PubMed Health⌕ Search

Biomedical subjects

P Baele

Publications and source records attributed to P Baele.

35 records · Page 2Linked to original sources
PubMed1989

Hyperbilirubinemia does not interfere with hemoglobin saturation measured by pulse oximetry.

This prospective clinical study evaluated the influence of high bilirubin plasma levels on the Nellcor pulse oximeter readings (SpO2). Twenty-nine icteric patients (mean total bilirubin 19.2 mg/dl, range 2.3-84.3 mg/dl) were compared with 46 controls. The difference between SpO2 and oxyhemoglobin percentage of hemoglobin (HbO2corr) or fractional saturation as measured by a seven wavelengths Corning Co 2500 Co-oximeter and corrected for the spectral error induced by hyperbilirubinemia in that co-oximeter was greater in icteric patients (bias and precision: 2.9% +/- 2.2% vs. 1.7% +/- 2.7%, P less than 0.03). However, icteric patients had also higher corrected carboxyhemoglobin levels (CoHbcorr) (1.8% +/- 0.7% vs. 1.3% +/- 0.8%, P less than 0.005) due to production of carbon monoxide during the catabolism of hemoglobin. Pulse oximeters read most of CoHb as oxyhemoglobin. After correcting SpO2 for carboxyhemoglobin in both groups of patients, the 99% confidence limits from the obtained regression line were the same in icteric patients (-0.81%, 1.03%) as in controls (-0.89%, 1.08%). There was thus no demonstrable direct influence of high bilirubin plasma levels on SpO2 as measured by a Nellcor pulse oximeter.

Adolescent↗
PubMed1989

Heart-transplant and mono-amine oxidase inhibitors.

A case of anesthesia for a heart-transplant operation on a patient on mono-amine oxidase inhibitors (M.A.O.I.) is reported. This 63-year-old farmer was in end-stage cardiac failure due to familial cardiomyopathy. For 24 hours before surgery, he was on a dobutamine infusion (3 mcg/kg/min). He had been taking nialamide (100 mg/day) for 8 years for reactional depression and had not stopped it, despite advice. Anesthesia was induced with etomidate and succinylcholine, and maintained with fentanyl (25 mcg/kg/min) and pancuronium. Cardio-vascular stability was maintained during induction and first stage of surgery, up to cardectomy. Graft ischemia was 188 minutes. Successful defibrillation occurred after verapamil 3 mg. Weaning from C.P.B. was easy with dopamine (5 mcg/kg/min) and isoprenaline (0.01 mcg/kg/min). Post-operatively, on day 1, hypertension appeared and needed a nitroprusside infusion. On day 3, the patient needed another anesthetic for removal of pericardial clots, without problems. He remained very confused and disorientated during all his stay in hospital, but improved greatly with a neuroleptic. He left the hospital on day 28 in a good shape, with an anxiolytic, captopril and immunosuppressors. One month later, he was back on nialamide. The pharmacology of the M.A.O.I. is reviewed and their interactions with anesthesia are discussed as well as the use of inotropes. In this case, the denervated heart-graft, free from M.A.O. inhibition, behaved normally when transplanted in a chronically M.A.O.I. treated recipient.

Adjustment Disorders↗
PubMed1988

Should amiodarone be discontinued before cardiac surgery?

Between October 1985 and October 1986, 37 patients, chronically treated with amiodarone, underwent general anesthesia for cardiac, thoracic or vascular surgery. Among them, the 8 non-cardiac surgery patients showed neither intra-, nor postoperative complications. The 29 cardiac surgery patients, had various complications ranging from dysrhythmias (52%), sometimes necessitating a pacemaker (24%), to marked and even fatal vasoplegia. We describe the only fatal case and compare our complication rate with that described in the available literature. Most complications could be symptomatically treated. In addition, amiodarone has a very long elimination half-life: therefore withdrawal before surgery implies delaying operations by several weeks, and puts patients at increased risk of malignant dysrhythmias. However, fatal vasoplegia does occur, and its real incidence should be assessed by a broader survey.

Aged↗
PubMed1987

Preoperative left ventricular dysfunction and operative risks in coronary bypass surgery.

