TopMedTalk

Perioperative Profiles is a new series from TopMedTalk which looks at both the professional and personal journey taken by some of the world's most innovative and successful perioperative practitioners and researchers.

In this, the first of the series, Andy Cumpstey interviews Professor Paul Myles, Director of Research in the Department of Anaesthesiology and Perioperative Medicine at the Alfred Hospital in Melbourne, and Head of Department at Monash University, Australia.

Recorded during the Evidence Based Perioperative Medicine (EBPOM) World Congress in London this year, hear how Paul was inspired by his mother with ambitions to become a country GP and then took a trip to the United Kingdom where he was inspired by a new vision; anesthesiologists leading practice changing research.

Paul Myles discusses his early years, his initial medical training at Monash University, and the pivotal experience in the UK that steered him towards anesthesiology. Hear about his transition into research, the challenges he faced, and his significant contributions, including the establishment of multi-center trials and the ANZCA Clinical Trials Network.

The discussion also touches on the balance between career and family, and the future of clinical trials with adaptive designs. The episode underscores the importance of collaboration, mentorship, and persistence in achieving success in medical research.

Perioperative Medicine and Promoting Diversity in Healthcare, A Deep Dive with David Story, Professor and Foundation Chair of Anaesthesia at the University of Melbourne; Head of the University Department of Critical Care, and President of the Australian and New Zealand College of Anesthetists (ANZCA).

In this piece we discuss the evolution of perioperative medicine and the importance of diversity and inclusion within healthcare, focusing particularly on the challenges and advancements involving First Nations people in Australia and Aotearoa New Zealand. Hear insights into the efforts to support Aboriginal and Torres Strait Islander peoples, and Māori, in medical education and practice, emphasizing the role of trust and cultural sensitivity. We also touch on gender equity in the medical field and the progress made towards a fairer, more inclusive environment in both Australia and Aotearoa New Zealand.

Recorded at the Evidence Based Perioperative Medicine (EBPOM) World Congress in London and presented by Andy Cumpstey.

For more information on EBPOM please visit www.ebpom.org

Recorded at the Evidence Based Perioperative Medicine (EBPOM) World Congress 2025 in London, this piece focuses upon pioneering work in ambulatory surgical care and enhanced recovery pathways.

Presented by Andy Cumpstey with his guest Dr. Anoushka Afonso, Associate Professor of Clinical Anesthesiology at Memorial Sloan Kettering Cancer Center (MSK), where she is the Director of Enhanced Recovery Program.

Hear how standardized care protocols, non-opioid analgesia, and real-time locating systems help to provide a higher standard for patients. Also, we look at the future of personalized care and the critical importance of 'Returning to Intended Oncological Therapy' (RIOT) for cancer patients.

Recorded at the Evidence Based Perioperative Medicine (EBPOM) World Congress in London this piece dives into the importance of metabolic flexibility in perioperative care. We discuss the prevalence of metabolic inflexibility in patients undergoing surgery and its impact on postoperative complications alongside insights from recent studies and potential future interventions, emphasizing the importance of recognizing metabolic inflexibility as an important factor in clinical practice. The conversation concludes with a look at how this concept extends beyond perioperative care to overall health and wellness.

Presented by Andy Cumpstey with his guest John Whittle, consultant in anaesthesia, critical care and perioperative medicine at University College Hospitals and an honorary associate professor at University College London, UK.

The data mentioned is here: https://discovery.ucl.ac.uk/id/eprint/10207017/4/Whittle_Metabolic Flexibility as a Candidate Mechanism for the Development of Postoperative Morbidity_AOP.pdf

Broadcasting from the Evidence-based Perioperative Medicine World Congress in London, UK, TopMedTalk takes you behind the scenes to the conference conversations that matter.

This episode delves into the importance of diversity in perioperative medicine, the patient-centred approach, the challenges of integrating multidisciplinary care, and the future of healthcare across different countries. Our guests share their experiences, challenges and strategies in implementing holistic, patient-focused care and the significance of leveraging technology and communication in improving patient outcomes.

Presented by Andy Cumpstey with his guests, David Selwyn, appointed as the inaugural Director of the Centre for Perioperative Care (CPOC) in May 2019 and tasked with establishing and developing CPOC as a truly cross-organisational, multidisciplinary initiative led by the Royal College of Anaesthetists (RCoA), facilitating cross-organisational working on perioperative care for patient benefit. He remains an active clinician, dealing with the competing demands of anaesthesia and adult critical care; Vanessa Beavis, Past President of ANZCA, a specialist anaesthetist at Auckland City Hospital, New Zealand and also an Honorary Senior Lecturer at the Department of Anaesthesiology at the University of Auckland; and Maxime Cannesson, Department Chair, Anesthesiology and Professor of Anesthesiology at UCLA, California, USA and the Director, Centre for Perioperative Medicine (CPMed), American Society of Anesthesiology.

TopMedTalk's Andy Cumpstey continues our coverage of the hugely successful Evidence-Based Perioperative Medicine (EPBOM) World Congress in London.

