TopMedTalk

This piece deals with the prediction of opioid induced respiratory depression for our inpatients on hospital wards, could a change in monitoring practices help? The postoperative period seems to be critical, the thirty day period immediately after anesthesia being a key area. 7.7% of postoperative deaths are in this period, according to The Lancet here; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33139-8/fulltext

What is happening in the post operative period? How do we find out more? Are hospital general care wards the safe haven we expect them to be? What should we monitor and how do we avoid "alarm fatigue"?

More on the "PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY)" trial here:

https://clinicaltrials.gov/ct2/show/NCT02811302

The official STOP BANG score website is here: http://www.stopbang.ca/osa/screening.php

This piece was sponsored by Medtronic.

This is part 1 of a two part piece.

Presented by Monty Mythen with Desiree Chappell and Ashish Khanna, Associate Professor, Section Head for Research, Department of Anesthesiology, Section on Critical Care Medicine,Wake Forest School of Medicine.

If you loved this piece you'll also enjoy this piece here:

Desiree's Roundtable | Can you bite your upper lip? Assessing patients to reduce post-op respiratory complications

http://www.topmedtalk.com/desirees-roundtable-can-you-bite-your-upper-lip-assessing-patients-to-reduce-post-op-respiratory-complications-2/

"Maybe it's time to evolve our practice"

Many believe ultrasound is an essential bedside tool which should be as common as the archetypal Doctor's stethoscope, with training made mandatory for all acute medicine specialists. This piece is structured as a debate where this point of view is advocated and debated.

Presented by Mark Edwards, Consultant in Anaesthesia and Perioperative Medicine at The University Hospital Southampton NHS Foundation Trust with Catherine Nix, Consultant Anaesthetist Intensivist at University Hospital Limerick, with panelists; Janette Brohan, Consultant in Anaesthesia and Intensive Care Medicine in Cork University Hospital, David Walker, Professor in Anaesthesia and Critical Care Medicine, University College London Hospitals, Honorary Senior Lecturer UCL, Kevin Murphy, Professor of Endocrinology & Metabolism at University College London, Ashley Miller, Intensivist at Shrewsbury and Telford Hospitals and Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care, University College London.

This piece starts with the challenges faced by non-consultant hospital doctors (NCHD's) in this pandemic environment and the challenges of teaching novice anesthesiologists during COVID19. What insights can be gained from this high stress high demand environment where correct and comprehensive training is essential?

The conversation is then thrown out to a panel and questions are considered; what is the future of training, what have we learned and what must we prioritize in the near and long term future?

Chaired by Janette Brohan, Consultant in Anaesthesia Intensive Care Medicine in Cork University Hospital with an initial short presentation from Niamh McAuliffe Anesthesiologist in Cork University Hospital and featuring the following panellists; Viki Mitchell, consultant anaesthetist and divisional clinical director at University College London Hospitals, Brian O'Brien, Consultant in Anaesthesia and Intensive Care Medicine, at Cork University Hospital, where he is Chairman of Department, Ray O'Conner Consultant in Anaesthesia at Cork University Hospital and Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care, University College London.

"There is some great literature out there that has been shared ... great data, especially in cardiac surgery, which is where we are using it and I would like to expand it out to other service lines as well..."

Methadone has had something of a resurgence recently, thanks in part to the work of some of our contributors in this piece. Could it be that this "opioid sparing opioid" could be a way to actually help fight the crisis we can see in US hospitals and beyond?

This piece gets into the detail, how and where and why is it used?

Presented by Sol Aronson with questions from the online audience for his panelists; Glenn Murphy, Jeffery S. Vender Chair of Anesthesiology Research and Education and Director of Cardiac Anesthesia and Clinical Research at NorthShore University HealthSystem, a hospital affiliated with the University of Chicago Pritzker School of Medicine, Evan Kharasch, Professor and Vice Chair for Innovation in the Department of Anesthesiology at Duke University, and Director of Academic Entrepreneurship in Duke University School of Medicine and Vicki Morton Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates, P.A.

We suggest listening to this piece alongside this excellent talk: https://www.topmedtalk.com/ebpom-chicago-methadone-use-in-perioperative-medicine/

This piece was originally part of EBPOM Chicago and is presented for the first time here exclusively to TopMedTalk listeners. For more details on Evidence Based Perioperative Medicine go now to www.ebpom.org

This piece, part 2 of 2, is a series of questions related to part 1; "Monitoring and management of neuromuscular blockade | EBPOM Chicago".

This piece gets into the detail regarding one of the stand out moments of EBPOM Chicago 2020; questions from the online audience facilitate the discussion.

Given the fact that our methods of monitoring residual neuromuscular blockade are often inadequate do you transport and do you recommend routine transport to patients from the operating room to the post-anesthesia care unit?

Sugammadex is a unique drug that does exactly what we want it to do; why are alternatives still used and available?

