The Perioperative Coach

"An operation is like a marathon, nobody prepares for that by starving themselves" - the first episode of this series provides some much needed food for thought regarding the essential the role of nutrition and nutrition screening in the perioperative process. Monty Mythen talks to Professor Paul Wischmeyer from the Department of Anesthesiology, Duke University, USA, about the e.published American Society of Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on Nutrition and Screening Therapy within an Surgical Enhanced Program. The latest research suggests as many as one in three admissions are malnourished. Malnourished patients have a three times greater risk of complications and a five times greater risk of mortality. It's the fourth most common cause of death, within thirty days of any surgery and yet it's the only directly modifiable cause of death in the top ten. Learn here how you can put your institution or practice swiftly into a better place by developing a perioperative enhancement team which keeps its focus on this clear way to improve standards and save lives. Click on this link to access the full paper: https://journals.lww.com/anesthesia-analgesia/Abstract/publishahead/American_Society_for_Enhanced_Recovery_and.96950.aspx -- Like this, want more? Paul Wischmeyer is a firm favourite on TopMedTalk, further listening is to be found here on our main podcast stream: https://www.topmedtalk.com/ebpom-2018-perioperative-nutrition/ Henrik Kellet is mentioned in this piece he was interviewed and profiled by TopMedTalk here: https://www.topmedtalk.com/asa-2018-san-francisco-henrik-kehlet-recovery-is-all-about-inflammation/ Additionally, this piece, covers many of the essential elements discussed above: https://www.topmedtalk.com/intensive-care-society-nutrition/

A conversation about enhanced recovery implementation. How do you get the whole team on the same page when it comes to implimenting an Enhanced Recovery Programme? Perioperative medicine requires a truly multidisciplinary team where everyone works together. This piece focuses upon educating and clarifying what colleagues and staff should work towards and expect from one another. "There are some hospitals where you walk in the door and you can feel the calm in the air" the attitude is "this is what we do here". Dr Joff Lacey is speaking with Mike Scott, Virginia Commonwealth University and Ross Kerridge, John Hunter Hospital, Newcastle, Australia. -- Like this, want more? Mike Scott has won many fans through his appearances on TopMedTalk, we'd love you to listen to this piece he contributed to here: https://www.topmedtalk.com/if-patients-come-to-us-anaemic-they-just-do-worse-ebpom-usa/ Ross Kerridge's evidence driven approach and trademark wit is always popular with our listeners, we advise you listen to more of him here: https://www.topmedtalk.com/prehab-periop-world-congress-lee-fleisher-ross-kerridge/ Joff Lacey is a very popular presenter and medical practitioner for TopMedTalk. If you enjoyed his work here check out this four part series he recorded especially for us; it focuses on the innovative and highly acclaimed Xtreme Everest story: https://www.topmedtalk.com/xtreme-everest-extra-the-problem-with-hypoxia-the-inception-of-xtreme-everest/

The introduction of complex carbohydrate drinks and challenging ideas such as the standard "nil by mouth" procedure before surgery is discussed here. The conversation then moves to intravenous therapy and the correct approach as surgery and fluid maintenance is prepared for. Monty Mythen is presenting with his guest Dr Scott Brudney, Professor, Departments of Anaesthesiology and Internal Medicine, University of Manitoba, Winnipeg, Canada. Click here for the American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-016-0049-9 If you enjoyed this and want more the conversation is taken from a longer piece to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/

The impact of The American Society for Enhanced Recovery (ASER) cannont be understated, it has helped practitioners to implement better practice across the US. In this piece we discuss the approach of a 'council of nurses' and how an Enhanced Recovery After Surgery (ERAS) programme can be advocated within an environment without leaving practitioners or patients behind. Learn how a round table approach combined with an evidence base can sometimes work better than the traditional hierarchical power structure. Front line providers can often be a source of innovation and best practice. They are also often the ones who can first identify issues with standards in protocol and best practice. Presented by Desiree Chappell with her guests Dr Ruchir Gupta, medical lead for enhanced recovery at Stony Brook University and Joni Brady, Perianesthesia, Pain Management Nursing Consultant Alexandria, Virginia. -- Like this, want more? Ruchir Gupta's insightful contributions also feature in this piece here: https://www.topmedtalk.com/asa-2018-san-francisco-eras-working-with-existing-resources/ More of Joni Brady's pragmatic approach is to be found here: https://www.topmedtalk.com/how-do-you-promote-eras-both-inside-and-outside-your-facility/ Also, our lead presenter Desiree Chappell's hugely popular series "Desiree's Roundtable" can be listened to here: https://www.topmedtalk.com/?s=roundtable

This is a discussion about fluid management in an enhanced surgical recovery pathway, in relation to guidelines from the American Society of Enhanced Recovery (ASER) and the work of the Perioperative Quality Initiative (POQI). Presented by Monty Mythen with his guest Dr Tim Miller, anaesthesiologist at Duke Medical Centre and Vice President of ASER. The Perioperative Quality Initiative (POQI) is an essential part of the route towards the latest thinking on enhanced recovery and perioperative medicine: http://www.poqi.org For more come to our meetings: http://www.ebpom.org/meetings --- Like this, want more? This highlight clip is taken from a longer conversation to be found here: http://www.topmedtalk.com/aser-ebpom-2017-pod-two-live-from-washington-dc/ Tim Miller is a much loved contributor to TopMedTalk and has featured many times, this piece here gets into more detail regarding the POQI guidelines: https://www.topmedtalk.com/topmedtalks-to-tim-miller/

This piece provides "a thumbnail sketch summary of the fluid debate". Challenging the "prevailing wisdom" regarding fluid management, the kidney and volume overload; "as a young Doctor you sort of got the impression that if you got the kidney to handle a lot of fluid somehow it would be happier". Sodium and volume overload are in fact issues and extra work for the kidney and have tended to cause more difficulties than they solved. Presented by Professor Monty Mythen and Dr Joff Lacey with guest John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh. The TopMedTalk team love reading feedback from our listeners, join in the debate and send us an email: [email protected] -- Like this, want more? This conversation is taken from a longer piece here: http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/ Also, this talk regarding nephrology, gets into more detail here: https://www.topmedtalk.com/periop-sig18-goal-directed-therapy-to-prevent-acute-kidney-injury/

It's about "optimal analgesia" rather than aiming for an entirely "pain free" approach. America's opioid crisis brings the importance of this concept into sharp relief and this episode of The Perioperative Coach reflects on the pain management discussions had by the American Society of Enhanced Recovery (ASER) and its members.   Presented by Monty Mythen with Dr Joff Lacey and Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton.  For further reading see the articles in Perioperative Medicine Journal: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0064-5 --- Like this, want more? This conversation taken from a longer piece to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/ The opioid crisis is a significant concern to us here at TopMedTalk, here is one of the more recent pieces we've done on the subject: https://www.topmedtalk.com/ebpom-usa-chicago-2018-the-opioid-crisis-can-we-kick-the-habit/

Perioperative urine output is a vital sign which can have a very significant impact on outcomes. This discussion emphasises the importance of monitoring it and using the data accordingly. It then moves further into permissive oliguria within an enhanced recovery protocol. This shows no difference in creatinine values and patients are not reporting that they feel uncomfortable or thirsty as a result. Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests Dr Tim Miller from Duke University Medical Centre and John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh. -- Like this, want more? This conversation is taken from a longer piece, which you can find in full here: https://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/ The above is complimented well by this podcast, which looks at some of the bigger trials that have taken place recently in the perioperative field: https://www.topmedtalk.com/ebpom-london-2018-any-answers-part-3-the-big-trials/

This podcast is crucial to understanding Enhanced Recovery After Surgery (ERAS). The ideas outlined in this series all lead up to it. In short, the length of stay as part of a patient's post operative recovery should be less than 3 days with over 90% of your patients mobilised on day one. This in depth discussion relates to the consensus paper from the Perioperative Quality Initiative (POQI), see link below. It focuses on: outcomes, length of stay and DREAMS (Drinking, Eating and Mobilising) within hours after major surgery. These are all measures of compliance and success in an Enhanced Recovery Program. Monty Mythen and Joff Lacey with Mike Grocott presenting alongside contributions from Dr Julie Thacker, Colorectal Surgeon from Duke University, President of the American Society of Enhanced Recovery (ASER) and Dr Tim Miller, Anesthesiologist from Duke University. The POQI website is here: http://www.poqi.org For further CME read the paper in Perioperative Medicine: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0062-7 -- Love this, want more? This piece is taken from a longer discussion here: http://www.topmedtalk.com/aser-ebpom-2017-pod-two-live-from-washington-dc/ Julie Thacker has made many important contributions to TopMedTalk, if you enjoyed hearing her not checkout this excellent Roundtable piece here: https://www.topmedtalk.com/what-is-asers-vision-for-2018/ Tim Miller's work is frequently celebrated here on TopMedTalk, this piece is a good place to go when you want to hear more: https://www.topmedtalk.com/fluid-matters-series-1-6-definite-definitions-fluid-physiology/

This final part of the series opens the door to a world beyond and answers the question, how do we apply the principles of Enhanced Recovery to obstetrics? Hear the story behind implementing such a programme for the first time ever in America. Insights from the UK were instrumental in adopting the practice. Should it be something which is also seen as the standard of care in the US? This podcast features Desiree Chappell interviewing Dr Attila Kett, anaesthesiologist and Chairman at St Peter's University Hospital at New Jersey. Thanks for listening to this series of The Perioperative Coach. Please visit the www.topmedtalk.com website for more details and to subscribe to the main podcast. We welcome feedback via email: [email protected] --- Love this, want more? This piece is an extract from a longer and more detailed conversation which you can find in full here: https://www.topmedtalk.com/eras-for-obstetrics/ The charismatic Attila Kett is greatly admired by the team at TopMedTalk and, if your interest has been piqued by this piece, we advise you get more here: https://www.topmedtalk.com/ebpom-highlight-1-26-eras-in-obstetric-surgery/