Central Line

Episode Number: 156

Episode Title: Inside the Monitor – The Road to and from the Perioperative Experience

Recorded: February 2025

 

(SOUNDBITE OF MUSIC)

 

VOICE OVER:

 

Welcome to ASA’s Central Line, the official podcast series of the American Society of Anesthesiologists, edited by Dr. Adam Striker.

 

DR. ZACH DEUTCH:

 

Hello, everybody, and welcome back to the Central Line Podcast. I'm your host for today's edition, Dr. Zach Deutch. I'm joined today by Drs. Mohammad Rafique and Igor Tkachenko, who are guest editors of the April issue of The Monitor. This is going to be on the subject of the perioperative experience, the road both to and from. So an all encompassing experience and an all encompassing topic which most of us are deeply involved in. I'm really excited to have both of these gentlemen with me today. Welcome to you both.

 

DR. MUHAMMAD RAFIQUE:

 

Thank you.

 

DR. IGOR TKACHENKO:

 

Thank you.

 

DR. DEUTCH:

 

Dr. Rafique. You've been here before, and we're well known to each other as members of the editorial board. But, Dr. Tkachenko, this is your first time with us, so I'd like to hear from both of you. But starting with you, give us a little background about yourself and what you're currently involved in professionally.

 

DR. RAFIQUE:

 

So I'm Doctor Mohammad Rafique. I'm a professor of anesthesiology and perioperative medicine at Loyola University School of Medicine in Maywood, Illinois. I specialize in pediatric anesthesia with a focus on delivering compassionate, high-quality care to our youngest patients. Beyond the operating room, I am deeply passionate about teaching, mentorship, and the use of simulation to advance the education and skills of future anesthesiologists.

 

DR. DEUTCH:

 

Can you introduce yourself to our listeners? Yes.

 

DR. TKACHENKO:

 

Thank you. Hello again. Yes, this is my first time here at podcast, and thank you so much for inviting me. I am an attending anesthesiologist and an associate professor at the Department of Anesthesiology at Loyola University Medical Center here in Maywood, Illinois. I'm also part of our pediatric anesthesiology section, and pediatric anesthesia is my primary area of expertise. Um, and also I am focused on medical education, specifically medical simulation. Yes. And together with Dr. Rafiq, we are part of our anesthesia, um, simulation curriculum.

 

DR. DEUTCH:

 

Very good. Thank you both. And we're going to get right into this topic. First to go forward, we're going to go back. We're a very technological society right now. Or at least we like to think of ourselves that way. And certainly we are in comparison to the past. So I'm going to ask you gentlemen, and I'm going to ask you, Dr. Rafique specifically, talk to us about the evolution of anesthesia and how we got to where we are and where we started. Um, you know, thinking back even to the days of the American Civil War with ether or alcohol or simply biting on a bullet to get things done?

 

DR. RAFIQUE:

 

Yes. Um, before anesthesia surgery was really a harrowing experience. And as you mentioned, that either alcohol or biting on the bullet or opium were used sometimes, but they were not enough relief. Surgery was performed on awake patients. They endured excruciating pain as surgeons operated and often racing against time to complete life saving procedures. The psychological trauma of surgery left many preferring death over the operating table. The breakthrough to this misery came in 1846, when Dr. William Morton demonstrated ether anesthesia during a surgery in Boston. For the first time, a patient went under a pain free operation. This was a revolution. Ether allowed for longer, more precise procedures, transforming surgery into a viable and humane option. Soon after, chloroform gained popularity, though it carried greater risks.

 

The 20th century brought rapid advancements. Early anesthesia machines improved delivery, while endotracheal intubation in the 1920s secured airways and enhanced surgery. The 1940s introduced muscle relaxants like curare, enabling lighter anesthesia with better surgical conditions. Halothane induced, introduced in the 1950s, became the first modern inhaled anesthetic, offering greater control and safety. The later half of the century focused on monitoring and specialization. Devices like pulse oximeters and capnographs provided real time physiological feedback, reducing complications. Regional anesthesia techniques such as epidural and spinal blocks became refined, and subspecialties like pediatric, cardiac or obstetric anesthesia emerged.

