POPULARITY
The podcast explores comprehensive recommendations for managing patients with non-cardiac implantable electrical devices during surgical procedures, emphasizing preoperative assessment, device interaction prevention, and safety protocols.• Types of devices include vagal nerve stimulators, deep brain stimulators, and spinal cord stimulators• Preoperative evaluation is crucial for identifying devices and contacting managing clinicians• Algorithm provided for assessing potential interactions with electrocautery, MRI, and neuromonitoring • Diathermy is absolutely contraindicated in patients with non-cardiac implantable devices• Critical information needed includes device type, manufacturer, lead locations, and latest interrogation results• Recent urgent safety alert issued about medication vial coring risks with specific interim recommendationsIf you have any questions or comments, please email us at podcast@apsf.org. Visit apsf.org for detailed information and check out the show notes for links to all topics discussed.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/252-managing-neurologic-stimulators-a-critical-guide-for-safe-anesthesia/© 2025, The Anesthesia Patient Safety Foundation
Listen as we discuss the highly-awaited ESOPEC trial, which examines treatment regimens for esophageal and EGJ adenocarcinoma. Wildly impress your thoracic attendings or peers with your nuanced knowledge! FLOT who? You'll know. Pull out the paper and listen along! Learning Objectives: -Discuss the patient population in the ESOPEC trial -Discuss the main differences between the ESOPEC trial and the CROSS trial -Describe the main drawbacks between FLOT and the CROSS regimen. Hosts: Chloe Hanson MD, Brian Louie MD, and Peter White MD Referenced Material https://www.nejm.org/doi/full/10.1056/NEJMoa2409408 Hoeppner J, Brunner T, Schmoor C, Bronsert P, Kulemann B, Claus R, Utzolino S, Izbicki JR, Gockel I, Gerdes B, Ghadimi M, Reichert B, Lock JF, Bruns C, Reitsamer E, Schmeding M, Benedix F, Keck T, Folprecht G, Thuss-Patience P, Neumann UP, Pascher A, Imhof D, Daum S, Strieder T, Krautz C, Zimmermann S, Werner J, Mahlberg R, Illerhaus G, Grimminger P, Lordick F. Perioperative Chemotherapy or Preoperative Chemoradiotherapy in Esophageal Cancer. N Engl J Med. 2025 Jan 23;392(4):323-335. doi: 10.1056/NEJMoa2409408. PMID: 39842010. https://www.nejm.org/doi/full/10.1056/NEJMoa1112088 van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A; CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31;366(22):2074-84. doi: 10.1056/NEJMoa1112088. PMID: 22646630. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32557-1/abstract Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, Kopp HG, Mayer F, Haag GM, Luley K, Lindig U, Schmiegel W, Pohl M, Stoehlmacher J, Folprecht G, Probst S, Prasnikar N, Fischbach W, Mahlberg R, Trojan J, Koenigsmann M, Martens UM, Thuss-Patience P, Egger M, Block A, Heinemann V, Illerhaus G, Moehler M, Schenk M, Kullmann F, Behringer DM, Heike M, Pink D, Teschendorf C, Löhr C, Bernhard H, Schuch G, Rethwisch V, von Weikersthal LF, Hartmann JT, Kneba M, Daum S, Schulmann K, Weniger J, Belle S, Gaiser T, Oduncu FS, Güntner M, Hozaeel W, Reichart A, Jäger E, Kraus T, Mönig S, Bechstein WO, Schuler M, Schmalenberg H, Hofheinz RD; FLOT4-AIO Investigators. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019 May 11;393(10184):1948-1957. doi: 10.1016/S0140-6736(18)32557-1. Epub 2019 Apr 11. PMID: 30982686. ***Fellowship Application Link: https://forms.gle/PQgAvGjHrYUqAqTJ9 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
How can a quick bedside ultrasound transform patient safety in anesthesia? Today, Sharon and guest co-host Carole Doyscher, CRNA, BSN, MS, APRN explore the growing role of gastric point-of-care ultrasound (PoCUS), a tool helping anesthesia providers assess stomach contents in real time. Joined by Rachel Edgerton, DNAP, MSNA, CRNA, APRN, CHSE and three doctoral students from St. Mary's University - Molly O'Neill, BSN, RN, Hannah Peine, BSN, RN, CCRN, CMC, Alyssa Klein, BSN, RN - the episode dives into their groundbreaking DNP project educating CRNAs on this skill. Here's some of what we discuss in this episode:
In this episode of the ESCRS IME podcast series on refractive IOLs, Drs. Nic Reus and Ramza Diamanti explore the critical steps of the preoperative workup for cataract patients aiming for spectacle independence. They emphasize the importance of thorough preparation to achieve optimal outcomes and explain how residual refractive error can impact both visual performance and patient satisfaction. The discussion also highlights common pitfalls that lead to postoperative refractive surprises, the scenarios in which they are most likely to occur, and practical strategies to minimize the risk. Don't forget to listen to the other insightful podcasts in the series! Independent medical education supported by Alcon (Gold) and J&J Vision (Gold).
PodChatLive 174: What orthoses prescriptions Podiatrists write, a scoping review of foot strengthening exercises, and why patients want bunion surgeryContact us: getinvolved@podchatlive.comLinks from this weeks episode:Custom Foot Orthoses: A Retrospective Analysis of 1000 Prescriptions From New Zealand PodiatristsMuscle Strengthening Exercises for the Foot and Ankle: A Scoping Review Exploring Adherence to Best Practice for Optimizing Musculoskeletal HealthWhy I Want Bunion Surgery—the Patient's Preoperative and Postoperative Perspective
Postoperative cognitive disorders (POCD) are often misunderstood, underdiagnosed, and underestimated, but they can dramatically affect a patient's recovery and long-term quality of life. We've invited Dr. Christine Detwiler to join us so we can better understand the science behind POCD, the risk factors, and the strategies anesthesia providers are using to protect brain health. Along with guest co-host Dana Pederson, CRNA, we dive into this topic with Christine while it's still very fresh on her mind. She shares the insights she uncovered during her doctoral research, including risk factors, early signs to watch for, and why anesthesia providers play a bigger role in brain health than they might think. Here's some of what we discuss in this episode:
Medication safety remains a cornerstone of anesthesia practice with complex environments and high-stakes decisions requiring vigilant attention to prevent errors. This collaboration between APSF and OpenAnesthesia spotlights critical aspects of perioperative drug safety with practical insights from Dr. Juan Li, a cardiothoracic anesthesia fellow at Beth Israel Deaconess Medical Center.• Perioperative anaphylaxis requires immediate recognition of cardiovascular, respiratory, and cutaneous manifestations• Neuromuscular blocking agents and antibiotics represent common triggers for anaphylactic reactions• Preoperative assessment must include thorough allergy history, medication reconciliation, and identification of drug-drug interactions• Standardized drug concentrations, preparation methods, and equipment minimize medication errors• Technology integration through barcode readers and computerized decision support enhances safety• Pharmacy support with pre-mixed solutions and pre-filled syringes reduces preparation errors• Post-operative monitoring remains critical for catching delayed medication reactions• Safety culture should emphasize root cause analysis rather than punishment for medication errors• Implementation of standard protocols is essential for managing new medications with limited safety dataVisit APSF.org and Openanesthesia.org for detailed information and resources on medication safety in anesthesia practice.
