TopMedTalk

In this TopMedTalk perioperative profile, host Andy Cumpstey interviews Professor Dan Sessler, Vice President for Clinical and Outcomes Research and Professor of Anesthesiology and Biostatistics at UTHealth Houston (McGovern Medical School), about his career as a perioperative trialist with over 1,000 publications.

Sessler describes his scientific family background, early inspiration from clinical trials through Henry Kaplan's Hodgkin's work, and a shift from planned pediatric oncology to anesthesiology. He recounts building a research career starting with perioperative thermoregulation at UCLA and UCSF, then expanding into broad outcomes research, ultimately founding a large Department of Outcomes Research at the Cleveland Clinic and advocating for large multicenter trials.

He emphasizes mentorship, philanthropy, and his current focus on reducing postoperative mortality through better ward monitoring and prevention beyond "failure to rescue."

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The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery.

Go now to http://www.ebpom.org

At The International Anesthesia Research Society (IARS) and Society of Critical Care Anesthesiologists (SOCCA) meeting in Montreal, TopMedTalk hosts Mike Grocott and former editor-in-chief Desiree Chappell speak with FAER board members Dr. Rebecca A. Aslakson, Chair and Professor with Tenure, Department of Anesthesiology, University of Vermont Health Network and Dr. Michael Gropper, Professor and Chair of the UCSF Department of Anesthesia and Perioperative Care, about the Foundation for Anesthesia Education and Research (FAER).

We describe how FAER's early-career support—especially the Mentored Research Training Grant—helped launch our guest's own research trajectories and facilitates transition to larger funding, with about 60% of MRTG recipients later obtaining NIH funding.

They outline FAER's origins (founded in 1986 in partnership with the ASA), funding mechanisms spanning medical students to early faculty, partnerships with multiple specialty organizations, and career development resources including networking, mock study sections, and a National Academy of Medicine collaboration, emphasizing mentorship and community as central to long-term research success.

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Find out more about EBPOM Dingle now: www.ebpom.org

In Scotland at St Andrews, TopMedTalk AI hosts Andy Cumpstey and James Bowness discuss AI in regional anaesthesia with Bernard Victor Delvaux, staff anesthesiologist at the Centre Hospitalier Privé Claude Galien in Quincy-sous-Sénart, France.

Bowness describes a regional anaesthesia course using AI-augmented ultrasound imaging, augmented reality simulated needling, and cadaveric ultrasound with real needle insertion. Delvaux discusses his research in AI-assisted nerve recognition, explains supervised model development through large-scale ultrasound image annotation for GE Healthcare's C-NERF, and they explore how to evaluate AI beyond pixel-based metrics toward clinically oriented utility and safety, including differences in usefulness for trainees versus experts. They discuss model design across anatomical sites, the need for diverse training and external validation data, risks from poor image acquisition, and barriers such as trust and autonomy. Delvaux outlines priorities for ESRA's AI working group, focusing on AI literacy and faster, reliable evaluation guidance.

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The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery.

Go now to http://www.ebpom.org

Recorded at the excellent ANESTHESIOLOGY® 2025 in San Antonio. Hear Andy Cumpstey and Mike Grocott interview Paul Myles, a Professor of Anaesthesiology and Perioperative Medicine at Monash University in Melbourne, Australia.

Here we focus upon his group's approach to large pragmatic, multicenter international trials and the process of selecting and developing study questions within a clinical trials network. Myles presents the ITACS trial (intravenous iron treatment for anaemia before cardiac surgery), designed because anaemia is common (~30%) in elective cardiac surgery and is associated with increased complications, longer hospital stay, mortality, and greater transfusion requirements, while prior randomized evidence supporting routine preoperative IV iron clinics has been weak despite observational associations.

The two-arm randomized controlled trial enrolled about 1,000 patients scheduled for cardiac surgery 1–26 weeks ahead across 33 hospitals in 10 countries; patients with anaemia due to causes unlikely to benefit from iron (e.g., megaloblastic anemia, certain iron storage diseases) were excluded, while non–iron deficiency anaemia was included. Participants received a single 1 g dose of IV iron in the weeks preoperatively, with a primary endpoint of days alive and at home at 90 days to capture patient-centered recovery and the functional impact of complications.

Results included a statistically significant one-day improvement in days alive and at home, modestly higher preoperative haemoglobin, markedly improved iron indices, and a marked reduction in red cell transfusions intraoperatively and through 30 days and 3 months; the team estimated saving 44 units of red cells per 100 patients treated. The one-day benefit was mainly driven by fewer readmission days, and a formal cost-effectiveness analysis (with Australian resource-use data) is underway with planned publication within six months. The discussion highlights why mild anaemia matters in major surgery due to postoperative blood loss and recovery, and notes that while extrapolation to other major surgeries with expected blood loss >500 mL may be considered, the hosts and Myles emphasize ongoing equipoise and the need for additional large randomized trials outside cardiac surgery.

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We strongly suggest you investigate our forthcoming EBPOM Ireland conference, being held in the beautiful location of Dingle. World leading experts in perioperative medicine presenting the latest cutting edge research in periperative medicine and enhanced recorvery after surgery.

Find more information at EBPOM.org

This presentation was recorded at the Evidence Based Perioperative Medicine (EBPOM) 2026 Annual Global Meeting.

It features Nicolai Bang-Foss, Consultant, head of GI and orthopaedic anaesthesia, Hvidovre University Hospital, Denmark

His main research field is the perioperative care of the elderly emergency patient. Specific areas of research have been regional analgesia, transfusion thresholds, outreach programs and perioperative logistics as well as perioperative haemodynamics.

He describes wide European variation in postoperative pathways driven largely by ICU bed capacity, with Scandinavian countries running lean systems that push PACUs toward 24-hour, higher-acuity perioperative units and preoperative optimization for emergency laparotomy and hip fracture care.