 

Today, anesthesia is safer and more precise than ever. Short acting drugs like propofol and sevoflurane minimize side effects and speed recovery, while ultrasound guided regional anesthesia allows for targeted pain management. ERA protocols optimize perioperative care and advanced monitoring tools like anesthesia depth monitors ensure patient safety and effective unconsciousness. The future seems even brighter with innovations like AI driven anesthesia and personalized care.

 

From its humble beginnings with ether to today's sophisticated practice, anesthesia has transformed surgery from a perilous ordeal into a safe, routine and lifesaving procedure. And I have to say here, the whole host of invasive cosmetic procedures are only possible because of the advances in safety and efficacy of anesthesia medications and techniques. This remarkable journey reflects the power of innovation and enduring commitment to patient care. In a nutshell, it is journey from agony to assurance.

 

DR. DEUTCH:

 

Mohammad, that's an excellent capsule summary, and I'm thinking we should almost condense it for social media posting and information by the ASA in general. So I appreciate that. And we'll move from that into our modern era. And Dr. Tkachenko, this will be addressed to you. Let's talk about what is our contemporary role in the OR. What are we doing now and how has that evolved, also looking back a little bit?

 

DR. TKACHENKO:

 

Thank you. Um, we all agree that the role of anesthesiologists and the operating room has always been pivotal. Uh, and that evolved along with the advancements in surgical technology and patient care. Today, anesthesiologists play a crucial role in highly complex procedures. We are utilizing techniques such as cardiac bypass, circulatory arrest, single lung ventilation, assisting with robotic assisted surgeries. As medical advancements have progressed, the idea of patients being quote unquote too sick for surgery has largely disappeared. We nowadays manage patients with significant comorbidities, and a good example of that is performing spinal fusion on a patient with single ventricle physiology. Additionally, we utilize a variety of airway management devices invasive, monitoring technique, intraoperative transesophageal echocardiography, all of that to enhance patient safety. The development of modern anaesthetic medications with a safety profile has allowed us faster and more reliable post-operative recovery, reinforcing the indispensable role of anesthesiologists in today's surgical care. From the moment the patient enters the operating room, I'll just manage anesthesia induction, airway control, hemodynamic stability. Throughout the surgery, we continuously monitor vital signs, adjust anesthetic depth, manage fluid balance, intervene in real time to address any complications. The expertise extends beyond anesthesia administration, of course, encompassing pain management, ventilation strategy, and intraoperative hemodynamic optimization. And also by maintaining constant communication with the surgical team and other OR staff, the anesthesiologist, we help to create a controlled environment where complex procedures can be performed safely and efficiently.

 

DR. DEUTCH:

 

Okay, also an excellent summary and I appreciate that. So we know that especially these days, it seems like almost anywhere can be an anesthetizing location. It's not just your standard OR, but it can be cardiology, interventional radiology, the emergency room, the ICU, you name it. So, Dr. Rafique, I'm going to ask you about operating rooms that aren't in the hospital, but in the ambulatory setting. These are obviously designed to minimize costs, maximize patient satisfaction by keeping them out of the hospital, getting them in, getting them out, but still getting them appropriate care, which is high quality. Talk to us generally about your views and impressions of surgery center care, ambulatory care, and the implications that it has for the overall picture of perioperative care in this country.