Summary In this episode of the Future of Dermatology Podcast, we share a truncated replay of Dr. Daniel Klufas's session from the SF Derm 2024 Annual Conference on the management of Hydradenitis Suppurativa (HS) with a focus on the surgical technique of deroofing. This session covers the importance of medical optimization, patient selection, and the benefits of deroofing, including low recurrence rates and high patient satisfaction. Dr. Klufas emphasizes the need for thorough preoperative planning and the role of patient expectations in surgical outcomes. Takeaways - HS was long considered a purely surgical disease. - Recent strides in medical management can delay surgical intervention. - Deroofing is a critical procedure for managing HS. - Medical optimization is essential before considering surgery. - Patients should be well-informed about their treatment options. - Deroofing can be performed on solitary or regional lesions. - Patient satisfaction rates for deroofing are high. - Recurrence rates for deroofing are generally low. - Preoperative planning is crucial for successful outcomes. - Pain management post-deroofing is often less than expected. Chapters 00:00 - Introduction to the Future of Dermatology Podcast 01:00 - Understanding Hydradenitis Suppurativa (HS) and Surgical Management 03:14 - Medical Optimization and Patient Selection for Deroofing 05:01 - Deroofing Technique and Surgical Pearls 08:15 - Patient Satisfaction and Outcomes of Deroofing
PDF Notes for Surgery 101 episode on Preoperative Medication Optimization
It goes without saying that surgeries come with a significant stress on the body, it is therefore imperative that patients, particularly those with significant co morbidities are medically optimized prior to surgery. Today we're going to consider how to properly prepare patients for surgery, looking specifically at the medications that patients are taking. After listening to this episode, you should be able to: 1. Explain the two main reasons why we need to know about medications that people are taking before they have surgery. 2. List classes of medications that should be: a. continued during the pre-operative period b. adjusted prior to surgery c. stopped prior to surgery
What surgical techniques and safety measures are important to consider when operating in a pregnant patient? In this episode of the BackTable OBGYN podcast, Dr. Craig Sobolewski, a minimally invasive GYN surgeon at Duke, speaks with host Dr. Mark Hoffman about the intricacies of laparoscopic surgery in pregnant patients. --- SYNPOSIS The surgeons delve into the critical importance of understanding anatomy and ensuring proper exposure during surgeries, particularly the challenges and techniques for operating during pregnancy. Key discussions include the use of liver retractors, the management of symptomatic ovarian cysts, and the methods for performing and evaluating abdominal cerclages. They also explore the physiological changes in pregnant patients and the adjustments needed for anesthesia, laparoscopic entry, pressures during surgery, and pre/post-operative care. --- TIMESTAMPS 00:00 - Introduction 07:20 - Laparoscopy in Pregnant Patients 11:23 - Common Surgeries During Pregnancy 15:56 - Laparoscopic Surgery Techniques 24:04 - Physiologic Changes in Pregnancy 27:33 - Access Methods and Pressure Considerations 28:53 - Managing Torsion and Cysts in Pregnancy 30:21 - Energy Use and Safety in Pregnant Patients 31:38 - Preoperative and Postoperative Care 34:15 - Cerclage Procedures and Counseling 47:46 - Professional Reflections and Conclusions
Send us a textDiese Woche widmen wir uns der Prämedikation, bzw. dem Aufklärungs-Teil des Prämedikationsgespräches: van den Heuvel, Sander F.; Jonker, Philip; Hoeks, Sanne E.; Ismail, Sohal Y.; Stolker, Robert Jan; Korstanje, Jan-Wiebe H.. The effect of stand-alone and additional preoperative video education on patients' knowledge of anaesthesia: A randomised controlled trial. European Journal of Anaesthesiology 42(4):p 313-323, April 2025. | DOI: 10.1097/EJA.0000000000002109 Mit im Studio: Lukas Ritzhaupt, wissenschaftlicher Mitarbeiter der Klinik für Anästhesiologie am UKHD
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Impact of Mandatory Preoperative Dental Screening on Infective Endocarditis in Patients Undergoing Surgical Valve Replacement
This week we delve into the world of cardiovascular surgery and general cardiology when we review a recent report from UVA on the topic of feeding around the time of neonatal heart surgery. Does preoperative oral feeding improve the chances for 'tube-free' enteral feeds at discharge after heart surgery in small infants? Why might oral feedings improve the chances of discharge oral feedings? How should clinicians think about the known benefits of early CHD surgery for some CHD lesions with the benefits of oral feedings? Dr. Aseel Dabbagh of Children's Mercy Hospital in Kansas City shares her insights into these and other questions. DOI: 10.1007/s00246-024-03750-z
Welcome to Season 2 of the Orthobullets Podcast. Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. Ali Araghi and is titled Spine Surgery Preoperative Optimization and Impact on Outcomes. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube
European Journal of Anaesthesiology | EJA - The EJA Podcast collection
Listen to the Q&A between Carolina Romero and Massimo Lamperti as they discuss the guideline, “Preoperative assessment of adults undergoing elective noncardiac surgery: Updated guidelines from the European Society of Anaesthesiology and Intensive Care”, found in the January 2025 issue of the EJA.
