Andy Cumpstey and Mike Grocott interview Kate Leslie about the SNaPP study (Sugammadex, Neostigmine, and Postoperative Pulmonary Complications). SNaPP is a pragmatic randomized study run from the University of Melbourne with the ANZCA Clinical Trials Network across 45 sites in Australia, New Zealand, and Hong Kong. Patients aged 40+ having major abdominal or thoracic surgery (≥2 hours, overnight stay) were randomized after induction to reversal with sugammadex or neostigmine, with anesthetists unblinded and encouraged to use quantitative neuromuscular monitoring. In this podcast Andy, Mike and Kate discuss the results and their implications for anaesthetists and healthcare systems.

Find the paper here: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00158-X/fulltext

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London.

Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/

At the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM) held in Auckland, New Zealand, Kate Leslie and Andy Cumpstey interview the annual scientific meeting convenor Kerry Benson-Cooper and conference cultural advisor Tui Blair about planning the meeting and how Māori traditions and culture have informed not only the conference but also patient care and education in New Zealand.

Dr Kerry Benson-Cooper is a specialist anaesthetist and intensive care physician at Te Toka Tumai Auckland Hospital, New Zealand. Tui Blair is interim co director of patient services, Health New Zealand | Te Toka Tumai Auckland, New Zealand.

At the SOAP meeting in Montreal, Desiree Chappell and Monty Mythen interview Dr. Marie Louise Meng, Assistant Professor of Anesthesiology at Duke University Department of Anesthesiology and her former cardio-obstetric fellow Liliane Ernst, assistant professor in the Obstetric and Gynecologic Anesthesia section Wake Forest University.

The conversation focuses on cardio-obstetric anesthesia, hemodynamics, monitoring, and patient-centered care.

Meng describes building multidisciplinary "pregnancy heart teams" to plan management for complex cardiac disease in pregnancy and reduce birth trauma. Ernst discusses research using the Premier database on preexisting atrial fibrillation in pregnancy (about 25 per 100,000 deliveries) and associated management and outcomes.

They review cases including mechanical circulatory support with an Impella to prolong pregnancy and highlight knowledge gaps about placental perfusion and pulsatility, including Fontan physiology. Meng outlines individualized hemodynamic monitoring for labor and C-sections, emphasizes recognizing hypertensive instability, and details preeclampsia with severe features, its end-organ criteria, incidence, disparities, postpartum follow-up challenges, and potential use of remote monitoring and noninvasive cardiac output/SVR monitoring to guide therapy.

Monty Mythen, founding editor-in-chief of TopMedTalk, is now Senior Vice President, Scientific Liaison, BD Advanced Patient Monitoring. He is also Emeritus Professor of Anaesthesia and Critical Care, University College London, UK.

Desirée Chappell, former co-editor-in-chief of TopMedTalk, is now Director of Medical Affairs and Medical Science Liaison, BD Advanced Patient Monitoring. She is also a CRNA at NorthStar Anesthesia, USA.

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London.

Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

EBPOM World Congress 2026

TopMedTalk introduces our new "TopMedTalk Classics" series with a classic TopMedTalk episode from 2018 that is still prescient today. This lecture, given by Sir Bruce Keogh marked the NHS's 70th birthday, a time framed by political volatility, financial constraint, rising demand, and shifting public expectations.

Keogh argues healthcare systems must adapt, highlighting the UK's strengths in medical science, innovation, life sciences, and the scale and complexity of the NHS. He describes quality improvement efforts since 2008, including defining quality as effectiveness, safety, and patient experience, developing outcomes measures, and using aligned clinical and managerial leadership to drive change.

Examples include major reductions in MRSA, rapid increases in VTE assessment, improved survival from major trauma networks, better hip-fracture care, strong heart-attack and sepsis performance, stroke centralization benefits, and increased dementia diagnosis for support. He emphasizes future pressures from ageing, prevention, the health–social care split, Brexit workforce and drug costs, and emerging forces like mobile tech, AI, genomics, and gene therapy, arguing the NHS's pooled, universal model is well suited to a genomics-enabled future.

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London.

Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/

00:00 TopMed Talk Intro 00:18 Classics Episode Setup 01:31 Introducing Sir Bruce 02:23 Politics And Adaptation 04:41 Global Pressures On Healthcare 05:48 Hard Times Build NHS 07:35 UK Innovation Advantage 10:33 NHS Scale And Complexity 12:27 Darzi Review Quality Drive 16:10 Outcomes Framework Explained 17:20 Safety And High Level Metrics 18:09 MRSA Turnaround Lesson 20:11 Mandating VTE Prevention 22:58 Trauma Networks Results 24:08 Hip Fracture Best Practice 25:21 Heart Attack Care Wins 26:17 Sepsis And Early Warning 28:01 Stroke Centralization Success 28:45 Dementia Targets Debate 30:31 Leadership And Brexit Risks 32:35 Health And Social Care Split 36:01 Tech Disruption Ahead 36:49 Genomics And NHS Values 38:00 Closing And Congress Promo

The Association of Anaesthetists meeting in London was the perfect spot for us to launch our new series on Artificial Intelligence.

Here, Andy Cumpstey and James Bowness discuss the new monthly series and the UK-Ireland "demand signaling" project on AI in anaesthesia, perioperative medicine and acute pain, supported by The Association.

They are joined by their guest Nicky De Beer, The Association's chief executive.

She explains that their members want problems defined in advance before technology solutions are imposed from above. She highlights key clinical themes—enhanced monitoring and decision support, personalized anaesthesia, and automation of routine tasks—and nonclinical impacts such as operational efficiency and data-driven decision making.

The conversation stresses embracing AI with caution, addressing basic IT shortcomings, developing CPD/training, multidisciplinary research, ethical and safety-focused policy, international collaboration, grant funding, and progressing toward practical AI guidelines and advocacy with policymakers.

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/

Settle yourself in for another fascinating glimpse behind the curtain as TopMedTalk's perioperative profiles focus upon the incredible journey of Vanessa Beavis.

Recorded at ANZCA's recent annual scientific meeting in Auckland, TopMedTalk host Andy Cumpsty interviews anesthetist and former ANZCA President Vanessa Beavis about her path from growing up in South Africa to moving to Auckland in 1993.

We discuss her early work in obstetrics, solo general practice, and training in anesthesia before emigrating. She describes becoming involved in departmental leadership, navigating hospital governance to implement safety changes, and progressing through examiner roles, national committees, council, and ultimately ANZCA presidency. A role which coincided with COVID-19, when the College focused on maintaining robust training and examinations and producing clear PPE and clinical guidance across changing state rules.

She also recounts helping develop ANZCA's perioperative medicine work from the 2004 task force to the SIG, qualifications, the Australian New Zealand Perioperative Patient Pathway, and the new chapter, and reflects on receiving the Companion of the New Zealand Order of Merit.

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Previous Perioperative Profiles you may also enjoy:

https://topmedtalk.libsyn.com/perioperative-profiles-denny-levett

https://topmedtalk.libsyn.com/perioperative-profile-rupert-pearse

https://topmedtalk.libsyn.com/perioperative-profiles-professor-michelle-chew-on-seizing-opportunities-in-anaesthesia-research-editing-and-guideline-work

Also, remember you can join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London.

Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/

From the World Congress of Anesthesiologists in Marrakech, TopMedTalk hosts Mike Grocott and Kate Leslie discuss perioperative cardiac risk assessment with Hilary Grocott, Professor and Head of, The Department of Anesthesiology, Pharmacology & Therapeutics (University of British Columbia) and Michelle Chew Professor of Anesthesiology and Intensive Care Medicine at Karolinska Institutet, Stockholm, Sweden, and editor for the British Journal of Anaesthesia.

The conversation reviews perioperative cardiac biomarkers, noting abundant prognostic data but limited evidence for biomarker-led management. The discussion emphasizes that elevated troponins can reflect non-cardiac complications (AKI, PE, sepsis) as well as myocardial injury or heart failure, requiring context-specific follow-up pathways.

The group highlights NT-proBNP as a specific marker for heart failure and useful for screening and optimization. The podcast then focuses on pulmonary hypertension and failing right ventricle: detect via history, exam, echo, and biomarkers; prioritize preemptive preparation, arterial beat-to-beat monitoring, modest fluids, early vasopressors/inotropes (norepinephrine, low-dose epinephrine), ventilatory optimization, and vigilant, rapid intervention.

