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Biomedical subjects

P Baele

Publications and source records attributed to P Baele.

At least 19 recordsLinked to original sources
PubMed2003

Occupational stress and burnout in anaesthesia.

BACKGROUND: Formal studies on stress in anaesthetists have usually measured stress through mental or physiological indicators. When using this approach, one must be careful not to confuse the effects of stress or outcome variables and the sources of stress or antecedent variables. To date, it seems from the literature that there is no clear evidence of a common pattern of physiological effects of stress for all the sources of stress. Furthermore, work characteristics such as job satisfaction, job control and job support may moderate the effects of stress. METHODS: We measured the effects of stress together with the sources of stress and job characteristics, using self-reported questionnaires rather than physiological indicators in order to better diagnose stress in anaesthetists. RESULTS: The mean stress level in anaesthetists was 50.6 which is no higher than we found in other working populations. The three main sources of stress reported were a lack of control over time management, work planning and risks. Anaesthetists reported high empowerment, high work commitment, high job challenge and high satisfaction. However, 40.4% of the group were suffering from high emotional exhaustion (burnout); the highest rate was in young trainees under 30 years of age. CONCLUSIONS: Remedial actions are discussed at the end of the paper.

Adult↗
PubMed2000

Application of tRNA intergenic spacer PCR for identification of Enterococcus species.

tRNA intergenic spacer PCR (tDNA-PCR) was evaluated for its usefulness in the differentiation of enterococcal species of human and animal origin. This technique was carried out for 124 strains belonging to 17 enterococcal species and generated DNA fragments, which were separated by capillary electrophoresis. tDNA-PCR enabled us to discriminate for all species tested. Enterococcus faecium showed minor but reproducible differences with Enterococcus durans, while Enterococcus hirae was easily distinguishable. Enterococcus avium, Enterococcus malodoratus, and Enterococcus raffinosus generated highly similar though distinctive patterns.

Animals↗
PubMed1998

Blood transfusion practice in Belgium. As assessed by a national survey.

In April 1995 the Ministry of Public Health invited all Belgian hospitals to participate to a survey on the use of blood transfusion. The questionnaire presented two parts, the first one devoted to products transfused and the second one to the transfusion organisation in the hospital. 71 hospitals answered: 7 university and 64 general hospitals. All hospitals reported the use of red cells, 31 of them still used whole blood. Surgical departments transfused the greatest absolute amount of units, but the highest intensity (units/bed/year) was observed in intensive care units. 52 hospitals mentioned the use of autologous predeposit. The highest consumption of platelets occurred in medicine but intensive care showed the highest intensity of platelet transfusion. In 41 hospitals platelets were obtained by cytapheresis. The number of plasma units transfused was highly correlated with the quantities of packed red cells and whole blood transfused. Ten hospitals didn't report the use of any blood conservation technique. Returning unused units to the blood bank was allowed in 80% of the hospitals, their return to the transfusion center was permitted in 65% of the hospitals. A transfusion committee existed in only 11 hospitals. Transfusion should be improved by a better education of all physicians and nurses involved with transfusion and by improving standardisation, by better documentation, better reporting and information of all health care workers involved.

Belgium↗
PubMed1998

Current anesthesia manpower in Belgium in relation to anesthesia work locations.

Two inquiries were conducted in 1995 and 1996 involving all anesthesiology departments in Belgium. The response rate was 57%. One aim of these surveys was to estimate the anesthesia manpower and the number of anesthesia work locations in each hospital, by hospital size and by region. In the operating theater, between 0.77 and 2.24 physicians (full time equivalents) were available per operating room. When considering also anesthesia in remote locations outside the operating theater, and the availability of fully trained physicians and trainees (efficiency estimated as 75% of a fully trained specialist), the ratio decreases to between 0.48 and 1.25, the highest ratios being found in larger hospitals (> 650 beds). When physicians currently in anesthesiology training will have graduated the mean availability of anesthesiologists per anesthesia work station will be 0.87 in Belgium, vs 0.52 in 1996.

Anesthesia Department, Hospital↗
PubMed1998

Can we predict the future evolution of anesthesiology workforce in Belgium?

Two models are proposed to predict the evolution of anesthesiology workforce over the next 20 years. Each model features various scenarios according to different assumptions related to future numbers of female anesthetists, working hours, or regulations for postgraduates' working for conditions. However the main uncertainties derive from the unknown evolution of demands. Despite their differences both models agree on several important conclusions: a 13 to 14% shortage of anesthesiologists currently exists to satisfy O.R. demands, this shortage will decrease over the next ten years, and after 2010 a new shortage could arise under the combined pressure of the numerus clausus, of the number of female anesthesiologists and of the aging of the still young population of anesthesiologists.

