Publications by authors named "Stefan De Hert"

132 Publications

Cardiac Biomarkers to Assess Perioperative Myocardial Injury in Noncardiac Surgery Patients: Tools or Toys?

Anesth Analg 2022 Feb;134(2):253-256

Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital - Ghent University, Ghent, Belgium.

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http://dx.doi.org/10.1213/ANE.0000000000005788DOI Listing
February 2022

Current trends in anesthetic depth and antinociception monitoring: an international survey.

J Clin Monit Comput 2021 Nov 26. Epub 2021 Nov 26.

Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.

Current trends in anesthetic depth (i.e., hypnosis) and antinociception monitoring are unclear. We thus aimed to determine contemporary perspectives on monitoring these components of anesthesia during general anesthesia. Participants received and responded anonymously to an internet-based international survey supported by the European Society of Anaesthesiology and Intensive Care. Comparisons, when applicable, were carried out using Chi analysis or Fischer's exact test. A total of 564 respondents, predominantly from Europe (80.1%), participated. There was a strong participation from Belgium (11.5%). A majority (70.9%) of anesthetists considered hypnotic monitoring important on most occasions to always. In contrast, a majority (62.6%) never or only occasionally considered antinociception monitoring important. This difference in the perceived importance of anesthetic depth versus antinociception monitoring was significant (p < 0.0001). A majority of respondents (70.1%) believed that guiding hypnosis and antinociception using these monitors would improve patient care on most occasions to always. Nonetheless, a substantial number of participants were unsure if hypnotic (23%) or antinociception (32%) monitoring were recommended and there was a lack of knowledge (58%) of any published algorithms to titrate hypnotic and/or antinociceptive drugs based on the information provided by the monitors. In conclusion, current trends in European academic centers prioritize anesthesia depth over antinociception monitoring. Despite an agreement among respondents that applying strategies that optimize anesthetic depth and antinociception could improve outcome, there remains a lack of knowledge of appropriate algorithms. Future studies and recommendations should focus on clarifying goal-directed anesthetic strategies and determine their impact on perioperative patient outcome.
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http://dx.doi.org/10.1007/s10877-021-00781-2DOI Listing
November 2021

Estimate of exposure to SARS-CoV-2 and performance of high-risk interventions by European anaesthesiologists: A Pan-European cross-sectional survey.

Eur J Anaesthesiol 2021 12;38(12):1293-1295

From the Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg (BS, PM, MS, MP, PK), Department of Pediatrics, University Hospital Wuerzburg, Wuerzburg (KH), Immunization Unit, Robert Koch-Institute, Berlin, Germany (SMS), Department of Anaesthesiology and Perioperative Medicine, University Hospital Gent, Gent, Belgium (SDH), Department of Anaesthesia and Intensive Care, Cochin University Hospital, Paris, France (CMS), Department of Anaesthesiology, Intensive Care and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany (KZ) and European Society of Anaesthesiology and Intensive Care, Bruxelles, Belgium (KZ).

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http://dx.doi.org/10.1097/EJA.0000000000001541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8635072PMC
December 2021

Human factors affecting intraoperative patient safety.

Authors:
Stefan De Hert

Curr Opin Anaesthesiol 2021 Dec;34(6):735-743

Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.

Purpose Of Review: This review addresses the importance of some of the human factors for intraoperative patient safety with particular focus on the active failures. These are the mishaps or sentinel events related to decisons taken and actions performed by the individual at the delivery end of a system. Such sentinel events may greatly affect intraoperative patient safety.

Recent Findings: Intimidating, aggressive and disruptive communication is a cause of adverse staff interaction, which may then represent an important patient safety threat. Also, anaesthesiologist's physical and mental state and limitations may interfere with patient safety.

