References of "LARBUISSON, Robert"
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See detailLa prise en charge cardiaque preoperatoire du patient vasculaire
Van Damme, Hendrik ULg; Larbuisson, Robert ULg; Limet, Raymond ULg

in Revue Médicale de Liège (2003), 58(6), 409-14

Peripheral vascular surgery (carotid, infrainguinal or aortoiliacal) is characterised by an increased cardiac risk with an infarction rate of 1 to 4%. Sixty percent of the vascular patients present a ... [more ▼]

Peripheral vascular surgery (carotid, infrainguinal or aortoiliacal) is characterised by an increased cardiac risk with an infarction rate of 1 to 4%. Sixty percent of the vascular patients present a concomitant coronary artery disease, often infraclinically. Preoperative cardiac risk stratification aims at reducing cardiac related morbidity and mortality. A clinical risk profile (patient's past history) and non-invasive cardiac tests allow subdividing the vascular patients into three categories: high risk, intermediate risk, and low risk. High-risk patients (unstable angina, recent infarction, overt congestive heart failure and critical aortic valve stenosis) require immediate intensive management of their underlying cardiac disease. This means delay or annulation of the planned vascular operation. For intermediate risk patients, a clinical cardiac risk index based on patient's past history (stable angina, previous infarction or episode of congestive heart failure, age of 70 years or more and diabetes) offers a rough orientation. These clinical markers lack specificity, since they are found in almost all vascular patients. The adjunction of a non-invasive cardiac testing allows to optimise the cardiac risk evaluation. Stress echocardiography with dobutamine has become a very popular test, with a negative predicting value exceeding 90%, but with a lack of specificity (many vascular patients have an uneventful postoperative outcome, despite a positive dobutamine test). These inconsistent results of cardiac risk evaluation render their routine use questionable. Nowadays, the management of patients requiring vascular surgery is based on the concept that every vascular patient should be considered as suffering from coronary artery disease. A certain degree of myocardial protection should be offered to every vascular surgery candidate. A preoperative treatment with betablockers provides myocardial protection against the operative stress and lowers myocardial oxygen requirement. There are arguments to continue or start aspirin treatment in the preoperative period, in order to lower the risk of sudden coronary thrombosis. [less ▲]

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See detailPeripheral vascular surgery: Update on the perioperative non-surgical management for high cardiac risk patients
Stammet, P.; Senard, Marc ULg; Roediger, Laurence ULg et al

in Acta Chirurgica Belgica (2003), 103(3), 248-254

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative ... [more ▼]

This review of the recent literature regarding perioperative management in peripheral vascular surgery emphasizes some of the important features for the 2003 state-of-the-art on non surgical perioperative care for these high cardiac risk patients. The most adapted preoperative cardiac evaluation for each patient is guided by its individual risk factors and clinical history. Perioperative medication should nowadays consist of pre- and postoperative beta-blockers and acetyl salicylic acid, both reducing cardiac morbidity and mortality. Neuraxial locoregional anaesthesia techniques are reasonable alternatives to general anaesthesia because of their potential advantages, by reducing postoperative inflammatory response and reducing procoagulating activity, and increasing peripheral vascular graft patency, but the individual benefit/risk balance has always to be evaluated for patients submitted to aggressive antithrombotic therapy. During the postoperative course, early detection and treatment of postoperative myocardial ischemia or infarction by ST wave changes and/or cardiac enzyme control has to be considered. [less ▲]

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See detailRemplacement valvulaire mitral par homogreffe
RADERMECKER, Marc ULg; Canivet, J. L.; Tambwe, W. et al

in Revue Médicale de Liège (2002), 57(7), 459-62

The total homograft replacement of the left AV valve and subvalvular apparatus constitutes a delicate operation, which may prove beneficial in young patients with extensive bacterial endocarditis. The ... [more ▼]