Age Factors↗
PubMed1997

Clinical evaluation of Duraflo II heparin treated extracorporeal circulation circuits (2nd version). The European Working Group on heparin coated extracorporeal circulation circuits.

OBJECTIVES: To evaluate whether the application of heparin treated circuits for elective coronary artery surgery improves postoperative recovery, a European multicenter randomised clinical trial was carried out. METHODS: In 11 European heart centers, 805 low-risk patients underwent cardiopulmonary bypass (CPB) with either an untreated circuit (n = 407) or an identical but heparin treated circuit (n = 398, Duraflo II). RESULTS: Significant differences were found among participating centers with respect to patient characteristics, blood handling procedures and postoperative care. The use of heparin treated circuits revealed no overall changes in blood loss, blood use, time on ventilator, occurrence of adverse events, morbidity, mortality, and intensive care stay. These results did not change after adjustment for centers and (other) prognostic factors as analysed with logistic regression. In both groups no clinical or technical (patient or device related) side effects were reported. Because female gender and aortic cross clamp time appeared as prognostic factors in the logistic regression analysis, a subgroup analysis with these variables was performed. In a subpopulation of females (n = 99), those receiving heparin treated circuits needed less blood products, had a lower incidence of rhythm disturbances and were extubated earlier than controls. In another subgroup of patients with aortic cross clamp time exceeding 60 min (n = 197), the amount of patients requiring prolonged intensive care treatment (> 24 h) was significantly lower when they received heparin treated circuits versus controls. CONCLUSION: These findings suggest that improved recovery can be expected with heparin treated circuits in specific higher risk patient populations (e.g. females) and when prolonged aortic cross clamp time is anticipated. Further investigations are recommended to analyses the clinical benefit of heparin treated circuits in studies with patients in different well defined risk categories and under better standardised circumstances.

Adult↗
PubMed1995

Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery.

Anesthetic, sedative, and analgesic drugs have been shown in animals and humans to selectively impair upper airway muscle activity. In patients with an already compromised upper airway, these drugs may further jeopardize upper airway patency, especially during sleep. Thus, patients with obstructive sleep apnea syndrome (OSAS) are at high risk for surgery because of the use of the aforementioned drugs in the perioperative period. It has been recommended that such drugs should be avoided or used with extreme caution in patients with OSAS submitted to surgery. We report herein on 16 adult patients with documented OSAS undergoing various types of surgical procedures, including coronary artery bypass surgery. Anesthesia was carried on with the usual type of drugs for each type of surgery. Postoperative opioid analgesia and sedation were not restricted. The first patient, whose OSAS was diagnosed but not treated, died after various complications, including a respiratory arrest in the ward. The second patient experienced serious postoperative complications until a treatment for OSAS with nasal continuous positive airway pressure (N-CPAP) was instituted, and thereafter he made an uneventful recovery. The 14 following patients were started on N-CPAP before surgery, were put on N-CPAP as soon as extubated, on a near-continuous basis, for 24 to 48 h and thereafter for all sleep periods. None of them had major complications. The intensive care unit and hospital stays were the normal ones for each type of surgery in our institution. We conclude that N-CPAP started before surgery and resumed immediately after extubation allowed us to safely manage a variety of surgical procedures in patients with OSAS, and to freely use sedative, analgesic, and anesthetic drugs without major complications. Every effort should be made to identify patients with OSAS and institute N-CPAP therapy before surgery.

Adult↗
PubMed1994

The use of somatosensory evoked potentials to determine the optimal degree of hypothermia during circulatory arrest.

We sequentially recorded subcortical (P14) and cortical (N20) somatosensory evoked potentials (SEPs) in 32 patients undergoing deep hypothermic circulatory arrest (CA). Under normal hemodynamic conditions, hypothermia initially produced N20 disappearance at a mean nasopharyngeal temperature of 20.4 +/- 2.6 degrees C (range 14.5 to 26.1 degrees C) and P14 disappearance at a mean of 16.9 +/- 2.0 degrees C (range 12.4 to 20.2 degrees C). On rewarming, P14 reappeared at mean temperature of 19.3 +/- 4.0 degrees C (range 13.5 to 29.2 degrees C) and N20 at a mean of 21.1 +/- 4.1 degrees C (range 14.3 to 29.6 degrees C). The delay of SEP reappearance after restoration of blood flow correlated significantly with CA duration (r = 0.74 for P14, and r = 0.62 for N20; p < 0.01). Neurological recovery was uneventful in 23 patients; 5 patients presented with neurological sequelae (minor or transient in 4; no recovery from anesthesia and death after 48 hours in 1), and 4 patients died during operation. Twenty-three of 24 surviving patients in whom P14 disappearance was the criterion that hypothermia was deep enough to perform CA (duration: 17 to 94 min) had a normal neurological outcome. By contrast, all surviving patients in whom cortical SEPs disappeared at higher temperatures presented neurological sequelae. In conclusion, the neurophysiological monitoring of brain stem activity, as specifically provided by SEPs, enables determination of the optimal temperature for CA, and demonstrates superiority of SEP monitoring over the use of EEG.