Summary: The concept of physician well being is multidimensional and includes factors related to each physician as an individual as well as to the working environment. Creating optimal safe conditions for patients, therefore, requires actions at both the personal level and the working conditions. Also, initiatives to ban rude and dismissive communication should be implemented in order to further improve intraoperative patient safety.
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http://dx.doi.org/10.1097/ACO.0000000000001059DOI Listing
December 2021

Expert consensus on peri-operative myocardial injury screening in noncardiac surgery.

Eur J Anaesthesiol 2021 06;38(6):569-570

From the Centre of Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark (CASH), Department of Anaesthesiology and Peri-operative Medicine, Ghent University Hospital - Ghent University, Ghent, Belgium (SDH) and Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden (MSC).

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http://dx.doi.org/10.1097/EJA.0000000000001497DOI Listing
June 2021

Incongruous effect of phenylephrine on changes in cerebral blood volume measured by near-infrared spectroscopy (NIRS) indicating extracranial contamination.

J Clin Monit Comput 2021 Apr 12. Epub 2021 Apr 12.

Department of Anesthesia, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.

We assessed extracranial contamination of the near-infrared spectroscopy (NIRS) signal during administration of phenylephrine. The study was performed with NIRO 200NX which employs both the Modified Beer-Lambert (MBL) method to measure total hemoglobin (tHb, expressed in µM), and Spatially Resolved Spectroscopy (SRS) to measure total hemoglobin content (nTHI, expressed in arbitrary units (a.u.)). SRS tends to not be affected by extracranial blood flow. As vasoconstriction with phenylephrine mainly occurs in the extracranial area, we hypothesized that if NIRS measurements are indeed prone to extracranial contamination, tHb will be more affected by the administration of phenylephrine than nTHI. After ethical committee approval, 20 consenting cardiac surgery patients were included. Phenylephrine was administered whenever clinically indicated and its effect on nTHI and tHb was evaluated. To adjust for the difference in raw scale units, Z-scores were calculated. Data were analyzed with Wilcoxon Signed Ranks Test and the Hodges-Lehmann method. A total of 191 data sets were obtained in 20 patients (10 male, 65 ± 15 years, 77 ± 16 kg, 166 ± 11 cm). The median difference before and after administration of phenylephrine was - 0.006 a.u. [95%CI - 0.010 to - 0.002] (p < 0.001) and - 0.415 µM [95%CI - 0.665 to - 0.205] (p < 0.001) for nTHI and tHb, respectively. The median difference between the Z-scores of nTHI and tHb was - 0.02 [95%CI - 0.04 to - 0.003] (p = 0.03), with a higher variability in the Z-scores of tHb. Phenylephrine induced significant larger changes in MBL values compared to SRS values, indicating that the MBL method might be more prone to extracranial contamination. Trial and clinical registry: Trial registration number: B670201939459, ethical committee number: 2019/0265, date of approval: March 19, 2019.
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http://dx.doi.org/10.1007/s10877-021-00702-3DOI Listing
April 2021

Levobupivacaine Consumption in Automated Intermittent Bolus in Ultrasound Guided Subparaneural Sciatic Nerve Catheters: A Prospective Double-Blind Randomized Trial.

Local Reg Anesth 2021 25;14:43-50. Epub 2021 Mar 25.

Department of Anesthesia and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium.

Purpose: Continuous sciatic nerve blocks have proven benefits for postoperative analgesia after foot surgery. However, the optimal mode of administration remains a point of debate. Ultrasound guided subparaneural injection accelerates onset time and increases duration after a single shot sciatic nerve block. This double blind prospective randomized trial compares the 48-hour local anesthetic (LA) dose consumption of an automated intermittent bolus technique to a continuous infusion regimen in a subparaneural sciatic nerve catheter after hallux valgus surgery.

Patients And Methods: Patients scheduled for hallux valgus surgery were randomized to receive either a continuous infusion of levobupivacaine 0.125% at 5mL/h (group A) or an intermittent automated bolus of 9.8 mL every 2 hours with a background of 0.1 mL/h (group B), both with a PCA bolus of 6 mL and lockout of 30 minutes. The 48 hour LA consumption, PCA boluses, Numeric Rating Scale (NRS), satisfaction and return of normal sensation were recorded.