The total homograft replacement of the left AV valve and subvalvular apparatus constitutes a delicate operation, which may prove beneficial in young patients with extensive bacterial endocarditis. The case of a staphylococcal endocarditis in a young drug addicted patient, operated three years previously of mitral valve repair for the same pathology, is presented. In addition to the complete excision of infected tissues and valvular substitution with biological material, this technique has the advantage of avoiding long term anticoagulation. The history, technical key points, and current indications of mitral homograft in the surgery of the left atrio-ventricular valves are reviewed. [less ▲]

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See detailA comparison of the training value of two types of anesthesia simulators: Computer screen-based and mannequin-based simulators
Nyssen, Anne-Sophie ULg; Larbuisson, Robert ULg; Janssens, Marc ULg et al

in Anesthesia and Analgesia (2002), 94(6), 1560-1565

In this study, we compared two different training simulators (the computer screen-based simulator versus the full-scale simulator) with respect to training effectiveness in anesthesia residents ... [more ▼]

In this study, we compared two different training simulators (the computer screen-based simulator versus the full-scale simulator) with respect to training effectiveness in anesthesia residents. Participants were evaluated in the management of a simulated preprogrammed scenario of anaphylactic shock using two variables: treatment score and diagnosis time. Our results showed that simulators can contribute significantly to the improvement of performance but that learning in treating simulated crisis situations such as anaphylactic shock did not significantly vary between full-scale and computer screen-based simulators. Consequently, the initial decision on whether to use a full-scale or computer screen-based training simulator should be made on the basis of cost and learning objectives rather than on the basis of technical or fidelity criteria. Our results support the contention that screen-based simulators are good devices to acquire technical skills of crisis management. Mannequin-based simulators would probably provide better training for behavioral aspects of crisis management, such as communication, leadership, and interpersonal conflicts, but this was not tested in the current study. IMPLICATIONS: We compared two different training simulators (computer screen-based versus full-scale) for training anesthesia residents to better document the effectiveness of such devices as training tools. This is an important issue, given the extensive use and the high cost of mannequin-based simulators in anesthesiology. [less ▲]

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See detailLevels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit
Amand, T.; Pincemail, Joël ULg; Blaffart, Francine ULg et al

in Perfusion (2002), 17(2), 117-123

Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous ... [more ▼]

Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous blood requirements in cardiac surgery with cardiopulmonary bypass (CPB). As the proinflammatory activity of the shed blood also contributes to morbidity during CPB, we conducted a prospective study in order to examine the quality of autologous blood before and after processing with five different devices [BRAT2, Sequestra, Compact Advanced, Cell Saver 5 (CS5), Continuous Autologous Transfusion System (CATS)]. All systems resulted in an excellent haemoconcentration, ranging from 53.7% (Compact) to 68.9% (CATS). The concentrations and elimination rates of several inflammatory markers [IL-1beta, IL-2, IL-8, TNFalpha, myeloperoxidase (MPO), elastase] were examined. Except for the Sequestra, an important increase in concentration of IL-1beta (between 30% and 220%) has been observed after processing with each device. In contrast, the attenuation rate of IL-6 and TNFalpha (95%) was optimal for all investigated blood salvages systems. Regarding IL-8, only the CATS and CS5 systems were able to attenuate this biological parameter with an excellent efficacy. The rate of attenuation in MPO and elastase, as markers of leukocyte activation, was higher than 80% for all devices. In conclusion, the different RBC washing systems tested in this study resulted in a significant attenuation of the inflammatory response. Increased levels of IL-1beta after processing remained, however, unclear. According to the type of protocol, based on inlet haematocrit, fill and wash speeds, and wash volumes, small variations in reducing the inflammatory response have been observed from one device to another. [less ▲]

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See detailUse of Anesthesia Simulator
Pendeville, Philippe; Mayne, Alain; LARBUISSON, Robert ULg et al

in Benelux quaterly journal on automatic control (2002), 43(2), 17-19

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See detailNicardipine Protocol for Cabg Using the Radial Artery Clinical and Angiographic Data
RADERMECKER, Marc ULg; Grenade, Thierry ULg; Cao-Thian, S. K. et al

in Acta Chirurgica Belgica (2001), 101(4, Jul-Aug), 185-9

The routine use of arterial grafts in coronary surgery is facilitated by peroperative adjunction of antispasmodic drug to reduce the event of spasm. Diltiazem has been favoured in most clinical studies ... [more ▼]

