Perioperative medicine tutorial of the month [POMTOM]

Tutorial of the month


Frailty in Perioperative Medicine

Dr Andrew Rogerson, Dr Sara Churchill & Dr Philip Braude

02 June 2017

As the number of older people increases the incidence of diseases amenable to definitive surgical intervention will increase. This will result in a greater number of older people undergoing surgery. Issues that become more prevalent with ageing, such as multimorbidity, functional dependence and frailty, contribute to adverse events after surgery.


Assessing perioperative risk

Dr. Nirav Shah & Dr Aoife Hegarty, Anaesthetic STRs London

11 May 2017

There are an estimated 313 million operations carried out worldwide every year[1], with over 4.2 million of these in England[2]. For a variety of reasons, it is difficult to gain a precise estimation of perioperative mortality and morbidity. However, it has been suggested that this may occur in between 3 and 17% of operations[3][4], with total UK inpatient surgical mortality up to 3.6%[5].


Goal Directed Therapy and Advanced Haemodynamic Monitoring

Dr Z Paris, Welsh Deanery

11 Apr 2017

At a time when the NHS is being faced with an ageing population with increasing complex needs and limited budget and resources, healthcare professionals need to be acutely aware that whilst we provide our patients with the best possible care we are mindful of cost effectiveness.


Enhanced Recovery: Pathways to Better Care

Dr. Nirav Shah & Dr Aoife Hegarty, Anaesthetic STRs London

01 Mar 2017

Enhanced recovery has become a familiar term in recent years in the landscape of anaesthesia and perioperative medicine. The concept of “fast-track surgery” was first described by Henrik Kehlet in Denmark in the 1990s. Looking at the use of multimodal packages in patients undergoing open colorectal surgery, he was able to demonstrate reductions in postoperative length of stay (LOS) and morbidity. From this, the concept of enhanced recovery after surgery (ERAS) was born.


Assessment of volume status and fluid responsiveness in intensive care

Ana-Catarina Pinho-Gomes, Manchester Royal Infirmary

06 Feb 2017

It is a typical morning intensive care round. There is a septic, mechanically ventilated patient, who remains hypotensive despite aggressive fluid therapy overnight. The patient is dependent on vasopressors to meet with the targets of ‘early goal directed therapy’. A lively debate ensues with someone advocating a fluid bolus, whilst someone else feels the patient is already overloaded. How can the conflict be resolved? How can volume status be accurately assessed?

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