Results: Sixteen patients were excluded because of protocol violation or technical problems and 42 patients remained for analysis. The 48 hour ropivacaine consumption was higher in group A (293 ±60 mL) than group B (257±33 mL). The median and highest NRS scores and patient satisfaction were not statistically different between groups. Normal sensation returned after 75 ± 22 hours (group A) and 70 ± 17 hours (group B).

Conclusion: Programmed bolus administration in subparaneural sciatic nerve catheters reduces LA consumption 48 hours after surgery with equal analgesia and patient satisfaction. Return of sensation is variable and can last more than 75 hours.
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http://dx.doi.org/10.2147/LRA.S299870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007557PMC
March 2021

[Cardiac biomarkers in noncardiac surgery patients : Review of cardiac biomarkers for risk stratification and detection of postoperative adverse cardiac events].

Med Klin Intensivmed Notfmed 2021 Feb 9. Epub 2021 Feb 9.

Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.

Background: Yearly, more than 200 million people worldwide undergo noncardiac surgery of whom about 5% will suffer adverse cardiac events. Therefore, risk stratification and early detection of these events is crucial.

Objectives: The goal of this review is to summarize the currently available evidence on the role of biomarkers in perioperative cardiac risk assessment. It presents current data of the established biomarkers troponin and brain natriuretic peptide (BNP), and it also reports on new biomarkers that are still under evaluation, e.g. copeptin (a marker of neurohumoral activation) and presepsin (an inflammation marker).

Materials And Methods: Narrative review.

Results And Conclusion: According to currently available data, there is a strong association between preoperative troponin or BNP values and postoperative adverse cardiac events and mortality. However, to date, there is only a weak recommendation for routine measurement of these biomarkers even in high-risk patients because the evidence on outcome improvement is still very limited. The evidence on treatment options in case of increased postoperative troponin values is also scarce so that international guidelines come to different conclusions regarding postoperative measurement of toponin. Meanwhile, several new biomarkers are under evaluation.
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http://dx.doi.org/10.1007/s00063-021-00788-2DOI Listing
February 2021

Treating patients across European Union borders: An international survey in light of the coronavirus disease-19 pandemic.

Eur J Anaesthesiol 2021 04;38(4):344-347

From the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, Frankfurt/Main, Germany (EH-A, AF, KZ), Clinic for Anaesthesia and Intensive Therapy, Clinical Center Nis, School of Medicine, University of Nis, Nis, Serbia (RJ) and Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (S-DH).

Background: In light of the coronavirus disease-2019 (COVID-19) pandemic, how resources are managed and the critically ill are allocated must be reviewed. Although ethical recommendations have been published, strategies for dealing with overcapacity of critical care resources have so far not been addressed.

Objectives: Assess expert opinion for allocation preferences regarding the growing imbalance between supply and demand for medical resources.

Design: A 10-item questionnaire was developed and sent to the most prominent members of the European Society of Anaesthesiology and Intensive Care (ESAIC).

Setting: Survey via a web-based platform.

Patients: Respondents were members of the National Anaesthesiologists Societies Committee and Council Members of the ESAIC; 74 of 80 (92.5%), responded to the survey.

Measurements And Main Results: Responses were analysed thematically. The majority of respondents (83.8%), indicated that resources for COVID-19 were available at the time of the survey. Of the representatives of the ESAIC governing bodies, 58.9% favoured an allocation of excess critical care capacity: 69% wished to make them available to supraregional patients, whereas 30.9% preferred to keep the resources available for the local population. Regarding the type of distribution of resources, 35.3% preferred to make critical care available, 32.4% favoured the allocation of medical equipment and 32.4% wished to support both options. The majority (59.5%) supported the implementation of a central European institution to manage such resource allocation.

