TopMedTalk

This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois.

Check out the AANA here: https://www.aana.com/

The Facebook Group "CRNA Inventors and Innovators" mentioned in this piece is here: https://www.facebook.com/groups/2150893568464906/

Presented by Desiree Chappell and Monty Mythen with their guests Diane Miller, Pediatric Devices for Induction of Anesthesia | Product Development | PeDIA, LLC and Jean Snyder, CRNA Inc. Co-owner Goodwin and Snyder Anesthesia Associates, PLLC

This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois.

Check out the AANA here: https://www.aana.com/

If you would like to contact our guest he has allowed us to post his email here: [email protected]

Presented by Desiree Chappell and Monty Mythen with Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology and their guest, Mark Silberman, Partner, Benesch Law Chair, White Collar, Government Investigations, & Regulatory Compliance Vice-Chair, Health Care.

This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois.

Check out the AANA here: https://www.aana.com/

The NHS's guidelines are here: https://www.nhs.uk/conditions/gender-dysphoria/guidelines/

Presented by Desiree Chappell and Monty Mythen with Jose Castillo, PhD, CRNA Faculty, Texas Wesleyan University, AANA Diversity and Inclusion Committee.

What do we now know about perioperative asprin? More specifically, what is the latest thinking on the results of the PeriOperative ISchemic Evaluation-2 Trial (POISE-2)? How do we educate patients about exercise? How do we support and help patients who have adverse outcomes to surgery? What's the best screening tool for malnutrition?

Moderated by Dr Catherine Gibb, Consultant physician in perioperative care, Monash University and featuring Harry Gibbs, FRACP, FCSANZ, The Alfred, Melbourne, Stephan A Schug, Anaesthesiology and Pain Medicine, University of Western Australia and Royal Perth Hospital, Sunil K. Sahai, MD, FAAP, FACP, Co-Director, The PeriOperative Evaluation & Management Center Section Chief & Professor of Medicine, Section of Consultative Medicine, Department of General Internal Medicine, MD Anderson Cancer Centre and Vasi Naganathan, Academic and Consultant Geriatrician at University of Sydney, Concord Repatriation Hospital, New South Wales, Australia.

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Brought to you by the Perioperative Medicine Special Interest Group (SIG) in association with the Australian and New Zealand Society for Geriatric Medicine and the Internal Medicine Society of Australia and New Zealand at the 7th annual Australasian Symposium of Perioperative Medicine.

The Perioperative Medicine Special Interest Group (SIG) has three aims; improve patient safety and outcomes, share knowledge and collaborate with specialty groups, develop the specialty of perioperative medicine with various craft groups.

For more information follow this link here: http://www.anzca.edu.au/fellows/special-interest-groups/perioperative-medicine

"Our hospital now has twice the capacity it had" cost of care and efficiency are up. Hear how enhanced recovery after surgery (ERAS) and the power of prehabilitation has dramatically shifted institutions towards better outcomes and a higher value of care.

Also in this piece; what is immunonutrition? How does stress alter our immune responses?

The piece mentioned in the podcast can be found here: https://journals.lww.com/annalsofsurgery/Abstract/2018/10000/Impact_of_a_Novel_Preoperative_Patient_centered.13.aspx

Presented by Desiree Chappell and Monty Mythen with their guest William Wooden, Director of Operative Services at Indiana University of Health.

Discussion begins with an explanation of 'Trainees with an Interest in Perioperative Medicine' (TRIPOM), a big hit at the conference this year, then a wider discussion follows which includes thoughts regarding further research and application of the perioperative method as well as where it impacts medicine and care. The importance of a multidisciplinary team based approach is strongly emphasised. The Getting It Right First Time (GIRFT) initiative is also discussed, more on that here: http://topmedtalk.libsyn.com/iseh-highlight-getting-it-right-first-time-girft

Further discussion of TRIPOM is here: https://www.topmedtalk.com/ebpom-2018-10-what-is-tripom/

Presented by Desiree Chappell with her guests; Dr Ramani Moonesinghe, Professor of Perioperative Medicine at University College London (UCL) and Anne-Marie Bougeard perioperative medicine fellow at the Royal College of Anaesthetists (RCoA).

