The difficult anatomical airway and the difficult physiology airway

TopMedTalk are proud to present The Siobhan Mythen Plenary Lecture, taken from our coverage of Evidence Based Perioperative Medicine (EBPOM) Ireland 2025. Professor Ellen O'Sullivan trained in anaesthesiology and intensive care in UK and USA and is now a Consultant Anaesthesiologist at St James's Hospital Dublin, Ireland, affiliated to Trinity College Dublin. She specializes in airway management and is Director of the Fellowship in Advanced Airway Management and Simulation. She is Past President of the Difficult Airway Society, DAS, and was appointed DAS Professor of Anaesthesia & Airway Management. She outlines the "The difficult anatomical airway" and introduces the Siobhan Mythen plenary lecturer Professor John Laffey. John Laffey is Professor of Anaesthesia and Intensive Care Medicine at the University of Galway (formerly National University of Ireland, Galway), where he also serves in clinical and research leadership roles. His work focuses on critical illnesses, particularly Acute Respiratory Distress Syndrome (ARDS), sepsis, mechanical ventilation strategies, and translational research including cell/gene therapies for these conditions. He discusses, "The Difficult Physiology Airway" -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

At the Royal College of Anaesthetists' Centre for Perioperative Care (CPOC) Perioperative Leads Day in London, host Andy Cumpstey speaks with James White, a perioperative medicine clinician (and qualified general practitioner) working within the NHS in Cheshire and Merseyside, serving as Clinical Lead for Perioperative Medicine and contributing to national improvement work with the Centre for Perioperative Care, Simon Rang, consultant anaesthetist at East Kent Hospitals University NHS Trust who also contributes to national healthcare improvement work including with the Centre for Perioperative Care, and Denny Levett, Director of the Centre for Perioperative Care, and a Professor of Perioperative Medicine and Critical Care and Consultant at University Hospital Southampton NHS Foundation Trust and the University of Southampton. The conversation covers how UK perioperative medicine policy is implemented through evolving NHS structures. They explain the relationship between national policy (Department of Health, NHS England) and delivery via regions, integrated care boards (ICBs), and local trusts, emphasizing integrated pathways spanning primary and secondary care, particularly post-COVID. James outlines five core requirements: early perioperative screening, proactive optimization/prehabilitation, maintaining health while waiting, listing patients only when medically fit, and shared decision-making. The guests discuss how regional and ICB networks share solutions, address variation and barriers (including finances and culture), and use CPOC guidance and resources alongside initiatives like GIRFT to support consistent implementation. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

At the ANESTHESIOLOGY® 2025 meeting in San Antonio, TopMedTalk hosts Andy Cumpstey and Kate Leslie interviewed Professor of Anesthesia and Perioperative Care at University of California, San Francisco, Adrian Gelb, this year's Ellison Pierce Lecturer. Dr Gelb recounts training in South Africa, work in England and Canada, and how he was steered into neuroanesthesia at a high-volume cerebral aneurysm center, becoming engaged by understanding surgical outcomes and encouraging trainees to learn the operative field. He describes developing global health interests, joining the World Federation of Societies of Anaesthesiologists (WFSA) through Alan Merry and others, and progressing from the patient safety committee to WFSA president. Gelb outlines updating WFSA standards with WHO involvement, emphasizing additive "minimum" requirements (e.g., oxygenation and pulse oximetry) and clarifying differences among policies, guidelines, and legally binding standards, urging implementation-focused sequencing. He also highlights AI's potential to advance decision-making, documentation, data, and feedback. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

Andy Cumpstey is joined by Christian Macutkiewicz Consultant General, HPB and Hernia Surgeon at Manchester Royal Infirmary, Director of The Gallstone Clinic and Manchester Hernia at Spire Manchester Hospital and the incoming President of the Association of Surgeons of Great Britain and Ireland, and Dimitris Damaskos Consultant General Surgeon within the Department of Surgery at the Royal Infirmary of Edinburgh (NHS Lothian), Honorary Clinical Senior Lecturer at the University of Edinburgh. They discuss the postoperative period as a critical part of the perioperative journey, emphasizing the importance of clear postoperative communication, reassurance even after "successful" operations, and explaining complications and expected recovery timelines. They highlight challenges in recognizing deterioration, including reduced reliance on clinical examination skills among junior doctors and the systems-based concept of "failure to rescue," arguing that consistent ward-based recognition systems and high-volume units help detect complications earlier. Enhanced Recovery After Surgery (ERAS) pathways are cited, including using day-3 CRP thresholds to trigger CT imaging for early detection of anastomotic leak. They note post-COVID pressures to clear surgical backlogs have increased situations where patients are operated on by surgeons who did not initially see them, potentially weakening trust and continuity when complications occur, and they discuss flattening hierarchy so trainees can do ward rounds with consultant support. The conversation covers future technology, including AI for risk stratification and imaging interpretation, and remote continuous vital-sign monitoring, while acknowledging data governance challenges and potential deskilling. The episode closes with a discussion of robotic surgery: improved optics and precision and usefulness for more complex cases (including abdominal wall reconstruction), but with concerns about cost, rollout, training implications, and differing adoption between the UK, US, and New Zealand. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

