TopMedTalk

 

What is 'the morpheus consortium'? What's the current thinking on pain management and the 'opioid crisis'? On reflection were people wrong to emphasise the message that 'pain is the fifth vital sign'? How did 'pain management' instead become 'opioid management'?

The UK has had a slightly different ride to the US in this respect, although not without its problems, could that be due to this 'fifth vital sign' message being less popular on the other side of the atlantic? Is it important to manage expectations and emphasise patient comfort rather than a total absence of any pain whatsoever?

Also here, there's a fascinating discussion of anemia and sex discrimination within its treatment. What is a normal level of hemoglobin in a patient and should this vary depending upon gender?

Presented by Monty Mythen with his guests Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton and a member of The Morpheus Consortium; Dr. Padma Gulur, anesthesiologist and a Pain Medicine Specialist who sees patients at Davis Ambulatory Surgical Center, Duke Pain Medicine and Duke Perioperative Pain Care; Annemarie Thompson, MD, Director, Residency Program, Professor of Anesthesiology at Duke University School of Medicine.

Monty sits down with one of the co-organisers of this year's meeting in Orlando and discusses this year's annual conference, "Controversies in perioperative medicine". The discussion encompasses pain relief, opioids, the increased use of ultrasound and the use of particular blocks during abdominal surgery. As ultrasound improves how is perioperative medicine changing? What are the challenges presented by larger patients? What are the potential problems with an ultrasound guided tap block? Presented by Professor Monty Mythen with his guest Professor Stuart Grant, MB ChB, FRCADirector, Medical Student Education, Duke University School of medicine. Join the debate and email us at [email protected]

Monty sits down with one of the co-organisers of this year's meeting in Orlando and discusses this year's annual conference, "Controversies in perioperative medicine". The discussion encompasses pain relief, opioids, the increased use of ultrasound and the use of particular blocks during abdominal surgery. As ultrasound improves how is perioperative medicine changing? What are the challenges presented by larger patients? What are the potential problems with an ultrasound guided tap block?   Presented by Professor Monty Mythen with his guest Professor Stuart Grant, MB ChB, FRCADirector, Medical Student Education, Duke University School of medicine.   Join the debate and email us at [email protected]

This conversation reflects a discussion had at the Perioperative Quality Inititative (POQI). It originally ran under the title, "Intervascular volume and fluid responsiveness" but, as this conversation explains, it was renamed "Fluid Responsiveness and venous capacitance".

With a genuinely multidisciplinary approach on display here this piece gives you a glimpse at the inner workings of the POQI process. How does macro circulation interlock with micro circulation and cellular function? How do people on the ground measure stroke volumes? What do you do when passive leg raising is not appropriate? How do we address hypovolemia? How do you define fluid responsiveness at the bedside?

Presented by Desiree Chappell and Mike Grocott with their guests David Kaufman Associate Professor, Director, Medical Intensive Care Unit at NYU School of Medicine, NYU-Langone Medical Center and Dr Greg Martin Director, Research Network, GaCTSA; Director, Predictive Health Institute; Research Director, Emory Critical Care Center.

This conversation reflects a discussion had at the Perioperative Quality Inititative (POQI). It originally ran under the title, "Intervascular volume and fluid responsiveness" but, as this conversation explains, it was renamed "Fluid Responsiveness and venous capacitance".

With a genuinely multidisciplinary approach on display here this piece gives you a glimpse at the inner workings of the POQI process. How does macro circulation interlock with micro circulation and cellular function? How do people on the ground measure stroke volumes? What do you do when passive leg raising is not appropriate? How do we address hypovolemia? How do you define fluid responsiveness at the bedside?

Presented by Desiree Chappell and Mike Grocott with their guests David Kaufman Associate Professor, Director, Medical Intensive Care Unit at NYU School of Medicine, NYU-Langone Medical Center and Dr Greg Martin Director, Research Network, GaCTSA; Director, Predictive Health Institute; Research Director, Emory Critical Care Center.

