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Sunday Special | Enhanced Recovery After Surgery (ERAS) leadership

TopMedTalk

Release Date: 12/29/2019

EBPOM 2020 London | EBPOM 2020 London | "The Business Case: UK" by Kay Mitchell

TopMedTalk

This piece presents an invaluable wealth of first hand experience in setting up various business cases in relation to perioperative medicine in the UK. At University College London (UCL) cardiopulmonary exercise testing (CPET) was set up as a research tool "but then clinicians came, became interested in the results of the tests and started to ask for tests to be done on their patients for clinical evaluation". An external contractor model, using a charitable organisation, enabled them to charge the NHS for these tests; as the service expanded they were able to expand to other clinical sites...

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EBPOM 2020 London | Extending roles: what is the future? show art EBPOM 2020 London | Extending roles: what is the future?

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"Just having more staff doesn't always equate to better care, especially when the staff do not have the skills required." Perioperative medicine has the opportunity to lead the way in advanced practice; the extended role of the practitioner within the perioperative pathway can be done with nurses, allied health professionals or physician associates. As we evolve these roles, we must be mindful and recognise not all services will be the same. How can you tailor your service to your specific needs? How do you construct a business case which provides a better quality of value based care within...

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Opioid-induced Respiratory Depression | EBPOM Las Vegas 2021 show art Opioid-induced Respiratory Depression | EBPOM Las Vegas 2021

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"46% pretty much means every other patient who was getting IV opioids was having some sort of a respiratory depression event" After a quick round up of COVID news in the contributor's respective areas this piece gets involved in a much needed discussion about the “PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY)” trial. PRODIGY trial is here: Presented by Desiree Chappell and Monty Mythen with Mike Grocott, and their guests Ashish Khanna, Associate Professor, Section Head for Research, Department of Anesthesiology, Section on Critical Care...

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Non-invasive evaluation of autonomic nervous system- A nociception monitor | EBPOM Las Vegas show art Non-invasive evaluation of autonomic nervous system- A nociception monitor | EBPOM Las Vegas

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Armed with a background in biomedical engineering, doubled with an EMBA in Finance, our guest has spent the past 20 years within the medical device industry. In 2010 he was instrumental in setting up MDoloris Medical Systems, with the mission to provide technologies that allow clinicians a reliable, continuous and non-invasive evaluation of autonomic nervous system (ANS) activity. Based on 23 years of academic research, performed by a French research lab, the technology allows anaesthetists and intensivists to effectively tailor analgesia; more so for patients who are unable to communicate....

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Guidance on prehabilitation for cancer | EBPOM London 2020 show art Guidance on prehabilitation for cancer | EBPOM London 2020

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This piece looks at the most recent guidance regarding prehabilitation for cancer, developed and published in 2009 by Macmillan Cancer Care. Extremely well received across the UK, and internationally, here we look at the details and some context in terms of UK national policy. From an NHS England point of view the desire is to ensure that all patients and participants have personalized care embedded into everyday NHS services. Work around streamlining multidisciplinary team meetings for cancer include the opportunity to discuss the needs of people with cancer and the importance of preparing...

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Perioperative oxygenation | EBPOM London 2020 show art Perioperative oxygenation | EBPOM London 2020

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"Oxygen is the commonest drug that we give to our patients today during surgery and the general anaesthetic" but what do we really know and understand about it from a perioperative perspective? This talk illustrates why, even with some of the evidence and background physiology that we have at our fingertips today, the following questions are still perplexing: How much is too little oxygen? How much is too much oxygen? And how much is just the right amount of oxygen? Presented by Daniel Martin, OBE, Professor of Perioperative and Intensive Care Medicine, University of Plymouth and the Royal...

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Panel discussion - Prediction of Opioid Induced Respiratory Depression: Does surveillance monitoring help? | EBPOM 2020 show art Panel discussion - Prediction of Opioid Induced Respiratory Depression: Does surveillance monitoring help? | EBPOM 2020

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This piece is a listener generated question and answer session from EBPOM 2020. Although it works as a stand alone piece it relates directly to this talk here: Some of the questions considered include: How much do you think partial / inadequate neuromuscular blockade reversal, contributes to post pulmonary complications, perhaps in combination with opioids? Why as a group would we prefer to save money by avoiding sugammadex to reverse rocuronium to ensure complete reversal? Lack of reversal more than an issue? If you did a pre op sleep study on these patients, would you not find similar...

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Finding Goldilocks, more or less | EBPOM 2020 show art Finding Goldilocks, more or less | EBPOM 2020

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With questions from the online audience, this piece looks at the "not too much and not too litte" sweet spot regarding fuel, fluid and oxygen; where is it and how do we get there, according to our distinguished panel? This podcast works well as a companion piece to the following talks which have already been released here on TopMedTalk: Helen McKenna, "Fuel, can you have too much?" Tim Miller "Optimising fluid and hemodynamic management during major surgery" Dan Martin "Perioperative Oxygenation" Presented by Mike Grocott and Dennie Levett with their panelists; Tim Miller, Associate...

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Fitness, function or frailty? P2 | EBPOM London 2020 show art Fitness, function or frailty? P2 | EBPOM London 2020

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This piece is a continued deep dive into the subject, of 'fitness, function, or frailty' and, perhaps, "fixing". It's essential listening for anyone interested in the latest thinking on this crucial topic and was a highlight of the London conference. How can we integrate frailty and cognitive scores in risk assessment tools to facilitate inclusion in shared decision making? How can we improve a surgical colleague's ability to identify frailty? Most patients will have an operation sometime in their life; should surgical school be renamed and moved to being a "well being" clinic and offered to...

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Fitness, function or frailty? P1 | EBPOM London 2020 show art Fitness, function or frailty? P1 | EBPOM London 2020

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Fitness, function and, or, frailty are important determinants of the quality of the life that we live. In the context of major surgery it's very important we recognize and work with individual patients improving and optimizing them and their ability to handle an operation. This piece is an essential deep dive into the subject, essential listening for anyone interested in the latest thinking on this crucial topic. What are the limitations on your resources when considering a plan of preoperative evaluation? This is part one of a two part piece. Each of the contributors comments upon talks which...

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More Episodes

A special edition of TopMedTalk recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

How can cold water adaption help people deal with medical issues? There's evidence to suggest that cold water adaption reduces inflamation, can open water swimming help with issues such as chrohn's disease? On the other hand how important is it to ensure patients do not become cold while in our care? Hypothermia is never good, how important is it to keep patients warm? Keeping patients and their environments warm is discussed, as is pre-warming, going beyond the standard blankets and patient insulation to include active warming and even patients exercising as a method of warming up. Further to this conversation, how do you measure a patient's temperature?

How do we drive change in our institutions towards enhanced recovery after surgery? The GIRFT (Getting It Right First Time) project is explained. The Health Foundation is also mentioned. The piece also includes patient communication and the question of 'how much is too much?', when administering a dose of morphine. Also, is there a hierarchy on the pathway of enhanced recovery after surgery?

The conversation features Professor Monty Mythen and his two guests; Dr Simeon West, consultant anaethetist at (University College London Hospitals) UCLH who sits on the board at Regional Anaesthesia UK (RAUK) and Mark Harper Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for theraputic purposes. There are also attributed questions from the audience.