TopMedTalk

We learn more about what the Perioperative medicine summit is and have a quick fire review of the current literature related to Perioperative Medicine. Discussions in this piece include the use of ACE inhibitors and ARBs, Hypotension, the Measurement of Exercise Tolerance before Surgery (METS) Trial and the improving fortunes of asprin. The SPAQI website is here: https://www.spaqi.org

Presented by Desiree Chappell with Monty Mythen and their guests Barbara Slawski, Professor of Medicine and Orthopaedic Surgery; Chief, Section of Perioperative and Consultative Medicine; Froedtert and Medical College of Wisconsin and Steven L. Cohn, Professor Emeritus, Director – Medical Consultation Service, Jackson Memorial Hospital University of Miami Miller School of Medicine.

We learn more about what the Perioperative medicine summit is and have a quick fire review of the current literature related to Perioperative Medicine. Discussions in this piece include the use of ACE inhibitors and ARBs, Hypotension, the Measurement of Exercise Tolerance before Surgery (METS) Trial and the improving fortunes of asprin.

The SPAQI website is here: https://www.spaqi.org

Presented by Desiree Chappell with Monty Mythen and their guests Barbara Slawski, Professor of Medicine and Orthopaedic Surgery; Chief, Section of Perioperative and Consultative Medicine; Froedtert and Medical College of Wisconsin and Steven L. Cohn, Professor Emeritus, Director – Medical Consultation Service, Jackson Memorial Hospital University of Miami Miller School of Medicine.

What simple things can we do in the operating room which might make a difference to the issue of post operative delirium? Should preoperative sedation be, generally speaking, withheld from people over 60? How do we explain the risks of this procedure to those who need it? Also - are we seeing a rise in post operative delirium and if so why? And finally - what should we make of the "triple low" story where patients with low blood pressure, a low bispectral index, and a low minimum alveolar concentration of volatile anesthesia are said to face an increased risk of adverse outcomes? This piece features Monty Mythen and Desiree Chappell in conversation with Dan Cole, professor of clinical anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles and former president of the American Society of Anesthesiologists (ASA).

What simple things can we do in the operating room which might make a difference to the issue of post operative delirium? Should preoperative sedation be, generally speaking, withheld from people over 60? How do we explain the risks of this procedure to those who need it?   Also - are we seeing a rise in post operative delirium and if so why?   And finally - what should we make of the "triple low" story where patients with low blood pressure, a low bispectral index, and a low minimum alveolar concentration of volatile anesthesia are said to face an increased risk of adverse outcomes?   This piece features Monty Mythen and Desiree Chappell in conversation with Dan Cole, professor of clinical anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles and former president of the American Society of Anesthesiologists (ASA).

A special edition of TopMedTalk recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

How can cold water adaption help people deal with medical issues? There's evidence to suggest that cold water adaption reduces inflamation, can open water swimming help with issues such as chrohn's disease? On the other hand how important is it to ensure patients do not become cold while in our care? Hypothermia is never good, how important is it to keep patients warm? Keeping patients and their environments warm is discussed, as is pre-warming, going beyond the standard blankets and patient insulation to include active warming and even patients exercising as a method of warming up. Further to this conversation, how do you measure a patient's temperature?

How do we drive change in our institutions towards enhanced recovery after surgery? The GIRFT (Getting It Right First Time) project is explained. The Health Foundation is also mentioned. The piece also includes patient communication and the question of 'how much is too much?', when administering a dose of morphine. Also, is there a hierarchy on the pathway of enhanced recovery after surgery?

The conversation features Professor Monty Mythen and his two guests; Dr Simeon West, consultant anaethetist at (University College London Hospitals) UCLH who sits on the board at Regional Anaesthesia UK (RAUK) and Mark Harper Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for theraputic purposes. There are also attributed questions from the audience.

A special edition of TopMedTalk recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

How can cold water adaption help people deal with medical issues? There's evidence to suggest that cold water adaption reduces inflamation, can open water swimming help with issues such as chrohn's disease? On the other hand how important is it to ensure patients do not become cold while in our care? Hypothermia is never good, how important is it to keep patients warm? Keeping patients and their environments warm is discussed, as is pre-warming, going beyond the standard blankets and patient insulation to include active warming and even patients exercising as a method of warming up. Further to this conversation, how do you measure a patient's temperature?

How do we drive change in our institutions towards enhanced recovery after surgery? The GIRFT (Getting It Right First Time) project is explained. The Health Foundation is also mentioned. The piece also includes patient communication and the question of 'how much is too much?', when administering a dose of morphine. Also, is there a hierarchy on the pathway of enhanced recovery after surgery?

The conversation features Professor Monty Mythen and his two guests; Dr Simeon West, consultant anaethetist at (University College London Hospitals) UCLH who sits on the board at Regional Anaesthesia UK (RAUK) and Mark Harper Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for theraputic purposes. There are also attributed questions from the audience.

This piece ploughs into some of the academic papers that have provoked discussion recently in the perioperative community.

We discuss the following papers:

Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses.

https://www.ncbi.nlm.nih.gov/pubmed/30552274

Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty.

https://www.ncbi.nlm.nih.gov/pubmed/29975266

Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries.

https://www.ncbi.nlm.nih.gov/pubmed/29440113

Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study.

https://www.ncbi.nlm.nih.gov/pubmed/30048320

Presented by Desiree Chappell and Monty Mythen with their guest Paul Grant, Hospitalist and Director of Perioperative and Consultant Medicine at the University of Michigan.

This piece ploughs into some of the academic papers that have provoked discussion recently in the perioperative community.

We discuss the following papers:

Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses.

https://www.ncbi.nlm.nih.gov/pubmed/30552274

Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty.

https://www.ncbi.nlm.nih.gov/pubmed/29975266

Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries.

https://www.ncbi.nlm.nih.gov/pubmed/29440113

Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study.

https://www.ncbi.nlm.nih.gov/pubmed/30048320

Presented by Desiree Chappell and Monty Mythen with their guest Paul Grant, Hospitalist and Director of Perioperative and Consultant Medicine at the University of Michigan.

Shared decision making is key to any perioperative enhancement team, this piece is a fascinating debate between various interesting positions.

For more on the (Perioperative Optimization of Senior Health) POSH clinic mentioned in this piece look here: https://medicine.duke.edu/divisions/geriatrics/patient-care/duke-perioperative-optimization-senior-health

Presented by Monty Mythen with his guest Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton and contributions from Lee Fleisher, Professor of Anesthesiology and Critical Care, University of Pennsylvania and Sol Aronson, tenured Professor at Duke University, Dr Tim Miller, Duke University and Dr Attilla Kett, St Peter's University Hospital at New Jersey.

Shared decision making is key to any perioperative enhancement team, this piece is a fascinating debate between various interesting positions.

For more on the (Perioperative Optimization of Senior Health) POSH clinic mentioned in this piece look here: https://medicine.duke.edu/divisions/geriatrics/patient-care/duke-perioperative-optimization-senior-health

Presented by Monty Mythen with his guest Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton and contributions from Lee Fleisher, Professor of Anesthesiology and Critical Care, University of Pennsylvania and Sol Aronson, tenured Professor at Duke University, Dr Tim Miller, Duke University and Dr Attilla Kett, St Peter's University Hospital at New Jersey.