If you enjoyed this piece there's a fantastic Perioperative Profile with Michelle Chew you can hear here: https://topmedtalk.libsyn.com/perioperative-profiles-professor-michelle-chew-on-seizing-opportunities-in-anaesthesia-research-editing-and-guideline-work

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/

At the Society for Obstetric Anesthesia and Perinatology (SOAP) meeting in Montreal, TopMedTalk hosts Desiree Chappell and Mike Grocott interview SOAP board member Dr. Dan Katz, an obstetric anesthesiologist at Mount Sinai, outgoing annual meeting chair and incoming vice president.

Katz reports record attendance—over 900 preregistrations and nearly 1,100 total—plus standing-room sessions and review of 600+ abstracts. He highlights opening with research presentations (magnesium and postpartum hemorrhage, gestational thrombocytopenia and hemorrhage, and potential immunotherapies tied to uterine atony), a translational theme on how guidelines evolve, public health/advocacy, and a maternal mortality panel.

Programming includes split research and clinical tracks, updates on postpartum hemorrhage, and an emerging focus on fetal surgery.

More here: http://soap.org

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/

At the 58th Society for Obstetric Anesthesia and Perinatology (SOAP) meeting in Montreal, TopMedTalk guest host Desiree Chappell and co-editor-in-chief Mike Grocott interview Dr. Grace Lim, SOAP vice president/president-elect and new University of Utah department chair.

They discuss her priorities for her upcoming presidency, healthcare's shifting challenges, highlighting the Frederick W. Hehre Lecture_,_ from Valerie A. Arkoosh about a systems-focused career from obstetric anesthesiology to leading public health roles in Pennsylvania.

Lim emphasizes anesthesiologists as systems thinkers linking perioperative and perinatal care with population health and social determinants, and describes SOAP goals to improve representation, support community and rural sites lacking subspecialists, and ensure scalable, culturally sensitive care. She also cites sustainable funding and philanthropy efforts, including "Party With a Purpose." Lim outlines SOAP's ELEVATE Project on patient-centered cesarean anesthesia choices and notes maternal mental health as a key mortality driver. She summarizes a pilot study using Hemosphere monitoring during labor epidurals to detect hypotension trends and assess patient and nurse acceptability.

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/

Our coverage of The World Congress of Anesthesiologists (WCA) in Marrakesh continues.

Andy Cumpstey and Kate Leslie discuss high-risk surgical patients with anesthesiologists Debra Leung (The Peter MacCallum Cancer Centre, Melbourne) and Duminda Wijeysundera (St. Michael's Hospital, Toronto). They explore how "high risk" extends beyond mortality (noting ~2% elective major surgery mortality in middle/high-income countries) to complications, medical morbidity, cognitive and functional decline, return to independence, and psychosocial factors such as social support. They describe a structured shared decision-making clinic: triage and preparation before visits, explaining surgery as an explicit choice, eliciting patient values and goals, and matching them to clinical information; she notes training needs and barriers, especially surgical engagement, overcome via surgical champions and formalizing "corridor conversations."They outline practical risk communication (natural frequencies, meaningful language, focusing on major events, ranking vs average, and what's modifiable) and highlights evidence that patients may refuse interventions sooner for functional/cognitive decline than for mortality risk. The conversation emphasizes linking risk prediction to actionable care pathways, prehabilitation/posthabilitation, and frameworks for both modifiable and non-modifiable risk amid aging, increasingly complex surgical populations.

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/

At the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM) held in Auckland, New Zealand, Kate Leslie and Andy Cumpstey interview incoming ANZCA president Tanya Selak and incoming FPM Dean Michael Veltman about their goals in the next two years and the challenges ahead, and their appreciation of the hard work and commitment of fellows and trainees at the coalface.

Dr Tanya Selak is a consultant anaesthetist in Woolongong, Australia. Professor Michael Veltman is consultant pain medicine physician in Perth, Australia.

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Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood.

Register here -

https://ebpom.org/product/ebpom-world-congress-2026/