What's the best way to reduce post-op pain after extractions? And why should we never use the term “painkiller” with patients? What to do when you hear the dreaded *crack* of a tuberosity? In this episode we talk about all things post-operative extraction complications! And I'm joined by one of the nicest guys in dentistry - Dr. Nekky Jamal Complications are something we ALL experience, so this episode is great for any dentist. Whether you're brushing up on dry socket prevention, mastering post-op communication, or just curious about advanced healing hacks, tune in for real-world advice to make extractions smoother - for both you and your patients https://youtu.be/BvB3hDESYDY Watch PDP210 on Youtube Protrusive Dental Pearl: The "Niche Kebab" concept encourages dentists to narrow their focus by reducing the variety of procedures they perform and prioritizing those they genuinely enjoy. By evaluating every new skill or treatment added and strategically dropping less-loved procedures, dentists can avoid overextension and the "jack of all trades, master of none" pitfall. Learn how to Extract Impacted 3rd Molars, don't miss out on Third Molars Online and use the coupon code ‘protrusive' to get 15% off! Key Takeaways Pain management is about setting realistic expectations. Dexamethasone can be beneficial but must be used cautiously. Dry socket is often overhyped; proper care can prevent it. Effective communication can alleviate patient anxiety and prevent misunderstandings and complaints. Preoperative care can help manage pain expectations. Understanding the signs of infection is essential for diagnosis. Chlorhexidine rinses can significantly reduce dry socket risk. Patients appreciate being informed about their unique dental situations. PRF can significantly reduce the incidence of dry socket. Dentists should embrace new techniques like PRF to enhance patient care. Patient involvement in post-surgical care is crucial for healing. Dentists should not hesitate to refer complex cases to specialists. Highlights of this episode: 02:54 Protrusive Dental Pearl 04:05 Dr. Nekky Jamal 08:39 Managing Post-Extraction Pain and Swelling 21:37 Infection 25:02 Identifying Dry Socket and How to Prevent it 28:30 Case Selection and Communication 37:13 Mitigating Dry Socket with Platelet-Rich Fibrin (PRF) 39:47 The Importance of Nicheing in Dentistry 43:19 Cryotherapy and Post-Surgery Care 47:32 Handling Tuberosity Fractures 55:08 Patient Consent 57:55 Litigation and Patient Communication This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A, C and D. AGD Subject Code: 310 ORAL AND MAXILLOFACIALSURGERY (Exodontia) Dentists will be able to: Identify and differentiate common postoperative complications, and recognise the key symptoms associated Evaluate the ethical and clinical considerations of case selection for extractions Communicate effectively with patients regarding potential complications If you loved this episode, be sure to check out another epic episode with Dr. Nekky Jamal - Wisdom Teeth Extractions – SURGICAL TOP TIPS
In today's episode, we had the pleasure of speaking with Yvonne Mowery, MD, PhD, about the phase 2 SU2C-SARC032 trial (NCT03092323) investigating the addition of pembrolizumab to preoperative radiotherapy and surgery in patients with soft-tissue sarcoma. Dr Mowey is a physician scientist and an associate professor of radiation oncology at the University of Pittsburgh Medical Center Hillman Cancer Center in Pennsylvania. In our exclusive interview, Dr Mowery discussed unmet needs for patients with soft-tissue sarcoma that prompted the initiation of this research, key efficacy and safety findings from the trial, and potential next steps for investigating the treatment regimen in this patient population.
In this episode of the ESCRS IME podcast series on toric IOLs, Drs. Marjan Farid and Andrzej Dmitriew explore the prevalence of astigmatism in cataract surgery patients and its significant impact on visual quality. They emphasize the importance of comprehensive preoperative assessments, provide key considerations for the decision-making process, and recommend modern IOL power calculation formulas to ensure precise calculations and optimal visual outcomes. Be sure to check out the other insightful episode in this podcast series! Independent medical education supported by Alcon (Platinum) and Zeiss (Bronze).
What are the steps involved in Functional Crown Lengthening? Which scenarios/teeth are best for this type of surgery? What is biologic width and why should we care? Is Bone sounding a diagnostic test, or just a genre of music? The answer to these questions and a lot more can be found in this packed episode with Dr Hiten Halai. We cover the right protocols when crown lengthening and understand the difference between aesthetic and functional crown lengthening. https://youtu.be/KRlEtz16I8c Watch PDP207 on Youtube Protrusive Dental Pearl - Bone Sounding Using a periodontal probe, go into the depth of the sulcus, pushing deeply until you hit bone, all while recording the measurement with the probe. This measurement will then guide you on how to carry out your crown lengthening procedure. Push hard to pass the connective tissue and ensure you are touching the bone. Not using AI to write your notes and letters for you yet? Save hours every day and save money using this affiliate link for DigitalTCO: Click Here Highlights of this Episode:03:19 Protrusive Dental Pearl06:10 Introduction - Dr Hiten Halai12:56 Functional Crown Lengthening15:41 Understanding Crown Lengthening Types18:42 University of Dental Instagram22:38 Biologic Width aka Supra-crestal Tissue Attachment25:51 Functional Crown Lengthening: Practical Considerations31:09 Assessments & Keratinised Tissue35:47 Understanding Tissue Phenotypes39:16 Case Study: Premolar Treatment43:17 Bone Sounding and Biologic Width46:58 Shape of Gingivectomy50:31 Flap Designs52:37 Burs for Crown Lengthening56:13 Healing and Restoration Timelines58:31 Learning and Training Opportunities Key Takeaways: Hiten's journey began with a passion for periodontics during dental school. Managing time effectively is crucial for specialists with busy schedules. Functional crown lengthening is often underutilized in practice. Aesthetic crown lengthening can lead to complications if not done correctly. Understanding biologic width is essential for successful crown lengthening procedures. Preoperative assessments are critical for determining candidacy for crown lengthening. The type of gingival tissue affects surgical outcomes and healing. Proper surgical techniques can prevent complications and ensure better healing. Postoperative care is vital for achieving desired aesthetic results. Continuous education and mentorship are important for dental professionals. This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcome C. ADG Code: 490 PERIODONTICS (Mucogingival management) Aim: To enhance knowledge and practical understanding of crown lengthening procedures, with a focus on distinguishing between aesthetic and functional crown lengthening, and the importance of biologic width in achieving predictable clinical outcomes. Learning Outcomes: Identify the key differences between aesthetic and functional crown lengthening and the clinical scenarios in which each is most appropriate. Demonstrate an understanding of biologic width and its significance in the success of crown lengthening procedures, including the impact on long-term periodontal health. Apply the principles of bone sounding to accurately assess the need for crown lengthening and ensure optimal restoration outcomes, minimising risks such as gingival recession and bone loss. If you liked this episode, check out: PDP079 - Crown Lengthening
Preoperative patient warming by AORNJournal
The addition of preoperative chemoradiation therapy to perioperative chemotherapy did not improve overall survival as compared with perioperative chemotherapy alone in patients with resectable gastric or gastroesophageal junction adenocarcinomas. The multi-continent, Phase III randomized TOPGEAR trial has definitively found no benefit from adding radiation before surgery in terms of overall or progression-free survival. This clear finding was reported simultaneously in the New England Journal of Medicine and at the ESMO 2024 Congress held in Barcelona, Spain. After presenting the findings , first author Trevor Leong, MD, Radiation Oncologist at the Peter McCallum Cancer Centre in Melbourne, Australia, met up with Oncology Times reporter Peter Goodwin.
