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Biomedical subjects

Franco Carli

Publications and source records attributed to Franco Carli.

27 records · Page 2Linked to original sources
PubMedDate not supplied

A physician workforce planning model applied to Canadian anesthesiology: assessment of needs.

PURPOSE: A human resource planning model for anesthesiology is described. METHODS: The model uses 'per capita' expenditure for anesthesiologists in Quebec, as a measure of clinical services provided to different age/gender groups. The future demand for anesthesia services is calculated as the product of 'per capita' expenditure and the population projections to a future date. Future demand was converted into full-time equivalent (FTE) providers required, by dividing by the annual 'units of service' optimally delivered by one FTE anesthesiologist. The pattern of age/gender (demographic) consumption of anesthesia services in Quebec was compared with data from Ontario to validate its use in a planning model. The model was then applied to all provinces and territories. RESULTS: The 'per capita' expenditures on anesthesia services in Quebec and Ontario showed a regular pattern. Using the model, the estimated 1999 demand for FTE anesthesiologists to provide clinical services in Quebec is 546 and 669 for 2016. When non-clinical demands were included, we estimated that Quebec's total demand will increase to approximately 730 FTEs in 2016. Similar estimates are made for all provinces. The population increase anticipated is 17.9% but the increase in FTE demand in Canada is 30.9%. CONCLUSION: The model showed that the cause of the increased FTE demand for anesthesiologists is a combination of increased population and its demographic composition. The relative impact of each of these factors varies in different provinces. Effective specialty-specific planning models can be designed but they need ongoing committed resources and personnel for their usefulness to be maximized.

Adolescent↗
PubMedDate not supplied

A physician workforce planning model applied to Canadian anesthesiology: planning the future supply of anesthesiologists.

PURPOSE: To examine the supply of physician anesthesia providers necessary to accommodate the previously described clinical and non-clinical service volume needs throughout Canada. METHODS: The Canadian Medical Association (CMA) physician database provided baseline specialist anesthesiologists numbers and ages as of January 1, 2000. The Royal College of Physician and Surgeons of Canada (RCPSC) provided annual anesthesia certificant numbers for the period 1971-2000. Combining these data with the separately reported estimates of anesthesia provider needs for the years 1999 and 2016, the matching of anesthesia provider supply and demand during the period 2000-2016 was examined. RESULTS: The CMA database included 2,287 anesthesiologists in Canada on January 1, 2000. The needs assessment (clinical and non-clinical) identified the requirement for 2,495 full time equivalent (FTE) anesthesiologists in 1999 and 3,265 in 2016 (31% increase). Taking into account the ages of current anesthesiologists, the increased future requirements and the current rate of graduation from RCPSC-approved training programs in Canada a deficit of at least 656 FTEs is identified for the period 2000-2016 (average 41 per year). CONCLUSIONS: Canada has a current shortage of anesthesiologists. Based on the assessment of future needs in Quebec and extrapolated to all provinces, this shortage will worsen, unless Canadian training programs are expanded or other steps are taken to augment the numbers of anesthesia practitioners. Ongoing studies in each province are required to validate and update these conclusions.

Adult↗
PubMedDate not supplied

Comparison of analgesic methods for total knee arthroplasty: metabolic effect of exogenous glucose.

BACKGROUND AND OBJECTIVES: This study was set up to assess whether postoperative suppression of gluconeogenesis by dextrose infusion would be influenced by continuous peripheral nerve block (CPNB) with local anesthetics, in comparison with epidural and with intravenous analgesia. METHODS: Twenty-seven patients, undergoing elective primary total knee arthroplasty for osteoarthritis, were randomly allocated to one of the three groups of 9 patients each: patient controlled analgesia (PCA) with i.v. morphine, epidural with bupivacaine 0.1% and fentanyl 3mug/ml, or continuous femoral and sciatic blocks with ropivacaine 0.2%. Endogenous glucose production, an index of gluconeogenesis, and glucose clearance, an index of whole body glucose uptake, were assessed on the second postoperative day by measuring [6,6-(2)H(2)]glucose kinetics after an overnight fast (fasted state), and during a 3-h period infusion of dextrose at 4 mg/kg/min (fed state). Visual analog scale (VAS) at rest and at knee flexion, use of morphine, mobilization, nutritional intake, and bowel function were also collected. RESULTS: Endogenous glucose production was totally suppressed by 3 h of dextrose infusion in all 3 groups (P < .001) while glucose clearance was unchanged. Blood glucose and insulin increased (P < .001), while glucagon decreased, with the greatest change in the epidural group (P < .05). VAS at rest and at knee flexion was significantly lower in patients receiving epidural and CPNB compared to i.v. morphine (P < .05). Restoration of bowel function, assessed as return of bowel movements, was faster in the CPNB group (P < .05). CONCLUSION: Excellent analgesia was achieved in the epidural and continuous nerve block groups. Postoperative gluconeogenesis was totally suppressed by dextrose infusion independent of the analgesia technique with no change in glucose utilization.

