Periop Coach 4.07 | Pain Relief in Enhanced Surgical Recovery.

This episode of The Perioperative Coach reflects on the pain management discussions being had by the American Society of Enhanced Recovery (ASER) and its members. For further reading see the articles in Perioperative Medicine Journal: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0064-5 This conversation taken from a longer piece to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/ Presented by Monty Mythen with Dr Joff Lacey and Professor Mike Grocott.

Looking forward to the World Congress of Anaesthesiologists | TopMedTalk

This piece reflects the fact we are currently getting ready for the 18th World Congress of Anaesthesiologists (WCA 2024) – we’re going to be bringing you all the coverage of the meeting that we can, live from Singapore. The podcast primes you for the topics we’re expecting to encounter and gives you a taste of where the discussions are at the moment. Featured in this piece are: Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London and Improvement lead for the National Emergency Laparotomy Network: TopMedTalk: EBPOM Highlight 1.27 | Obstetric anaesthesia (libsyn.com) Dr Attila Kett, anaesthesiologist and Chairman at St Peter’s University Hospital at New Jersey: TopMedTalk: Enhanced Recovery for obstetrics | Perioperative Coach (libsyn.com) Alexander J Butwick, Obstetric Anesthesiologist and Researcher in maternal hemorrhage, pain relief in labor, and obstetric epidemiology at Stanford University TopMedTalk: TopMedTalk | Why is maternal mortality so high in the USA? (libsyn.com) Adriane Chapman, Professor at University of Southampton, Head of Digital Health Research Group, Director for the Centre for Health Technologies TopMedTalk: The Potential of Artificial Intelligence in Perioperative Care Q&A | EBPOM World Congress (libsyn.com) Sandy (Alexander) Jackson, specialty trainee in anaesthetics and intensive care medicine and an NIHR Doctoral Fellow at the University of Southampton TopMedTalk: Artificial Intelligence in Perioperative Care – Part 2 | EBPOM 2023 (libsyn.com) Guy Ludbrook Professor of Anaesthesia at the University of Adelaide and Royal Adelaide Hospital TopMedTalk: The hidden pandemic of post operative complications | EBPOM London 2020 (libsyn.com) Denny Levett, Professor in Perioperative Medicine and Critical Care at the University of Southampton and a Consultant in Perioperative Medicine at Southampton University Hospital NHS Foundation trust TopMedTalk: Morpheus Plenary Lecture: Exercise is a Perioperative medicine | EBPOM World Congress 2022 (libsyn.com) Kate Leslie, Honorary Professor, Monash University, Melbourne, Australia, Specialist Anaesthetist, The Royal Melbourne Hospital & North Western Mental Health and Non-Executive Director, Australian Medical Council TopMedTalk: Diversity and gender balance in research | TopMedTalk (libsyn.com)

Perfusion – not just pressure! Predict, diagnose and treat underlying cause. Don’t just ‘squeeze’! | TopMedTalk Highlight

This essential TopMedTalk Highlight represents the culmination of a number of important threads we’ve been examining over the last few years around interoperative hypotension (IOH). Now though we’re hearing from practitioners who are looking at the consequences of new methods and technology to deal with this threat at scale. Could we see an end to the era of dangerous interoerative hypotension? Selected and edited for your convenience this was originally released as a long form conversation; part of our exclusive coverage of the annual International Anesthesia Research Society, (IARS) meeting organised with the Association of University Anesthesiologists (AUA) and The Society of Critical Care Anesthesiologists (SOCCA). Check out their website here: ​https://iars.org/ It features Monty Mythen, Desiree Chappell and Mike Grocott in conversation with Wael Saasouh, Regional Director of Research at NorthStar Anesthesia. If you have comments or questions about the research and would like to take it further email: contact@topmedtalk.com NOTES: FEDORA trial: https://www.bjanaesthesia.org/article/S0007-0912(17)54207-5/fulltext TOPMEDTALK PREVIOUSLY: https://topmedtalk.libsyn.com/journal-club-the-fedora-trial The RELIEF (Restrictive versus liberal fluid therapy in major abdominal surgery) trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1801601 TOPMEDTALK PREVIOUSLY: https://topmedtalk.libsyn.com/the-relief-trial-results 

TopMedTalk | Why is maternal mortality so high in the USA?