Preoperative dental treatment by AORNJournal
In a conversation with CancerNetwork®, Georgios Evangelou, MD, MSc spoke about his manuscript titled Neoadjuvant Capecitabine Plus Temozolomide in Atypical Lung NETs, which he and his coauthors published in the July issue of ONCOLOGY®. Evangelou, a medical oncologist and consultant in the 3rd Department of Medicine at Sotiria General Hospital in Athens, Greece, reviewed the results of a case study involving the use of neoadjuvant capecitabine (Xeloda) plus temozolomide (Temodar; CAPTEM) for a 62-year-old woman with well-differentiated atypical carcinoid. The patient was asymptomatic at diagnosis, with imaging revealing an atypical bronchial neuroendocrine tumor (NET) as well as a pancreatic mass indicating another NET. This patient subsequently underwent treatment with CAPTEM, which resulted in minor volume reductions of masses in the left lower lobe and subcarinal lymph node after 6 months of therapy. Although the pancreatic mass increased in size, Evangelou and colleagues excised it via central pancreatectomy, allowing the patient to resume treatment with CAPTEM for 6 additional months and undergo lobectomy with lymph node dissection. Further use of CAPTEM produced a partial response in the mediastinal lymph nodes and a 21% reduction in the size of the primary tumor. Following treatment, the patient was able to recover without any significant complications. Additionally, follow-up scans revealed no avid lesions, and there were no signs of disease recurrence at 24 months after the lobectomy. Based on the results of this case study, the authors noted how neoadjuvant therapy may significantly impact the management of patients with atypical carcinoids, although larger clinical trials may be necessary to affirm the potential survival benefit of CAPTEM. “I hope that others will recognize the potential value of CAPTEM as a neoadjuvant treatment in similar cases. Sometimes, these cases are very difficult to manage; you need the neoadjuvant treatment because it can offer tumor shrinkage. Eventually, it can lead to radical excision of the disease,” Evangelou said. “We need larger studies to better understand the effectiveness of the regimen as a neoadjuvant treatment.”
Did you miss the ESMO Congress 2024? Listen here: NEJM Editor-in-Chief Eric Rubin and NEJM Evidence Associate Editor Oladapo Yeku discuss research that was presented at the 2024 European Society of Medical Oncology annual meeting. Visit NEJM.org to read the latest research.
This week we delve into the world of the single ventricle when we speak with Dr. David Hoganson, Assistant Professor of Surgery at Harvard Medical School about a recent work he co-published with investigators from Boston Children's Hospital on computational fluid dynamic modeling in the planning of the Fontan operation. Single ventricle heterotaxy patients with interrupted IVC are at enhanced risk for the development of pulmonary AVM's due to flow maldistribution to the pulmonary arteries from the hepatic veins in a Fontan. Can a computational fluid dynamic model predict which operative approach would result in the most balanced hepatic venous flow distribution? Can this reduce the incidence of pulmonary AVM's? How well did the models predict the actual pulmonary flow measured after surgery on CMR? Who beyond the heterotaxy patient might benefit from this approach? Dr. Hoganson offers us a peek into the world of personalized surgery in this week's exciting episode. DOI: 10.1016/j.jacadv.2024.101057
Josh created a preoperative total joint replacement (TJR) screener targeting patient-initiated cancellation. This TJR screener gives patients scores/ratings based on how likely they are to cancel their surgeries.
Josh created a preoperative total joint replacement (TJR) screener targeting patient-initiated cancellation. This TJR screener gives patients scores/ratings based on how likely they are to cancel their surgeries.
David McDermott discusses the adjuvant vs neoadjuvant immune therapy trial and its wider implications.
How can we best prevent diabetic related complications before surgery? Learn all about it in this weeks perioperative episode. This episode was written by Dr. Michael Wong (Internal Medicine Resident) and reviewed by Dr. Robyn Houlden (Endocrinology) and Dr. Kristen Marosi (General Internal Medicine). Infographic by Dr. Valarie Kim (Internal Medicine Resident). Support the Show.