 

DR. RAFIQUE:

 

Yes. Very good question. Ambulatory surgery centers, or ASCs as we call them, have really revolutionized surgical care by offering efficient, cost effective, and patient focused outpatient procedures. Today's ASCs handle about 35 to 40% of all surgeries annually in the US. And procedures at ASC cost almost 40 to 60% less than in the main hospitals. So they save money to the patients and the hospitals, as well as they free hospital resources for more complex cases. According to a report, the ASCs save about more than 4 billion to Medicare annually. At the core of ASC success are anesthesiologists who not only ensure patient safety, but also play a pivotal role as leaders in surgical efficiency, innovation and quality improvement. So the costs can be cut but quality is maintained or even enhanced. Beyond clinical care, anesthesiologists are instrumental in developing and implementing protocols that enhance patient outcomes and streamline workflows. They lead initiatives such as ERAS, multimodal pain management, and opioid sparing techniques, all of which improve efficacy and reduce complications. Their expertise and resource optimization and OR scheduling help maximize case volumes while maintaining patient safety. Anesthesiologists also take the lead in staff training, crisis management, and quality assurance. By conducting simulation based training and emergency preparedness drills, they ensure surgical teams can respond swiftly to complications. Their role in infection control, sedation policies and standardization anesthesia techniques further enhances ASC. Safety and reliability. In addition, anesthesiologists influence ASC policy, accreditation and compliance with regulatory standards. Their leadership in benchmarking performance metrics and driving continuous quality improvement ensures ASCs maintain the highest standards of care while remaining financially sustainable. In a sense, I have to say, the ACSs exemplify modern, efficient surgical care, and anesthesiologists, as leaders in the center for perioperative medicine are their driving force. Through clinical expertise and visionary leadership, they ensure ASC continues to set the standard for excellence in outpatient surgery.

 

DR. DEUTCH:

 

Okay, so I like what you have to say, but I'm going to bring up a small point that I'd like to hear both of you comment on. And I'm going to ask you, Muhammad, to comment first, which all of us have encountered. And I'll just put it this way. It's like this in in quotes. I can't believe they want to do blank at the surgery center. Now you take it from there.

 

DR. RAFIQUE:

 

Oh, very good comment and question. Yes. Surgery centers, although they are very safe places to get surgery done, but they have their limitations. One of the biggest things is that the resources are limited there and the help is limited there. And at the end of the day, everybody goes home, which means that they shut the doors and go home. So there is nobody to take care of patients if a patient needs to stay there for longer or maybe overnight. So like patients who have certain comorbidities probably are not the candidates for surgery, like I would say, patients with very high BMI. In our surgery center here, we have a kind of cutoff of between 45 and 50. If somebody is that high, we probably prefer them to be in the main hospital. Somebody who has really bad comorbidities like cardiac issues or arrhythmias, or sometimes if somebody could need postoperative ventilation for several hours. Those are the kind of patients who may be going and undergoing a smaller procedure, probably are not the best suited for the ASCs because of their own safety.

 

DR. DEUTCH:

 

Okay, Dr. Tkachenko, I'm going to ask you to to give your commentary on that. And I'm also going to ask you to specifically relate to us. What was the most ridiculous thing that you've seen proposed, and did it happen or not happen?

 

DR. TKACHENKO:

 

That's a great question, and I agree with you and Dr. Rafique on the division of the ambulatory surgery center nowadays, that surgeons are trying to do things that are more complex and require higher level of anaesthetic care. Traditionally or historically, so to speak, surgery centers evolved as institutions that provide care to healthier patients for straightforward procedures. But with advancements, again getting back to technology and pharmacology, we can provide safer care for patients who are sicker with more comorbidities for more complex surgical procedures. Classic example of that, as you mentioned, is patients with higher BMI. And I'm afraid to say that that we're pushing the envelope further and further, and we need more evidence-based support for our practice in that aspect of anesthetic care. But overall, we know that we provide very safe care to all, all the patients with significant comorbidities and utilizing techniques like regional anesthesia avoiding systemic opioids. We make their care a lot safer and reliably can discharge them home on the same day.

 

As to the most ridiculous thing that I've ever heard or seen in the ambulatory surgery center, it's difficult to come up with a specific example. But sometimes, you know, when we do our preoperative assessment, just looking through the patient's chart, many of us are a little bit puzzled with the choice of ambulatory surgery center as the place to perform certain procedures, and we bring that to the surgical teams, discuss that with them. And we most of the time agreed on what we need to do, what is the safest way to provide care to those patients.

