Discover and read the best of Twitter Threads about #periop

Most recents (7)

Our new meta analysis led by @SylvieAucoin now out in @_Anesthesiology. Seems like a good time for a thread on choosing a frailty instrument for #periop care 1/
2/ There are dozens of frailty instruments (big problem) but in reality 4 are commonly used: Frailty Index, Frailty Phenotype, Clinical Frailty Scale, Edmonton Frail Scale
3/ All 4 Frailty instruments predict/are associated with bad outcomes. Effective sizes vary but are not substantively different. Discrimination generally moderate, calibration WAY under-reported
Read 9 tweets
By request (incl @afedwardMD @SaraJPharmD @bethgarbitelli), a #periopmedicine #tweeetorial #MedThread about marijuana management

This is one of my longer tweetorials—there’s a lot to cover!

Also, no silly weed or "high" GIFs…my purpose here is to teach, not stereotype...

1/N
Why do we need to ask about how we can best manage marijuana use perioperatively?

❇️ use is increasing
❇️ multiorgan effects
❇️ potential for intoxication or withdrawal
❇️ interaction with anesthetic agents
❇️ risk of postop complications

2/N
What do we mean when we say “marijuana”?

the Cannabis plant (species incl sativa, indica, & ruderalis), which contains > 500 chemical compounds, 100+ of which are “cannabinoids”

Potential ”medicinal” effects:
Antiemetic
Muscle relaxant
Anticonvulsant
Analgesic

Photo Wiki

3/N
Read 28 tweets
Welcome back! Time for #tweetorial part 2 of #periopmedicine meets #meded
This time? #GME!
I’m going to continue to look at this through the lens of my experience practicing perioperative medicine as an #IMproud internist

1/N
Let’s start with an “origin story”.

Do you know what my first exposure to the concept and question of “is this patient of an acceptable risk to proceed to the OR?” Was?

Want to take a guess?

2/N
It was on a hepatology elective! We were consulted to inform #periop risk discussions for a young patient with cirrhosis scheduled for an open abdominal surgery (fyi, this can be high risk)
It was a lightbulb moment for me as an IM resident!
Periop wasn’t just cardiac…
3/N
Read 24 tweets
#periopmedicine #tweetorial time!
Thank you for the votes—“clinical pearl” was the clear front runner, so here we go—with a TWIST!

HOW & WHY can you utilize the periop space to clinically TEACH

That’s right, this is a #periop #meded #medthread!

1/N
This is going to be a 2-parter, because I have that much to say.
Stay tuned for #tweetorial part 2 later this week

I’m hoping to be comprehensive and apply a broad arc about #meded to #periopmedicine

Today we start with #UME (medical students), later #GME
2/N
For starters, what are your current thoughts on teaching in the #perioperative setting?
3/N
Read 24 tweets
#Periopmedicine #Medthread!
Based on requests (esp @JenniferBrokaw), a long over-due #tweetorial with my advice & pearls for providing patient-centered care for the surgical patient with #ParkinsonsDisease
1/x
@JenniferBrokaw Caveats
1⃣I’m not an anesthesiologist & don’t care for pts w PD #intraoperatively
2⃣I practice outpatient #PREoperative medicine, so I am not providing inpatient postop care
3⃣There are several high yield publications/resources, & much of this is pulled from my own experience
2/x
@JenniferBrokaw Caveats out of the way, let’s chat about why understanding #periop #ParkinsonsDisease management is so foundational.
Remember how Osler said to know syphilis is to know all of internal medicine?
Yeah…PD meets #periopmedicine is potentially THAT informative.
3/x
Read 28 tweets
Followup #Medthread #Tweetorial about #periop med management as promised!
Thank you to all who voted.
So...the answer was an MAO-I.
all the agents are ones to stop pre-op, but why was MAO-I the answer I was going for?? 1/x
First choice was Ephedra--definitely something to stop pre-op given it's sympathetic effect and risk of cardiovascular instability.
HOWEVER, Ephedra was banned by the FDA in 2/2004, so I haven't seen a patient on this in the preop setting in years 2/x
thinking about Ephedra is a good opportunity to this about herbal/nutraceutical/supplement management periop, given hypothetical or KNOWN risk of:
✅cytochrome up/down regulation
✅cardiovascular instability
✅changes to platelet/coagulation function
✅drug/drug interactions 3/x
Read 13 tweets
A quick, spontaneous Saturday #tweetorial #Medthread about periop OSA inspired by @cacace_frank's journal catch up (w my first response below). Going to make this interactive (& tag #periop hospitalists & anesthesiologists along the way)... 1/x
@cacace_frank rightfully so, #periop OSA is getting more and more attention. It, and the company it keeps (OHS, PHTN, R heart failure) are driving periop risk factors, for respiratory events (resp failure, esp with opioids on board) AND cardiac events 2/x
@cacace_frank society guidelines recommend screening for OSA pre-op (ex. STOP-BANG), but what do you do with a positive screen? recall, it only takes 3/8 points on STOP-BANG to get to "high risk". It's a patient risk/benefit AND systems-based Q re utilization of/access to sleep studies...3/x
Read 19 tweets

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