By embracing a holistic approach that considers not only the surgical procedure itself but also the patient's overall health and well-being, practitioners can optimize the recovery process and enhance long-term outcomes. Functional medicine emphasizes the interconnectedness of various bodily systems, recognizing the importance of factors such as nutrition, inflammation management, and stress reduction in promoting healing. When applied with conventional techniques, these can play a crucial role in supporting patients more comprehensively and effectively. In this compelling discussion with Taylor Dukes, we explore the various aspects of recovery in her brain tumor healing journey, shedding light on the importance of holistic approaches to healing, from addressing inflammation to optimizing restorative sleep. Join us as we unravel personal narratives, share valuable insights, and highlight the critical role of support systems in the recovery process. Functional medicine, integrating conventional and holistic approaches to healthcare Taylor recounts a period of significant stress and trauma in their life, exacerbated by working night shifts in an ICU in Austin, Texas. Despite being previously healthy, she found herself experiencing various health issues, including hair loss, joint pain, stomach problems, and skin inflammation. Despite consulting various specialists and undergoing invasive procedures, she struggled to find answers to her declining health. Her desperation to recover led her to seek alternative approaches, eventually leading her to functional medicine practitioner Ann Shippy, who significantly improved her health through testing and dietary changes. This experience propelled her into the field of functional medicine, where she subsequently worked as a nurse for Amy Myers and eventually opened her own practice. Brain tumor diagnosis, treatment, and healing journey Amidst her newfound health and career success, she received a Prenuvo scan – a full-body preventative scan. This led to the shocking discovery of a brain tumor, despite her lack of symptoms. Reflecting on her journey, she emphasizes the integrative approach of functional medicine, combining conventional and holistic practices to address illness at its roots. Her experiences highlight the significance of thorough patient history and consideration of factors like lifestyle, genetics, and environment for achieving optimal health outcomes. Following the unexpected discovery of a brain tumor, Taylor went through the stages of acceptance and preparation. She also explored the treatment options available. With an integrative approach to healthcare in mind, she sought complementary methods to address the tumor, emphasizing the importance of early detection and intervention. Utilizing a combination of diet modifications, alternative therapies, and stress reduction techniques, she diligently prepared her body for surgery over a span of five months. This proactive approach not only allowed her to explore various treatment modalities but also facilitated the remarkable feat of shrinking the tumor by half before undergoing surgery. Collaborating with healthcare professionals across different disciplines, including a neurosurgeon and integrative treatment centers, she took charge of their healing journey with determination and resilience. Integrative oncology and preparing the body for brain surgery Addressing inflammation is a cornerstone of my approach to health and wellness, and it's something I consistently highlight. Whether you're dealing with chronic health issues or simply striving for optimal well-being, managing inflammation is key. One of the most powerful tools in combating inflammation is through dietary intervention, and this is where the ketogenic diet comes into play. A strict ketogenic diet involves drastically reducing carbohydrate intake and focusing on clean, whole foods that are rich in healthy fats and nutrient-dense, low-glycemic vegetables. A keto diet can help to rebalance inflammatory responses and processes in the body. However, it's important to note that not all ketogenic diets are created equal. While some may opt for a more lenient approach, indulging in processed and inflammatory foods, we encourage individuals to have a strict, clean ketogenic diet instead. Brain surgery recovery, sleep issues, and the importance of sleep for healing The aftermath of surgery is often similar to a delicate dance, with patients backpedaling and preparing for the next set of events. In Taylor's case, her meticulous preparation undoubtedly paved the way for a more efficient recovery. However, the confusion among providers regarding surgical outcomes isn't solely due to technical advancements; rather, it's deeply intertwined with the patient's overall health status and risk factors. From pre-surgery preparations to post-operative care, every aspect plays a pivotal role in achieving optimal outcomes. In a time where trust in medical professionals is increasingly fragile, it's essential to provide patients with transparent explanations and evidence-based recommendations. Taylor's journey serves as a testament to the transformative power of proactive, holistic care, where surgery is just one piece of the puzzle. The period between surgeries wasn't merely a waiting game; it was a time of profound physical, mental, and emotional healing. From grappling with sleep disturbances to confronting the need for patience in the recovery process, every step brought its own set of challenges and lessons. Yet, through it all, Taylor remained steadfast in her commitment to her well-being, recognizing that true healing extends far beyond the operating room. That's why it's crucial to find a provider who not only understands your medical history but also approaches your treatment with empathy and intuition. Sleep, stress, and self-care after brain surgery Rest is also one of the major contributors to the healing process, particularly for the brain. There's often confusion about why we emphasize hormones and sleep so much, but it's crucial, especially after surgery. When someone finds themselves needing to take afternoon naps or experiencing disrupted sleep patterns, it's a sign that something's amiss. Adequate rest allows the brain to repair and regenerate, facilitating cognitive function and emotional well-being. For someone recovering from brain surgery, ensuring quality sleep is paramount, as it supports the body's natural healing mechanisms and helps mitigate potential complications. Taylor's experience highlights the importance of maintaining a consistent sleep schedule to facilitate deep, uninterrupted sleep, which is vital for the healing process. Without adequate rest, recovery can be prolonged, leading to increased fatigue and inflammation. She emphasizes the need for prioritizing self-care, including stress regulation, deep breathing, and unplugging from technology, as essential strategies to support healing. Taylor also addresses why she didn't remove her breast implants sooner, explaining that financial constraints and life circumstances played a significant role. She acknowledges that she wishes she had acted sooner but hopes her experience encourages others to take proactive steps for their health, especially if they have the means to do so. Ultimately, there are no shortcuts when it comes to self-care, and investing in these practices is essential for optimal recovery outcomes. Taylor hopes that sharing her story and the resources she provides will inspire others to prioritize their health. She emphasizes the importance of taking care of the body, managing stress, and eating clean, not as a chore but as a way to enhance overall well-being. Post-surgical care and diet for breast implant patients It is crucial for doctors to provide patients with comprehensive information so they can make informed decisions about their health. By ensuring that patients are fully informed about the potential risks and benefits of medical interventions like implants, doctors empower them to take an active role in their healthcare journey. Biofilm, which is found on