 

DR. DEUTCH:

 

Well, I was looking for the cheap laugh to get the story of the patient who was on ECMO, but they wanted to bring him over to do a cataract. But you guys did not oblige me, so we'll just move on. But I think…

 

DR. RAFIQUE:

 

I have an example of very close to that. Uh, once I was reviewing the charts and patient was scheduled to be at ask for a shoulder surgery, which is very common there. The patient had heart transplant and had a liver transplant, two transplants, and was quite inactive. And they wanted to bring him to surgery center and do the surgery and send him home. I was like, no, this is somebody who needs to be in the bigger hospital where all the specialties are around. If there is a need for a cardiologist to come by, or if there is a need for a cardiac anesthesiologist to come by and take care of him during the procedure, or give consultation and during the procedure, that is the place for him. So somebody like that? I don't think so.

 

DR. DEUTCH:

 

Well, hats off to you for being the first and last line of defense there, although I do actually have to give some kudos to whoever the transplant surgeons were, because if this guy is in a position where the biggest thing that's bothering him is his shoulder, they must have done something right. So I guess in a certain way, there's a silver lining to this.

 

DR. RAFIQUE:

 

That is true.

 

DR. DEUTCH:

 

So we'll move on. I think we covered that. And I thank you guys for your input there. Um, we'll talk a little bit Alpha and Omega here--pediatric and geriatric. These patient populations have unique challenges as we all know. Dr. Tkachenko, I'm going to ask you to discuss the challenges that come with these differing ends of our lifespan in terms of anesthetic and perioperative management. And you know, how they differ from each other and how they differ from adults in the middle.

 

DR. TKACHENKO:

 

That is a very important question. As part of a pediatric anesthesiology section, we provide care to pediatric patients and adult patients and very often geriatric patients. Pediatric and geriatric anesthesia presents very distinct perioperative challenges. Those require very tailored approach to ensure their safety and optimal outcomes. Pediatric patients are very often otherwise healthy, and we do many of those procedures in ambulatory surgery center, leading to a fast-paced condensed surgical schedule. However, psychological preparation is very crucial not only for the child but also for the family. Building trust with the patients and their families and alleviating their anxieties and fears is a very essential part of pediatric anesthesia care. I would say this is the art of pediatric anesthesia, so to speak. In contrast, geriatric patients typically have complex medical histories, and that necessitates very thorough chart reviews, extensive medical optimization, coordination with consulting services. Geriatric patients may be accompanied by extended family member or at times they may face surgery alone. This shifts our focus towards quality of life, shared decision making, and balancing surgical benefits with overall well-being of our geriatric patients. While both populations require very specialized care, the emotional and medical consideration for each are very different and that shape anesthesiologist role in the very unique way.

 

DR. DEUTCH:

 

Well, I don't like to hijack these sessions as the host, I like to let the guest speak, but I'm going to give a slight monologue since we're on the subject of pediatric and geriatric. On the subject of pediatric, I just want to say you guys mentioned earlier single ventricle patient for complex spine surgery. And I just wanted to say I'm really glad people like you are doing that, because I sure as heck don't want to do it. And I'm glad we've got some pediatric experts that can really do some serious stuff. So that was what did I want to say about pediatric. Um, as far as geriatric goes, one of the things that I find puzzling is treating patients at extreme of age in the sense that they're there at the end of their natural lifespan, regardless of any comorbidities, medical or surgical. For example, I mean, you get to be like, I don't know what our life expectancy currently is in this country, but I think we'd all agree when you're 90 plus, you could die of natural causes in your sleep at any time, and that would be an appropriate biological event. So for example, last night we treated a patient who was 97 years old for a hip fracture, and the patient did quite well, as they often do in this situation. And I found myself thinking the whole thing seems a bit absurd because the patient could literally die in their sleep tonight, unrelated to anything that had been done in the perioperative setting. And then, of course, we all know what would happen. The patient would be coded and all these interventions would happen. And I found it just very, very troubling. And I also it also made me think, and we'll get to this in another question, that we really haven't figured out how to approach end of life in this country. So that's my monologue from the beginning and the end. And if you guys have anything you want to add to that, I'd be happy to hear it as well.