The routine use of arterial grafts in coronary surgery is facilitated by peroperative adjunction of antispasmodic drug to reduce the event of spasm. Diltiazem has been favoured in most clinical studies devoted to the radial artery graft. The aim of this study was to assess the efficacy of a spasm preventing protocol associating hydrostatic dilation of the graft with a diluted solution of papaverine and nicardipine infusion, starting preoperatively and continued postoperatively in i.v. and per os forms. Between September 1996 and March 1997, a consecutive series of 50 patients underwent myocardial revascularization using the radial artery. The radial artery was prepared by hydrostatic dilation with papaverine (1%) and nicardipine was administrated at 0.25 microgram/kg/min and titrated according to the arterial systemic pressure. Operative mortality was 4% (sepsis). There was no evidence of perioperative MI nor hypoperfusion syndrome. Mean CKMB level at 18 hours was 36 micrograms/l. No ischaemic anomalies of the ECG were detected. Angiography performed in the last 20 patients showed a 98% (51/52) permeability rate for all graft; 19/20 radial grafts (95%) were patent. One radial graft presented a 50% stenosis at the proximal anastomosis, and another a moderate spasm (40%) in the middle part of the conduit. This study confirms that the radial artery conduit can be used with satisfactory results for routine coronary artery bypass. The use of nicardipine allows the control the vasoreactivity of the radial graft without totally obviating at least angiographic spasm. This drug is easy to titrate, and well tolerated in association to beta-blockers in the routine perioperative management of the coronary patients. [less ▲]

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See detailNicardipine Protocol for Cabg Using the Radial Artery Clinical and Angiographic Data
RADERMECKER, Marc ULg; Grenade, Thierry ULg; Cao-Thian, S. K. et al

in Acta Chirurgica Belgica (2001), 101(4, Jul-Aug), 185-9

The routine use of arterial grafts in coronary surgery is facilitated by peroperative adjunction of antispasmodic drug to reduce the event of spasm. Diltiazem has been favoured in most clinical studies ... [more ▼]

The routine use of arterial grafts in coronary surgery is facilitated by peroperative adjunction of antispasmodic drug to reduce the event of spasm. Diltiazem has been favoured in most clinical studies devoted to the radial artery graft. The aim of this study was to assess the efficacy of a spasm preventing protocol associating hydrostatic dilation of the graft with a diluted solution of papaverine and nicardipine infusion, starting preoperatively and continued postoperatively in i.v. and per os forms. Between September 1996 and March 1997, a consecutive series of 50 patients underwent myocardial revascularization using the radial artery. The radial artery was prepared by hydrostatic dilation with papaverine (1%) and nicardipine was administrated at 0.25 microgram/kg/min and titrated according to the arterial systemic pressure. Operative mortality was 4% (sepsis). There was no evidence of perioperative MI nor hypoperfusion syndrome. Mean CKMB level at 18 hours was 36 micrograms/l. No ischaemic anomalies of the ECG were detected. Angiography performed in the last 20 patients showed a 98% (51/52) permeability rate for all graft; 19/20 radial grafts (95%) were patent. One radial graft presented a 50% stenosis at the proximal anastomosis, and another a moderate spasm (40%) in the middle part of the conduit. This study confirms that the radial artery conduit can be used with satisfactory results for routine coronary artery bypass. The use of nicardipine allows the control the vasoreactivity of the radial graft without totally obviating at least angiographic spasm. This drug is easy to titrate, and well tolerated in association to beta-blockers in the routine perioperative management of the coronary patients. [less ▲]

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See detailPrincipes et intérêts du simulateur en anesthésie-réanimation
Larbuisson, Robert ULg; Nyssen, Anne-Sophie ULg; Janssens, Marc ULg et al

in Praticien en Anesthésie Réanimation (Le) (2001), 5(4), 225

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See detailSma Circuits Reduce Platelet Consumption and Platelet Factor Release During Cardiac Surgery
Defraigne, Jean-Olivier ULg; Pincemail, Joël ULg; Dekoster, Guy ULg et al

in Annals of Thoracic Surgery (2000), 70(6), 2075-81

BACKGROUND: Platelet count and function are particularly damaged by cardiopulmonary bypass (CPB). This study evaluated the effects of a novel CPB circuit in terms of platelet count and activation, and ... [more ▼]