Some wearables have accelerometer hardware, are you aware of, or do you know if anyone is studying, firm software solutions, marshaling this ubiquitous hardware?

Don't forget, for more details on Evidence Based Perioperative Medicine EBPOM conferences go now to www.ebpom.org

Presented by Sol Aronson, tenured Professor at Duke University, Glenn Murphy, Jeffery S. Vender Chair of Anesthesiology Research and Education and Director of Cardiac Anesthesia and Clinical Research at NorthShore University HealthSystem, a hospital affiliated with the University of Chicago Pritzker School of Medicine.

This piece is an informative conversation about "the Perioperative Care Team"; who is essential to the team and how do we make sure everyone feels included? What elements do you need to make up such a team, how do you keep people energized and excited about it over the long term? How do we ensure, in this context, that a fee for service system interlocks with the needs of both the institution and its patients? Furthermore, how does such a team increase our commitment to value based care and good quality long term outcomes?

Also, an exciting commitment is made toward a journal club, stick with TopMedTalk for more details.

Presented by Vicki Morton with panelists Dennie Levett, Professor in Perioperative Medicine and Critical Care at Southampton University Hospital NHS Foundation trust and Honorary Associate Professor at the University of Southampton, Kay Mitchell, Senior Research Manager for Critical Care Research, NIHR Biomedical Research Center, University Hospital, Southampton, UK and Gina McConnell, ERAS Coordinator for all WakeMed health systems.

"If you want to take population based data, and define hypotension, you'll be right for the majority of our average patients, but not for all patients and it appears that the amount of time we spend below the lower limit of autoregulation has meaning for patient outcomes"

Starting from the origins of blood pressure monitoring, via the father of neurosurgery endocrinology, Harvey Cushing, through to the current debate as to what exactly constitutes hypotension this piece is an important part of a longstanding discussion here on TopMedTalk. How and why does hypotension occur and what is the correct evidence based strategy now the data are mounting as regards potential patient harm and unsatisfactory outcomes?

Presented by Charles Hogue, Professor and Chair of Anesthesiology at Northwestern University in Chicago.

"It was successful early on within the National Health Service.. [because] you could eliminate the cost of some unhelpful, unnecessary tests... referrals to other "-ologists"... in our system that works, because more work is just more work. It's not more money."

Is the business case for prehabilitation a "slam dunk", as some enthusiasts claim? If so how do you measure value versus volume, is value always a subjective term and can the balance between the two be addressed? How does the NHS's "internal market" compare to the US's fee for service environment? Furthermore, where are the sensible limits of prehabilitation, how far do we take it before we move forward to an operation?

This piece has been available to EBPOM London attendees since it was first recorded in the earlier part of the year. For exclusive access to other similar pieces now and in the future please visit www.ebpom.org

Presented by Monty Mythen and Kay Mitchell, Senior Research Manager for critical care research, NIHR Biomedical Research Centre, University Hospital Southampton, UK, with their guests, David Selwyn, Deputy Medical Director at Nottingham University Hospitals NHS Trust and Director of The Centre for Perioperative Care (CPOC), Sol Aronson, tenured Professor, Duke University and Jeff Vender, Emeritus, Harris Family Foundation Chairman of the Department of Anesthesiology at NorthShore University Health System, Evanston, Illinois and Clinical Professor at the University Of Chicago Pritzker School Of Medicine in Chicago, Illinois

What do we mean by "nutritionally fit" and why does it matter? How do we identify those most at risk in terms of screening and assessment and what's the difference between these two processes? How can we use screening and assessment to triage patients into care? Also, in the time of COVID19, are there ways we can perform some tasks related to these processes remotely?

Presented by Steve Wooton, Senior Lecturer in Human Nutrition within Medicine at the University of Southampton.

"Studies suggest that even three fourths of patients may be anemic when they present for surgery and many of these patients are previously undiagnosed"

This common problem is known to cause issues both within the perioperative period and beyond. How can we manage this condition and where does the latest data lead us?

Following a presentation there is a panel discussion featuring questions from the EBPOM Chicago audience. Check out www.ebpom.org to find out how you can attend our online conferences.

Make sure you also check out the article mentioned in this piece here: https://pubs.asahq.org/anesthesiology/article/133/1/109/109133/An-Effective-and-Efficient-Testing-Protocol-for

If you enjoyed this piece we suggest you go here next:

TopMedTalk | Iron Man vs Anemia https://www.topmedtalk.com/topmedtalk-iron-man-vs-anemia/

Presented by Monty Mythen with Bobbie Jean Sweitzer, Professor of Anesthesiology and Associate Chair for Perioperative Clinical Practice at Northwestern University and Jeanna Blitz, Associate Professor of Anesthesiology, Director of the Preoperative Anesthesia and Surgery Screening Clinic, Director of Perioperative Medicine Fellowship at Duke University School of Medicine, Durham, North Carolina.