 

DR. RAFIQUE:

 

Yes. Uh, very rightly said, you're spot on in this situation that a lot of our seniors present for care. And sometimes there are surgeries which really look absurd, that these surgeons want to perform surgeries on these patients who are never going to walk or they're never going to ambulate, but because there is a fracture, we need to fix it kind of surgeons are out there.

 

DR. DEUTCH:

 

Dr. Tkachenko, any thoughts?

 

DR. TKACHENKO:

 

Yes. I think this is a very important part of our discussions with the patients and their families, because we very often put life expectancy as the first priority and quality of life a little bit aside. And the families look at us for suggestions for our expert advice. They look at their primary care physicians, and very often it's a very difficult decision. Many of us face that during our lifetime, you know, with our older relatives at some point. But sometimes I feel to make a good decision, you really need to know medicine. You almost need like to have a degree in healthcare, because knowing about complications and seeing complications is very different. When we mention during discussions about surgical consent, anesthesia consent, we mentioned those complications. But very often the patients and family members don't really have great idea about how difficult their post-operative period might be.

 

DR. DEUTCH:

 

Yes. Well said. And I've often thought that having worked, as many of us have to get appointments for myself, my kids, my wife, friends, by knowing people, by having the cell phone numbers of proceduralists, how difficult it must be to navigate the system as, quote, an outsider. So I think that's a very good point and could be the topic of a whole, I mean, probably a whole issue of the ASA Monitor and multiple podcasts as well. But since we've kind of touched on one of my pet topics, which is the inherent absurdity of much of American medicine, I would like to look abroad and I'd like to hear from both of you. But, Mohammed, I'd like to hear from you first. Talk about the role of anesthesiologists, perioperatively and otherwise in countries outside the US.

 

DR. RAFIQUE:

 

Thank you very much. A very good question. Uh, any operative care in and the role of anesthesiologists varies significantly across the world and is shaped by the differences in healthcare infrastructure, workflow, distribution, training, and resource availability. While anesthesiologists play a central role in ensuring patient safety and optimizing clinical outcomes, the scope of their responsibilities differs based on the region's healthcare system and economic status.

 

For example, in high income countries, anesthesiologists are deeply integrated into all phases of perioperative care, including preoperative risk assessment, intraoperative management, postoperative pain control, controlled and critical care. They often lead initiatives for patient improvement and care improvement like multimodal analgesia, ERAS, and other perioperative medicine programs. They work collaboratively with surgeons and other specialists to optimize patient outcomes. Advanced health care systems allow for subspecialization in areas such as regional anesthesia, cardiac anesthesia, or pediatric anesthesia, and further expand their role. Anesthesiologists in these settings are actively involved in quality improvement, patient safety, and healthcare policy development.

 

In low and middle income countries. Access to anesthesiologists is often limited, leading to significant disparities in perioperative care. Many regions rely on non-physician anesthesia providers, such as anesthesia nurses or other non-physician extenders to deliver anesthesia services due to workforce shortages. Perioperative care is frequently constrained by limited resources, outdated equipment, and a higher burden of untreated comorbidities, making anesthesia riskier. Anesthesiologists in these settings often take on broader responsibilities including critical care, trauma management, and training of non-physician providers to expand access to safe anesthesia care.

 

Global health organizations have focused on these disparities by training programs and capacity building initiatives. Cultural and systemic factors also influence perioperative care. In some countries, preoperative optimization is limited due to delayed healthcare access. A lot of times, anesthesiologist is the first doctor these patients see in their lifetime when they come for an urgent and emergent surgery leading to higher perioperative co-morbidities and mortality. Post-operative pain management also varies significantly. In high income countries, they are devising different techniques such as opioid sparing or regional anesthesia or other initiatives. But in low and middle income countries, a lot of times no pain medicine is available and pain totally goes untreated. Despite these differences, the role of anesthesiologists as advocates for patient safety and surgical outcomes remains universal. Efforts to strengthen perioperative care globally continue through training programs, telemedicine initiatives, and international collaboration aimed at reducing anesthesia related disparities and improving surgical safety worldwide.