Conclusion: Experts in critical care support the allocation of resources from centres with overcapacity. The results indicate the need for centrally administered allocation mechanisms that are not based on ethically disputable triage systems. It seems, therefore, that there is wide acceptance and solidarity among the European anaesthesiological community that local medical and human pressure should be relieved during a pandemic by implementing national and international re-allocation strategies among healthcare providers and healthcare systems.
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http://dx.doi.org/10.1097/EJA.0000000000001423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969157PMC
April 2021

Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies.

Authors:
Stefan De Hert

Local Reg Anesth 2020 28;13:171-183. Epub 2020 Oct 28.

Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.

Approximately, one in three physicians is experiencing burnout at any given time. This may not only interfere with own wellbeing but also with the quality of delivered care. This narrative review discusses several aspects of the burnout syndrome: prevalence, symptoms, etiopathogenesis, diagnosis, impact, and strategies on how to deal with the problem.
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http://dx.doi.org/10.2147/LRA.S240564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604257PMC
October 2020

New algorithm to quantify cardiopulmonary interaction in patients with atrial fibrillation: a proof-of-concept study.

Br J Anaesth 2021 01 1;126(1):111-119. Epub 2020 Nov 1.

Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium; Department of Basic and Applied Sciences, Ghent University, Ghent, Belgium.

Background: Traditional formulas to calculate pulse pressure variation (PPV) cannot be used in patients with atrial fibrillation (AF). We have developed a new algorithm that accounts for arrhythmia-induced pulse pressure changes, allowing us to isolate and quantify ventilation-induced pulse pressure variation (VPPV). The robustness of the algorithm was tested in patients subjected to altered loading conditions. We investigated whether changes in VPPV imposed by passive leg raising (PLR) were proportional to the pre-PLR values.

Methods: Consenting patients with active AF scheduled for an ablation of the pulmonary vein under general anaesthesia and mechanical ventilation were included. Loading conditions were altered by PLR. ECG and invasive pressure data were acquired during 60 s periods before and after PLR. A generalised additive model was constructed for each patient on each observation period. The impact of AF was modelled on the two preceding RR intervals of each beat (RR and RR). The impact of ventilation and the long-term pulse pressure trends were modelled as separate splines. Ventilation-induced pulse pressure variation was defined as the percentage of the maximal change in pulse pressure during the ventilation cycle.

Results: Nine patients were studied. The predictive abilities of the models had a median r of 0.92 (inter-quartile range: 89.2-94.2). Pre-PLR VPPV ranged from 0.1% to 27.9%. After PLR, VPPV decreased to 0-11.3% (P<0.014). The relation between the Pre-PLR values and the magnitude of the changes imposed by the PLR was statistically significant (P<0.001).

Conclusions: Our algorithm enables quantification of VPPV in patients with AF with the ability to detect changing loading conditions.
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http://dx.doi.org/10.1016/j.bja.2020.09.039DOI Listing
January 2021

Effects of propofol and sevoflurane on hepatic blood flow: a randomized controlled trial.

BMC Anesthesiol 2020 09 22;20(1):241. Epub 2020 Sep 22.

Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.

Background: Maintaining adequate perioperative hepatic blood flow (HBF) supply is essential for preservation of postoperative normal liver function. Propofol and sevoflurane affect arterial and portal HBF. Previous studies have suggested that propofol increases total HBF, primarily by increasing portal HBF, while sevoflurane has only minimal effect on total HBF. Primary objective was to compare the effect of propofol (group P) and sevoflurane (group S) on arterial, portal and total HBF and on the caval and portal vein pressure during major abdominal surgery. The study was performed in patients undergoing pancreaticoduodenectomy because - in contrast to hepatic surgical procedures - this is a standardized surgical procedure without potential anticipated severe hemodynamic disturbances, and it allows direct access to the hepatic blood vessels.

