TopMedTalk

In this piece we discuss perioperative medicine with Ramani Moonesinghe, an anaesthetist and intensive care specialist from London, England, and Phuong Markman, an anaesthetist from Cairns, Australia. We explore access to and outcomes from surgery, particularly in relation to remoteness and socioeconomic deprivation. Then we talk about specific interventions to improve the patient experience, such as Sip til Send, and the challenges of implementing the program and demonstrating that it's safe with respect to aspiration. Finally we discuss whether AI and robotics can assist patients in the perioperative journey.

Presented by Andy Cumpstey and Kate Leslie on location at the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in Cairns, Australia, with their guests, Professor Ramani Moonesinghe, Professor of Perioperative Medicine, University College London, National Director of Patient Safety and National Clinical Director for Critical and Perioperative Care, NHS England, and Dr Phuong Markman, Consultant Anaesthetist, Cairns Hospital, Australia.

In this piece we discuss pain medicine with Nadine Attal, a neurologist and pain medicine specialist from France, and Allen Finley, an anesthesiologist and pain medicine specialist from Canada. The episode delves into neuropathic pain and the need to personalize its management, and efforts to standardize the management of paediatric pain in Canada. We talk about the ICD-11 which recognizes chronic pain as a disease, and ChildKind.org which nurtures holistic and responsive support for children or all ages and abilities.

Presented by Andy Cumpstey and Kate Leslie on location at the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in Cairns, Australia, with their guests, Professor Nadine Attal, Director for the Center of Evaluation and Treatment of Pain, Ambroise Paré Hospital, Paris, France, and Professor Allen Finley, Professor of Anesthesia and Psychology at Dalhousie University, and Medical Director of Pediatric Pain Management at IWK Health Centre in Halifax.

In this piece we discuss prevention of intraoperative hypothermia with Holly Tonkin, a trainee anaesthetist from Australia. Holly describes her study, in which she measured the prevalence of hypothermia using routine forced air warming and then the prevalence using the 3M™ Bair Hugger™ Universal Warming Gown. Significant reductions in hypothermia were observed. Holly's study was supported by Solventum. We then discussed the value of trainee research.

Presented by Andy Cumpstey and Kate Leslie on location at the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in Cairns, Australia, with their guest, Dr Holly Tonkin, Manning Base Hospital and Royal North Shore Hospital, New South Wales, Australia.

In this piece we discuss hot topics in anaesthesia and pain medicine with David Story, President of the Australian and New Zealand College of Anaesthetists and Dilip Kapur, Dean of the Faculty of Pain Medicine. The episode delves into the exciting presentations and events at the meeting, and discusses 'Future proofing' through developing emerging leaders, supporting research and advocating for sustainability in healthcare in Australia and New Zealand.

Presented by Andy Cumpstey and Kate Leslie on location at the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in Cairns, Australia, with their guests, Professor David Story, Chair, Department of Critical Care, University of Melbourne, and Dr Dilip Kapur, a pain medicine from South Australia.

In this piece, Andy Cumpstey and Kate Leslie introduce listeners to the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine, being held in Cairns, in beautiful Far North Queensland, Australia. They discuss the history of the meeting, the role of the College and Faculty in CPD for specialists and the wonderful events coming up at the conference. Also, hear about how to tell a 'freshy' from a 'salty' (crocodile, that is)!

Presented by Andy Cumpstey and Kate Leslie on location at the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in Cairns, Australia.

Recorded at the close of the recent IARS (International Anesthesia Research Society) annual meeting held in Honolulu, Hawaii.

Our co-editor in Chief Professor Mike Grocott's arrival at the IARS from the UK was delayed by a fire at Heathrow airport. This piece turns his late arrival into your good fortune, as both Professor Kate Leslie and Professor Monty Mythen, TopMedTalk's founder, fill him in on the conference.

If you missed the IARS this year or were there but could do with a high level summary of the highlights, this podcast is a great place to start.

The discussions cover Monty's workshop presentation on clinical trials and industry partnerships, reflections on clinical trials conducted outside the US, and the potential underutilization of American data in large pragmatic trials. They also talk about cutting-edge trial designs, new drug developments in anesthesia, and notable research abstracts presented at the meeting. Moreover, they cover topics like exercise prehabilitation, nutrition, and cognitive training pre-surgery.

There's an emphasis on the importance of evidence-based guidelines, the potential for combining protocolization with personalized care, and the significant role interactive physical and cognitive exercise plays in patient outcomes.