Why does the US have the highest maternal mortality rate of any developed country? This piece tackles a very controversial issue in healthcare head on, could the problem be due to racism? The chances of a serious issue is “substantially higher if you come from a minority group, in particular if you are African-American”. We also cover the issue of postpartum hemorrhage, what are the key signs that a patient is at risk? Furthermore, how are quality care initiatives and standardization of care helping improve the field of obstetrics? Also, what is the latest thinking on home births, are they a financial decision for some? The California Maternal Quality Care Collaborative is here: https://www.cmqcc.org/ For more info on the Society for Obstetric Anesthesia and Perinatology (SOAP) go to www.soap.org Presented by Desiree Chappell and Monty Mythen with their guest Alexander J Butwick, Obstetric Anesthesiologist and Researcher in maternal hemorrhage, pain relief in labor, and obstetric epidemiology at Stanford University. — Like this, want more? On the subject of obstetrics find out more here: EBPOM Highlight 1.27 | Obstetric anaesthesia – https://www.topmedtalk.com/ebpom-highlight-1-27-obstetric-anaesthesia/ ASA 2018 San Francisco | Smith’s Medical Symposium on Enhanced Recovery – Part 5 – https://www.topmedtalk.com/asa-2018-san-francisco-smiths-medical-symposium-on-enhanced-recovery-part-5/ Periop Coach 4.10 | Enhanced Recovery for obstetrics https://www.topmedtalk.com/periop-coach-4-10-enhanced-recovery-for-obstetrics/

ASA | Henrik Kehlet: Recovery is all about inflammation!

On the morning of the first day of the 2018, annual conference, of the American Society of Anesthesiologists (ASA) Monty Mythen and Desiree Chappell were lucky enough to get an exclusive interview with Professor Henrik Kehlet. Henrik Kehlet is a gastrointestinal surgeon and former professor of surgery, Copenhagen University, and now professor of perioperative therapy and Head of Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University. He has published more than 650 articles within perioperative pathophysiology, pain relief and surgical outcome summarized into the concept of ‘fast-track surgery’, which also includes a focus on perioperative fluid management.

ASA 2019 | Perioperative haemodynamic management – making sure you deliver more

“It’s like running an election campaign…” Perioperative hemodynamic management; how do you make it really work within an institution? With extensive reference to real life experience hear first hand stories from our guest and Editor in Chief’s experience of doing just that. How do you get people both in and outside of the team to understand the importance of it? Hear about new developments in Enhanced Recovery After Surgery (ERAS) and perioperative haemodynamic management. Find out how new technologies, techniques and information are being applied in this piece. Also, when dealing with an institution, how important is the value proposition? “Are they up on the deal?” We discuss The RELIEF trial in more detail here: https://www.topmedtalk.com/ebpom-highlight-1-30-visiting-professor-plenary-lecturer-results-of-the-relief-trial/ We discuss the INPRESS trial in more detail here: https://www.topmedtalk.com/ebpom-london-2018-any-answers-part-3-the-big-trials/ Presented by Desiree Chappell and Monty Mythen with Michael Scott, M.B., Ch.B. Professor of Anesthesiology at the University of Pennsylvania.

EBPOM 2019 | The Opioid Crisis – Q&A

This question and answer session is a valuable insight into where the latest thinking is as regards tackling the opioid crisis. How do we get to an understanding where the entire continuum of care is on the same page as regards pain relief? What’s the level of adoption for opioid free anaesthesia? Can re-languaging pain or “re-writing the narrative” help, for example is it better to speak of ‘comfort levels’ as opposed to pain? What’s the latest thinking as regards caffeine as an aid to comfort? Should we be worried about post operative delerium as regards ketamine use? What about gabapentinoids in the elderly? What about Midazolam? What should we send patients home with afterwards? Presented by Michael Manning, MD, PhD, Assistant Professor at Duke University Medical Center, Director of research for the Perioperative Medicine Fellowship at Duke.