various implants, has become increasingly prevalent. Unfortunately, its implications for implant recipients are often not adequately disclosed. As a result, many patients may not fully understand the risks associated with biofilm and its potential impact on their health. It is crucial for healthcare providers to ensure that patients are well-informed about biofilm and its implications before undergoing implant procedures. In my practice, I prioritize leveraging genetics to tailor treatment plans uniquely to each patient, aiming to optimize outcomes based on their genetic predispositions and responses to various interventions. This personalized approach allows for more targeted and effective care, as it takes into account individual differences and genetic factors that may influence treatment efficacy. Additionally, the support from loved ones throughout the decision-making process plays a vital role in patient well-being and recovery. Their encouragement and understanding can provide invaluable emotional support and contribute significantly to a patient's overall resilience and confidence in their treatment journey. After surgery, it's crucial to prioritize a low-inflammatory diet, including avoiding gluten, dairy, processed foods, refined sugars, and seed oils. The good news is that The Well in Austin is one of the few places that offers such options, providing patients with nutritious meals to support their recovery. Personalized healthcare and surgical recovery After surgery, it's crucial to prioritize rest and provide your body with the time it needs to heal. However, integrating gentle movement, spending time outdoors in the fresh air, and soaking up some sunshine can also play a significant role in facilitating recovery. These simple yet effective strategies can help boost mood, enhance circulation, and promote overall well-being during the healing process. In addition to rest and physical activity, proper nutrition is paramount for supporting the body's recovery efforts. Consuming nutrient-rich foods that are high in electrolytes, minerals, and protein can provide the essential building blocks necessary for tissue repair and regeneration. By fueling the body with the right nutrients, patients can optimize their healing potential and expedite the recovery process. Furthermore, post-operative care extends beyond the immediate aftermath of surgery. It encompasses ongoing support and guidance to address any underlying health issues and ensure a comprehensive approach to healing. Each patient's journey is unique, and personalized care tailored to their specific needs is essential for promoting long-term recovery and wellness. Central to this personalized approach is the recognition of bio-individuality – the understanding that every individual is unique and may respond differently to various treatments and interventions. By acknowledging and addressing these individual differences, healthcare providers can develop tailored treatment plans that optimize outcomes and support each patient's unique path to recovery. Moreover, emphasizing the importance of personalized care underscores the need for healthcare providers to consider a range of factors, including genetics, gut health, immune function, and dietary sensitivities. By taking a holistic approach that considers these diverse elements, healthcare providers can develop comprehensive treatment strategies that address the root causes of inflammation and promote sustainable healing. Preoperative testing and detox programs are also integral parts of our comprehensive approach to surgery and recovery. Again, I want to emphasize that we must prioritize reducing inflammation through a combination of methods tailored to each patient's unique needs. Links and Resources While Taylor has retired from her practice, she remains dedicated to education and empowerment through her online community. By joining her Facebook group, members gain access to the TDW team and a supportive community of like-minded individuals. For $39 a month, members receive resources, support, and monthly wellness-related topics discussed via Zoom calls, equipping them to make informed choices and navigate their wellness journey effectively.: https://taylordukeswellness.com/tdw-community Dr. Robert Whitfield's Website (https://drrobssolutions.com/) Follow Dr. Rob on Instagram https://www.instagram.com/drrobertwhitfield/ For more information on Virtual and In Person Consultations, we always answer our messenger personally: https://www.drrobertwhitfield.com/contact/ About Dr. Rob Dr. Robert Whitfield (https://www.drrobertwhitfield.com/dr-whitfield-2/) In 2012, Dr. Whitfield came to Austin and became renowned for his breast surgery expertise. He set up his own practice in 2017. Here, he offers the men and women of Austin a full range of cosmetic procedures, both surgical and non-surgical, addressing the full array of breast, body and face. Born and bred in Las Vegas, Austin plastic surgeon Dr. Whitfield received his medical degree from the University of Las Vegas School of Medicine. This was followed by six years of surgical training, as well as his plastic surgery residency at Indiana University Medical Center. He returned to Nevada for a one year microsurgery fellowship before settling down to practice and teach at the Medical College of Wisconsin for seven years. Board-certified by the American Board of Plastic Surgery, Dr. Whitfield's approach to medicine has really been shaped by both his upbringing and his education. As a child of the “wild west,” he was born with an adventurous spirit. One of the reasons that he was drawn to plastic surgery is the constant innovation. In the field of plastic surgery, with innovative techniques and technologies developed each year, there are simply issues for which a solution has yet to be invented. Dr. Whitfield tempers his intrepid attitude with Midwestern pragmatism. It makes for a pretty winning combination.
Face transplants. Nope, that's not just something you see on Grey's Anatomy. It's a real procedure and SLPs can support pre-operative evaluations, postoperative rehabilitation, and lifelong happiness for those who undergo this process. And in this week's episode of the Swallow Your Pride Podcast, you'll get to hear from two SLPs who have direct experience with serving this population! Join Meg Lico and Kaitlin Hanley, both SLPs at NYU Langone Health in New York City, as they share the challenges, triumphs, and profound impact of their collaboration with a surgical team as they navigate the complexities of their roles when serving those who receive a transformative face transplant. Gain insight into the passion and dedication driving Meg and Kaitlin's work with craniofacial and facial transplant populations as they advocate for increased awareness and education. Start challenging the traditional perceptions of speech-language pathology and celebrate the multifaceted expertise of these dedicated professionals. Ready to learn how SLPs played a MAJOR role in a groundbreaking face transplant? Tune in to this week's discussion and hear what Meg and Kaitlin have to share about it! Get the show notes for this episode here: https://syppodcast.com/325 Timestamps: The introduction (00:00:12) Introducing the speakers (00:01:10) Preparation for the case (00:02:56) Post-surgery updates (00:04:49) Collaboration and patient progress (00:08:21) Preoperative assessment and strategies (00:09:38) Inpatient care and progress (00:12:17) Utilizing research and strategies (00:15:29) Passive Stretching Therapy (00:18:02) Collaboration Challenges (00:18:56) Critical Thinking and Collaboration (00:19:37) Interdisciplinary Collaboration (00:20:25) Expertise and Collaboration (00:23:33) Patient Journey and Preparation (00:25:45) Specialty Populations (00:31:43) The lack of awareness about speech pathology (00:35:02) Challenges in explaining the profession (00:35:44) The limited understanding of speech pathology (00:36:12) The profound impact of speech pathology (00:37:33) The post 325 – Reconstructing Hope with Meg Lico and Kaitlin Hanley appeared first on Swallow Your Pride Podcast.