BACKGROUND: Platelet count and function are particularly damaged by cardiopulmonary bypass (CPB). This study evaluated the effects of a novel CPB circuit in terms of platelet count and activation, and postoperative need for blood products. METHODS: One hundred patients undergoing coronary grafting were randomized in two groups: control group (n = 50) and test group (n = 50, surface modifying additives circuit, SMA group). Blood samples were taken before, during, and after CPB. Postoperative blood loss, number of transfused blood products, and postoperative variables were recorded. RESULTS: The platelet count decreased less in the SMA group compared to the control group (end of CPB: respectively, 165 +/- 9 x 10(3)/mm3 vs 137 +/- 8 x 10(3)/mm3; p < 0.01). This was paralleled by a reduction in beta-thromboglobulin plasma levels in the SMA group. There was a trend to decreased blood loss in the SMA group, but the difference was significant only in patients taking aspirin preoperatively (p < 0.05). In the SMA group nearly 50% less fresh frozen plasma and platelet units were administered (p < 0.01). No operative deaths were observed. CONCLUSIONS: The use of circuits with surface additives is clinically safe, preserves platelet levels, and attenuates platelet activation. This may lead to a reduced need for blood products. [less ▲]

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See detailCytokine Release and Neutrophil Activation Are Not Prevented by Heparin-Coated Circuits and Aprotinin Administration
Defraigne, Jean-Olivier ULg; Pincemail, Joël ULg; Larbuisson, Robert ULg et al

in Annals of Thoracic Surgery (2000), 69(4), 1084-91

BACKGROUND: Cardiopulmonary bypass (CPB) initiates a whole-body inflammatory response where complement and neutrophil activation and cytokine release play an important role. This prospective trial ... [more ▼]

BACKGROUND: Cardiopulmonary bypass (CPB) initiates a whole-body inflammatory response where complement and neutrophil activation and cytokine release play an important role. This prospective trial examined the effects of both heparin-coated circuits and aprotinin on the inflammatory processes during CPB, with respect to cytokine release and neutrophil activation. METHODS: Two hundred patients undergoing cardiac surgery were randomized in four groups of 50 patients each: heparin-coated circuit with aprotinin (HCO-A) or without aprotinin (HCO) administration, and uncoated circuit with aprotinin (C-A) or without aprotinin administration (C). In groups receiving aprotinin, a high-dose regimen was given. In all groups, high initial doses of heparin were used (3 mg/kg intravenously). Tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-8, and myeloperoxidase and elastase levels were measured in plasma samples taken before, during, and after CPB. RESULTS: In all groups, the TNF-alpha, IL-6, and IL-8 levels reached a maximum after protamine administration. After 24 hours, they remained significantly elevated (IL-6 and IL-8) or returned to baseline values (TNF-alpha). A similar pattern was observed with myeloperoxidase and elastase levels. No significant intergroup differences were observed. CONCLUSIONS: CPB is associated with cytokine release and neutrophil activation, which are not attenuated by the use of heparin-coated circuits or by the administration of aprotinin. Aprotinin and heparin-coated circuits do not show additive effects. [less ▲]

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See detailLa commission d'hemovigilance du CHU.
Baudoux, Etienne ULg; Blaffart, Francine ULg; Bouffioux, Christian ULg et al

in Revue Médicale de Liège (2000), 55(9), 878-80

As suggested by the National Blood Council, a Hemovigilance Committee was set up in the University Hospital of Liege in 1995. A multidisciplinary discussion takes place on any action aiming at the ... [more ▼]