Methods: Patients were randomized according to the type of anesthetic drug used. For both groups, Bispectral Index (BIS) monitoring was used to monitor depth of anesthesia. All patients received goal-directed hemodynamic therapy (GDHT) guided by the transpulmonary thermodilution technique. Hemodynamic data were measured, recorded and guided by Pulsioflex™. Arterial, portal and total HBF were measured directly, using ultrasound transit time flow measurements (TTFM) and were related to hemodynamic variables.

Results: Eighteen patients were included. There was no significant difference between groups in arterial, portal and total HBF. As a result of the GDHT, pre-set hemodynamic targets were obtained in both groups, but MAP was significantly lower in group S (p = 0.01). In order to obtain these pre-set hemodynamic targets, group S necessitated a significantly higher need for vasopressor support (p < 0.01).

Conclusion: Hepatic blood flow was similar under a propofol-based and a sevoflurane-based anesthetic regimen. Related to the application of GDHT, pre-set hemodynamic goals were maintained in both groups, but sevoflurane-anaesthetized patients had a significantly higher need for vasopressor support.

Trial Registration: Study protocol number is AGO/2017/002 - EC/2017/0164. EudraCT number is 2017-000071-90. Clin.trail.gov, NCT03772106 , Registered 4/12/2018, retrospective registered.
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http://dx.doi.org/10.1186/s12871-020-01150-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507611PMC
September 2020

Getting old.

Eur J Anaesthesiol 2020 12;37(12):1081-1083

From the Department of Anaesthesia, Newcastle upon Tyne Hospitals, Newcastle upon Tyne (NR), Past President of the Association of Anaesthetists of Great Britain & Ireland, London, UK (PCl), Regional Institute of Oncology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania (IG), Department of Anaesthesia and Intensive Care, Mater Dei Hospital, Tal-Qroqq, Msida, Malta (PCa), Department of Anaesthesia and Intensive Care Medicine, Bærum Hospital, Sandvika, Norway (JM-O), Medical Simulation Centre, University Medical Centre, Ljubljana, Slovenia (VN-J), Department of Anaesthesiology and Intensive Care Unit, DPC-OHII, Budapest, Hungary (IB), Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH), Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany (KZ) and Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy (EDR).

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http://dx.doi.org/10.1097/EJA.0000000000001266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752238PMC
December 2020

Rapid sequence induction: An international survey.

Eur J Anaesthesiol 2020 06;37(6):435-442

From the Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Jihlavska, Brno, Czech Republic (JK, MKo, MKr, MT, RS, PS), Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy, University Hospital Frankfurt, Frankfurt, Goethe University, Germany (KZ), Department of Anaesthesiology and Peri-operative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH) and Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Jihlavska, Brno, Czech Republic (HZ).

Background: Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction.

Objective: The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations.

Design: Online survey.

Settings: A total of 56 countries.

Participants: Members of the European Society of Anaesthesiology.

Main Outcome Measures: The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia.

Results: From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O2 for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4% (n=656) of respondents. First-line medications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure <12 cmH2O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12 cmH2O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741).

Conclusion: We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines.

Trial Registration: ClinicalTrials.gov identifier: NCT03694860.
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http://dx.doi.org/10.1097/EJA.0000000000001194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259384PMC
June 2020

Cardiac Biomarkers for the Prediction and Detection of Adverse Cardiac Events After Noncardiac Surgery: A Narrative Review.

Anesth Analg 2020 07;131(1):187-195

Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.

Yearly, more than 200 million people worldwide undergo noncardiac surgery, of whom about 5% will develop cardiovascular complications. Prevention, early recognition, and prompt treatment of these adverse cardiovascular events is therefore an important concern in perioperative medicine. The present narrative review aims to provide an overview and critical analysis of the currently available evidence on the role of biomarkers in perioperative cardiac risk assessment and monitoring of perioperative cardiac events before and after noncardiac surgery.
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http://dx.doi.org/10.1213/ANE.0000000000004711DOI Listing
July 2020

Women anaesthesiologists' attitudes and reported barriers to career advancement in anaesthesia: a survey of the European Society of Anaesthesiology.

