TopMedTalk

"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.

"Perhaps assessing functional performance is something that we've overlooked in medicine"

This piece is about the role of functional assessment and status in perioperative medicine.

The Duke Activity Status Index (DASI) can be found here: https://www.mdcalc.com/duke-activity-status-index-dasi

The Mini Cog assessment is here: http://mini-cog.com/wp-content/uploads/2015/12/Mini-Cog-Form-010816.pdf

The video resources mentioned in the piece are here: https://www.youtube.com/channel/UCvOamR8Sb4RXENr56fvRehA/featured

Presented by Daniel Conway, Consultant in Anaesthesia and Critical Care, Group Lead for Perioperative Medicine, Manchester Royal Infirmary, UK and Chair of the Manchester Perioperative Medicine Society.

This piece digs deep into the realities of coping with COVID 19 patients who have had their care escalated to the Intensive Care Unit (ICU); "we don't seem to be looking at our typical sepsis patients who get multiple organ failure in the classical way" and "you're surprised at how young some of the patients are...".

Our guest provides us further insight; a 'household name' in the haemodynamic monitoring space; he is treating patients in a medium sized hospital (500 beds) with mostly COVID patients in Spain. How are things going there, how does it compare to Italy? How are the patients being dealt with, what can we learn about the basics here, airway, breathing, ventilation (ABC)?

There is also a gripping discussion regarding dynamic arterial elastance. If you'd like to know more about that do check out our discussion here: https://www.topmedtalk.com/periop-coach-2-09-haemodynamic-monitoring/

The webinar mentioned in this piece can be found here: https://www.esicm.org/education/webinars/

Presented by Desiree Chappell and Monty Mythen with their guest Dr. Manuel Ignacio Monge García who works in an ICU in the South of Spain.

This piece gives us a look at some of the latest thinking on Post Operative Nausea and Vomiting (PONV). It includes a discussion about Amisulpride and discusses new, yet to be published, consensus guidelines for PONV.

The original guidelines are here: https://www.ncbi.nlm.nih.gov/pubmed/24356162

Also, you may like to check out the details of this paper here: Amisulpride: A New Dopamine Antagonist for Treatment of Postoperative Nausea and Vomiting https://www.ncbi.nlm.nih.gov/pubmed/31094771

Presented by Desiree Chappell and Monty Mythen with their guest Tong Joo (TJ) Gan, Professor and Chairman at Stoney Brook in New York.

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Like this, want more?

Check out TJ Gan's masterful presentation "EBPOM USA Part 5| Practical realities; How and why multimodal Analgesia matters" here: https://www.topmedtalk.com/ebpom-usa-part-5-a-perioperative-practicum-with-tj-gan/

"Some practical tips you can take away and implement in your hospital..."

In the UK there is a legal imperative to minimalise and individualise risk now but it's widely understood to be helpful if you want to provide better value and patient outcomes. How can risks be identified and minimised? How can these risks then help to provide better quality shared decision making? How can plan a perioperative pathway tailored to these needs?

Presented by Ramani Moonsinghe, Professor of Perioperative Medicine at University College London (UCL).

IMPORTANT NOTE: We discuss "The Montgomery Case" in more detail here; this piece is very relevant to you and your patients, legally speaking, if you work in the UK: https://www.topmedtalk.com/sunday-special-being-on-the-right-side-of-the-law-2

"I did a study back in 2002 where I was able to count a grand total of forty patients above the age of eighty in our (Intensive Care Unit) ICU and our (High Dependency Unit) HDU, nowadays I'd count close enough to a hundred and sixty"

How do we refine our diagnostic tools? How can teaching in this area help to save lives? Should you consider a 'geriatric intensive care unit'? Is this an area where true perioperative practice and surgery is a guarantee we can immediately see improvement in an institution?

Presented by Dr Brian Marsh, Anaesthesia, Critical Care Medicine, Extracorporeal Life Support, The Mater Hospital, Dublin.

This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers now. This piece is part two of two.

This piece gets a mention "End of life decision planning in the perioperative setting: the elephant in the room?" https://academic.oup.com/bja/article/115/5/648/230412?login=true

The Global Council on Brain Health is here on the American Association of Retired People's website: https://www.aarp.org/health/brain-health/global-council-on-brain-health/

This is part one of a two part piece, part two features questions from the online conference audience.

