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1. Dynamic Characteristics of Cerebral Lipid Microemboli: Videomicroscopy Studies in Rats

Author

Zhilan Wang, Brendan Mullen, C. David Mazer, Robert J. Byrick, and J. Colin Kay

Subjects
Male, Cerebral veins, medicine.medical_specialty, Resuscitation, Pathology, Vena Cava, Superior, Blood Pressure, Embolism, Fat, Microcirculation, Rats, Sprague-Dawley, Stereotaxic Techniques, Bone Marrow, Internal medicine, Occlusion, medicine, Animals, Humans, Fat embolism, Lung, Microscopy, Video, business.industry, Brain, medicine.disease, Cerebral Veins, Rats, Anesthesiology and Pain Medicine, Blood pressure, Intracranial Embolism, Injections, Intravenous, Stereotaxic technique, Cardiology, Pulmonary Embolism, business, Postoperative cognitive dysfunction
Abstract

UNLABELLED: Cerebral lipid microemboli (LME) may cause postoperative cognitive dysfunction after orthopedic and cardiovascular surgery. In 13 anesthetized rats, we created a cranial window to study LME using orthogonal polarization spectral imaging videomicroscopy. All rats received 0.2 mL of human marrow fat, obtained from surgical waste during arthroplasty, injected into the superior vena cava. Five rats died within seconds of this injection, despite resuscitation efforts. Seven minutes later, we injected an additional 0.1 mL in 6 of the 8 surviving rats. We observed the videomicroscopy for 1 h in all 8 rats. Arterial blood pressure (BP) was continuously measured. No LME were observed in the first 7 min (n = 8); however, within seconds of the additional 0.1 mL injection, mean BP decreased from 79 +/- 31 mm Hg to 28 +/- 12 mm Hg (n = 6; P < 0.02). Epinephrine and crystalloid infusion increased BP to 161 +/- 9 mm Hg and 20-100 LME were seen within 5 min. LME changed shape and fragmentation, erosion, and streaming patterns were noted, with transient arteriolar occlusion (10-220 s). Increasing BP resulted in reperfusion of occluded arterioles. No venous LME were noted. Postmortem, brain and lung LME were found with no patent foramen ovale. This model may be useful in studying cerebral LME. IMPLICATIONS: Marrow lipid may pass through the lung during orthopedic surgery, creating cerebral lipid microemboli (LME). We created a cranial window in rats to study LME flowing through pial-cortical vessels. Cerebral LME appeared after resuscitation from hypotension and vessel occlusion was transient. This model may be useful in studying cerebral LME.

Published
2003
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2. Inhaled nitric oxide does not alter pulmonary or cardiac effects of fat embolism in dogs after cemented arthroplasty

Author

J. Colin Kay, Gerald Edelist, Patricia M. Murphy, Thomas E. Stewart, Robert J. Byrick, and Brendan Mullen

Subjects
medicine.medical_specialty, Hypertension, Pulmonary, Vasodilator Agents, medicine.medical_treatment, Blood Pressure, Embolism, Fat, Pulmonary Artery, Nitric Oxide, Arthroplasty, Nitric oxide, Random Allocation, chemistry.chemical_compound, Dogs, Internal medicine, medicine.artery, Administration, Inhalation, medicine, Animals, Fat embolism, Lung, Hypertrophy, Right Ventricular, business.industry, Respiratory disease, Bone Cements, Hemodynamics, General Medicine, medicine.disease, Pulmonary hypertension, Anesthesiology and Pain Medicine, medicine.anatomical_structure, chemistry, Anesthesia, Ven, Pulmonary artery, Cardiology, Invasive hemodynamic monitoring, Pulmonary Embolism, Nuclear medicine, business, Echocardiography, Transesophageal
Abstract

Purpose: We examined the effect of inhaled nitric oxide (NO) on the acute pulmonary hypertension and right ven- tricular (RV) dilation after fat embolism. Methods: A bilateral cemented arthroplasty (BCA), created fat embolism in 20 dogs. In Part A, 12 dogs were ran- domized to an NO group (n = 6, inhaled NO 40 ppm before BCA and throughout the study) or a control group (n =6). In Part B, a third group of dogs (n=8) were given NO 20-40 ppm 2-3 min after BCA when pulmonary artery pres- sure (PAP) increased. Transesophageal echocardiography (TEE) and invasive hemodynamic monitoring evaluated the hemodynamic response to BCA. Postmortem, quantitative morphometry was used to estimate the number of fat emboli and diameter of lung vessel occluded by fat. Results: Part A: The increase in PAP in the NO group (I 6 -+ I to 34 _+ 9 mmHg) within three minutes of BCA was not different from that in the control group ( 14 _+ 4 to 35 +- 9 mmHg). W~hin three minutes of BCA, TEE demon- strated RV dilation in all groups (P ~ 0.05) but there was no difference in the change in RV area in the NO and con- trol groups. When NO was given after BCA, no difference in PAP or RV dilation was noted from that in the control group. There were no differences, at post mortem, between the groups in the diameter of lung vessel occluded by fat Conclusion: Whether given before the embolic insult or two to three minutes after the onset of pulmonary hyper- tension, inhaled NO did not attenuate the acute pulmonary hypertension or RV dilation after cemented arthroplasty. Objectif : I~tudier reffet de I'oxyde nltrique inhal~ (NO) sur I'hypertension pulmonaire aigu~ et la dilatation du ven- tricule droit (VD) apr& une embolie graisseuse. M&hode : Une arthroplastie bilat&ale ciment& (ABC) a cr~ une embolie graisseuse chez 20 chiens. Dans la partie A de I'essai, 12 chiens ont &~ r~partis de fa~on al~atoire vers un groupe NO (n = 6, 40 ppm de NO inhal~ avant I'ABC et tout au long de r&ude) ou vers un groupe t~moin (n = 6 ). Dans la pattie B, un troisi~me groupe de chiens (n = 8) ont re~su 20-40 ppm de NO, 2-3 min apr& I'ABC, au moment off la pression de I'art&e pulmonaire (PAP) s'est ~lev~e. On a ~valu~ la r~ponse h~modynamique ~ rABC par &hocardiographie transcesophagienne (ETO) et par monitorage h~modynamique effractif. Apr~s la mort, on a utilis~ la morphom~trie quantitative pour ~valuer la propor- tion du syst~me vasculaire pulmonaire obstru~e par la graisse. R~.sultats : Partie A : I'augmentation de PAP dans le groupe NO (I 6 + I ~ 34 -+ 9 mmHg), en moins de trois min- utes suivant I'ABC, ~tait semblable ~ celle du groupe t~moin (14 - 4 ~ 35 - 9 mmHg). Moins de trois minutes apr& I'ABC, I'ETO a montr~ une dilatation du VD dans tousles groupes (P ~ 0,05) mais pas de diff&ence intergroupe de changements survenus au VD. Aucune diff&ence de PAP ou de dilatation du VD, en comparaison avec les chiens t~moins, n'a ~t~ not& suivant radministration de NO. A rautopsie, il n'y avait pas de diff&ence intergroupe quant au diam&re du vaisseau pulmonaire obstru~ par la graisse. Conclusion : Que le NO soit administr~ avant rembolie ou deux ou trois minutes apr~s le d~but de rhypertension, il ne r~duit pas rhypertension pulmonaire aigu~ ou la dilatation du VD ~ la suite d'une arthroplastie ciment&.

