Selected educational podcasts from experts in perioperative medicine
Podcasts
1 June 2015
BJA – 'Fit to fly' overcoming barriers to preoperative haemoglobin optimization in surgical patients
Patient blood management (PBM) is a multifaceted approach to reducing allogenic blood transfusion (ABT) in the surgical population. In this podcast Professor Manuel Munoz, a haematologist from Malaga in Spain, talks to us about the way in which a PBM program functions to reduce ABT and in so doing, can have a dramatic impact on patient morbidity and mortality. One of the cornerstones of PBM is the detection and treatment of preoperative anaemia which is in itself an independent and potentially modifiable risk factor in both elective and emergency surgery. Professor Munoz dispels some of the widely held misconceptions regarding anaemia, talks through the implications of starting surgery with sub-optimal haemoglobin levels and describes some of the effective and surprisingly expeditious treatments available in the preoperative period.
June 2015 || Volume 115 - Issue 1 || 27 Minutes
1 April 2015
BJA – Fluid Thinking with Professor Monty Mythen
Assessment, calculation and composition of replacement fluid is a fundamental tenet of anaesthetic practice. Mounting evidence from the colorectal and enhanced recovery literature shows that attention to detail throughout the perioperative period results in both reduced patient morbidity and length of stay. In addition to our highly tuned clinical acumen, exist a myriad of monitors we can use to augment our decision making and maintain our patients' milieu intérieur. As such, one would expect to observe a high degree of consistency in the volumes of fluid given by experienced anaesthetic practitioners to similar groups of patients or at the very least, a degree of internal consistency when looking at an individual anaesthetist's practice. A large retrospective data analysis from the US looking at over 6000 patients has yielded results that are as alarming as they are surprising. Whilst it would appear the God doesn't play dice, we observe the distinct possibility the anaesthetists may! Professor Monty Mythen from UCLH talks to us about his reaction to the paper, the repercussions of poor perioperative fluid management and strategies for getting it right.
April 2015 || Volume 114 - Issue 5 || 26 Minutes
1 February 2015
BJA – They tried to make me go to prehab...
Whilst medical cancer therapies are increasing in their utility and efficacy, the physiological effects of intensive combined treatment regimes on patients' reserves are becoming a greater concern. It is now routine practice to combine medical and surgical therapeutic options in the form of neoadjuvant chemoradiotherapy for conditions such as colorectal cancer. Since the 1990s we have been aware of the inverse relationship between cardiorespiratory fitness as measured by CPET and post-operative morbidity. This raises legitimate concerns over whether improvements in resection margins may come at the expense of increased surgical morbidity and mortality. Mr Malcolm West, an NIHR clinical academic fellow at the unit of cancer services in Southampton, talks to us about his ground breaking work in the field of prehabilitation medicine; the concept of improving a patient's cardiorespiratory fitness pre-operatively after a deliberate and in this case, measured toxic insult. Not only does his group's structured exercise program have a statistically and clinically significant effect on functional reserve, but this impressive pilot study hints at an unexpected and potentially yet more remarkable story.
February 2015 || Volume 114 - Issue 2 || 27 Minutes
1 January 2015
BJA – Pregabalin use in the perioperative period: indications, dosage and the current evidence
As with many anticonvulsants, pregabalin is enjoying an ever increasing spectrum of use. Originally licensed for the treatment of epilepsy, diabetic neuropathic pain and post-herpetic neuralgia; pregabalin has become a staple of the chronic pain armamentarium. To date, well over 100 studies have explored pregabalin's use in the perioperative period on a diverse range of symptoms including acute pain and preoperative anxiety. This issue of the BJA carries a meta-analysis looking at the utility and prescribing rationale for pregabalin in the peri-operative period. In this podcast Dr Ashraf Habib from Duke University Medical Centre takes us through the potentially practice changing evidence for pregabalin use in the perioperative period.
January 2015 || Volume 114 - Issue 1 || 22 Minutes
1 December 2014
BJA – Repercussions: post-operative morbidity and the mortality hangover
Millions of operations take place in the UK each year; the majority occurring without undue patient morbidity. However, dependant on the nature of the procedure, post-operative morbidity is not uncommon and we will all recall patients who have suffered an unexpected complication after surgery. Large epidemiological studies have suggested that post-operative morbidity is not confined to the discrete episode of post-operative care, and in fact may have a significant impact on a patient's long-term mortality. Dr Ramani Moonesinghe from the UCL/UCLH Surgical Outcomes Research Centre talks to us about her work in this area, pre and post-operative scoring systems and the post-operative morbidity domains significantly associated with decreased survival after surgery, as well as what we can do as peri-operative physicians to influence longer-term patient outcomes.
December 2014 || Volume 113 - Issue 6 || 28 Minutes
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