Br J Anaesth 2020 Mar 21;124(3):e171-e177. Epub 2020 Jan 21.

Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universität, Dresden, Germany.

Background: Previous studies have confirmed gender imbalance in anaesthesia leadership. Whether women anaesthesiologists aspire to career advancement has not been reported. This European Society of Anaesthesiology (ESA) survey explored anaesthesiologists' motivation to advance their careers into leadership positions, and to identify reported barriers to advancement.

Methods: ESA members (n=10 033, 5245 men, 3759 women, 1029 undefined) were invited to complete a 25-item, Internet-based survey, and responses were analysed thematically.

Results: In total, 3048 ESA members (1706 women, 1342 men, 30% of all members) responded to the survey. The majority were specialists, married or with a partner, and have children; 47% of women and 48% of men wish to pursue a leadership career. Barriers to career promotion noted by women were primarily attributed to work-private time considerations (extra workload and less personal time [84%], responsibility for care of family [65%], lack of part-time work opportunities [67%]), and the shift away from clinical work [59%]). Men respondents indicated the same barriers although the proportions were significantly lower. Considerations related to the partner (lack of support, career development of partner) were last on the list of variables reported by women as barriers. Importantly, many women noted deficiencies in leadership (68%) and research education (55%), and women role models (41%) and self-confidence (44%).

Conclusions: This is the largest survey to date of women anaesthesiologists' view on career advancement. Despite the many barriers noted by women, they are as eager as men to assume leadership positions. The survey results help in identifying possible areas for intervention to assist in career development.
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http://dx.doi.org/10.1016/j.bja.2020.01.005DOI Listing
March 2020

Reply to: will one hour less make any difference?

Eur J Anaesthesiol 2020 01;37(1):53

From the Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy (ND), Department of Anaesthesia, Great Ormond Street Hospital, London, UK (MT), Department of Paediatric & Obstetric Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA), Département d'Anesthésie, Réanimation pédiatrique Hôpital Jeanne de Flandre, CHU de Lille, Lille, France (FV) and Department of Anaesthesiology & Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH).

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http://dx.doi.org/10.1097/EJA.0000000000001034DOI Listing
January 2020

Aprotinin Relicense and Use of Nonapproved Interventions.

J Cardiothorac Vasc Anesth 2020 04 10;34(4):1123-1124. Epub 2019 Oct 10.

Harefield Hospital, Harefield, Middlesex, UK.

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http://dx.doi.org/10.1053/j.jvca.2019.10.001DOI Listing
April 2020

Why and how to assess cerebral autoregulation?

Best Pract Res Clin Anaesthesiol 2019 Jun 22;33(2):211-220. Epub 2019 Jul 22.

Department of Anesthesiology, Ghent University Hospital, Ghent University, Corneel Heymanslaan 10, B-9000, Ghent, Belgium. Electronic address:

Around the turn of the century, a better understanding of the complex physiology of cerebral blood flow (CBF) regulation has emerged. It is now acknowledged that cerebral autoregulation is much more complicated than we previously thought it was, with the shape of the autoregulation curve and limits of autoregulation that may vary enormously and unpredictably, both within and between patients. The consequence is that to safeguard the cerebral circulation, the dogma that an empirically chosen blood pressure guarantees adequate CBF in any individual patient has to be abandoned. Integration of cerebral autoregulation monitoring in daily perioperative patient care offers the opportunity to guide blood pressure management to the individual patient's need. The most common approach tests the effect of changes in blood pressure on an estimate of CBF. However, a "gold standard" to assess cerebral autoregulation is not yet available, and the literature shows considerable disparity of methods and criteria.
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http://dx.doi.org/10.1016/j.bpa.2019.05.007DOI Listing
June 2019

Ephedrine and phenylephrine induce opposite changes in cerebral and paraspinal tissue oxygen saturation, measured with near-infrared spectroscopy: a randomized controlled trial.