The PREPARE trial piece is here: https://topmedtalk.libsyn.com/the-prepare-trial-with-daniel-mcisaac-iars

We mention the forthcoming "2025 World Congress of Prehabilitation and Perioperative Medicine - International Prehabilitation and Perioperative Exercise Testing Society" meeting. More details on that here:

https://ipoetts.org/2025-World-Congress-of-Prehabilitation-and-Perioperative-Medicine

Also, we mention Chelsia Gillis, Assistant Professor in the School of Human Nutrition in the Faculty of Agricultural and Environmental Sciences at McGill University. She has featured multiple times on TopMedTalk, if you'd like to hear some of her work start here: https://topmedtalk.libsyn.com/nutritional-screening-and-assessment-tools-for-prehab-world-congress-of-prehabilitation

The Cipher HPI study focuses on continuous, iterative, perioperative, holistic risk evaluation using advanced hemodynamic monitoring data. The study, integrates preoperative and intraoperative data to predict the need for vasopressors or fluid after surgery. We discuss the study's methodology, results, and the potential implications for clinical practice, including the use of machine learning techniques for better risk prediction and resource optimization in critical care settings. The episode emphasizes the importance of utilizing rich patient data throughout the surgical journey to enhance outcomes and support clinician decision-making.

Presented by Mike Grocott and Kate Leslie on location at the International Anesthesia Research Society (IARS) and Society of Critical Care Anesthesiologists meeting in Honolulu, Hawaii, with their guest, Alexander (Sandy) Jackson an anaesthetist and intensive care physician who is also a clinican data scientist, currently funded by the UK's National Insitute of Health and Care Research (NIHR), based at the NIHR Southampton Biomedical Research Centre.

We mention Guy Ludbrook, Professor of Anaesthesia at the University of Adelaide and Royal Adelaide Hospital, and an occasional presenter here on TopMedTalk. This thought provoking talk from him is a good place to learn more: https://topmedtalk.libsyn.com/the-hidden-pandemic-of-post-operative-complications-ebpom-london-2020-0

The PREPARE trial is a randomized control trial aimed at improving surgical outcomes for older patients with frailty through prehabilitation. This discussion covers the inspiration behind the trial, the structure of the prehabilitation program, and the trial's results. Despite not finding significant improvements in the primary outcomes across all patients, the trial revealed that those who adhered to the program showed clinically meaningful improvements.

The conversation delves into the challenges of patient adherence, the role of technology, and the importance of personalized interventions in prehabilitation.

Presented by Mike Grocott and Kate Leslie on location at the International Anesthesia Research Society (IARS) and Society of Critical Care Anesthesiologists meeting in Honolulu, Hawaii, with their guest, Daniel McIsaac, Associate Professor of Anesthesiology & Pain Medicine, University of Ottawa, Canada.

Further resources:

We mention Chelsia Gillis, Assistant Professor in the School of Human Nutrition in the Faculty of Agricultural and Environmental Sciences at McGill University. She has appeared on this podcast multiple times, this presentation is a good place to start: TopMedTalk: Nutritional screening and assessment tools for prehab | World Congress of Prehabilitation

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

There's also an excellent presentation on which relates to this conversation here: TopMedTalk: EBPOM London 2020 | Functional Assesment

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In this piece we discuss a ground breaking study on gender differences in surgical efficiency and outcomes with Anika Bald, a medical student from Germany, and Dr. Matthias Eikermann, a clinician scientist and department chair at Montefiore Einstein in New York. The study reveals that women surgeons have shorter delays to starting surgical add-on cases and better postoperative outcomes compared to men. The episode delves into the implications of these findings and discusses the value of diversity and inclusion in medical research and practice.

Presented by Mike Grocott and Kate Leslie on location at the International Anesthesia Research Society (IARS) and Society of Critical Care Anesthesiologists meeting in Honolulu, Hawaii, with their guests, Matthias Eikermann, Professor and Chair of Anesthesiology at the Montefiore Medical Center in New York USA and Anika Bald a medical student from Germany.

Join us at the International Anesthesia Research Society (IARS) and Society of Critical Care meeting in Honolulu, Hawaii. Here we look at the Anesthesia Patient Safety Foundation (APSF) and speak about the latest advancements and key discussions from the conference. Major topics include the risks and management of intraoperative hypotension, gaps in patient communication, and new research findings.

The conversation highlights the importance of continuous monitoring, the Delphi method used in their research, and future directions for APSF, including public campaigns and emerging technologies.

Kate Leslie and Mike Grocott speak with their guest, Daniel J. Cole, MD, the president of the Anesthesia Patient Safety Foundation (APSF)