 

DR. DEUTCH:

 

And Muhammad, I remember from our previous discussions that you had trained in Pakistan and worked there maybe for a few years before coming to this country. Do you have experience working or via medical missions or anything else in any other countries besides those two.

 

DR. RAFIQUE:

 

I did work a little bit in Middle East and Saudi Arabia, and I have done mission trips to Pakistan. And what I saw, I would say in Saudi Arabia, although it is a rich country in a sense of economic status, but it lacks trained professionals. The only way for them to get trained professionals is from foreign. They hire doctors from the West like US or Europe. They hire a lot of doctors from other Middle Eastern countries or Asian countries where education is there. But because of economic constraints, people want to go abroad. So you will see in Saudi Arabia, a lot of physicians who trained in different parts of the world, and they come there for work. Uh, one of the biggest problems I noticed there that there is a lot of times there is a lack of cohesion between different parts of the care for a patient. Sometimes the team building is challenging because of language barriers, and other cultural barriers sometimes make it difficult, and in the end it is usually the patient who is suffering. And while doing mission trips in Pakistan, I saw a lot of misery. We regularly used to go to Pakistan for pediatric cardiac surgeries, and you would go there for a 6 or 7 day period, and wherever you are, you look outside and there is like a thousand people gathered and they all want their kid to be seen and operated in the seventh day. At least that is their hope. And that always broke my heart that this is something which all these people deserve. But for known and unknown reasons, they cannot get that care. And they have their hopes that this team who came from a different country will take care of their loved one.

 

DR. DEUTCH:

 

Yes. And I think that point, especially for someone like myself that grew up with the very, you know, I would, I would say privileged background in the sense that I never had to worry about these type of things in terms of, you know, shelter, food, education, having a family that cared. So I always take these moments to say, no matter what faith you are, what whatever belief system you have, count yourself lucky for the things that you have that are so important. So absolutely. I'm reminding myself of that, listening to what you've said.

 

DR. RAFIQUE:

 

Um, absolutely. We are very privileged and very lucky to be living in this society, in this country where everything is definitely available and accessible one way or the other.

 

DR. DEUTCH:

 

Now, Dr. Tkachenko, I'd like to hear from you as well. And I'm going to guess from your last name that you have some experience in Ukraine or that part of the world, and I'd like to hear about your experiences abroad and in this country and your thoughts about, you know, international medicine from a pragmatic and personal experience perspective.

 

DR. TKACHENKO:

 

Yes. Thank thank you so much. Indeed, I did my medical school and started my medical career in Ukraine, and I've been working here in the United States for almost 30 years. I constantly remind myself how lucky we are, providing cutting edge healthcare to our patients, and being able to meet all the challenges that we face nowadays with patients being sick and complex surgical procedures. I always think when we bring the arterial blood gas machine to the operating room and check blood gases on the spot, I always think about when I started my medical career in one of the pediatric intensive care units, we got that large arterial blood gas machine that was donated by one of the German hospitals, and we were calibrating that every morning, and in a couple of months we ran out of, um, supplies for that. So we were not able to check blood gases any longer. Luckily, we had another shipment of supplies, but it was such a tremendous improvement of our ability to provide care to sick children. And every time I step in the operating room and provide care to our patients, I feel how lucky we are.

 

DR. DEUTCH:

 

And this is why I'm grateful to be in medicine, as well as to meet people with different backgrounds so that I can get more of a window on the world than I've gotten just from from my life and my travels so far, which have been compared to others, somewhat limited. Um, out of curiosity, have you done any mission work or any type of work outside of this country since that time, 30 years ago, when you transitioned to living here and working here?