Commentary by Dr. Candice Silversides
In this week's issue Canalicular dexamethasone inserts may eventually become an option for lasting relief from inflammatory dry eyes Water-free formulations of cyclosporine are effective in treating inflammatory dry eye, but future studies comparing water-free to standard formulations will show if these changes lead to greater efficacy for this hydrophobic molecule Preoperative chlorhexidine reduces ocular surface bacterial load to a greater extent than povidone iodine - and is better tolerated
In this Care Plan episode, the focus is on total or hemicolectomy procedures and considerations surrounding these surgeries. The discussion goes into the differences between total colectomy and hemicolectomy and their respective indications, whether for conditions like ulcerative colitis, Crohn's disease, or colon cancer. Anesthesia choices, encompassing laparoscopic or open procedures, are explored, emphasizing the significance of pain management, ERAS protocols, and avoiding complications like anastomotic leaks or ileus. Preoperative considerations are detailed, spanning from bowel rupture scenarios to bowel obstructions, electrolyte imbalances, and the importance of thorough patient assessment. The episode also touches on anesthetic considerations, emphasizing the avoidance of nitrous oxide, fluid management strategies, and opioid-sparing techniques for pain control. To connect with Rhea and Sachi, check them out on Instagram @crna_scientist and @thecrnaclub. Also, be on the lookout for the launch of their new company featuring basic and clinical science education for the nurse anesthesia community.Support the showTo access all of our content, download the CORE Anesthesia App available here on the App Store and here on Google Play. Want to connect? Check out our instagram or email us at info@coreanesthesia.com
Expert Insights for Successful Nose Surgery Journey Discover everything you need to know about rhinoplasty, from initial consultation to full recovery. Dr. Undavia from NJENT shares invaluable insights, covering preoperative prep, surgical details, and post-op care, ensuring a well-informed and confident approach to nose surgery. What you'll learn: The rhinoplasty consultation process and visualize surgical outcomes using advanced computer imaging technology. Preoperative preparations, including medication management, risk assessment, and scheduling tips for a smooth surgical experience. The rhinoplasty procedure step-by-step, understanding incisions, swelling management, and essential post-operative guidelines for optimal healing. Listen now for all your facial plastic surgery and ENT questions and get insights from the experts. For professional ENT support, schedule a consultation today at our Marlton, New Jersey location by visiting NJENT.com or call 609-710-NOES (6673). https://njent.com/complete-guide-to-rhinoplasty-from-consultation-to-recovery/
In this Care Plan episode, the focus is on total hip replacements, exploring the various considerations involved in this common orthopedic surgery. Preoperative considerations are detailed, emphasizing patient age, activity level, pain management, and the impact of comorbidities like cardiovascular issues. The episode also dives into anesthesia choices, such as single-shot spinal or general anesthesia, based on patient suitability for regional anesthesia. Special monitoring, blood loss, positioning, and anesthetic considerations, including potential complications like thromboembolism and bone cement implantation syndrome, are thoroughly discussed. The podcast wraps up with postoperative concerns like nerve injury, bleeding, infection, and urinary retention, shedding light on comprehensive postoperative care for patients undergoing total hip replacements. To connect with Rhea and Sachi, check them out on Instagram @crna_scientist and @thecrnaclub. Also, be on the lookout for the launch of their new company featuring basic and clinical science education for the nurse anesthesia community.Support the showTo access all of our content, download the CORE Anesthesia App available here on the App Store and here on Google Play. Want to connect? Check out our instagram or email us at info@coreanesthesia.com
This episode is a review of the paper by Dr. Campisi and colleagues in Italy, published in the journal Lymphology in 2019, exploring the potential benefits of a two-week targeted skin care program in the pre-surgical treatment of peripheral lymphedema and lipedema.The authors suggest that the use of specialized skincare products demonstrated promise in addressing common skin changes associated with both conditions, indicating potential benefits for individuals with lymphedema and lipedema.
With any type of surgery there are risks and possible complications. We are tackling a topic on this episode of the DiepCJourney podcast that is frequently discussed in the community served at DiepCFoundation. I reached out to an expert in the field for our discussion on fat grafting in breast reconstruction. Dr. Emily A. Williamson founded Plastic Surgery Northwest in Spokane Washington in 2010 after completing her surgical training at the prestigious University of Washington Plastic Surgery Residency. She works with a group of five other surgeons performing various aesthetic and plastic surgery procedures including autologous breast reconstruction like DIEP flap. Preoperative patient education and counseling is imperative to minimize fears about fat grafting. Dr. Williams discusses how a skilled surgeon minimizes the occurrence of fat necrosis for both implant-based and autologous breast reconstruction. She describes how fat is utilized to achieve symmetry but also signs and symptoms of fat necrosis and what can be done for patients who develop this after a fat grafting procedure. Recent study from France: Oncological Safety of Autologous Fat Grafting in Breast Reconstruction after Mastectomy for Cancer: A Case-control Study Article from the Cleveland Clinic: Autologous Fat Grafting For Breast Reconstruction: Safe but Worrisome to Patients Social Media Links for Dr. Emily A. Williamson: Facebook: Plastic Surgery Northwest Instagram: emilywilliamsmd
Length: 27.30 minutes This guideline was created as an educational tool to guide qualified physicians in assessing patients' bone mineral density prior to spine surgery and how to optimize it with select treatments if it is found to be a risk for poor surgical outcomes. Participants: J. Bradley Elder, MD John Dimar, MD Praveen V. Mummaneni, MD Rushikesh Joshi, MD
Preoperative risk factors contributing to poor outcomes after arthroscopic partial meniscectomy (APM) have not yet been consolidated and codified into an index scoring system used to predict APM success. In conclusion, using this model, the authors developed an index score that, using preoperative factors, can help identify which patients will achieve clinical improvement after APM. Longer symptom duration and higher KL grade were associated with a decreased likelihood of clinical improvement as measured by KOOS Pain at 1 year postoperatively. Click here to read the article.
