TopMedTalk

This piece discusses how the contributors are driving better perioperative care in their clinics; the importance of getting patient records in advance; ERAS for obstetrics; challenging opioid use with the multimodal pain management; shared decision making in pain management; the importance of clear communication pathways and patient literacy.

This podcast features Desiree Chappell interviewing; Dr Ellen Flanagan, anaesthesiologist and medical director at the Duke preoperative assessment testing clinic, Dr Attila Kett, anaesthesiologist and Chairman at St Peter's University Hospital at New Jersey and Lynn Reede, CRNA and chief clinical officer at the (AANA) American Association of Nurse Anaesthetists.

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This piece discusses how the contributors are driving better perioperative care in their clinics; the importance of getting patient records in advance; ERAS for obstetrics; challenging opioid use with the multimodal pain management; shared decision making in pain management; the importance of clear communication pathways and patient literacy.

This podcast features Desiree Chappell interviewing; Dr Ellen Flanagan, anaesthesiologist and medical director at the Duke preoperative assessment testing clinic, Dr Attila Kett, anaesthesiologist and Chairman at St Peter's University Hospital at New Jersey and Lynn Reede, CRNA and chief clinical officer at the (AANA) American Association of Nurse Anaesthetists.

Add to the discussion [email protected]

Marc Koch President & CEO of Somnia Inc reviews the conference with Desiree Chappell. What should you expect at an EBPOM meeting? How useful is the practical advice given? How important is the networking side of an event like this?

Hosted by Desiree Chappell.

Join us on www.topmedtalk.com sign up for our email updates and never miss a live streamed conference again.

Marc Koch President & CEO of Somnia Inc reviews the conference with Desiree Chappell. What should you expect at an EBPOM meeting? How useful is the practical advice given? How important is the networking side of an event like this?

Hosted by Desiree Chappell.

Join us on www.topmedtalk.com sign up for our email updates and never miss a live streamed conference again.

When it comes to breathlessness how do we better diagnose and apply treatment earlier? How do we overcome the fact that referring to a specialist can sometimes take a patient 'down the wrong route' with a condition that might not be just heart or lung related?

Ronan Astin, clinical consultant in respiratory medicine at UCL Hospital, explains his more holistic approach to treatment and diagnosis.

"Nick the patient" asks a few questions and demonstrates the misunderstanding that many sufferers might have; breathlessness is not of course always connected to your lungs.

"Johnny the patient" then speaks about his Mother, 84, who has recently experienced breathlessness, she didn't want to complain about it, how can we pick these issues up earlier?

Dan Martin, anaesthetist at The Royal Free Hospital, speaks about his processes including the cardiopulmonary exercise testing they use. Testing patients, during a session on an exercise bike, reveals physiological and pathological causes but furthermore it can reveal the psychological issues which may be behind the problem.

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This podcast is presented by Professor Monty Mythen and features contributions from; Ronan Astin, clinical consultant in respiratory medicine at UCL Hospital; Dan Martin, anaesthetist at the Royal Free Hospital and finally 'the patients' Nick Margerrison and Johnny Themans.

When it comes to breathlessness how do we better diagnose and apply treatment earlier? How do we overcome the fact that referring to a specialist can sometimes take a patient 'down the wrong route' with a condition that might not be just heart or lung related?

Ronan Astin, clinical consultant in respiratory medicine at UCL Hospital, explains his more holistic approach to treatment and diagnosis.

"Nick the patient" asks a few questions and demonstrates the misunderstanding that many sufferers might have; breathlessness is not of course always connected to your lungs.

"Johnny the patient" then speaks about his Mother, 84, who has recently experienced breathlessness, she didn't want to complain about it, how can we pick these issues up earlier?

Dan Martin, anaesthetist at The Royal Free Hospital, speaks about his processes including the cardiopulmonary exercise testing they use. Testing patients, during a session on an exercise bike, reveals physiological and pathological causes but furthermore it can reveal the psychological issues which may be behind the problem.

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This podcast is presented by Professor Monty Mythen and features contributions from; Ronan Astin, clinical consultant in respiratory medicine at UCL Hospital; Dan Martin, anaesthetist at the Royal Free Hospital and finally 'the patients' Nick Margerrison and Johnny Themans.

Professor Monty Mythen presents Journal Club Express.

Postoperative delirium in total knee and hip arthroplasty patients: a study of perioperative modifiable risk factors

DOI: 10.1016/j.bja.2017.12.046

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S. M. Weinstein et al. Br J Anaesth 2018; 120(5): 999-1008

This is an American single center retrospective study with 41,766 patients undergoing hip and knee arthroplasties over a seven year period. They showed that 22.1% patients developed post operative delirium according to the ICD 9 definition of delirium. Delirium occurs more in patients with multiple co-morbidities, older age, higher baseline creatinine, lower haemoglobins and longer patients stays.

They looked at the type of anaesthetic as well as the use of opioids, ketamine and benzodiazepines. They found the rates of delirium were higher in the knee arthroplasty group compared with the hip arthroplasty group.

Those that received a neuroaxial block had a lower rate of delirium; Spinal: OR 0.55 (CI 0.37-0.83), Epidural: OR 0.59 (CI 0.38-0.93), CSE: OR0.56 (CI 0.40-0.80). There was a high risk with the use of postoperative benzodiazepines (OR 2.47 CI 2.04-2.97) and ketamine infusion ()R 10.59 CI 5.26-19.91) as well as intraoperative ketamine (OR 1.27 CI 1.01-1.59) and opioids (OR 10.59 CI 5.26-19.91).

This podcast concerns sleep apnea as part of pre-operative patient optimisation. How important is it to evaluate patients for sleep disorders before surgery? Are patients with sleep apnea aware of their condition and are they using some form of treatment? What are the health problems associated with sleep disorders? How do you build a financial case for including this in your practice?

A piece originally streamed live from Atlanta Georgia during TopMedTalk's coverage of "EBPOM-USA Masters Course, A Perioperative Care Practicum".

Featuring hosts Desiree Chappell and Vicki Morton interviewing Dr Andrew R. Spector, Neurologist, Sleep Medicine Specialist at Duke Health.

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Originally streamed live from Atlanta Georgia during TopMedTalk's coverage of "EBPOM-USA Masters Course, A Perioperative Care Practicum" this podcast includes discussion about psychological optimisation for surgery; who should have it, what does it mean and how does it work? Further conversation moves into weaning patients off opioids in advance of surgery and cutting their dependency afterwards. Also, the question of consent to opioids during and after surgery comes up - should we be educating patients more and is it time to look more deeply at the issue of consent?

Hosted by Desiree Chappell and Vicki Morton featuring 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.

Join us on www.topmedtalk.com sign up for our email updates and never miss a live streamed conference again.

Originally streamed live from Atlanta Georgia during TopMedTalk's coverage of "EBPOM-USA Masters Course, A Perioperative Care Practicum" this podcast includes discussion about psychological optimisation for surgery; who should have it, what does it mean and how does it work? Further conversation moves into weaning patients off opioids in advance of surgery and cutting their dependency afterwards. Also, the question of consent to opioids during and after surgery comes up - should we be educating patients more and is it time to look more deeply at the issue of consent?

Hosted by Desiree Chappell and Vicki Morton featuring 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.

Join us on www.topmedtalk.com sign up for our email updates and never miss a live streamed conference again.