Clinical Faculty

Ian J. Welsby, MB BS

Associate Professor in the Department of Anesthesiology

Department:
Anesthesiology

Division:
Anesthesiology

Mailing Address:
DUMC 3094 Durham, NC 27710

Office Telephone:
919-668-2699

Fax:
919-681-7425

Training:
MB BS, University College and Middlesex School of Medicine, England, 1990

Fellowship:
Critical Care, Duke University Medical Center, 1996-1997

Residency:
North East Thomas School of Anaesthesia, England, 1993-1999

Clinical Interests:
Cardiothoracic anesthesia, critical care and perioperative coagulopathy, transesophageal echocardiography

Research Interests:
I am currently collecting data assessing the usefulness of various scoring systems in predicting morbidity, as reflected by length of hospital stay, and suitability for "fast-track" care following cardiac surgery. This will be developed into a model allowing accurate prediction of likely Intensive Care bed utilisation in this population.

Various aspects of perioperative coagulation continue to be of interest to me. I am using the thromboelastograph (TEG) to assess hypercoagulability in patients with intracerebral tumor presenting for craniotomy and correlating these measurements to the incidemce of venous thromboembolic disease in the postoperative period as diagnosed clinically or by duplex scanning of leg veins. To continue this investigation, I am using TEG to monitor the response to anticoagulation with low molecular weight heparin in this group.
As part of an audit of the introduction of perioperative TEG monitoring in the cardiac surgery setting, I'll be looking at the economic impact of point-of-care monitoring on blood product usage in addition to establishing a point-of-care coagulation laboratory for the cardiac operating rooms and the cardiac surgery ICU (3200).

Publications:
Welsby IJ, Ryan JM, Booth JV, Flanagan E, Messier RH, Borel CO. The bispectral index in the diagnosis of perioperative stroke: a case report and discussion. Anesth Analg. 2003 Feb;96(2):435-7, table of contents.

Mathew JP, Grocott HP, Phillips-Bute B, Stafford-Smith M, Laskowitz DT, Rossignol D, Blumenthal JA, Newman MF (Welsby IJ, NORG Member),  . Lower endotoxin immunity predicts increased cognitive dysfunction in elderly patients after cardiac surgery.  Stroke.  2003 Feb;34(2):508-13.

Lombard FW, Welsby IJ, Booth JV. Systemic air embolism during off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2003 Jun;17(3):403-4.

Welsby IJ, McDonnell E, El-Moalem H, Stafford-Smith M, Toffaletti JG. Activated clotting time systems vary in precision and bias and are not interchangeable when following heparin management protocols during cardiopulmonary bypass. J Clin Monit Comput. 2002 Jul;17(5):287-92.

Welsby IJ, Bennett-Guerrero E, Atwell D, White WD, Newman MF, Smith PK, Mythen MG. The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass. Anesth Analg. 2002 May;94(5):1072-8, table of contents.

Booth JV, Schinderle D, Welsby IJ. Pro: Vasopressin is the vasoconstrictor of choice after cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2002 Dec;16(6):773-5.

Klein SM, Slaughter TF, Vail PT, Ginsberg B, El-Moalem HE, Alexander R, D'Ercole F, Greengrass RA, Thangam TM, Welsby IJ, Gan TJ. Thromboelastography as a perioperative measure of anticoagulation resulting from low molecular weight heparin : A comparison with anti-Xa concentrations. Anesth Analg 2000; 91: 1091-1095.

Bennett-Guerrero E, Welsby IJ, Dunn TJ, Young LR, Wahl TA, Diers TL, Phillips-Bute BG, Newman MF, Mythen MG. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalisation after routine, moderate-risk, elective surgery.Anesth Analg 1999; 89(2): 514-9.

Gan TJ, Welsby IJ, Kucmeroski D, Mythen MG, Glass PSA. Thromboelastographic coagulation changes after 6% hetastarch administration for the treatment of perioperative hypovolemia [abstract]. Br J Anesth 1998; 80(S):A170.

Bennett-Guerrero E, Welsby I, Dunn T, Nelson C, Yen M, Wong C, Mitchell D, Eastwood N, Mythen M. Intraoperative low gastric mucosal pH (pHi) predicts morbidity and prolonged hospital length of stay following moderate risk elective surgery [abstract]. Critical Care Medicine 1997; 25(1) Suppl. A112.

Atwell D., Welsby I.J., White W.D., King S.A., Mythen M.G. Postoperative complications following cardiac surgery with cardiopulmonary bypass [abstract]. Critical Care 1997; 1 (1); 103