesthesiologist at St Michael's Hospital.

This piece takes a look at the San Diego front line of the global fight against COVID 19. What unique pressures are there here; the large homeless population is a particular challenge, how do psychiatric patients further the conundrum. Also, what about the assumption that patients are likely to be carrying the virus so should all be treated as if that is the case, does that apply here?

There is also a short update on our Editor in Chief, another front line medical provider, who tested positive for Corona Virus last week.

Presented by Desiree Chappell with Roneet Lev, MD FACEP, Chief Medical Officer, White House Office of National Drug Control Policy Director of Operations, Scripps Mercy Hospital Emergency Department San Diego.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"We keep being told we're one to two weeks away from the peak..."

This piece takes a look at how Monty is getting on with his diagnosis, COVID 19 symptoms infamously vary in severity throughout the infection. Now he has been diagnosed how, if at all, will his behaviour change? What is the UK's policy on practitioners who are COVID 19 positive? Further discussion includes the news that 'rapid tests' are being introduced in the battle against the global pandemic as well as 'drive through' testing. How reliable are they, how might they work?

Presented by Desiree Chappell and Monty Mythen.

Thank you for your emails, if you would like to contribute to the discussion please do: [email protected]

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

Australia has an interesting history both generally and with perioperative medicine specifically. Here the story is told and their current progress is revealed. How do comparisons between various countries help us to understand where improvements can be made? How do the differences between the way in which healthcare is funded impact patients and providers?

Moderated by Dr Mark Edwards, University College London Hospital, with his guests Ross Kerridge, John Hunter Hospital, Newcastle, Australia, often cited as 'the father of Modern Perioperative Medicine', Sol Aronson, tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton.

"About a year ago our chief CRNA sent me a podcast from TopMedTalk about fluid management" - this podcast is a fascinating insight into how Enhanced Recovery continues to reach out across the world to the bedside of patients.

How do you take your institution from where you're at now to where you need to be tomorrow? What are the essential ingredients? How do you work, through education, towards real patient engagement and empowerment? How do you manage a sensible quality improvement programme?

Presented by Desiree Chappell with co-host Korey Sprigman and their guests, Jamie Harris, CRNA, Hillcrest Hospital, Tulsa, Oklahoma and Carol Schmidt, CRNA, Royal Oak, Michigan.

The British Journal of Anaesthesia article, which inspired this series, is here: https://bjanaesthesia.org/article/S0007-0912(20)30003-9/fulltext

This piece focuses on the SuperNO2VA mask, which delivers positive airway pressure to stent open the upper airway, allowing for the preoperative delivery of positive pressure ventilation and oxygen for patients with a decreased level of consciousness.

The website mentioned in the piece is here: https://www.vyaire.com/

Presented by Desiree Chappell with Monty Mythen and Michael Pedro, VP, Medical Director at Vyaire Medical.

"It is interesting how well you can feel, compared to the night time [...] it gives you this real false sense of wellness for a period of time and then it hits you, man it hits you hard, when it hits you."

The UK Prime Minister has tested positive for COVID 19 as has The UK's Health Secretary, Matt Hancock, MP. Yesterday we revealed there were concerns our Editor in Chief Monty Mythen had some of the symptoms, only days before he was set to return to active duty in Critical Care. Acting responsibly precautions were already being taken and the assumption was that it was likely, given its profusion in London where he lives, that he had the new virus. The test results confirmed that last night.

Also on this podcast we get into further discussion regarding Continuous Positive Airway Pressure (CPAP), something which we have discussed a lot in this series, see links below.

There is also an assortment of questions from the audience, if you'd like to add your thoughts to one of next week's podcasts email us now: [email protected]

Presented by Desiree Chappell with Monty Mythen, Editor in Chief of TopMedTalk.

The European Society of Anaesthesiology (ESA) webinar was here: https://www.esahq.org/event/webinar-on-covid-19/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"When you start to think about how we can protect ourselves; we have some reasonably robust literature for a few interventions [..] that do seem to associate with the prevention of viral infections..."; maintain a normal vitamin D level, probiotics, vitamin C.

This piece is a fascinating conversation with a TopMedTalk favorite. How are preparations going at Duke University? How can we optimise ourselves for an oncoming viral attack? How can we make sure our patients get the best possible care and are as informed as they can be? What research is being carried out into COVID 19?

Presented by Desiree Chappell with her guest Paul Wischmeyer, Professor of the Department of Anesthesiology and Critical Care, Duke University.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation