Perioperative Pain Management; the Opioid Epidemic and opioid reduction strategies

This series of talks hits upon one of the longstanding themes of TopMedTalk, opioids and opioid reduction in a perioperative setting. We discuss the opioid epidemic, the issue of persistent opioid use after surgery, and strategies for opioid reduction. Topics include historical usage, the dangers of high-dose opioids, and alternative pain management techniques such as opioid-free anesthesia and multimodal analgesia. The discussion also highlights the importance of ongoing research, patient education, and evidence-based practices to minimize the side effects of opioids while ensuring effective pain management. Presented by Tim Miller, Professor of Anesthesiology at Duke University Medical Center. Tim completed his training in Nottingham, UK followed by a fellowship in cardiothoracic anaesthesia at Glenfield Hospital, Leicester, UK. He is a fellow of the Royal College of Anaesthetists.

In this piece we look at the opioid crisis in the UK and how it has translated into clinical practice. Hear about the history and data behind opioid prescription trends, specifically highlighting the high-risk patient demographics and mortality figures associated with opioid use. Learn how a multidisciplinary approach, taken by the opioid reduction service at Guy’s & St. Thomas', helps showcase early outcome data and the strategies employed in opioid weaning. Emphasizing the importance of patient engagement and personalized care we detail the clinic’s processes, preparations, and long-term strategies for opioid tapering. The episode concludes with a compelling patient testimonial video reflecting the positive outcomes of the service. Fauzia Hasnie, Consultant Lead, Opioid Multidisciplinary Pain Management Clinic, Joint Lead, Combined Sickle-Opioid Virtual Multidisciplinary Clinic Guy’s & St Thomas’ NHS Foundation Trust. Resources: UK National Institute for Health Care Excellence (NICE) guidelines: Overview | Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults | Guidance | NICE US Centers for Disease Control and Prevention (CDC): Guideline Recommendations and Guiding Principles | Overdose Prevention | CDC

This piece focuses on strategies for opioid-sparing anesthesia guided by the NOL Index, emphasizing the variability in patient responses to opioids. The importance of monitoring nociception, using advanced devices and techniques to customize opioid dosing, reduce side effects, and confirm the effectiveness of regional anesthesia. Our presenter shares personal experiences from their professional life and case studies, illustrating the benefits and challenges of implementing multimodal and opioid-free anesthesia approaches. The talk highlights the need for individualized treatment strategies in critical care and anesthesia. Presented by Esteban Salas Rezola, Specialist in Anaesthesiology, Resuscitation and Pain Therapy at Hospital General Alicante.

Euroanaesthesia 2025: the annual meeting of the European Society of Anaesthesiology and Intensive Care, in Lisbon, Portugal. TopMedTalk were there, check out our coverage on our podcast timeline. We’ve released many bonus episodes over the last few weeks! In this piece Kate Leslie and Nick Margerrison speak with their guests Sarah Saxena, course director and professor of anaesthesiology at the University of Mons, Belgium and Mia Gisselbaek, an anaesthesiologist and PhD student in medical education at University of Geneva Hospital, Switzerland. Drs Saxena and Gisselbaek were members of the working group for the ESAIC Mellin-Olsen Declaration on Diversity, Equity and Inclusion, which was signed at the opening ceremony of Euroanaesthesia 2025 in Lisbon, Portugal. The declaration can be found here: ESAIC Mellin-Olsen declaration on diversity, equity and inclusion. Eur J Anaesthesiol. 2025 May 2. doi: 10.1097/EJA.0000000000002186 A link to the machine learning algorithm for delirium developed by Drs Saxena and Gisselbaek can be found here https://delirium.streamlit.app

This piece was recorded at Euroanaesthesia 2025 in Lisbon. Kate Leslie interviews Wayne Morriss, Clinical Associate Professor, University of Otago, Christchurch, and Specialist Anaesthetist, Christchurch Hospital, New Zealand. He is the Immediate Past President of the World Federation of Societies of Anaesthesiologists (WFSA). He shares his insights from his journey in global anaesthesia, including his tenure as WFSA president. We discuss global issues in anaesthesiology, the importance of international aid and education, and the development of the Essential Pain Management program. Wayne also reflects on influential figures such as the late Dr. Jannicke Mellin-Olsen and the WFSA's ongoing initiatives under its current leader, Prof Daniela Filipescu.