Adult↗
PubMed1993

[Somatosensory evoked potentials in patients undergoing circulatory arrest under profound hypothermia].

The surgical repair of ascending aorta aneurysms can only be carried out under total circulatory arrest, and is consequently to be performed under deep hypothermia, in order to adequately decrease the metabolic requirements of the brain. However, the optimal temperature to be reached is poorly known. SEPs to median nerve stimulation were recorded in 21 operations performed in 20 patients undergoing profound hypothermia. The latencies of all SEP components increase to 21 degrees C. Waves N20 and P14 disappear at mean naso-pharyngeal temperatures of 20 degrees C and 17 degrees C, respectively, although a wide inter-individual variability was observed. We suggest to use the P14 disappearance as the criterion to perform the circulatory arrest: in fact, all surviving patients in whom this criterion was fulfilled recovered without any detectable neurological sequellae, while three patients in whom brain activities disappeared independently on body temperature presented with neurological sequellae. Moreover, particularly if patients presenting with ischemia-induced disappearance of Erb's point activities were excluded, we found a significant correlation between the duration of the circulatory arrest and the delay of N20 and P14 reappearance on rewarming. This confirms the importance of sufficient hypothermia, on the one hand; and on the other hand, our findings imply that, even if SEP monitoring considerably decreases the risk of neurological sequellae associated with these operations, the duration of the circulatory arrest should be reduced as far as possible.

Adult↗
PubMed1991

The effects of halothane, enflurane, and isoflurane on the length-tension relation of the isolated ventricular papillary muscle of the ferret.

The effects of halothane, enflurane, and isoflurane on the length-tension relation were investigated in papillary muscles of the right ventricle of adult male ferrets at 30 degrees C. Isometric twitch contractions were obtained at lengths ranging from the shortest length yielding the greatest active force development under isometric conditions (Lmax) to 86% of Lmax, in two consecutive protocols: first in [Ca2+]o ranging from 0.45 to 2.25 mM, and then in [Ca2+]o 2.25 mM before, during, and after exposure to incremental concentrations of halothane (n = 9 muscles), enflurane (n = 9 muscles), and isoflurane (n = 9 muscles), each in steps of 0.25 MAC to total concentrations up to and including 1.5 MAC. Each of the three anesthetics caused a concentration-dependent decrease in developed force. The relative extent of the negative inotropic effect was not different at various muscle lengths. Because myofibrillar Ca2+ responsiveness (Ca2(+)-affinity of troponin C) decreases at shorter muscle lengths, the results suggest that an alteration in myofibrillar Ca2+ responsiveness by volatile anesthetics is minor relative to the anesthetic-induced decreased intracellular Ca2+ availability in ventricular myocardium.

Animals↗
PubMed1991

Bacteriologic quality of intraoperative autotransfusion.

Controversies remain about the bacteriologic aspects of intraoperative blood salvage despite the widespread use of this technique. In this prospective study, intraoperative salvaged blood was cultured in 401 patients, according to a direct plating technique. Bacterial growth was detected in 12.7% of cases. These results were compared with those obtained in control studies with sterile water and blood bank units under the same culture conditions. Most microorganisms were coagulase-negative staphylococci, followed by other skin and environmental contaminants. Quantitative estimates of contaminations showed low counts of colony-forming units (CFU/ml): 82% of positive cultures yielded 1 or 2 CFU/ml and 6% had 5 to 20 CFU/ml. Patients were followed up for a minimum of 3 months to detect septic complications. No statistically significant correlation could be found between bacteriologic results of autotransfused blood and infectious complications. This study suggests that bacteriologic monitoring of patients who have undergone autotransfusion may help in detecting surgical field contamination. It also confirms that intraoperative autotransfusion adds little septic risk to cardiac surgery.

Bacteria↗
PubMed1990

A novel preservation medium protecting prostacyclin production and endothelial integrity of the human saphenous vein graft.

Patency rates of coronary artery saphenous vein bypass grafts can be as low as 50% in the first year after surgery. Of these occlusions, 70% can be attributed to mural thrombus formation. Improvements in surgical handling techniques and in preservation media have improved patency rates, as has the introduction of perioperative antiplatelet therapy. The authors describe a novel preservation medium consisting of heparinized blood from the patient, papaverine and dipyridamole. This medium enhances prostacyclin production and maintains endothelial integrity in preserved saphenous vein segments.

Blood Physiological Phenomena↗