Preoperative left ventricular function variables were evaluated as potential risk factors for peroperative and postoperative complications in 183 consecutive patients undergoing coronary bypass surgery. Fifty-six patients had no abnormal criteria and 127 had at least one criterion (AN). The incidence of history of infarction was significantly greater in the AN (71.6 percent) than in the N (39.6 percent) group (p less than 0.04). During the early postoperative course, N and AN differentiated significantly in (1) the need for inotropic therapy (II vs 30 percent, p less than 0.05); (2) intra-aortic balloon pump (0 vs 13 percent); (3) arrhythmias (20 and 40 percent, p less than 0.002); and (4) stay in the Intensive Care Unit (2.3 +/- 0.8 and 3.9 +/- 2 days, p less than 0.01). Perioperative necrosis and mortality were not different. During a follow-up period of two years, N and AN did not show any difference in mortality and recurrence of angina.

Arrhythmias, Cardiac↗
PubMed1985

Amrinone in the management of low cardiac output after open heart surgery.

Hemodynamic effects of amrinone were studied in 2 groups of patients after open heart surgery. Group I consisted of 10 patients with moderate heart failure. In the absence of inotropic agents, their mean cardiac index (CI) was 2.02 +/- 0.41 liters/min/m2 and mean pulmonary capillary wedge pressure (PCWP) 19 +/- 3 mm Hg. Amrinone was administered 24 hours postoperatively by bolus injection (2 mg/kg) and by 12-hour infusions (20 micrograms/kg/min). Hemodynamic data and plasma concentrations were obtained 10 and 20 minutes after the bolus injection and at 1, 4, 8 and 12 hours during infusion. Significant beneficial changes were noted in CI, PCWP, right atrial pressure, systemic vascular resistance and pulmonary vascular resistance. Group II consisted of 5 patients in severe cardiogenic shock (mean CI 1.97 +/- 0.3 liters/min/m2, mean PCWP 28 +/- 8 mm Hg) despite adrenergic agonists in all patients and intraaortic counterpulsation in 2. After these measures, amrinone was given intravenously for 36 to 72 hours as additional inotropic support. Significant improvement was observed in CI, PCWP, right atrial pressure, systemic vascular resistance and pulmonary vascular resistance. Four patients in this group were discharged; 1 patient died after 5 days in acute renal failure and coma grade IV. No serious adverse effects of amrinone were observed in any group II patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Clinical use of continuous monitoring of mixed venous oxygen saturation during and after cardiovascular surgery.

This paper presents the authors' initial experience with a new technique for continuous monitoring of the mixed venous oxygen saturation (SvO2) during and after open heart Surgery. The method uses reflectometric measurements of SvO2 via a fiberoptic pulmonary artery catheter with the capability for thermodilution cardiac output estimates. Changes in SvO2 reflect changes in one or more of the three interacting factors of the Fick equation: arterial oxygen content, cardiac output, and total body oxygen utilization. Intra-and postoperative examples illustrate these various situations. The very short response time of the System allows for early diagnostic and therapeutic decisions.

Cardiac Surgical Procedures↗
PubMed1984

Clinical use and bacteriological studies of catheter contamination sleeves.

A system combining a valved introducer sheath and a plastic protective sleeve enabling repositioning of pulmonary artery catheters was tested in 73 cardiac surgical patients. It was used for a mean time of 70.3 h and allowed for improved hemodynamic monitoring. A 12 percent incidence of valve contamination was found and makes the safety of the device questionable.

Catheterization↗
PubMedDate not supplied

Median nerve somatosensory evoked potentials in profound hypothermia for ascending aorta repair.

Median nerve somatosensory evoked potentials (SEPs) were recorded in 9 patients undergoing profound hypothermia for surgical repair of the aortic arch. In addition to the known increase in peak latencies, hypothermia gave rise to the appearance of peaks ('P13,' 'N14') inconsistently recognized at normothermia; moreover, profound hypothermia is associated with the disappearance of cortical activities around 20 degrees, of subcortical waves at lower temperatures. The practical implications of the results are 3-fold: firstly, they suggest that the 'P13' and P14 should both be intracranially generated, at a pre- and postsynaptic level with respect to the cuneate nucleus, respectively; secondly, they show that some discrepancies between previous papers dealing with SEPs and hypothermia can be explained by differences in the choice of the reference; thirdly, they bring some suggestions on a better use of SEPs to monitor patients undergoing aortic arch surgery.