We're at Euroanaesthesia 2025 in Lisbon, Portugal. Here we discuss the European Society of Anaesthesiology and Intensive Care's initiatives, focusing on the innovations in the scientific program in anaesthesia and perioperative medicine, and the importance of inclusivity and diversity within the society. The episode also highlights the future direction of the society, the role of trainees, and offers insights into the upcoming Congress in Rotterdam. Listeners are encouraged to apply for roles and join the society for its educational resources and global networking opportunities. Presented by Kate Leslie with her guests, Michel Struys is Professor and Chair, Department of Anesthesiology, University of Groningen and University Medical Center Groningen, the Netherlands, and chair of the Scientific Committee of ESAIC, and Fabio Guarracino, Head of the Department of Cardiothoracic Anaesthesia and Intensive Care at Pisa University Hospital, Pisa, Italy, and incoming chair of the Scientific Committee of ESAIC.

Recorded at Euroanesthesia 2025 in Lisbon, Portugal, the annual meeting of the European Society of Anesthesiology and Intensive Care. The episode features an interview with Edoardo de Roberti, a former ESAIC president, who shares insights into the challenges and advancements in the field of anesthesiology. Key topics include patient safety, sustainability in medical practices, and the role of artificial intelligence in improving anesthesiology. Eduardo also discusses workforce shortages in Europe and the importance of maintaining a well-trained and happy workforce for optimal patient outcomes. Presented by Kate Leslie, with her guest Edoardo De Robertis, Professor and Director of Anaesthesiology and Intensive Care, Università degli Studi di Perugia, Italy, and former president of ESAIC. He currently serves on the National Anaesthesiologists Societies Committee (NASC).

Recorded at the Euroanaesthesia 2025 meeting in Lisbon, Portugal. Here the focus is on patient safety in anaesthesiology. We discuss the importance of patient safety preoperatively, intraoperatively, and postoperatively, with innovations in perioperative medicine and artificial intelligence. The ESAIC Patient Safety and Quality Committee developed a patient safety education project: the Safer Care to Save Lives, a comprehensive package of patient safety education for anaesthesiologists, healthcare professionals, hospital management and patients. We also look at the need for standardized protocols, effective communication, and remote monitoring to enhance postoperative patient care. The episode concludes with a call to action for practitioners to engage in patient safety training and a look forward to the next congress in Rotterdam. Presented by Kate Leslie, with her guest, Benedikt Preckel, Professor of Anaesthesiology, Patient Safety in the Perioperative Period and Quality of Care, University of Amsterdam Medical Center, in the Netherlands, and Chair of the ESAIC Patient Safety and Quality Committee.

In this piece we discuss the intricacies of right heart failure, the differences between the right and left ventricles, and the challenges of early detection and monitoring. With a focus upon research we discuss the Swan-Ganz IQ pulmonary artery catheter, with the FastCCO algorithm, from BD Advanced Patient Monitoring. We cover its innovative capabilities, explore its impact on patient care and look particularly at high-risk patients like those with pulmonary hypertension and LVADs. The episode highlights the importance of new monitoring techniques, future research directions, and the promise of continuous data in improving right ventricular function diagnosis and treatment. Presented by Kate Leslie with her guest Joerg Ender, Director of the Department for Anesthesiology and Intensive Care Medicine, Heart Center, Leipzig, Germany. He is second president of the German Society of Anesthesiology and Intensive Care Medicine and former Secretary General of the European Association of Cardiothoracic Anaesthesiologists (EACTA).

Our guest, Chiara Robba, delves into her work on cerebral autoregulation in relation to critical illness. We explore the mechanisms of cerebral autoregulation in healthy and brain-injured patients, the potential of new monitoring technologies, and the importance of personalized patient care. The discussion also touches on the broader implications for managing blood pressure in various clinical scenarios, including sepsis and shoulder surgery. Presented by Kate Leslie and Monty Mythen with their guest, Chiara Robba who is Professor of Anaesthesia and Intensive Care, IRCSS Policlinico San Martino, Genova, Italy; and Past Chair of the Neurointensive Care Section of European Society of Intensive Care Medicine.