Perioperative Medicine Podcast Series

If you have just been told that you need an operation, you're now at the start of a surgical journey. It may be a short journey or it may be a long one, but either way this podcast series is here to help you.

A Just Culture in the workplace means that everyone should feel safe to speak up, and leads to open and honest communication, systems thinking, engagement, and participation, where everyone is involved in making improvements. Professor Janet Anderson and Garry Mann, our Human Factors team, talk to Yooralla’s Director of Just Culture Miranda Cornelissen, about the benefits of implementing a Just Culture in the workplace.

The GLP-1 agonists have been generating much discussion and a degree of consternation in the Perioperative Medicine community. Our panel of experts discusses the mode of action, indications, and perioperative implications of this class of medications.

Thuy Bui is the Lead Pharmacist of the Analgesic Stewardship and Perioperative Medicine Services at the Alfred. She discusses the very important role of the pharmacist in all stages of the Perioperative process.

Any patient undergoing a procedure or intervention should be provided with an explanation of the procedure and the risks involved, and be asked to give their consent. Often this is a process that is poorly done or misunderstood by both of the clinician and the patient. Dr Maryanne Balkin discusses the legal and ethical issues surrounding informed consent and the capacity to provide consent.

Increasing numbers of older people are undergoing surgery and adverse outcomes are common within this patient group. Dr Margot Lodge is a Geriatrician with a special interest in Perioperative Medicine. She discusses the role of the geriatrician in Perioperative Medicine and the use of implementation science in adopting new models of care for the older person undergoing surgery.

Dr Lana Vestarkis is an Anaesthetist at Sunshine Coast University Hospital. For her Master of Perioperative Medicine Capstone Project, Lana worked with her colleague Dr Anna Pietzsch to attempt to rationalise preoperative blood testing in the elective surgical setting. Their project is not only having a major impact in their health network but has gone on to win a national prize. Lana and Anna discuss their project, including the challenges faced and the lessons learned when trying to bring about change.

Dr Sarah Wilmot is a GP Anaesthetist in rural Victoria. For her Master of Perioperative Medicine Capstone Project, Sarah redesigned the pre-anaesthetic process in her practice in an effort to improve patient experience. She discusses her project, including the challenges she faced and the lessons learned when trying to bring about change. Note: this podcast was recorded earlier this year. At the time, Sarah had been recently diagnosed with a terminal illness. Despite feeling unwell she was keen to share her project with a wider audience. Tragically Sarah passed away last month. This conversation is shared in memory of Dr Sarah Wilmott and her dedication to the best care of her patients.

In this episode, Dr Olivia Leahy talks to Dr Harry Sivakumar (Anaesthetist and Pain Specialist) and Dr Martyn Lloyd-Jones (addiction medicine specialist) about buprenorphine, an opioid analgesic used in the management of acute and perioperative pain, and selectively in chronic pain, as well as in opioid replacement therapy.

SARS-CoV-2 infection increases perioperative risks, both with the acute infection and its aftermath. Accruing data suggests that elective surgery should be deferred for 7 weeks for most types of surgery, although individualised risk assessment may reduce or increase this timeframe. Paul Myles talks with Dr Kariem El-Boghdadly from Guy's Hospital in London, the lead author of a recently published consensus statement arising in the UK.

Methadone creates many challenges for the perioperative physician. In this episode, Dr Olivia Leahy talks with Dr Harry Sivakumar - a fellow of both ANZCA and the faculty of pain medicine - regarding the use of methadone in opioid replacement therapy, chronic pain and acute pain management contexts.

In this episode Dr Adam Sutton talks to Aidan Baron about healthcare for people with diverse genders. They explore healthcare outcomes, what is meant by gender identity, gender expression, sex and attraction and how these relate to the LGBTQIA PLUS acronym. Aidan provides insights as to how to improve communication and engagement with this community and an overview of gender affirming medical care in Australia.

The Australian health care sector makes up approximately 7% of Australia’s national carbon footprint. In this episode Jamie Smart talks to Dr Eugenie Kayak, the national convenor of Doctors for the Environment Australia’s Sustainable Healthcare Special Interest Group. They discuss the impact of healthcare on climate change, and the steps necessary for a more environmentally sustainable future.

In this episode Joff Lacey talks to Hilary Madder, consultant anaesthetist at The Alfred and former Clinical Director of Neurosciences Intensive Care at the John Radcliffe, in Oxford. They explore the growing sub-speciality of neurocritical care, including the rationale for the development of specialised neuro intensive care units, the evidence of impact on patient outcome and what may be the key determinants of improved clinical care.

In this episode, Prof Rachelle Buchbinder and Prof Ian Harris join us for a discussion on their new thought-provoking book, Hippocrasy. Through the lens of the modern version of the Hippocratic Oath, the book explores medical overdiagnosis, over-investigation and over-treatment­—and why doctors sometimes cause more harm than healing.

Postoperative delirium is a serious complication of surgery associated with prolonged hospitalisation, long-term cognitive decline, and mortality. Associate Professor Lisbeth Evered joined us from New York to discuss her recent paper, published in the British Journal of Anaesthesia, with Associate Professor Christine Ball. This important paper resulted from a sub-study of the BALANCED trial to determine whether targeting bispectral index (BIS) readings of 50 (light anaesthesia) was associated with a lower incidence of POD than targeting BIS readings of 35 (deep anaesthesia).

Dexamethasone is widely used by anaesthetists in the perioperative period, principally as an effective antiemetic to prevent postoperative nausea and vomiting (PONV). The molecular mechanisms underlying dexamethasone’s antiemetic action are not fully understood. However, because it is a potent glucocorticosteroid, it is has immunosuppressive and hyperglycaemia effects. It is hypothesised that these actions may increase the risk of perioperative infections, particularly in patients with diabetes mellitus, who are already at increased risk of complications. Whether the use of dexamethasone in the perioperative period increases the risk of surgical site and other infections, has not been definitively established. This is an important health priority as in Australia alone up to one million patients will receive dexamethasone as part of their anaesthesia care annually. This study aims to definitively address the impact of dexamethasone on surgical site infection and will be stratified according to diabetes status.

Professor Toby Richards, (the Lawrence-Brown Professor of Vascular Surgery at the University of Western Australia) joins Dr Jonathan Nicholson, Dr Ron Glick and Dr Alan Peirce to discus the PREVENTT trial. Published in the LANCET (Sept, 2020), PREVENTT was a landmark RCT investigating preoperative iron transfusion prior to major abdominal surgery and its impact on postoperative mortality and overall transfusion rates.

Professor Robert Sanders, Nuffield Professor of Anaesthesia at Sydney University joins Dr Ron Glick and Dr Alan Peirce to discuss the NEUROVISION study (Lancet, 2019) and its relevance to anaesthetic practice, and current and future directions of research in perioperative cognitive dysfunction.

Professor Myles is the co-author of an editorial accompanying a paper published in this week's the Lancet, looking at mortality and pulmonary complications in COVID-19 positive patients undergoing surgery. He discusses the implications of this trial on elective surgery and planning for future pandemics.