TopMedTalk

This discussion, recorded on day one of EBPOM 2017, a truly international gathering with many countries represented. The Intraoperative hypotension is discussed. New information regarding cognitive function for patients raises big questions. Should shared decision making be re-evaluated? The team then discuss the Perioperative Quality Initiative (POQI) and new information regarding intraoperative hypotension. How rapidly should you attend to fluctuations? What is an appropirate response nowadays? The subject of perioperative nephrology is discussed, including topics such as the fluid challenge, urine output, biomarkers and the timing of renal replacement therapy. Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests Dr Tim Miller from Duke University Medical Centre and John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh. Join in the debate: [email protected]

Discussion includes a recap of the last few podcasts.

Desiree Chappell joins us to update the team on 'the opioid crisis'; 50 overdoses in a twenty hour period reported in Kentucky? Can a perioperative multimodal approach to pain management help tackle it? How important is managing patient expectations as regards pain?

Dr Ramani Moonesinghe, Director of the Health Services Research Centre at the RCoA, discusses patient data. Why is important to report both median and mean length of stay when collating data in relation to enhanced recovery after surgery. Various UK patient data initiatives are discussed including the Perioperative Quality Improvement Programme (PQIP) , what's the importance of making this data available to all? Should we also work towards making it more available to patients? The SNAP-2 project is also discussed.

The PQIP website mentioned is here: http://www.pqip.org.uk/

Scott Brudney Professor Departments of Anaesthesiology and Internal Medicine, University of Manitoba, Winnipeg joins us to discuss fluid management: Is it really ok to have a drink before an operation? What about a carbohydrate drink? Is it really for the best to have had 'nil by mouth' from 6pm the night before?

Mike Grocott Professor of Anaesthesia and Critical Care Medicine at the University of Southampton joins us on the line with some other guests including; Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and Dr Paul E Wischmeyer of Duke University. They provide some insight into the ASER conference, more depth regarding what to do with someone who is mulnourished, the advantages of pre-habilitation and the importance of nutrition clinics as part of preparation for surgery. How do you build a robust financial model for such an enterprise?

Sol Aronson explains the acronym POET - a truly multidisciplinary Perioperative Enhancement Team, responsible for project managing optimisation programmes. The fundamental philosophy is espoused that people should have surgery, when they are ready.

Finally Dr. Timothy Miller, Assistant Professor of Anesthesiology at Duke University Medical Center, joins us to discuss ASER and an optimistic future for the perioperative movement.

The link mentioned in the podcast is here: https://ebpom.org/ASER-EBPOM-2017

Sponsored by EBPOM and Edwards Life Sciences

Guests include; Desiree Chappell, a nurse anaesthetist CRNA and ASER board member from Kentucky; Dr Ramani Moonesinghe Director of the Health Services Research Centre at the RCoA; Scott Brudney Professor Departments of Anesthesiology and Internal Medicine, University of Manitoba, Winnipeg; Mike Grocott Professor of Anaesthesia and Critical Care Medicine at the University of Southampton; Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology; Dr Paul E Wischmeyer of Duke University; Dr. Timothy Miller, Assistant Professor of Anesthesiology at Duke University Medical Center. The show is presented by Professor Monty Mythen.

This is a recorded programme, the phone number used is not applicable for podcast listeners.

Join the debate: [email protected]

Find us online: http://www.topmedtalk.com/

In this piece you will hear more discussion regarding the POQI papers, a growing concensus on goal directed fluid therapy and the move away from opioids. One of the big stories, The American College of Surgeons's announcement that ERAS is to be rolled out to more than 750 hospitals, is also discussed.

The POQI (Perioperative Quality Initiative) papers on outcomes and fluid management are discussed.

The outcomes paper offers a framework for how data on ERAS might be collected. How quickly are people drinking eating and mobilising? What are the lengths of stay and readmission rates? How should these numbers be coallated? How can outcomes continue to be improved beyond the initial adoption of enhanced recovery after surgery (ERAS)? The importance of DREAMS (Drinking Eating Mobilising and Sleep) is emphasised in the discussion.

The fluid management paper is said to offer a general concensus. The key message regarding shortening the gap between the time a patient stops, and then resumes, taking fluid orally is empahasised in the discussion. The importance of getting the IV down and minimising maintainence fluid is also discussed.

Shouldn't all fluid therapy be goal directed? What about fluid restriction?

Finally there's discussion about some of the sessions at ASER 2017; prehabilitation and rehabilitation, dealing with patients on chemotherapy who are less physically fit than average and the possible improvement in cancer tumour regressions brought about by physical exercise.

The link mentioned in the podcast is here: https://ebpom.org/ASER-EBPOM-2017

Sponsored by EBPOM and Edwards Life Sciences

Featuring Dr Tim Miller anaesthesiologist at Duke Medical Centre and Vice President of ASER and presented by Monty Mythen, live from London, with Joff Lacey and Mike Grocott in Washington.

Join the debate: [email protected]

Find us online: www.topmedtalk.com

ASER 2017 a "truly multidisciplinary conference" and "one of the best ones yet"; looking to continue to increase membership and push further education; taking on the challenge of applying new ideas on site; the challenge of reaching both surgeons and anaesthetists; tips for people trying to engage multidisciplinary teams and also overcoming concerns related to perioperative surgery by 'keeping it about the patient, don't give it a name, focus on outcomes and remembering that data talks'. Furthermore, download this podcast for a comprehensive introduction to the POQI (Perioperative Quality Initiative) papers; a method adopted to bring 20-30 experts together for 2-3 days, seminar style. With equal numbers of anaesthetists and surgeons alongside some industry sponsors, nurses and CRNA members they face topical questions in a process which is useful because it raises more questions than answers. Each manuscript they produce contains 'future steps' and produces 'more mature questions'. Dealing with 4 main areas – pain infection, outcomes and fluid management. Also, how does ERAS apply to elective colorectal surgery? By, amongst other thing, discussing expectations with patients, staying 'patient focused' and having a protocol which starts right at the point of diagnosis the perioperative process has brought dramatic reductions in length of stay and increased patient satisfaction. Discover more about "the POQI Pain paper". Should we be encouraging patients to 'DRink EAt Mobilise and Sleep – DREAMS'? What is optimal analgesia? Should we minimise pain rather than aim to be 'pain free'? Should we set our target to be opioid free if we can use the multimodal approach? Finally, the bowel prep discussion is included here. Bowel prep has moved on and become "less harmful", patient satisfaction is now part of the process, which it wasn't always previously. Difference in fluid management are discussed and the need for more reports regarding it. How is surgical site infection balanced with patient comfort? Sponsored by EBPOM and EDWARDS life sciences. This is the first ever pilot episode of TopMedTalk; Monty couldn't make it to ASER that year so worked with some friends to pick up on the big stories. Dr Joff Lacey and Professor Mike Grocott join him live from Washington DC with their guest Dr Julie Thacker, the then president elect at ASER. Join in the debate [email protected] Or check out the website for more http://www.topmedtalk.com/