Adult↗
PubMedDate not supplied

Sequential mammary artery grafts in one hundred and twenty consecutive patients: indications, operative technique, 6 months postoperative functional and angiographic controls.

In the hope of establishing the internal mammary artery (IMA) as a true but superior substitute for the saphenous vein (SV) we reviewed our initial experience in complex IMA grafting. The first 120 consecutive patients, having received at least one sequential IMA graft were analyzed. The length of the IMA pedicle was the only limitation imposed on its use. Technical artifices enhancing the versatility of the IMA are described. The significant peri-operative myocardial infarction rate was 3.3%. There was no cardiac operative mortality, and 1 late mortality (0.8%). Excellent functional results were illustrated by a 2.5% rate of residual angina and dyspnoea. Six months postoperative angiographic controls could be performed in 70% of the patients: all of the sequential mammary conduits were patent, as were 95% of the anastomoses. By contrast 87.2% of the concomitant venous anastomoses were still functioning. With the expanding utilization of the free graft, IMA is expected to become a true, better and all round substitute for the saphenous vein.

Adult↗
PubMedDate not supplied

Orthotopic heart transplantation eleven years after left pneumonectomy.

Orthotopic heart transplantation was performed in a 21-year-old medical student 11 years after left pneumonectomy for a rhabdomyosarcoma. The cardiomyopathy was the result of the administration of doxorubicin (Adriamycin). The surgical procedure was largely facilitated as a result of an in-hospital donor and the absence of major adhesions. The early postoperative course was mainly uneventful. The patient is doing well 9 months after operation, without any episode of rejection or infection.

Adult↗
PubMedDate not supplied

[Risk factors in surgery of the abdominal aorta].

Surgical risk factors of abdominal aortic disease. Between January 1, 1982 and October 1986, 327 surgical repairs were performed on abdominal aortic obstructive diseases and aneurysms at the St. Luc University Hospital. 150 pre-, per- and postoperative data were collected retrospectively for each patient. Ninety-one per cent of patients were smokers, 57.5 per cent had heart disease, 43 per cent arterial hypertension, 51 per cent peripheral vascular disease and 28 percent had obstructive lung disease. Concerning cardiac morbidity, the post-operative infarction rate was 4.4 per cent in patients who had previously suffered from an infarction, and 1.9 per cent in patients with no previous infarction. Post-operative angina-ischemia rate were respectively 23 and 4.7 per cent. Two hundred and thirty two elective operations resulted in 6 deaths (2.6 per cent) while 95 emergency operations resulted in 34 deaths (35.8 per cent). The causes of the death and the post-operative complications are detailed. The decrease of the morbidity and the mortality rates inherent to this pathology depends on an early diagnosis and surgical treatment by a team, knowledgeable of this pathology, who are able to prevent and correctly treat the complications, especially those affecting the cardiovascular system.

Adult↗
PubMedDate not supplied

[Pulmonary embolectomy. Clinical experience].

Between 1969 and 1984, twenty-three patients underwent an emergency pulmonary embolectomy under extracorporeal circulation in the Catholic University of Louvain (UCL), Department of Cardiovascular and Thoracic Surgery. The aim of this paper is to delineate the indications of this procedure. Patients were 23 to 70 years old. Diagnosis of Pulmonary Embolism was made according to clinical signs, ECG and Chest X Ray with Swan-Ganz catheter insertion into the pulmonary artery and the help of pulmonary angiogram if time permitted. The surgical technique is briefly described. Four patients died during the immediate postoperative period and three died later. The sixteen survivors all enjoy a normal life.

Adult↗
PubMedDate not supplied

[Coarctation of the aortic isthmus in the adult].

Forty four patients over the age of eighteen operated upon for coarctation of the aorta from 1962 to 1983 at our institution were followed for one to 21 years (mean 13 years 3 months). Hypertension was found in 86% of the patients and 82% were preoperatively symptomatic. There were three late deaths. During the follow-up period, drug resistant hypertension persists in 31% of the patients at rest and/or exertion and 18% have functional symptoms. These data emphasize the importance of early diagnosis and treatment for patients with coarctation of the aorta.

Adolescent↗