Saturday 9th December 2023
I am pleased to see that Dr Ross Kerridge of Newcastle Hospital NSW and Dr Hilmy Ismail from the Peter Mac Hospital in Victoria are both invited to the UK to talk at the upcoming EBPOM meeting in 2024.
My congrtatulations to them as represenatives for Australia
Dr Paul Older
Friday 27th October 2023
The Peter Mac Hospital is proud to host Professor Mike Grocott, Professor Sandy Jack and Associate Professor Malcom West who are lecturing at a conference on CPET being held currently at that famous Hospital. Professor Bernhard Riedl and Dr Ismail have been staunch supporters of the use of CPET for assessment of surgical patients for many years at the Peter Mac.
For some time the Peter Mac has been training people in the performance and interpretation of CPET tests. This is expanding the use of such a method to evaluate surgical risk in the elderly throughout Australia. CPET is now the “Standard of Care” for preoperative evaluation of surgical patients in the UK. One can only hope that this technique will become more and more accepted in this country.
Dr Paul Older
Australia is a very large country but the main centre for CPET is in Melbourne where the pioneering work of Dr Older and Dr Hall on preoperative analysis of operative risk was performed. The work still continues but the laboratory at the Western Hospital is now headed up by Dr Simon Frenkel. He is a Respiratory Physician but has a major interest in preoperative CPET. He is strongly supported by Dr Robert Smith, an anaesthetist, who was also involved in the original work. Dr Hall has moved to Brisbane and we hope to hear from him from time to time.
We get enquiries from many centres on just how we perform our tests on surgical patients. Firstly we do not push the elderly patients to their peak VO2 as we are more interested in the anaerobic threshold. The average age of our patients is 64 and despite thousands of patients being tested we have not had anyone collapse. We have had a few patients develop an SVT but we always stop the test if that occurs. I do not believe that attempting to obtain peakVO2 in surgical patients adds to the study in diagnostic terms. I am aware that some centres find that peakVO2 of greater value in surgical risk assessment. We do not. Either way both the AT and peakVO2 are measures of aerobic capacity.
The average ramp for our patients is 15 watts per minute and most of the tests last about 6 minutes after unloaded cycling. It is very uncommon for us not to obtain the anaerobic threshold but that is not the only thing we examine. The oxygen pulse, the VO2 /work rate relationship and the ventilatory equivalents are also important.
There is an increasing interest in CPET from the surgeons and disappointingly not such an increase in interest by the anaesthetists. There is no doubt that this test has a lot to offer in analysis of operative risk. We have recently had a visitor from the UK working with us and he left very impressed. It is important to combine the CPET with a preoperative assessment clinic staffed by Consultant Anaesthetists.
As we get more queries from around the world I will pass on the information to you.
Try to join ‘CPX International Inc’ and you will get regular updates on papers relevant to CPET.
Dr Paul Older
MD, MB BS, LRCP MRCS, FRCA, FANZCA, FCICM
Executive Director CPX International Inc