TopMedTalk

This piece focuses upon the unique 'Collaborative Clinical Trials in Anaesthesia biennial conference', of which this was the fifth, organised in Prato, Italy, by Monash University.

TopMedTalk was given the chance to listen in on this cutting edge gathering of trialists, academics and practitioners as it happened. We take a deeper dive on the history behind this very special meeting, how it works and special moments from the meeting.

Learn how some of the big trials gather pace and how major studies get established.

The ANZCA Clinical Trials Network is here: http://www.anzca.edu.au/ctn

More detail on the African Surgical Outcomes Study - 2 (ASOS-2) here: https://www.asos.org.za/index.php/about-the-study

Presented by Desiree Chappell with Monty Mythen and their guest Paul Myles, Director, Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University.

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Bruce Biccard is interviewed here: https://www.topmedtalk.com/prato-2019-bruce-biccard/

This piece focuses upon goal directed fluid therapy, with an automated system, for decision support; "a step between a simple monitor and a fully automated system".

The "proof of concept" paper we highlight towards the end of the podcast, "Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate - and high-risk surgery" has now been published and can be found here: https://bjanaesthesia.org/article/S0007-0912(19)30443-X/abstract

This paper here "Perioperative goal directed therapy using automated closed-loop fluid management: the future?" is also referenced: https://www.ncbi.nlm.nih.gov/pubmed/26578397

You may also find this piece, which our guest is also part of, here interesting: https://www.ncbi.nlm.nih.gov/pubmed/29068831

Presented by Desiree Chappell and Monty Mythen with their guest Alexandre Joosten, Anesthetist at Hospital Erasme.

"Updates in cardiac devices, Part 2" was a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: "Updates in Perioperative Medicine 360" which took place between November 7th-9th 2019.

This piece is focused upon transcatheter aortic valve implantation (TAVI) devices. "A balloon valvular plasti in comparison to a TAVI is 90% of the risk, 10% of the gain" you're trading one problem with another, argues our speaker.

Find out more about ANZCA here: http://www.anzca.edu.au/

Presented by Dr Karl Poon, TAVI specialist at St Andrews War Memorial Hospital, Physician Proctor, Edwards LifeSciences, Senior Lecturer, University of Queensland Interventional cardiologist, The Prince Charles Hospital, Brisbane.

"Updates in cardiac devices, Part 1" was a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: "Updates in Perioperative Medicine 360" which took place between November 7th-9th 2019.

This piece is a look at some of the new technology which looks set to become more widely used. A leadless pacemaker is a small implantable "bullet like" device that sends electrical pulses to the heart whenever it senses that the heartbeat is too slow. Also new implantable cardioverter defibrillators are discussed as are implantable cardiac monitors. There is also discussion regarding cardiac resynchronization therapy.

The TYRX™ Absorbable Antibacterial Envelope is here: https://www.medtronic.com/us-en/healthcare-professionals/products/cardiac-rhythm/infection-control.html

The CardioMEMS™ Heart Failure System: https://www.cardiovascular.abbott/us/en/hcp/products/heart-failure/cardiomems-hf-system.html

Find out more about ANZCA here: http://www.anzca.edu.au/

Presented by Dr Stephen Pavia, Cardiologist and Cardiac Electrophysiologist at The Wesley Hopsital.

The POCAPALOOZA, a celebration of perioperative care that went around the world in the wake of EBPOM 2020.

"Early intervention and people taking it seriously is a big thing"

The conversation evolves as our guest speaks to the realities of moving internationally to pursue your career in medicine. Can a truly global perspective better position the medical community when it comes to international co-operation?

The World Congress of Anaesthesiologists is here: https://www.wcaprague2020.com/

Also, what's the future of medical conferencing in the world of COVID 19 and the global pandemic?

Presented by Desiree Chappell and Monty Mythen with Mike Irwin, Professor, Head and Chief of Service, Anaesthesiology Hong Kong University, Gleneagles Hospital.

"4-10% of opioid naïve patients will continue to use opioids more than 90 days after surgery"

Opioids are good for pain control but there's another issue, they also numb emotional pain. How do we responsibly deal with this? It's important to remember: "When you give patients high doses, you're putting them at risk".

Long term listeners will recall TopMedTalk spent the best part of our launch year on this topic. If you're one of our many new listeners please use this huge resource of podcasts to help update your practice and cut down unnecessary risk: https://www.topmedtalk.com/?s=opioid

"We should be minimizing opioids every chance we can", if you want to cut straight to our groundbreaking talk on opioid free anesthesia please go here: https://www.topmedtalk.com/ebpom-2019-opioid-free-anaesthesia-2/

Presented by Desiree Chappell and Monty Mythen with their guest Jennifer Lanzillotta-Rangeley, CRNA, PhD, Assistant Professor, College of Nursing, University of Cincinnati, Cincinnati, Ohio.

"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

This piece focuses on intensive care, the use of data and the future of fluid therapy research and its related physiological outcomes.

The article mentioned in this podcast is here: "Perioperative haemodynamic therapy for major gastrointestinal surgery: the effect of a Bayesian approach to interpreting the findings of a randomised controlled trial" https://bmjopen.bmj.com/content/9/3/e024256

Presented by Desiree Chappell and Monty Mythen with their guest Maurizio Cecconi, Head of the Anaesthesia and Intensive Care Department at Humanitas Research Hospital; President-elect of the European Society of Intensive Care Medicine (ESICM) for 2020-2021, Chair Division of Scientific Affairs at ESICM; Director of the Master in Patient Blood Management at Humanitas University.

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Rupert Pearse, one of the co-authors of the above article, was interviewed on TopMedTalk here: https://www.topmedtalk.com/anaesthesia-2019-rupert-pearse/

"Cognitive testing has been in the news ... there are recommendations for keeping pets mentally sound by implementing nutritional modifications, regular exercise and mental stimulation, we should certainly think about providing the same support to our geriatric patients."

What does the latest research say about this vital issue? How is frailty defined? What's the clinical impact of preoperative cognitive dysfunction?

Presented by Angela Bader, MD, MPH 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. She is also the founding director of the Weiner Center for Preoperative Evaluation.

For more on this subject check out this piece here: https://www.topmedtalk.com/poet-3-04-is-paternalism-always-bad/

The 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care after Surgery (SNAP-2 - EPICCS) study launched in March 2017 around the UK. More than 2,200 investigators at more than 250 sites across the UK were signed up to take part. The observational study collected data on all patients undergoing inpatient surgery during a one-week period (21 March to 27 March) in UK NHS hospitals.

The website is here: https://www.niaa-hsrc.org.uk/SNAP-2-EpiCCS?newsid=1710

This talk explains the study and its far reaching implications.

Another talk on SNAP-2 is available here: https://www.topmedtalk.com/what-is-snap-2/

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