Presented by Monty Mythen with Angela Bader, Professor of Anesthesia at Harvard Medical School and Vice Chair for Perioperative Medicine in the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women's Hospital, founding Director of the Weiner Center for Preoperative Evaluation, Sarah Lenz Lock, Senior Vice President for Policy and Brain Health in the American Association of Retired People's (AARP) Policy, Research and International Affairs (PRI), Executive Director of the Global Council on Brain Health, Jeanna Blitz associate professor of Anesthesiology at Duke University School of Medicine, Director of the Preoperative Anesthesia Surgical Screening (PASS) Clinic. There's also a surprise appearance from the EBPOM Chicago 2020 host, Sol Aronson, tenured Professor at Duke University.

This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers.

This piece gets a mention "End of life decision planning in the perioperative setting: the elephant in the room?" https://academic.oup.com/bja/article/115/5/648/230412?login=true

The Global Council on Brain Health is here on the American Association of Retired People's website: https://www.aarp.org/health/brain-health/global-council-on-brain-health/

This is part one of a two part piece, part two features questions from the online conference audience.

Presented by Monty Mythen with Angela Bader, Professor of Anesthesia at Harvard Medical School and Vice Chair for Perioperative Medicine in the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women's Hospital, founding Director of the Weiner Center for Preoperative Evaluation, Sarah Lenz Lock, Senior Vice President for Policy and Brain Health in the American Association of Retired People's (AARP) Policy, Research and International Affairs (PRI), Executive Director of the Global Council on Brain Health, Jeanna Blitz associate professor of Anesthesiology at Duke University School of Medicine, Director of the Preoperative Anesthesia Surgical Screening (PASS) Clinic. There's also a surprise appearance from the EBPOM Chicago 2020 host, Sol Aronson, tenured Professor at Duke University.

"It might just be 'boring old blood pressure ... (but) ... every fourth operation there is evidence of a modifiable risk factor".

The Perioperative Quality Initiative (POQI) is our starting point for this conversation, seven concensus conferences focusing on various topics of interest to the perioperative practitioner. Check out their extensive open source resources here: www.poqi.org

Hypotension and Mean Arterial Pressure (MAP) are discussed in detail; how are patients now being managed? How can a 'hazard index' help?

"25% of our patients experience hypotension!"; regular TopMedTalk listeners know this has been frequently highlighted as an issue for patient mortality.

Also, 26 minutes in, hear about the recent POQI and Acute Dialysis Quality Initiative (ADQI) meeting of 2019. "There is no such thing as a bit of a creatinine bump that is 'normal'".

Presented by Desiree Chappell, Monty Mythen and a surprise appearance from Sol Aronson, with their guest Andrew Shaw, Chairman, Department of Anesthesiology and Pain Medicine at The University of Alberta, Edmonton, Alberta and Zone Clinical Department Head for Anesthesia, Alberta Health Services Edmonton Zone. He is also a Fellow of the Royal College of Anaesthetists (UK), the American College of Critical Care Medicine and the Faculty of Intensive Care Medicine (UK).

Like this, want more?

Find out more about POQI here: "Desiree's Roundtable | What is the Perioperative Medicine Summit?" https://www.topmedtalk.com/desirees-roundtable-what-is-the-perioperative-medicine-summit/

For more regarding the papers published by POQI, referenced in this piece, go here: "Sunday Special | Blood Pressure" https://www.topmedtalk.com/sunday-special-blood-pressure/

We speak with Dan Sessler here: https://www.topmedtalk.com/topmedtalks-to-dan-sessler-2

Also, if you enjoyed Andrew Shaw's take on these issues go listen to this fascinating conversation: "Desiree's Roundtable | Fluids in the 2020's" https://www.topmedtalk.com/desirees-roundtable-fluids-in-the-2020s/

Finally, Professor Sol Aronson, tenured, Duke University, who features on this podcast, delivered a talk you're bound to love here: "Perioperative Medicine is population health" https://www.topmedtalk.com/poet-6-01-perioperative-medicine-is-population-health/

"We're so invested in outcomes and data that it really gives us an objective view on how to approach things"

This wide ranging conversation looks at how a data driven approach to change can produce better results in terms of patient outcomes. How do you highlight those opportunities with tact and clarity? How do we start to reward and recognise the best care that the evidence supports?

We also hear more about Evidence Based Perioperative Medicine (EBPOM) in 2021; for more on the opportunities mentioned in this piece please go to www.ebpom.org

Also, if you're aligned with the great nation of Wales or you love perioperative medicine, you'll be delighted to hear about the Welsh Perioperative Medicine Society:

Their Twitter is here: https://twitter.com/pomswelsh

Their Facebook page is here: https://www.facebook.com/PomsWelsh/

And their excellent website is here: https://www.welshpoms.com/

Presented by Desiree Chappell and Monty Mythen with Marc Koch, President and CEO of Somnia Anesthesia and Shelley Sharma, Acute Pain service line Director for Somni Anesthesia.