"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...

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...

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...

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...

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...

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...

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...

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...

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)...

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...