In this episode of TopMedTalk, hosted by Andy Cumpstey at the anaesthesia research meeting in Birmingham, we dive into drug allergy and its mislabeling with Louise Savic, consultant anaesthetist and NIHR doctoral researcher at Leeds Teaching Hospitals NHS Trust, UK, who specialises in drug allergy and peri-operative anaphylaxis, and Tom Abbott, clinical senior lecturer in anaesthesia and peri-operative medicine at Queen Mary University of London, UK, and a consultant anaesthetist whose research uses clinical epidemiology and trials to improve surgical outcomes and reduce peri-operative complications. The discussion highlights the vast disparity between true drug allergies and mislabeling, emphasizing that around 90-95% of penicillin allergy labels are incorrect. Dr. Savic shares her journey in drug allergy research, focusing on the perioperative setting, while Dr. Abbott discusses the linkage between antimicrobial prescribing and resistance. The talk covers results from the Sapphire Project, revealing the high incidence of mislabeled drug allergies and their associated increased postoperative risks. The episode also explores potential strategies for 'de-labeling' patients, the role of multidisciplinary collaboration, and the next steps in research and practice change. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

Andy Cumpstey welcomes Joseph Alderman, a clinical lecturer in anaesthesia at the University of Birmingham, to discuss the hurdles AI faces in the healthcare sector. Dr. Alderman, who has a background in cell biology and immunometabolism, shares his insights into why AI technologies often fail to reach patients. He identifies three primary challenges: misalignment between AI development and healthcare needs, inadequate resourcing, and premature solution-oriented thinking. The conversation also touches on the importance of involving patients and clinicians in the AI development process and an exciting new initiative by Dr. Alderman's team to create a health chatbot user guide. The episode concludes with a look into regulatory challenges and the need for better patient empowerment and risk management in AI-driven healthcare. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

Michelle Chew is a Professor of Anesthesiology and Intensive Care Medicine at Karolinska Institutet, Stockholm, Sweden, and editor for the British Journal of Anaesthesia. Hear her sharing her Perioperative Profile on TopMedTalk with Andy Cumpstey. After initial anaesthesia training in Denmark, she moved to Lund University, Sweden, combining clinical work and research, later establishing her own experimental haemodynamics group studying septic and haemorrhagic shock and myocardial changes. She balances academic and family life by prioritizing rather than seeking "life balance," noting challenges for women in academia despite Scandinavian support. She explains journal editing—from rapid assessment, literature checks, peer review coordination, to feedback synthesis—and entered the field via the European Journal of Anaesthesiology, later serving at BJA and other journals. She also describes developing clinical guidelines, emphasizing expert panels, systematic reviews, consensus, and local adaptation, with involvement in Scandinavian and European anesthesia societies. Throughout, she highlights lessons from mentors and family, especially her grandmother, stresses taking opportunities and putting in the work, and emphasizes that science and clinical medicine ultimately serve patients. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

ANESTHESIOLOGY® 2025, the annual meeting of the American Society of Anesthesiologists (ASA), and Desiree Chappell hosts Professor Michael Scott from the University of Rochester and Dr Wael Saasouh, director of research for NorthStar Anesthesia. The discussion centers on the evolution of patient-centered monitoring, the importance of continuous hemodynamic monitoring, and the broader implications of hemodynamic instability. The guests delve into their recent consensus paper with the Anesthesia Patient Safety Foundation and highlight the need for more comprehensive monitoring technologies that are accessible and cost-effective. The conversation also explores international collaborations, differences in practice settings (academic vs. private), and the future of enhanced recovery and post-operative care. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

Desiree Chappell, Kate Leslie, and Mike Grocott welcome Harriet W. Hopf, a physician-scientist and professor of anesthesiology and adjunct professor of biomedical engineering at the University of Utah, UK. Dr Hopf is known for her leadership in academic governance, medical education, and healthcare research. She shares insights on her distinguished career focusing on surgical site infections and faculty development. We discuss pivotal research on the importance of oxygen in wound healing, mechanisms behind surgical site infections, and the significance of maintaining normothermia during surgery. The conversation also touches on the impact of thermoregulation, volume status, and the use of oxygen in improving patient outcomes. Dr. Hopf emphasizes the necessity of hand hygiene and proper surgical practices to mitigate infections. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/

This piece takes us to The American Society of Anesthesiologists (ASA) annual meeting in San Antonio, ANESTHESIOLOGY® 2025 where Andy Cumpstey is joined by co-host Desiree Chappell and guest Dr Joyce A. Wahr — Professor Emeritus of Anesthesiology at the University of Minnesota Medical School (Minneapolis, USA) and former Executive Medical Director of Perioperative Services at M Health Fairview and Vice-Chair for Quality & Safety. Joyce shares her journey from surgery residency to becoming a cardiac and thoracic anesthesiologist, and her involvement in patient safety. She discusses her Severinghaus Lecture titled 'It's Not Your Fault: The Cognitive Basis of Error,' discussing how subconscious processes generate errors beyond our control, and how we can implement barriers to prevent these errors from harming patients. The conversation delves into the cognitive mechanisms behind errors, the importance of system-level protections, and the role of technology in enhancing patient safety. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/