This discussion focuses on the perioperative quality initiative's intense focus this year on total body water and electrolights. How often should we weigh patients to monitor water balance? What can we learn from a real understanding of the circulation of interstitial fluid and lymphatics? What is the role of diuretics for the perioperative practitioner? Also, haemodilution, what should you do if you have a patient with a positive post operative fluid balance and a low haemoglobin? Finally, how do we deal with sodium balance and Chloride?

Coming from this summer's Peroperative Quality Initiative (POQI) hosted at Washington Duke University in Durham this podcast is presented by Monty Mythen and Henry Howe with their guests Tom Woodcock, an independent consultant in patient safety, medical law and ethics, and Manu Malbrain, Professor at Faculty of Medicine and Pharmacology Vrije University in Brussells.

The website mentioned in this piece is here: https://www.fluidacademy.org/

You can email the team via [email protected]

This discussion focuses on the perioperative quality initiative's intense focus this year on total body water and electrolights. How often should we weigh patients to monitor water balance? What can we learn from a real understanding of the circulation of interstitial fluid and lymphatics? What is the role of diuretics for the perioperative practitioner? Also, haemodilution, what should you do if you have a patient with a positive post operative fluid balance and a low haemoglobin? Finally, how do we deal with sodium balance and Chloride?

Coming from this summer's Peroperative Quality Initiative (POQI) hosted at Washington Duke University in Durham this podcast is presented by Monty Mythen and Henry Howe with their guests Tom Woodcock, an independent consultant in patient safety, medical law and ethics, and Manu Malbrain, Professor at Faculty of Medicine and Pharmacology Vrije University in Brussells.

The website mentioned in this piece is here: https://www.fluidacademy.org/

You can email the team via [email protected]

How does perioperative care relate to obstetrics? Who does it benefit, the patient, the hospital or both? How does it help to engage pregnant patients through the perioperative process? Furthermore, does the issue of addiction arise in this area?

Coming from this summer's Peroperative Quality Initiative (POQI), hosted at Washington Duke University in Durham, this podcast features Monty Mythen and Desiree Chappell interviewing their guests Dr Attila Kett, anaesthesiologist and Chairman at St Peter's University Hospital at New Jersey and Dr. Elizabeth Cherot Medical Doctor/Managing Partner at Brunswick Hills Obstetrics and Gynecology. The team are also joined by Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

How does perioperative care relate to obstetrics? Who does it benefit, the patient, the hospital or both? How does it help to engage pregnant patients through the perioperative process? Furthermore, does the issue of addiction arise in this area?

Coming from this summer's Peroperative Quality Initiative (POQI), hosted at Washington Duke University in Durham, this podcast features Monty Mythen and Desiree Chappell interviewing their guests Dr Attila Kett, anaesthesiologist and Chairman at St Peter’s University Hospital at New Jersey and Dr. Elizabeth Cherot Medical Doctor/Managing Partner at Brunswick Hills Obstetrics and Gynecology. The team are also joined by Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

Names, titles and definitions were sliced, diced and discussed at the Perioperative Quality Initiative (POQI). This conversation, recorded on the morning of the second day of the meeting and featuring some of the participants, reflects that.

"Stress volumes" and "Pre-load" are a couple of examples given in this piece. Everyone involved knew what these words described but once discussions got into detail it became clear multiple definitions were at play. Part of the point of an initiative like POQI is to bring terms like this, used by different people in different ways, to a concensus. This conversation explores some of the dillemmas which emerged as a result.

'Starling pressures' are discussed as is the role of lymph in the fluid balance of our patient's bodies. Furthermore the topic of fluid responsiveness comes up as does passive leg raising. Also, how does the fact that a patient's blood pressure can be normal, even if they've lost upto 25% of blood volume, impact on our understanding of these things?

Finally, how does this relate to the practitioners at the bedside? How do we translate these debates into practical advice which will make a real difference to patients, this piece goes some way towards answering those questions.

Send us your thoughts and contribute ot the debate: [email protected]

Coming from this summer's Peroperative Quality Initiative (POQI) hosted at Washington Duke University in Durham this podcast is presented by Desiree Chappell with Professor Monty Mythen, Henry Howe and their guest Tim Miller, anaesthsiologist from Duke University Medical Centre and organiser of the POQI meeting.