TopMedTalk

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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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). 

The importance of exercise, weight and perioperative nutrition. Which is worse, being fat or not being fit? Malnutrition, a silent epidemic? How useful are protein shakes? Are supervised exercise sessions cost effective?

Finally the team discuss the importance of starting these conversations with children, optimising nutrition and exercise for them will enhance their lives forever.

Hosted by Monty Mythen and Mike Grocott with their guests; Dr Denny Levett, consultant in Perioperative Medicine and Critical Care at Southampton University Hospital NHS Foundation trust, and Dr Paul Wischmeyer Professor of Anaesthesiology and Surgery at Duke Anesthesiology.

The importance of exercise, weight and perioperative nutrition. Which is worse, being fat or not being fit? Malnutrition, a silent epidemic? How useful are protein shakes? Are supervised exercise sessions cost effective?

Finally the team discuss the importance of starting these conversations with children, optimising nutrition and exercise for them will enhance their lives forever.

Hosted by Monty Mythen and Mike Grocott with their guests; Dr Denny Levett, consultant in Perioperative Medicine and Critical Care at Southampton University Hospital NHS Foundation trust, and Dr Paul Wischmeyer Professor of Anaesthesiology and Surgery at Duke Anesthesiology.

Professor Monty Mythen's full presentation regarding 'the FEDORA trial'.

This piece was originally presented during the Third Annual Quality Improvement Leadership Forum, 2018, at the Union League Club in Philidelphia.

The trial looked at the effect of goal-directed haemodynamic therapy on postoperative complications in low–moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial).

Randomised Controlled Multicentre trial; n=420; GDHT vs Control

Conclusions:

"Oesophageal Doppler monitor-guided GDHT reduced postoperative complications and hospital length of stay in low–moderate risk patients undergoing intermediate risk surgery, with no difference in mortality at 180 days."

Click here for full text.

http://bjanaesthesia.org/article/S0007-0912(17)54207-5/fulltext

If you are using this article to earn your CPD points please now, having listened, click here:

http://pmp.ocbmedia.com/podcasts/journal-club-the-fedora-trial/

Join Desiree and Monty as they reflect on the EBPOM USA weekend so far and look ahead to what remains.

Also - a reminder that you still have chance to hear the conference presentations live from the www.topmedtalk.com website. Go there now to get details, it's free and has proven to be incredibly popular around the world!

Join Desiree and Monty as they reflect on the EBPOM USA weekend so far and look ahead to what remains.

Also - a reminder that you still have chance to hear the conference presentations live from the www.topmedtalk.com website. Go there now to get details, it's free and has proven to be incredibly popular around the world!

Professor Monty Mythen's full presentation regarding 'the FEDORA trial'.

This piece was originally presented during the Third Annual Quality Improvement Leadership Forum, 2018, at the Union League Club in Philidelphia.

The trial looked at the effect of goal-directed haemodynamic therapy on postoperative complications in low–moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial).

Randomised Controlled Multicentre trial; n=420; GDHT vs Control

Conclusions:

"Oesophageal Doppler monitor-guided GDHT reduced postoperative complications and hospital length of stay in low–moderate risk patients undergoing intermediate risk surgery, with no difference in mortality at 180 days."

Click here for full text.

http://bjanaesthesia.org/article/S0007-0912(17)54207-5/fulltext 

A fascinating discussion and debate regarding the central dichotomy inherent in periperative medicine. No stone is left unturned as the team get their teeth into the subject tackling the always tricky subject of profit and patient optimisation.

Recorded on the first day of the conference this piece is a real stand out moment for TopMedTalk, make sure you both listen in and provide us with your thoughts [email protected]

Featuring Desiree Chappell, Monty Mythen, Dr Lee A. Fleisher Chair of Anesthesiology and Critical Care (University of Pennsylvania) and Vicki Morton DNP and Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates University of South Carolina.

Remember, TopMedTalk are live streaming the conference for free, exclusively for listeners to the podcast. Go now to www.topmedtalk.com

Originally streamed live from the EBPOM USA conference. Desiree Chappell, Monty Mythen, Dr Tim Miller (anaestheseologist at Duke University) and Dr Angela Edwards (head of perioperative medicine at Wake Forest University School of Medicine) discuss some of the presentations and their personal highlights.

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