TopMedTalk

Podcast 11: Monty Mythen and Mike Grocott are joined by Dr Liam Brennan (President of the Royal College of Anaesthetists) and Dr Fay Gilder (Addenbrooke’s, Cambridge) to discuss the importance of screening and risk mitigation of cognitive dysfunction and delirium in the perioperative period.

Podcast 10: Monty Mythen, Mike Grocott and Joff Lacey talk to Dr Tim Miller (Duke University Medical Centre) about a recent study investigating the impact of GDFT on postoperative acute kidney injury in the colorectal patient.

This conversation explores the extended role of the anaesthetist, brought about partly by perioperative care but more widely because of societal changes. Practitioners face a dilemma; how do you best impact value based care, as a specialist, when multidisciplinary approaches are becoming essential?

In the UK, The Royal College of Anaesthetists, are working on this very issue; find out how they are becoming part of conversations regarding public health and modifiable risk factors, as relate to a patient's lifestyle choices and pathology.

The transatlantic perspective is essential here, how do organisations like EBPOM USA advocate these ideas within an American funding model?

No matter which side of the Atlantic you live on there's a very real debate to be had about training students; the job of the anaesthetist has fundamentally altered in recent times. Furthermore, how do those already practising update their skills and stay with the times?

Monty Mythen and Joff Lacey presenting with their guests Liam Brennan, President of the Royal College of Anaesthetists, and Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

Anaesthesiology has reached a moment of great change, the discipline is evolving rapidly. With change comes opportunity, this conversation explores the transitional situation experts, practitioners and students find themselves in, how can you best fit into the new world? Renumeration is one changing factor but so is the idea that prevention is a clear goal for people who would like to avoid being seen as patients.

The transatlantic side of this debate is useful as a paradigm to think about where things might go but there are further elements which are outside of that picture; the evolution of AI and technology means concepts such as patient optimisation and 'the new economy of healthcare' may take on unpredictable forms in the future. How does a world of limited resources and increased technological capacity fit into the perioperative movement?

'Evidence Based Perioperative Medicine USA' is discussed alongside the intention to get beyond advocacy and into practical realities. How do we apply all these ideas?

Presented by Monty Mythen, Mike Grocott and Joff Lacey; joined by their guest Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology.

Discussion about the challenge of delivering patient-centred, value-driven healthcare.

Value based care is discussed, value for the patient is emphasised and discussion is had about how much people trust hospitals and doctors. The difference between the perception of healthcare institutions and practitioners in UK and the US is debated.

Perioperative medicine, perioperative surgical home, enhanced recovery after surgery (ERAS); the terms differ but are they all really the same thing?

Does value based care mean we have to ask our patients what they value? Shared decision making and an awareness of where an individual's priorities lie is becoming an essential part of the picture now.

How does this dovetail into the questions regarding multiple morbidities and pathological health concerns? Prehabilitation may mean modifiable risk factors brought on by lifestyle need to be addressed as part of patient optimisation.

How does this work in a fee for service environment? The answers vary but if there's a significant saving for a hospital can it be funded by the institution itself?

Professor Monty Mythen, Professor Mike Grocott and Dr Joff Lacey presenting with their guest Prof Zeev Kain, Chancellor's Professor of Anaesthesia at University of California at Irvine and President of the American College of Perioperative Medicine.

The challenges facing the anaesthesia community as the need for big trials looms large. Why does it take so long for the anaesthesia community to adopt new techniques? Goal directed fluid therapy, as an example, seems to work but involves a cultural change and huge trials before it can be adopted.

The Optimisation of Peri-operative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is discussed in detail, as is the FLO-ELA (FLuid Optimisation in Emergency LAparotomy) trial.

Could it be that because fluid therapy involves a cultural change within the anaesthesia community there is a difficulty for some to accept the evidence as it is?

Finally Monty asks, as regards big trials, "blood pressure, shouldn't there be more of a focus on that?".

Presenting live from Boston ASA; Professor Monty Mythen, Professor Mike Grocott and Dr Joff Lacey.

Join the debate: [email protected]

The largest gathering of anaesthesiologists in the world; feel as if you're there with the TopMedTalk team at ASA 2017.

This discussion covers the birth of anaesthesia, in Boston, and its adoption around the world. The contrast between demonstration and adoption in the 1800's and in the modern world is questioned, are we too cautious in adopting new ideas these days? Also - what has been the impact upon surgery, do patients now have unrealistic expectations as regards pain management as a result of it?

And finally, is perioperative medicine a natural evolution of this history?

Professor Monty Mythen, Professor Mike Grocott and Dr Joff Lacey recorded this piece live in Boston at the ASA 2017.

Join the debate [email protected]

Monty Mythen and Joff Lacey are joined by leaders from both sides of the Atlantic. Liam Brennan (President of the Royal College of Anaesthetists) and Sol Aronson (Duke University Medical Centre) discuss changes to training in anaesthesia, the role of perioperative medicine in public health and the challenges facing its implementation

Monty Mythen, Mike Grocott and Joff Lacey are joined by Prof Sol Aronson (Duke University Medical Centre) to explore where we are and what the future holds for Perioperative Medicine in the USA

Monty Mythen, Mike Grocott and Joff Lacey are joined by Prof Zeev Kain, Chancellor's Professor of Anaesthesia at University of California at Irvine and President of the American College of Perioperative Medicine, to discuss the challenge of delivering patient-centred, value-driven healthcare.