As suggested by the National Blood Council, a Hemovigilance Committee was set up in the University Hospital of Liege in 1995. A multidisciplinary discussion takes place on any action aiming at the improvement of transfusion safety, and the follow-up of its implementation. The first issue to be discussed was the set up of a detailed documentation of all blood transfusions. The data are now recorded on a single document allowing proper identification of people and products involved, and of the eventual incidents. This document has lead to a better transfusion safety and to an improved administrative management of blood transfusion. The Commission has been coordinating two multi-centric studies analyzing the consumption of fresh blood products and the incidence of transfusion reactions. Among blood-saving policies, autologous transfusion and volume reduction of samples drawn for laboratory purposes have been discussed. Other measures were taken to improve the labeling of samples for cross-mach and to actively follow-up transfusion reactions. By its actions and advises, the Commission aims to direct strategies towards a safe and rational use of blood products. [less ▲]

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See detailUse of Anaesthesia Simulator: Initial Impressions of Its Use in Two Belgian University Centers
Larbuisson, Robert ULg; Pendeville, P.; Nyssen, Anne-Sophie ULg et al

in Acta Anaesthesiologica Belgica (1999), 50(2), 87-93

459 trainees in Anesthesia and Intensive Care Medicine, accompanied by fully certified specialists from several Belgian University Hospital Centers, spend at least a 3 hour session at the Anaesthesia ... [more ▼]

459 trainees in Anesthesia and Intensive Care Medicine, accompanied by fully certified specialists from several Belgian University Hospital Centers, spend at least a 3 hour session at the Anaesthesia Simulator. Each session comprises three segments: the briefing, the simulation session and the debriefing. The use of simulations allows significant individualization of the learning experience. The simulator helps to develop the capacity to understand, explain a phenomenon and to resolve problems. Another important aspect of the use of the simulator involves the trainee's "right to make mistakes". This allows to widen the spectrum of executional situations, and decreases the number of dangerous situations. Two University Centers (ULg and UCL) have each organized simulator sessions despite some differences in their approaches. The simulator is a teaching tool worthy of an obligatory role in the most up-to-date training possible of modern anesthesiologist. This is all the more important given that the current practice of anesthesiology is so complex that any error could cost a human life. [less ▲]

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See detailChirurgie vasculaire chez l'octogénaire
VAN DAMME, Hendrik ULg; SMITZ, Simon ULg; LARBUISSON, Robert ULg et al

in Revue Médicale de Liège (1998), 53(3), 149-57

The prevalence of peripheral vascular disease increases with aging of the population. About 8% of the octogenarians present significant carotid artery stenosis, about 4% have an abdominal aortic anneurysm ... [more ▼]

The prevalence of peripheral vascular disease increases with aging of the population. About 8% of the octogenarians present significant carotid artery stenosis, about 4% have an abdominal aortic anneurysm of 40 mm or more, and 6% suffer critical limb ischemia. Carotid endarterectomy in octogenarians is a valuable tool for stroke prevention, only if the combined perioperative stroke-mortality rate is lower than 3%. Operating an abdominal aneurysm of 50 mm or more in octogenarians is characterized by an operative mortality that is higher compared to that observed in a younger patient group (4.7% vs 2.7%). Aneurysm-surgery remains nevertheless justified, since it is the only way to prevent the evolution to rupture, that is almost fatal. Limb salvage surgery should always be considered for an 80-years patient with critical limb ischemia, since readaptation after major limb-amputation is not evident for octogenarians. An extensive review of literature is presented concerning vascular aging and results of carotid surgery, aneurysm repair and lower limb revascularization in octogenarians. The authors report their own recent experience with carotid surgery and aneurysm repair in patients aged 80 years or older. [less ▲]

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See detailAnaesthesia for thoracoscopic surgery
Larbuisson, Robert ULg; Lamy, Maurice ULg

in Current Opinion in Anaesthesiology (1997), 10

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See detailLes anesthésiques
Larbuisson, Robert ULg; Lamy, Maurice ULg

in Revue Médicale de Liège (1996), 51(1), 129-32

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See detailLes morphinomimétiques en réanimation
Lamy, Maurice ULg; Joris, Jean ULg; Damas, Pierre ULg et al

in Revue Janssen-Cilag (1996)

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