ASA 2019 | Depth of anaesthesia

“We believe these results are applicable to a very broad population” Focusing on a study of over 6,000 patients, this hugely important piece attempts to finally move forward discussion regarding the long term consequences of deep anaesthesia? There is no difference in the survival rate of patients who have had a “deep level” of anaesthesia, which is still strictly within the bounds of normal clinical practice. Could this research lead to us using less anaesthesia overall and improving our environmental impact? The paper being discussed, “Anaesthetic depth and complications after major surgery: an international, randomised controlled trial” is here: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(19)32315-3.pdf We discuss the RELIEF trial briefly, if you want more on that go here: https://www.topmedtalk.com/ebpom-highlight-1-30-visiting-professor-plenary-lecturer-results-of-the-relief-trial/ We also discuss the work of Dan Sessler, who we interviewed here: https://www.topmedtalk.com/topmedtalks-to-dan-sessler-2/ A fuller look into The Clinical Trials Network is here: https://www.topmedtalk.com/anaesthesia-2019-the-clinical-trials-network-and-optimising-shared-decision-making/ Presented by Desiree Chappell and Monty Mythen with their guests Kate Leslie, Honorary Professor, Monash University, Melbourne, VIC, Australia, Specialist Anaesthetist, The Royal Melbourne Hospital & North Western Mental Health and Non-Executive Director, Australian Medical Council and Timothy Short, Clinical Anaesthetist and Honorary Professor at Auckland University Hospital, New Zealand.

Periop SIG18 | Risk prediction and research – panel discussion

This piece is a question and answer session regarding the care of elderly patients undergoing surgery. Discussion topics include; The RELIEF trial, e health tools, gathering and accessing data, whether it is better to over estimate risks and which risk calculator is most appropriate to use where you are? It features; Professor Jacqueline Close, Geriatrician, Prince Of Wales Hospital, Clinical Director, Falls, Balance and Injury Research Centre, David Storey, Head of Anaesthesia, Perioperative and Pain Medicine Unit (APPMU), Melbourne Medical School, University of Melbourne; Director, Melbourne Clinical and Translational Sciences (MCATS) research platform and Dr Doug Campbell, Anaesthesia Specialist at Auckland City Hospital. — Brought to you by the Perioperative Medicine Special Interest Group (SIG) in association with the Australian and New Zealand Society for Geriatric Medicine and the Internal Medicine Society of Australia and New Zealand at the 7th annual Australasian Symposium of Perioperative Medicine. The Perioperative Medicine Special Interest Group (SIG) has three aims; improve patient safety and outcomes, share knowledge and collaborate with specialty groups, develop the specialty of perioperative medicine with various craft groups. For more information follow this link here: http://www.anzca.edu.au/fellows/special-interest-groups/perioperative-medicine

COVID 19 | Rapid deployment of US National Reserves ease stress in New York

The war against COVID 19 is ongoing but some relief has reached the frontlines in New York. Hear how a rapid response military team, United States Air Force Reserves, deployed into the “war zone” built and supported the first wave of our battle against this terrible virus. How has this effort been received and implemented? What is the significance for this unprecedented move in the US? What lessons are being learned and could the end result improve healthcare for all? Presented by Desiree Chappell with Monty Mythen and their guests USAF Col Jennifer ‘Robyn’ Ratcliff, Orthopedic surgeon, Orlando VA Hospital, USAF Lt Col Reco Evans CRNA, Temple TX VA Hospital and Captain Joel Sherwood, Medical Science Liaison, National Director, Government Affairs, Pacira Pharmaceuticals Thank you to our sponsor Edwards Life Sciences. Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation