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A series of short articles on key topics in perioperative medicine, published in the British Journal of Hospital Medicine

POM in a Nutshell

12

Frailty in perioperative medicine

Dr Andrew Rogerson, Staff Registrar, Department of General Medicine, Sengkang General Hospital, Singapore 544886 Dr Philip Braude, Consultant Geriatrician, Department of Ageing and Health, Guys and St Thomas’ NHS Foundation Trust, London

01 June 2019

As the proportion of older people in the population increases so too will the prevalence of age-related diseases, many of which are amenable to surgery. This will result in higher numbers of older people considering and undergoing surgical treatment. However, syndromes such as frailty, multimorbidity and functional dependenc render this cohort prone to adverse postoperative outcomes. Identifying frailty early can facilitate timely shared decision making, resource planning and optimization of health to improve outcomes.

11

The importance of pain management in perioperative outcomes

Dr Ben Morrison, Clinical Fellow, Department of Anaesthesia, Royal Marsden NHS Trust

01 April 2019

Recent focus by leading experts on enhanced recovery after surgery has been on not only a patient-specific but also a procedure-specific approach to analgesia in the perioperative period. Analgesic planning should begin at the earliest possible opportunity, not least to adequately counsel patients about what their anaesthetic will likely entail.

10

Perioperative exercise

Dr Catrin Williams, Consultant in Anaesthesia and Perioperative Medicine, University College Hospital, London

01 Feb 2019

Discusses recent evidence for the effectiveness of perioperative exercise programmes in reducing complications.

9

Renin-angiotensin-aldosterone antagonists

Miss Ana-Catarina Pinho-Gomes ST2, Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester M23 9LT

20 Dec 2018

Discusses evidence for and against stopping renin-angiotensin-aldosterone antagonists perioperatively in cardiac and non cardiac surgery.

8

Assessing volume status and fluid responsiveness in critical care

Miss Ana-Catarina Pinho-Gomes ST2, Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester M23 9LT

01 Oct 2018

Although insufficient and excessive resuscitation are both associated with worse clinical outcomes, most decisions regarding fluid therapy are still made empirically.

The quintessential questions in fluid resuscitation are what the current state of the patient’s intravascular volume is and whether the patient’s physiological variables will improve if he/she receives continued fluid resuscitation or a fluid bolus?

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