10 Mar 2014

Focus on anaesthesia research: Dr Stefan Dieleman

Professor Paul Myles and Dr Stefan
Dieleman reviewing an echo result
Dr Stefan Dieleman was appointed a Research Fellow in the Department of Anaesthesia in 2013, and a General and Cardiac Anaesthesia Fellow at the Alfred Hospital. Stefan trained as an anaesthetist in the University Medical Center Utrecht in The Netherlands, completing in 2012. Stefan has been involved in cardiac anaesthesia research for over 10 years. Stefan will be working together with Professor Paul Myles on two major research projects. These are firstly, the preparation of a randomised study of prophylactic corticosteroids for cardiac and major non-cardiac surgery, and secondly, addressing the value of intraoperative transoesophageal echocardiography (TOE).

The rationale for the new study on prophylactic corticosteroids is based on the beneficial effects of dexamethasone on the secondary endpoints of respiratory complications and postoperative ICU and hospital length of stay, that were observed in the DECS study. The aim is to use expertise from both the Dutch and the Australasian clinical trials networks to establish a collaborative multinational trial.

The TOE project will address the value of intraoperative transoesophageal echocardiography (TOE), which is nowadays routinely used by anaesthetists during cardiac surgery. Despite its widespread use, the value of many quantitative techniques of TOE in the intraoperative setting, as well as an evaluation of cost-benefit of its routine use cardiac surgery, have only been poorly investigated. Together with Dr Enjarn Lin, Stefan will be starting a prospective study into the intraoperative evaluation of right ventricular function by different echocardiographic measurements. In addition, he will design a model for evaluating cost-effectiveness of routine intraoperative TOE.

During his medical training, Stefan worked on an animal model for cognitive impairment after cardiopulmonary bypass. Since 2005, he has been involved in clinical research into the effects of corticosteroids in cardiac surgery. As part of his PhD project, he designed and successfully completed a multicentre randomised trial comparing dexamethasone to placebo in 4500 cardiac surgery patients (the DECS study). The primary results of this study were published in JAMA in 2012. He also published a Cochrane meta-analysis on this same topic.

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