In this episode, we review the high-yield topic of Arthroplasty Preoperative Medical Optimization from the Recon section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
Interview with Mark Coburn, MD, and Ana Kowark, MD, authors of Preoperative Midazolam and Patient-Centered Outcomes of Older Patients: The I-PROMOTE Randomized Clinical Trial. Hosted by Amalia Cochran, MD. Related Content: Preoperative Midazolam and Patient-Centered Outcomes of Older Patients
Dr. John Clohisy discusses treatment of the anemic patient from the Potpourri of Perioperative Clinical Dilemmas for Patient Undergoing TJA. To see the presentation while you listen, download the free ConveyMED App: Apple Store click here Google Play click here For more information about CCJR, please visit: https://ccjr.com/ccjr-2023/
Drs. Rebecca Soares, Akshay Thomas, and Sarwar Zahid join to discuss four recent publications in high-impact ophthalmology journals.URM Fellowship Applications (https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2809093)AAO Meeting Carbon Footprint (https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2808045) Preoperative Positioning for Fovea-On Detachments(https://www.ophthalmologyretina.org/article/S2468-6530(23)00435-9/fulltext)Loss to Follow-up in DR Clinical Trials (https://journals.lww.com/retinajournal/abstract/9900/characteristics_of_participants_in_diabetic.440.aspx)Relevant Financial Disclosures: NoneYou can claim CME credits for prior episodes via the AAO website. Visit https://www.aao.org/browse-multimedia?filter=Audi
Those few precious minutes in the Preoperative area spent speaking with a patient and their significant others are essential to the initiation of a successful anesthetic, as is the “vibe” generated during the entire time until the induction agent for General Anesthesia goes in. What are the keys to success? We speak with Dr. Phil Jones, a cardiac anesthesiologist now in Toronto, Canada, who nearly trained as an actor in Britain before enrolling in Medicine studies at Cambridge. He was a consultant in Anesthesia and Critical Care Medicine at the prestigious St. Bart's Hospital in London. He is passionate about this topic, and about the importance of communication to improve the patient's perioperative experience. Follow Dr. Jones (@philjones6) and Dr. Lin (@LudwigLin) on Twitter.
Full article: https://www.ajronline.org/doi/abs/10.2214/AJR.23.29609 Hong Linda Li, MD discusses a new AJR article that details how preoperative MRI-based staging can predict biochemical recurrence of prostate cancer after radical prostatectomy as effectively as post-surgical pathologic staging.
Join Dr. Michael Blankstein as he discusses Intertrochanteric Femur Fractures including: • Preoperative considerations • Classification: Stable vs. Unstable fractures • Implant choice • Intraoperative considerations • Postoperative management To see the presentation while you listen, download the ConveyMED App for free: AApple Store click here Google Play click here For additional educational resources visit https://ota.org/
Host Liana Tedesco, MD Guest interviewee Monti Khatod, MD, FAAOS, discussing his research article “Preoperative Patient Optimization: Outcomes from Elective Total Joint Arthroplasty in a Large US Healthcare System” from the July 15, 2023 issue (https://journals.lww.com/Jaaos/toc/2023/07150) Article summarized from the July 1, 2023 issue (https://journals.lww.com/Jaaos/toc/2023/07010) Research article “The Effect of Resident Involvement in Hip Fracture Surgery: An Analysis of a Single Institution Before and After the Addition of an Orthopaedic Surgical Residency” Article summarized from the July 15, 2023 issue (https://journals.lww.com/Jaaos/toc/2023/07150) Research article “Total Ankle Arthroplasty for Posttraumatic Fracture Versus Primary Osteoarthritis: An Analysis of Complications, Revisions, and Prosthesis Survival” Follow this link to download these and other articles from the July 1, 2023 issue of JAAOS (https://journals.lww.com/Jaaos/toc/2023/07010) and the July 15, 2023 issue of JAAOS (https://journals.lww.com/Jaaos/toc/2023/07150). The JAAOS Unplugged podcast series is brought to you by the Journal of the American Academy of Orthopaedic Surgeons and the AAOS Resident Assembly.
Please join Drs. Graham Skelhorne-Gross, Jordan Nantais and Ashlie Nadler from our Emergency General Surgery Team for a discussion on cirrhotic patients. Child-Pugh Score (https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality) · Bilirubin, albumin, INR, ascites, encephalopathy · Used to predict operative mortality based on cirrhosis severity · Mortality in EGS: - Child-Pugh A: 10% electively and 22% emergently - Child-Pugh B: 30% electively and 38% emergently - Child-Pugh C: 80% electively and up to 100% emergently Model for End Stage Liver Disease (MELD) (https://www.mdcalc.com/calc/10437/model-end-stage-liver-disease-meld?utm_source=site&utm_medium=link&utm_campaign=meld_12_and_older) · creatinine, bilirubin, INR, and sodium · MELD < 20 – 1% increase in mortality with each point increase · MELD > 20 – 2% increase in mortality with each point increase Pre-operative Planning · Identification of cirrhosis with physical examination, bloodwork and imaging · Involvement of other medical services (internal medicine, hepatology, ICU) as needed · Cirrhosis optimization, if possible · Abdominal wall mapping Unexpected Intraoperative Finding Communicate unexpected findings to the operative team and think of additional adjuncts you may need such as additional ports, topical hemostatic agents or energy devices. Think about why you are in the OR. If its an elective situation and can wait, consider bailing. If its emergent, you may have to do something more definitive. Exposure may be a challenge, you may have to alter your typical approach including where the assistant grabs and retracts. Extra hands are helpful. Bleeding can be a big deal. If possible, map out the abdominal wall ahead of time with cross-sectional imaging. Stay away from varices around the umbilicus or porta Ventral Hernia + Cirrhosis · Ideally, control ascites pre-operatively, if you can't consider leaving drains · Small (< 2cm) hernias close primarily · Larger (>2cm) hernias repair with mesh unless infected filed (controversial) · Minimally invasive repairs can be performed Benign Biliary Disease + Cirrhosis · Incidence of gallstones is 4-5 times higher in cirrhotic patients · Prophylactic laparoscopic cholecystectomy (LC) generally not done · LC generally considered acceptable in CP A or B but not C (exceptions: HD instability, gangrenous cholecystitis, hemorrhagic cholecystitis) · Cholecystostomy and ERCP are safe References: Bleszynski, M. et. Al. Acute care and emergency general surgery in patients with chronic liver disease: how can be optimize perioperative care? A review of the literature. 2018. World Journal of Emergency Surgery; 13:32 Mansour A, Watson W, Shayani V, et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122:730–5. Yeom SK, Lee CH, Cha SH, Park CM. Prediction of liver cirrhosis, using diagnostic imaging tools. World J Hepatol. 2015 Aug 18;7(17):2069-79. doi: 10.4254/wjh.v7.i17.2069. PMID: 26301049; PMCID: PMC4539400. Jain D, Mahmood E, V-Bandres M, Feyssa E. Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery. Ann Gastroenterol. 2018 May-Jun;31(3):330-337. doi: 10.20524/aog.2018.0249. Epub 2018 Mar 15. PMID: 29720858; PMCID: PMC5924855. **Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other Emergency General Surgery episode here: https://behindtheknife.org/podcast-category/emergency-general-surgery/