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Perioperative medicine tutorial of the month [POMTOM]

Tutorial of the month

5

Assessing perioperative risk

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

11 May 2017

Introduction
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].

4

Goal Directed Therapy and Advanced Haemodynamic Monitoring

Dr Z Paris, Welsh Deanery

11 Apr 2017

Introduction
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.

3

Enhanced Recovery: Pathways to Better Care

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

01 Mar 2017

Introduction
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.

2

Assessment of volume status and fluid responsiveness in intensive care

Ana-Catarina Pinho-Gomes, Manchester Royal Infirmary

06 Feb 2017

Introduction
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?

1

The Rationale for Perioperative Medicine

Dr Sam de Silva

01 Jan 2017

Introduction
The Perioperative Medicine Programme established by the Royal College of Anaesthetists in January 2015 describes the development of a new medical subspecialty aimed at improving patient care throughout the entire surgical journey1. The subspecialty of perioperative medicine has evolved in response to advances in surgical and anaesthesia techniques, enabling surgery to take place on an increasingly complex surgical population.

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