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Biomedical subjects

J W Bland

Publications and source records attributed to J W Bland.

8 recordsLinked to original sources
PubMed1997

Pulmonary vascular complications of chronic airway obstruction in children.

OBJECTIVE: To study the clinical presentation, treatment, and outcome of pulmonary artery hypertension (PAH) that develops in children with chronic airway obstruction. DESIGN: Case study. SETTING: Academic tertiary care children's hospital. PATIENTS: A 3-year (October 1, 1992, to September 30, 1995) review of the medical records of all children with chronic airway obstruction in whom PAH developed. MAIN OUTCOME MEASURE: The clinical course, including objective laboratory data to measure PAH (cardiac catheterization, echocardiography, electrocardiography) both before and after treatment. RESULTS: Pulmonary artery hypertension developed in 18 patients. It was diagnosed using cardiac catheterization in 13 patients and echocardiography in 5 patients. Obstructive problems include chronic lung disease (9 patients), tracheobronchomalacia (6 patients), adenotonsillar hypertrophy (5 patients), laryngomalacia (4 patients), macroglossia (5 patients), subglottic stenosis (2 patients), and pharyngeal collapse (2 patients). Nine patients were born prematurely and 7 had Down syndrome. Treatments included tracheotomy (7), adenotonsillectomy (5), adenoidectomy (3), laser epiglottoplasty (1), and supplemental oxygen (12). Fourteen patients had documented improvement of PAH as seen from the cardiac catheterization, echocardiography, or electrocardiography findings; in 4 patients, PAH worsened (3 deaths). CONCLUSIONS: Chronic airway obstruction may lead to PAH. In this study, PAH was more likely to develop in premature infants or children with Down syndrome and cardiac anomalies. Surgery or supplemental oxygen will usually improve PAH, but fixed and irreversible PAH developed in patients with the most severe airway disease.

Child, Preschool↗
PubMed1976

The perioperative management of pericardial tamponade.

A case report of a patient with acute pericardial tamponade is presented. The etiology, pathophysiology, and management of cardiac tamponade is discussed. Preoperative management includes volume expansion, administration of catecholamines, and pericardiocentesis. Intraoperatively, monitoring should include continuous measurement of arterial and central venous pressures. Ketamine has been found to be very useful in these patients.

Anesthesia, General↗
PubMed1976

Anesthetic technic using profound hypothermia for correction of congenital heart defects in infants and small children.

Profound hypothermia can be a useful adjunct in the intraoperative management of infants and small children undergoing surgical correction of congenital heart defects. A case description of a 5 1/2-month-old male infant with total anomalous pulmonary venous drainage who had successful repair using surface cooling, cardiopulmonary bypass, and pump cooling to 20 C with intermittent periods of low systemic blood flow illustrates the technic. Discussed are the value of surface cooling before cooling on cardiopulmonary bypass, physiologic changes affecting the intraoperative and postoperative course, and the major risks and advantages of the technic.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Propranolol and cardiac surgery: a problem for the anesthesiologist?

Propranolol therapy has been implicated as a cause of myocardial depression and increased morbidity and mortality in patients undergoing coronary artery surgery. The authors reviewed 169 consecutive patients undergoing cardiac surgery, of whom 143 had been taking propranolol, with regard to preoperative administration of propranolol and intraoperative or postoperative complications. Patients taking propranolol until 24 hours before surgery showed no increased incidence of hypotension or bradycardia before cardiopulmonary bypass. Hypotension after bypass was no more common in patients off propranolol 12 to 48 hours than in patients who either discontinued the drug over 48 hours before operation or had never taken the drug. Myocardial contractility as measured by systolic time intervals was normal 24 to 48 hours after stopping propranolol therapy. Five patients had preoperative myocardial infarctions within 48 hours of discontinuing the drug. The operative mortality rate was 4 percent in patients taking propranolol within 48 hours of surgery and 6 percent in all other patients. Seven risk factors, other than propranolol, were identified in those patients requiring inotropic support. The authors conclude that propranolol can be given safely within 24 to 48 hours of coronary artery surgery provided the patient is a satisfactory candidate for myocardial revascularization.

Angina Pectoris↗
PubMedDate not supplied

Successful use of a reduced dose of protamine after cardiopulmonary bypass.

The dose of protamine necessary to reverse heparin was examined in 60 patients. Half the patients (controls) received a reversal dose of protamine equal to the entire amount of heparin given them, while half received a reversal dose based on a heparin half-life of 2 hours. Postoperative chest drainage for the first 12 hours and for 48 hours was markedly reduced in patients given the reduced dose of protamine. Platelet counts were higher and postoperative clotting studies varied less from control in patients receiving the smaller dose of protamine. The authors suggest reevaluation of the dose of protamine necessary to reverse the anticoagulant effects of heparin in patients for cardiopulmonary bypass, since larger doses protamine may contribute to the conditions which increase postoperative bleeding.

Cardiopulmonary Bypass↗