Aged↗
PubMedDate not supplied

Epidural analgesia and postoperative lipid metabolism: stable isotope studies during a fasted/fed state.

BACKGROUND AND OBJECTIVES: Although previous studies have reported an inhibitory effect of epidural block and glucose feeding on plasma concentrations of glycerol and free fatty acids (FFA), it remains unclear how epidural analgesia modifies the postoperative production and uptake of lipid metabolites. This can be achieved by determining the rate of lipolysis during a feeding state with dextrose. METHODS: Twelve patients with or without postoperative epidural analgesia were studied 48 hours after surgery. They underwent a 6-hour stable isotope infusion study using [1,1,2,3,3,-(2)H(5)] glycerol; 3 hours of fasting, and 3 hours of dextrose infusion (4 mg/kg/min). The rate of glycerol appearance (R(a) glycerol) i.e., rate of lipolysis, and plasma concentrations of glycerol, FFA, glucose, lactate, insulin, glucagon, and cortisol were measured during the fasted and the fed states. RESULTS: The rates of lipolysis were similar in both groups during the fasted state and were not modified by dextrose infusion. In contrast, plasma concentrations of glycerol and FFA were decreased significantly during the fed state (P <.01). Glycerol clearance (ratio between R(a) glycerol and plasma glycerol concentration) increased significantly in both groups (P <.05) with feeding. Similarly, plasma concentrations of glucose and insulin increased significantly following feeding with dextrose in both groups. CONCLUSIONS: The elevated rates of lipolysis associated with surgery cannot be suppressed by either epidural analgesia or dextrose feeding implying that the sustained stress response continues in the postoperative period and is the most important factor responsible for the increased release of glycerol.

Adult↗
PubMedDate not supplied

Epidural blockade suppresses lipolysis during major abdominal surgery.

BACKGROUND AND OBJECTIVES: The purpose of the study was to investigate the effect of thoracic epidural administration of local anesthetic, i.e., epidural block on perioperative lipolysis. METHODS: Fourteen patients undergoing elective colorectal surgery were randomly assigned to receive either general anesthesia combined with epidural block (EDA, n = 7) or general anesthesia alone (control, n = 7). The rates of glycerol appearance (R(a) glycerol), i.e., lipolysis, were assessed by the stable isotope tracer [1,1,2,3,3-(2)H(5)]glycerol before, during, and 2 hours after the operation. Plasma concentrations of metabolic substrates (glycerol, free fatty acids [FFA], lactate) and hormones (insulin, glucagon, cortisol) were also determined. RESULTS: In the EDA group, R(a) glycerol decreased to lower intra- and postoperative values than in the control group (P <.05). Perioperative plasma concentrations of glycerol, FFA, lactate, and insulin remained unaltered with both anesthetic techniques. Intraoperative plasma glucagon and cortisol concentrations were lower in the EDA group than in the control group (P <.05). CONCLUSIONS: Epidural block suppresses lipolysis during and 2 hours after major abdominal surgery without affecting plasma glycerol or FFA concentrations.

Aged↗
PubMedDate not supplied

Effect of i.v. dextrose administration on glucose metabolism during surgery.

BACKGROUND: The inhibitory influence of exogenous dextrose on glucose production has been shown to be less pronounced during injury and sepsis. This protocol was designed to investigate the effect of i.v. hypocaloric dextrose on glucose metabolism during elective abdominal surgery. METHODS: Fourteen patients with rectal cancer were studied under fasting conditions and toward the end of a 3-hour infusion of dextrose (2 mg.kg-1 per minute) either in absence (control group, n = 7) or presence of colonic surgery (surgery group, n = 7). Endogenous glucose production was determined by using primed continuous infusions of [6,6-2H2]glucose before and during dextrose administration. We also measured the plasma concentrations of glucose, lactate, cortisol, glucagon, and insulin. RESULTS: The administration of dextrose decreased the endogenous glucose production in all patients (p < .05). This decrease was less pronounced during surgery (p < .05). Plasma glucose concentration increased during dextrose infusion in both groups (p < .05), with higher values in the surgery group than in the control group (p < .05). Plasma concentrations of lactate and glucagon remained unaltered. Dextrose infusion increased the plasma insulin concentrations to the same extent in both groups (p < .05). Cortisol plasma levels increased only in the surgery group (p < .05). CONCLUSIONS: Surgical stress blunts the inhibitory effect of i.v. dextrose on endogenous glucose production.

Blood Glucose↗