 

DR. TKACHENKO:

 

No, unfortunately, I didn't have an opportunity to do that. But many of my coworkers here at Loyola and at my previous job at the University of Chicago did that. And I clearly early how helpful and enlightening that experience was for them. We had one of our CRNAs who went on a mission trip a couple of years ago, and she presented at our grand round her experience in, I believe it was in Colombia. It was very exciting for all of us to see how we bring advances in patient care to the countries that have limited access to patient care.

 

DR. DEUTCH:

 

Yes, agreed. I've seen staff members, whether they be physicians or nurses, come back from trips and do AV presentations, and it's just so great because you can really get a sense like this is what their sterile processing looks like. This is what the recovery room looks like. This is the equipment you have to work with. And that just really drives the point home. So those are always excellent educational and not just educational, but delivering perspective experiences that are good for everybody.

 

Um, okay, gentlemen, we're coming to the end here. And I'm going to I want to hear from both of you, having worked together to edit this issue of the Monitor and obviously thought deeply about this topic. Talk to our listeners and potential readers of that issue. What do you feel are the most important takeaways? What are the bullet points they really need? What things do you feel most passionate about? And Muhammad, I'm going to start with you.

 

DR. RAFIQUE:

 

So I would say the pursuit of excellence and innovation has been key to the progress which has been made in the perioperative care in the last two centuries, and the same desire to excel and the same desire to innovate will take us to the next step, whatever it is for tomorrow. So until and unless we continue to believe in excellence and keep innovating, we will keep progressing and surgery and anesthesia will become even more safer and, uh, a better experience for the patient, um, in the coming days.

 

DR. DEUTCH:

 

And Dr. Tkachenko, your thoughts? Yes.

 

DR. TKACHENKO:

 

To me, it's very important. And I feel for all of us to embrace the role of being not just intraoperative physicians, but being more involved in perioperative care. Um, anesthesia extends far beyond intraoperative management. It is a very comprehensive, patient centered approach that begins well before the first dose of anaesthetic is administered. And effective perioperative care starts with a thorough preparation assessment, very thorough review of patient's medical history, developing of very individual strategies to optimize their conditions. As anesthesiologists, we evaluate risk factors in their cardiovascular disease, pulmonary conditions, genetic metabolic disorders. We create very tailored perioperative plan and this may include managing their hypertension, optimizing glycemic control many, many other things. And that detailed evaluation and interdisciplinary approach interdisciplinary collaboration, as anesthesiologist, we ensure that patients enter the operating room in the best possible condition. You know, we very often have that discussion with surgical teams or conversations, so to speak, about what we can do to better optimize patients and ultimately improving surgical outcomes and minimizing intraoperative risks are the most important goal of perioperative management. I think this is a very important part of our practice, and this is the big aspiration for me and for all of us.

 

DR. DEUTCH:

 

Agreed. It all comes down to risk benefit. The biggest simplification you could ever make, because the patient is at the center and everything else should be secondary to that.

 

DR. RAFIQUE:

 

Absolutely.

 

(SOUNDBITE OF MUSIC)

 

DR. DEUTCH:

 

It's been great speaking with both of you. Thank you for joining us on this edition of Central Line Podcast. You gentlemen are obviously learned and passionate and articulate, and I look forward to reading the April edition of the ASA Monitor.

 

For our listeners out there, you can always go to asamonitor.org for more information on this topic or other topics that might be of interest to you. We look forward to seeing you next time on the Centerline podcast. Take care.

 

DR. RAFIQUE:

 

Thank you very much. Zach.

 

DR. TKACHENKO:

 

Thank you. Thank you so much.

 

VOICE OVER:

 

Create and Improve Systems for Perioperative Care with CPMed Perioperative Medicine Highlights 2025. Delve into ten sessions from anesthesiology 2024 that address managing concurrent diseases, aging patients, and perioperative clinics. Visit asahq.org/cpmed to learn more.

 

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