J Clin Monit Comput 2020 Apr 5;34(2):253-259. Epub 2019 Jun 5.

Department of Anaesthesiology and Perioperative Medicine, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.

While the effects of phenylephrine (PE) and ephedrine (E) on cerebral oxygen saturation (rSO) already has been studied, the effect on paraspinal oxygen saturation (rSO) is still unexplored. This study aims to assess the effect of PE and E on rSO and rSO, measured with near-infrared spectroscopy. A randomized 4-treatment cross-over trial was designed in 28 patients under BIS-titrated anaesthesia with sevoflurane. If MAP decreased more than 20% from baseline, incremental doses of PE and/or E were given according to the randomization (group I: E-PE-E, group II: PE-E-PE, group III: E-E-E, group IV: PE-PE-PE). rSO and rSO on T-T, T-T and L-L were recorded. Differences in rSO (post-pretreatment) within each group were analyzed with paired Student's t test. Differences in effects of PE and E on rSO and rSO were analyzed with linear mixed-modelling. Following PE administration, rSO decreased significantly (- 2.7% ± 3.5), while it remained stable following E (- 0.6% ± 3.6). Contrastingly, rSO at T-T, T-T and L-L slightly increased following PE (0.4% ± 2.5, 0.7% ± 2.0 and - 0.1% ± 1.4, respectively), while it decreased after E administration (- 1.3% ± 3.4%, - 0.7% ± 2.6% and - 1.3% ± 2.7%, respectively). Compared to E, PE administration was associated with a significant decrease in rSO (- 2.1%, 95% CI [- 3.1%, - 1.2%], p < 0.001). In contrast, compared to PE, E was associated with a significant decrease in rSO at T-T, T-T and L-L (- 2.0%, 95% CI [- 2.8, - 1.1], p < 0.001; - 1.4%, 95% CI [- 2.4%, - 0.4%], p = 0.006; and - 1.5%, 95% CI [- 2.3%, - 0.8%], p < 0.001, respectively). An opposite effect on rSO and rSO was observed after bolus administration of PE and E.
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http://dx.doi.org/10.1007/s10877-019-00328-6DOI Listing
April 2020

New advances in perioperative cardioprotection.

F1000Res 2019 24;8. Epub 2019 Apr 24.

Department of Anesthesiology & Perioperative Medicine, Ghent University Hospital, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.

With the increasing age of the general population, medical conditions necessitating a surgical intervention will increase. Concomitant with advanced age, the prevalence of type 2 diabetes mellitus will also increase. These patients have a two- to three-fold higher risk of occurrence of cardiovascular events and are at higher risk of perioperative myocardial ischemia. This review will discuss recent advances in the field of perioperative cardioprotection and focus specifically on strategies that have aimed to protect the diabetic and the aged myocardium. This review will not deal with potential putative cardioprotective effects of opioids and anesthetic agents, as this is a very broad area that would necessitate a dedicated overview.
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http://dx.doi.org/10.12688/f1000research.17184.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484454PMC
June 2020

The anaesthesiologist: The unsung hero of peri-operative intensive care.

Eur J Anaesthesiol 2019 06;36(6):387-389

From the Department of Anaesthesiology and Intensive Care and Trauma Centre, Nord University Hospital, Marseille, France (CM), Division of Anaesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Italy (EDR) and Department of Anaesthesiology, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH).

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http://dx.doi.org/10.1097/EJA.0000000000000982DOI Listing
June 2019

Clear fluids fasting for elective paediatric anaesthesia: The European Society of Anaesthesiology consensus statement.

