Emil Blair

Anatomy of the Ventricular Coronary Arteries in the Dog

The ventricular coronary arterial system of the dog displays preponderance of the left in 100 per cent of the animals studied. The single most important source of blood supply is the left circumflex artery, which supplies not only most of the left ventricle, but also significant portions of the right ventricle. Details of the septal branch are described. Morphological implications concerning death or survival in experimental coronary occlusive procedures are discussed. A simple nomenclature is offered.

Hypocapnia and gram-negative bacteremic shock☆☆☆

Abstract Gram-negative bacteremic shock is characterized by hypocapnia. Survivors consistently demonstrated pH compensation (alkalosis), although this did not serve as a wholly reliable index of prognosis. Hypocapnia persisted at the time of death. The lungs continued to perform well and the cause of death could not be attributed to pulmonary failure.

Peripheral Ramification of the Cardiac Conducting System

The study of the peripheral distribution of the right bundle branch in bovine, dogs, goats, lambs, and human hearts demonstrates an anatomical basis for the production of varying degrees of right bundle-branch block on operative incision of the anterior wall of the right ventricle.The left branch of the cardiac conducting system, with its transventricular cavity conducting bundles to the papillary muscles and the ventricular wall in bovine, dogs, goats, lambs, and human hearts, offers an anatomical basis for varying degrees of disturbance in left ventricular conduction due to operative incision or instrumentation in the left ventricle. Comparative anatomical studies in man and animals show conducting fibers which traverse the ventricular cavities in structures previously termed pseudotendons or false chords.In man, the existence of these transventricular cavity conducting bundles has not been emphasized, probably because of the traditional methods of opening the heart at autopsy.The combined electrocardiographic and anatomical concepts provide a useful background for caution in open-heart operation, lest stretching during manipulative procedures or cutting these peripheral conducting bundles produces irrevocable conduction-damage.

Clinical physiology of late (refractory) gram-negative bacteremic shock.

Abstract Gram-negative bacteremic shock in late stages is characterized by relatively higher cardiac outputs and lower vascular resistance in patients with the poorest prognoses. The cuff arterial pressure is not a reflection of the actual pressure present. Lactacidemia proved to be the consistent abnormality and further served as a suggestive index of the degree of shock and patients prognosis. Hypocapnia and respiratory alkalosis were consistent features, but bore no relationship to hemodynamics and further had no bearing on the patients outcome. All patients had been referred as being in refractory shock on the basis primarily of the status of arterial pressure with respect to vasopressors and “adequate” fluid therapy. Analysis by hemodynamic and metabolic criteria indicated that less than 50 per cent were in true physiologic refractory shock. Alpha adrenergic drugs proved deceptive in patient evaluation and likely contributed to deterioration.

Hyperbaric oxygenation in the treatment of experimental shock

Abstract The effect of OHP was studied in hemorrhagic and bacteremic shock in dogs. Beneficial effects in hemorrhagic shock occurred only early in the less severe stage of shock. In bacteremic shock, direct exposure of the microorganisms to OHP appears to be necessary for growth inhibition and subsequent improvement in survival. Many problems relating to the correction of oxygen deficits and oxygen poisoning, to have an effect on host mechanisms as well as on microorganisms, require continued and expanded investigation.

Electrocardiographic and Biochemical Study in Hemorrhagic Shock in Dogs Treated with Hyperbaric Oxygenation

A modification of the standard Fine preparation for hemorrhagic shock yielding an 83 per cent mortality rate was developed. Hyperbaric oxygenation (OHP) at 3 atmospheres absolute was found to decrease the mortality rate significantly, to 26 per cent. Electrocardiographic changes induced by OHP were bradycardia and sinus arrhythmia, which were abolished by vagotomy. Tachycardia, depression of the S-T segment, with changes in the configuration of the T wave that indicated myocardial damage, was observed in shock dogs treated with OHP. All changes improved after decompression and reinfusion of shed blood. The improved survival rate is attributed to better oxygenation of the hypoxic tissues[see figure in the PDF file]by the increased physically dissolved oxygen.

Use of Intravenous Mannitol in Postperfusion Oliguria-Anuria

We have applied the principle of acute functional renal failure in the management of the oliguric-anuric state encountered in 19 of 158 patients undergoing open-heart operations. Mannitol was administered to nine patients who experienced acute renal failure, with successful diuresis and restoration of kidney function in eight.

Anesthesia for cardiac surgery: The immediate postoperative period∗

Abstract The problems that arise in the immediate postoperative period following cardiac surgery are primarily related to events in the preoperative preparation and the anesthetic and surgical manipulation in the operating room. The difficulty may be increased by failure to provide adequate support for an inefficient respiratory mechanism and a precariously balanced circulation with little reserve. Emphasis should be placed on complete preoperative preparation including adequate digitalization and a baseline neurologic examination. The use of minimal doses of preanesthetic drugs, anesthetic agents and muscle relaxants is essential. The sternal-splitting incision and minimal handling of heart and lungs is recommended. Early use of a mechanical respiratory assistor through a cuffed tracheostomy tube should be considered the conservative approach when indicated. The need for sufficient replacement of blood to provide an effective circulating volume and the judicious use of sympathomimetic amines are outlined.