He outlines nonstandardized PACU/IMC structures, variable nursing education, and Danish strategies such as bypassing PACU for uncomplicated spinal anesthetic hip/knee replacements to free capacity for high-risk cases.

He also reports research suggesting PACU nurses' clinical judgment outperforms discharge scores and highlights deteriorating surgical ward staffing and post-COVID pressures affecting triage and outcomes.

If you'd like to hear presentations of this standard - before anyone else - we suggest you investigate our forthcoming EBPOM Ireland conference, being held in the beautiful location of Dingle. World leading experts in perioperative medicine presenting the latest cutting edge research in periperative medicine and enhanced recorvery after surgery.

Find more information at EBPOM.org

Recorded at the Evidence Based Perioperative Medicine (EBPOM) World Congress in London this episode of TopMedTalk sees Andy Cumpstey speaking with a panel of experts about the VITAL trial: a pragmatic randomised controlled trial about volatile vs total intravenous anaesthesia (TIVA) for major non-cardiac surgery in adult patients. The primary outcome was days alive and out of hospital at 30 days.

Despite finding no significant differences in the primary outcome, the trial reveals that patients receiving TIVA anesthesia experience better recovery, with less postoperative nausea and other side effects. The conversation also touches on the trial mechanics, related ongoing studies, and implications for future research and clinical practice.

Our guests include Professor Joyce Yeung, Director, Perioperative Medicine Clinical Trials Network, Associate Clinical Professor at University of Warwick and Honorary Consultant in critical care; Dr Shaman Jhanji, Consultant in Anaesthetics and Intensive Care Medicine at the Royal Marsden Hospital, London and Professor Bernhard Riedel, Director, Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia

The paper is here: https://jamanetwork.com/journals/jama/fullarticle/2852741

For more about EBPOM check out www.ebpom.org

At the ANZCA Annual Scientific Meeting in Auckland, Kate Leslie and Andy Cumpstey discuss ANZCA's Emerging Leaders Conference (ELC), a retreat-style program held immediately before the ASM for clinicians within five years of achieving FANZCA, with allowances for career disruptions.

Their guests, Dr Saana Taylor FANZCA and Dr Vik Singh FANZCA, co-conveners of this year's ELC, describe shaping this year's New Zealand-hosted ELC with an Aotearoa focus, naming it Te Herenga Matua ("the pursuit of consciousness") and emphasizing collaboration, communication, wellbeing, compassion, and equity.

The program included Māori and Pacific health sessions, leadership self-reflection, and an interactive session challenging fixed leadership "styles," alongside strong mentorship and networking with senior college leaders. Highlights included the openness of delegates, relationship-building, and a keynote on leadership "outside the box." Next year's ELC will be in the Adelaide Hills, with applications opening in September.

More here:

https://www.anzca.edu.au/fellowship/information-for-new-fellows/emerging-leaders-conference

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The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery.

Go now to http://www.ebpom.org

From the 58th annual meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP) in Montreal, Mike Grocott and new co-host Joe Larvin speak with SOAP president Ron George about SOAP's growth to over 1,000 attendees and its international, collaborative community.

George outlines his career from Dalhousie to UCSF and back to Canada as director of obstetric anesthesia at Mount Sinai Hospital in Toronto, highlighting its high-risk referral practice and large, internationally diverse fellowship program. He reflects on his presidency's focus on mission alignment and partnerships, including work with the New York State Society of Anesthesia, discussions with the California Society of Anesthesia, and a planned memorandum of understanding with the World Federation of Societies of Anaesthesiologists (WFSA) to support evidence-based global education.

He also discusses formative work in low- and middle-income settings, advocacy, peripartum anesthesiologist roles, and meeting highlights such as trainees, pain during cesarean delivery panels, and the Gerard W. Ostheimer Lecture.

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The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery.

Go now to http://www.ebpom.org

This classic TopMedTalk piece was originally cast in April 2020.

The debate 'Direct laryngoscopes should be consigned to history', was hosted by The Royal College Of Anaesthetists and carried out by our two guests on this piece, where the debate is outlined in advance.

We get into the advantages and challenges behind the two techniques; video laryngoscopy and direct laryngoscopy. The conversation explores the fact that these skills are a key part of the job of practitioners, are we "de-skilling" the profession in an overly enthusiastic race toward new technology or are some resisting it simply because it's not what they are used to?

Presented by Joff Lacey and Monty Mythen with their two guests; Professor Tim Cook, Consultant in Anaesthesia and ICM, Royal United Hospitals, Bath and Dr William Harrop-Griffiths, St Mary's Hospital, Imperial College Healthcare NHS Trust.

Live from Euroanaesthesia 2026 in Rotterdam, Kate Leslie and Andy Cumpstey speak with Laszlo Vutskits and Hugh Hemmings ahead of the "Hot Topics in General Anaesthesiology" lecture.

Vutskits discusses reports of devastating neurologic outcomes after minor procedures in previously healthy patients, linked in a Spanish series to a shared mitochondrial DNA haplotype traced to Venezuela, including a rare ND4 complex I mutation; cybrid and fibroblast experiments showed clinically relevant sevoflurane rapidly suppresses oxidative phosphorylation but reversibly on washout, while propofol (tested without lipid) did not.

Hemmings highlights the DAS 2026 airway management guidance advocating video laryngoscopy as first-line for routine and difficult intubation and emphasizes continuous oxygen delivery during intubation, prompting debate about skill retention and global feasibility.

We reference this classic episode of TopMedTalk: https://topmedtalk.libsyn.com/-sunday-special-should-direct-laryngoscopy-be-consigned-to-the-history-books

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The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery.

Go now to http://www.ebpom.org