Surgery Archives - obsgynaecritcare

  Hi Everyone, This week is part two of a series where Dr Mark Johnson and I discuss the emerging field of onco-anaesthesia. An increasingly enormous number of people every year undergo anaesthesia in order to have cancer surgery. Many different aspects of their surgical, anaesthetic and post surgical analgesic care are known to have effects on the immune system, the inflammatory response to surgery and some drugs act directly on receptors on cancer cells themselves. Is it possible or even probable that there are aspects of the techniques and drugs we use that could effect our patients long term cancer outcomes? Links How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676329/ Influence of perioperative anaesthetic and analgesic interventions on oncological outcomes: a narrative review https://youtu.be/Qj_MifzPGzo

Hi Everyone, This week I am joined by Dr Mark Johnson for part 1 of a two part series where we discuss the emerging field of onco-anaesthesia. An increasingly enormous number of people every year undergo anaesthesia in order to have cancer surgery. Many different aspects of their surgical, anaesthetic and post surgical analgesic care are known to have effects on the immune system, the inflammatory response to surgery and some drugs act directly on receptors on cancer cells themselves. Is it possible or even probable that there are aspects of the techniques and drugs we use that could effect our patients long term cancer outcomes? Links How Anesthetic, Analgesic and Other Non-Surgical Techniques During Cancer Surgery Might Affect Postoperative Oncologic Outcomes: A Summary of Current State of Evidence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676329/ Influence of perioperative anaesthetic and analgesic interventions on oncological outcomes: a narrative review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563034/ https://youtu.be/Qj_MifzPGzo

Case scenario: Mrs A Nonymous is a 67 yr old woman with a diagnosis of probable ovarian cancer who is booked for a midline laparotomy and debulking cancer surgery. She is a smoker, has a BMI of 50 and weighs 115kg. She was diagnosed with OSA 5 years ago but doesn’t use CPAP because she couldn’t tolerate it. She has had longstanding back pain for many years which she blames on an epidural which she had during childbirth 30 years ago. She has had 2 previous back operations “which didn’t help” and now takes 3 analgesics for this pain which include moderately high dose oxycodone, pregabalin, and tramadol. She tells you that she definitely will not consent to any spinal or epidural because of all of her previous back issues… She is opioid tolerant and at high risk of serious opioid related respiratory adverse effects – how are you going to manage her pain, get her mobilising and avoid any technique that involves a needle in the back! Hi everyone, This week we have an interview with Dr Matt Rucklidge, a colleague and good friend who is also a consultant anaesthetist practicing here in Western Australia. Matt trained in the UK and worked in southern England, one of the pioneering regions, where he first became acquainted with the use of rectus sheath catheters for postoperative analgesia after midline laparotomy. He has helped us successfully introduce this very effective technique into our institution where it has now become the default analgesic technique for the majority of our patients undergoing major intra-abdominal surgery with a midline incision. BJA EDUCATION Article https://bjaed.org/article/S2058-5349(18)30033-7/abstract Unfortunately contrary to my comments on the podcast – this article does not appear to be open access and when I tried to access it today it requires an institutional subscription or an individual payment. If you are an employee of a health service / university or a member of a college you may be able to access the article through these channels. Want to know more about the open access debate? See our previous podcast on this here: https://www.obsgynaecritcare.org/036-sci-hub-earthquakes-listener-mail-pirate-jokes-and-another-quiz/ Instructional Videos https://youtu.be/Xq-H3SLLwO0   https://youtu.be/_r_pVQf4C5w

Hi everyone, Join us on the podcast where this week we have part 2 of the discussion with Dr Sonya Ting on tips for management of acute perioperative pain. We explore some advice on how to manage a tricky obstetric patient with post caesarean pain issues. I also failed dismally to entice any responses to last weeks quiz entitled “Anaesthetist or serial killer”. In one final last ditch attempt to rescue this quiz from abject failure I have now rebranded it. I have supplied you with a small crossword which can be used to get some hints as to the name of the individual who is pictured – and then I am guessing using the power of  the internet someone should be able to figure out who this is! QUIZ 4 – Anaesthetist or serial killer? Who is this person?

Hi everyone, This week I am joined again by my colleague Dr Sonya Ting – where I attempt to pick her brains for some useful advice in managing difficult perioperative pain issues. Sonya’s first episode on the opioid epidemic has already taken first place on the podcast download list as the most popular episode so far! Hypothetical Patient A 50yr old woman is on your list and scheduled to undergo a laparascopic hysterectomy. You see her in the preoperative area: Q – What issues / history should you explore to identify if this patient is at risk of perioperative pain issues? Q – How are you going to explain to her the plan for her perioperative pain management, what are the goals and what strategies fo you use to manage her expectations? Q – What communication strategies can you use, what about non-verbal and verbal communication? Listen to Sonya and I discuss these issues on the podcast – and finally have a crack at the latest instalment of our quiz below: Anaesthetist or Serial Killer? Quiz 4 Is the following person an anaesthetist or is he a serial killer (or perhaps is he both!) Massive bonus points available if you can actually name this individual!