Eur J Anaesthesiol 2019 03;36(3):173-174

From the Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genoa, Italy (ND), Department of Anaesthesia, Great Ormond Street Hospital, London, UK (MT), Department of Paediatric & Obstetric Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA), Département d'Anesthésie, Réanimation pédiatrique Hôpital Jeanne de Flandre, CHU de Lille, Lille, France (FV) and Department of Anaesthesiology & Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH).

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http://dx.doi.org/10.1097/EJA.0000000000000914DOI Listing
March 2019

Pitfalls of clinical practice guidelines in the era of broken science: Let's raise the standards.

Eur J Anaesthesiol 2018 12;35(12):903-906

From the Department of Paediatric and Obstetric Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA) and Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH).

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http://dx.doi.org/10.1097/EJA.0000000000000892DOI Listing
December 2018

Device or target? A paradigm shift in airway management: Implications for guidelines, clinical practice and teaching.

Eur J Anaesthesiol 2018 11;35(11):811-814

From the Department of Anaesthesia and Intensive Care - AOU Policlinico Vittorio Emanuele Catania, Catania, Italy (MS), Department of Pediatric and Obstetric Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (AA) and Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (SDH).

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http://dx.doi.org/10.1097/EJA.0000000000000893DOI Listing
November 2018

Burnout Among Anesthesiologists: It׳s Time for Action!

Authors:
Stefan De Hert

J Cardiothorac Vasc Anesth 2018 12 19;32(6):2467-2468. Epub 2018 Jun 19.

Department of Anesthesiology and Perioperative Medicine Ghent University Hospital, Ghent University Ghent, Belgium.

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http://dx.doi.org/10.1053/j.jvca.2018.06.010DOI Listing
December 2018

Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology.

Eur J Anaesthesiol 2018 06;35(6):407-465

: The purpose of this update of the European Society of Anaesthesiology (ESA) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence. Well performed randomised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries. This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care. The Guidelines Committee of the ESA formed a task force comprising members of the previous task force, members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies. Electronic databases were searched from July 2010 (end of the literature search of the previous ESA guidelines on pre-operative evaluation) to May 2016 without language restrictions. A total of 34 066 abtracts were screened from which 2536 were included for further analysis. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members, individual or national (thus including most European national anaesthesia societies). Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.
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http://dx.doi.org/10.1097/EJA.0000000000000817DOI Listing
June 2018

Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging.

Eur Heart J Cardiovasc Imaging 2018 05;19(5):475-481

Cardiology Department, University of Medicine and Pharmacy 'Carol Davila' - Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania.

There is a growing trend of using ultrasound examination of the heart as a first-line diagnostic tool for initial patient evaluation in acute settings. Focus cardiac ultrasound (FoCUS) is a standardized but restricted cardiac ultrasound examination that may be undertaken by a range of medical professionals with diverse backgrounds. The intention of this core curriculum and syllabus is to define a unifying framework for educational and training processes/programmes that should result in competence in FoCUS for various medical professionals dealing with diagnostics and treatment of cardiovascular emergencies. The European Association of Cardiovascular Imaging prepared this document in close cooperation with representatives of the European Society of Anaesthesiology, the European Association of Cardiothoracic Anaesthesiology, the Acute Cardiovascular Care Association of the European Society of Cardiology and the World Interactive Network Focused On Critical Ultrasound. It aims to provide the key principles and represents a guide for teaching and training of FoCUS. We offer this document to the emergency and critical care community as a reference outline for teaching materials and courses related to FoCUS, for promoting teamwork and encouraging the development of the field.
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http://dx.doi.org/10.1093/ehjci/jey006DOI Listing
May 2018

Anesthetic Preconditioning: Have We Found the Holy Grail of Perioperative Cardioprotection?

J Cardiothorac Vasc Anesth 2018 06 4;32(3):1135-1136. Epub 2018 Jan 4.

Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital - Ghent University, Ghent, Belgium.

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http://dx.doi.org/10.1053/j.jvca.2018.01.001DOI Listing
June 2018
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