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Biomedical subjects

J E Wynands

Publications and source records attributed to J E Wynands.

66 records · Page 4Linked to original sources
PubMed1978

The high-risk cardiac patient undergoing general surgery.

The challenge of the high-risk cardiac patient undergoing general surgery will be met only when an aggressive approach is taken to avoid an unfavourable balance between the oxygen supply and demand of the myocardium. In the past this challenge has been accepted in the operating room but postoperative care has been less than adequate. The intelligent use of potent, effective pharmacologic agents and intensive monitoring of myocardial performance intra- and postoperatively have greatly reduced morbidity and mortality in patients with ischemic heart disease undergoing aortocoronary bypass procedures; they can achieve similar results in such patients who must undergo general surgery.

Anesthesia, General↗
PubMed1966

Human lung homotransplantation.

Left lung homotransplantation was performed in a 31-year-old man in terminal irreversible respiratory failure due to advanced silicosis. Within 10 minutes of completion of transplantation, arterial pO(2) rose from 52 to 211 mm. Hg, pCO(2) dropped from 90 to 43 mm. Hg, and pH rose from 7.15 to 7.42. On assisted ventilation, arterial O(2) tension was maintained within normal limits for the first four days. Thereafter, arterio-alveolar difference for O(2) increased to 300 mm. and that for CO(2) to 25 mm. Xenon-133 ventilation perfusion ratios confirmed differences between the two lungs. Terminally, bronchopneumonia and hypoxemia were present. Surfactant content of the lung was within normal limits. Postmortem examination revealed bronchopneumonia, bronchial infarction, lymphatic engorgement and mild rejection. Future efforts should emphasize selection of non-infected donors, minimal reliance on steroids for immunosuppression, cardiopulmonary bypass during transplantation, and more definite criteria for rejection.

Adult↗
PubMedDate not supplied

Initial Canadian experience with artificial blood (Fluosol-DA-20%) in severely anemic patients.

Fluosol-DA-20% (FDA), a synthetic perfluorocarbon emulsion with oxygen (O2) carrying capability, has recently become available in North America for clinical trials in severely anemic patients. Three patients have so far received FDA at our institution. All were severely anemic (Hct's 12-15%), and were administered FDA in anticipation of perioperative blood loss. Observations made in these patients indicate that: FDA can act as a plasma expander; no firm conclusions can be made as to whether FDA increases O2 consumption in the absence of directly measured arterial and mixed-venous O2 contents; mixed-venous oxyhemoglobin saturation at high FiO2 increases following FDA administration because a significant proportion of the consumed O2 (24-37% in our patients at FiO2 = 1.0) is transported by FDA; hemodynamic reactions to a test dose of FDA may occur, and may be serious enough to preclude further FDA administration; and technical recommendations for the administration of FDA should include the use of direct arterial and mixed-venous O2-content determinations, and continuous spectrophotometric mixed-venous oxyhemoglobin saturation monitoring.

Anemia↗