Here we dive deep into the realm of patient monitoring, exploring the use of wearable sensors and advanced algorithms for early detection and preventive care in hospital environments. Learn about ongoing research, innovation challenges, and prospective trials aiming to enhance patient care and safety. A comprehensive discussion on the future of healthcare technology and its implications on clinical practice.

Presented by Andy Cumpstey with his guests, Sadia Khan, Consultant Cardiologist at West Middlesex University Hospital, Meera Joshi, Specialist registrar at Ashford and St Peter's Hospital NHS Foundation Trust and clinical research fellow in the department of surgery cancer at Imperial College London and Jasjit Syan, Senior Clinical Fellow in Cardiology and a PhD candidate in Digital Health at Chelsea and Westminster NHS Foundation Trust.

The final instalment of our series "Perioperative Pain Management" is a panel discussion where we answer the question: What are the various challenges and strategies in managing perioperative pain, particularly with regard to opioid use?

The discussion covers the complexities of opioid de-escalation in preoperative periods, the benefits and risks of opioid-free anesthesia, and the use of multimodal approaches. We also touch on the coordination of patient care across multiple specialties and the impact of intraoperative practices on postoperative pain management and long-term opioid use. The session emphasizes the importance of patient education, consistent communication, and empowered collaboration among healthcare providers.

The speakers on the panel are; Tim Miller, Professor of Anesthesiology at Duke University Medical Center, Fauzia Hasnie, Consultant Lead, Opioid Multidisciplinary Pain Management Clinic, Joint Lead, Combined Sickle-Opioid Virtual Multidisciplinary Clinic Guy's & St Thomas' NHS Foundation Trust, and Esteban Salas Rezola, Specialist in Anaesthesiology, Resuscitation and Pain Therapy at Hospital General Alicante.

Chaired by John Whittle, Clinical Academic working in Perioperative Translational Medicine at UCL and Honorary Consultant in Perioperative Medicine, Anaesthesia and Critical Care at University College Hospitals London.

The three presentations which accompany this piece are here:

https://topmedtalk.libsyn.com/perioperative-pain-management-the-opioid-epidemic-and-opioid-reduction-strategies

https://topmedtalk.libsyn.com/perioperative-pain-management-opioid-reduction-service

https://topmedtalk.libsyn.com/perioperative-pain-management-opioid-sparing-analgesia-strategies-guided-by-nol-index

Recorded at this year's annual Evidence Based Perioperative Medicine (EBPOM) World Congress in London, this conversation deals with a crisis that modern practitioners will recognise; how do we adapt to the needs of a collectively older population?

We begin by focusing upon the Australian Intergenerational Report's alarming projections about an aging population and its impact on healthcare expenditure. It's a problem mirrored by many other Western nations. The conversation covers the ARC model, a solution that shows promise in improving postoperative outcomes by offering advanced recovery room care. We also discuss the importance of addressing blood pressure, fluid management, and potential cost-effective healthcare strategies to manage the increasing elderly population requiring surgery. We conclude by emphasizing the need for comprehensive measures beyond the ARC model to tackle the emerging healthcare challenges globally.

Presented by Andy Cumpstey with Guy Ludbrook, Professor of Anaesthesia at the University of Adelaide and Royal Adelaide Hospital and Esrom Leaman is a specialty trainee in anaesthetics at the Royal Adelaide Hospital and Research Fellow at the Centre for Perioperative Health Economics & Policy.

This series of talks hits upon one of the longstanding themes of TopMedTalk, opioids and opioid reduction in a perioperative setting.

We discuss the opioid epidemic, the issue of persistent opioid use after surgery, and strategies for opioid reduction. Topics include historical usage, the dangers of high-dose opioids, and alternative pain management techniques such as opioid-free anesthesia and multimodal analgesia. The discussion also highlights the importance of ongoing research, patient education, and evidence-based practices to minimize the side effects of opioids while ensuring effective pain management.

Presented by Tim Miller, Professor of Anesthesiology at Duke University Medical Center. Tim completed his training in Nottingham, UK followed by a fellowship in cardiothoracic anaesthesia at Glenfield Hospital, Leicester, UK. He is a fellow of the Royal College of Anaesthetists.

In this piece we look at the opioid crisis in the UK and how it has translated into clinical practice. Hear about the history and data behind opioid prescription trends, specifically highlighting the high-risk patient demographics and mortality figures associated with opioid use.

Learn how a multidisciplinary approach, taken by the opioid reduction service at Guy's & St. Thomas', helps showcase early outcome data and the strategies employed in opioid weaning. Emphasizing the importance of patient engagement and personalized care we detail the clinic's processes, preparations, and long-term strategies for opioid tapering. The episode concludes with a compelling patient testimonial video reflecting the positive outcomes of the service.

Fauzia Hasnie, Consultant Lead, Opioid Multidisciplinary Pain Management Clinic, Joint Lead, Combined Sickle-Opioid Virtual Multidisciplinary Clinic Guy's & St Thomas' NHS Foundation Trust.

Resources:

UK National Institute for Health Care Excellence (NICE) guidelines: Overview | Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults | Guidance | NICE

US Centers for Disease Control and Prevention (CDC): Guideline Recommendations and Guiding Principles | Overdose Prevention | CDC