How can you make a difference in the preoperative assessment clinic? How do we remain working as a team while respecting everyone's skillset in a multidisciplinary environment?

The value of a good comprehensive preoperative evaluation is clear; how do we ensure that, when this can happen, it does?

How do we best use the 'teachable moment' that prehabilitation for surgery is? Looking at the data is it fair to "try to tell patients, you don't have to stop smoking for good but can't you stop for the next two weeks?"

The Duke Activity Status Index (DASI) can be found here: https://www.mdcalc.com/duke-activity-status-index-dasi

"Can perioperative risk in the frail be managed?", gets referenced frequently in this podcast, if you're curious to have a listen go here; https://www.topmedtalk.com/periop-medicine-sig18-can-perioperative-risk-in-the-frail-be-managed/

Presented by Bobbie Jean Switzer, Professor of Anesthesiology and Director of Perioperative Medicine at Northwestern University in Chicago, Illinois.

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Brought to you by the Perioperative Medicine Special Interest Group (SIG) in association with the Australian and New Zealand Society for Geriatric Medicine and the Internal Medicine Society of Australia and New Zealand at the 7th annual Australasian Symposium of Perioperative Medicine.

The Perioperative Medicine Special Interest Group (SIG) has three aims; improve patient safety and outcomes, share knowledge and collaborate with specialty groups, develop the specialty of perioperative medicine with various craft groups.

For more information follow this link here: http://www.anzca.edu.au/fellows/special-interest-groups/perioperative-medicine

How can goal directed therapy be used to prevent acute kidney injury (AKI)? What do we know about AKI? Which members of the surgical team should be involved in AKI detection? Where do we stand on ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin-receptor blockers)? Where should a perioperative practitioner stand on the choice between restrictive versus liberal fluid therapy?

The slides for this piece are here: http://www.anzca.edu.au/documents/02-vincent-dintini_goal-directed-therapy-to-preven.pdf

Presented by Vincent D'Intini, Senior staff specialist, Nephrologist, Alfred Hospital Melbourne.

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Brought to you by the Perioperative Medicine Special Interest Group (SIG) in association with the Australian and New Zealand Society for Geriatric Medicine and the Internal Medicine Society of Australia and New Zealand at the 7th annual Australasian Symposium of Perioperative Medicine.

The Perioperative Medicine Special Interest Group (SIG) has three aims; improve patient safety and outcomes, share knowledge and collaborate with specialty groups, develop the specialty of perioperative medicine with various craft groups.

For more information follow this link here: http://www.anzca.edu.au/fellows/special-interest-groups/perioperative-medicine

Is it fair to say that prehabilitation is the new direction for practitioners of Enhanced Recovery After Surgery (ERAS)?

Discussion expands into patient awareness initatives, The Macmillan Cancer Support, Principles and guidance for prehabilitation guide mentioned is here: https://www.macmillan.org.uk/about-us/health-professionals/resources/practical-tools-for-professionals/prehabilitation.html

Age care naturally follows as the roundtable discussion continues. This piece gives a truly pan-national perspective with informed comment from prominent perioperative opinion leaders from The UK, Australia and America. How do those different systems work and what can they each learn from the others?

The journal article mentioned in this piece is here: https://jamanetwork.com/journals/jamasurgery/fullarticle/2732511

Presented by Desiree Chappell with Monty Mythen and Lee A. Fleisher, Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania and Ross Kerridge, John Hunter Hospital, Newcastle, Australia, often cited as 'the father of Modern Perioperative Medicine'.

A discussion about fluid management in an enhanced surgical recovery pathway in relation to the guidelines from ASER and the work of The Perioperative Quality Initiative (POQI http://www.poqi.org). Presented by Monty Mythen with his guest Dr Tim Miller, anaesthesiologist at Duke Medical Centre and Vice President of ASER. For more come to our meetings: http://www.ebpom.org/EBPOM-USA

This highlight clip is taken from a longer conversation to be found here: http://www.topmedtalk.com/aser-ebpom-2017-pod-two-live-from-washington-dc/