Published
1999
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3. Abstracts

Author

Cristina Hurtado, John Bradley, Andrew R. Burns, Keyvan Karkouti, Rob Anderson, Simon D. Abrahamson, C. David Mazer, O. R. Hung, L. Comeau, Joseph A. Fisher, Janet Tessler, Joshua Rucker, Alix Mathicu, Sara Murray-Foster, Chou Tz-Chong, Li Chi-Yuan, Takako Tsuda, Akihiko Tabuchi, Hiroshi Sasano, Masanobu Kiriyama, Akinori Okada, Junichiro Hayano, Akinori Takeuchi, Hirotada Katsuya, Claude P. Tousignant, Elizabeth Ling, Ramiro Arellano, N. Dowd, J. Karski, D. Cheng, J. Carroll-Munro, D. K. Rose, C. O. Mazer, M. M. Cohen, D. Wigglesworth, William P. S. McKay, Robert J. Teskey, Julio Militzer, Guy Kember, Travis Blanchet, Peter H. Gregson, Steven R. Howells, James A. Robblee, Terrance W. Breen, Laura Dierenfield, Tacie McNeil, Donna J. Nicholson, Stephen E. Kowalski, G. Andrew Hamilton, Michael P. Meyers, Carl Serrette, Peter C. Duke, Ingrid Custeau, Rend Martin, Sonia Larabée, Martine Pirlet, Madeleine Pilote, Jean-Pierre Tetrault, Ban C. H. Tsui, Sunil Gupta, Brendan Finucane, Mitchell J. Weisbrod, Vincent W. S. Chan, Z. Kaszas, C. Dragomir, M. R. Cohen, M. Gandhi, A. S. Clanachan, B. A. Finegan, Lisa Isaac, William M. Splinter, L. A. Hall, H. M. Gould, E. J. Rhine, Lyne Bergeron, Michel Girard, Pierre Drolet, Hong Hanh Le Truong, Carl Boucher, Daniel Vézina, Martin R. Lessard, Marie Gourdeau, Claude A. Trépanier, Theresa Yang, Alison Macarthur, P. Chouinard, F. Fugère, M. Ruel, Pekka Tarkkila, Marja Silvasti, Marjatta Tuominen, Nils Svartling, Per H. Rosenberg, David M. Bond, John F. Rudan, Michael A. Adams, Brian K. Tsang, Wanda Keahey, Lucia Gagliese, Marla Jackson, Paul Ritvo, Adarose Wowk, Alan N. Sandler, Joel Katz, J. G. Laffey, J. F. Boylan, Neal H. Badner, Wendy E. Komar, R. A. Cherry, S. M. Spadafora, R. J. Butler, Fiona McHardy, Joanne Fortier, Frances Chung, Scott Marshall, Ananthan Krishnathas, Jean Wong, Ewan Ritchie, Andrew Meikle, Nicole Avery, Janet van Vlymen, Joel L. Parlow, David Sinclair, Gabor Mezei, Fengling Jin, Andrew Norris, Tharini Ganeshram, Bernard A. MacLeod, Aliréza Azmudéh, Luigi G. Franciosi, Craig R. Ries, Stephan K. W. Schwarz, William PS McKay, Benjamin W. S. McKay, Pascal Meuret, Vincent Bonhomme, Gilles Plourde, Pierre Fiset, Stevens B. Backman, Alex Vesely, Leeor Sommer, Joel Greenwald, Elana Lavine, Steve Iscoe, George Volgyesi, Ludwik Fedorko, Joseph Fisher, Emilio B. Lobato, Cheri A. Sulek, Laurie K. Davies, Peter F. Gearen, François Bellemare, François Donati, Jacques Couture, Hwan S. Joo, Sunil Kapoor, Shahriar Shayan, Kenneth M. LeDez, Jim Au, John H. Tucker, Edwin B. Redmond, V. Gadag, Catherine Penney, Gregory M. T. Hare, Timothy D. G. Lee, Gregory M. Hirsch, Fan Yang, Eric Troncy, Gilbert Blaise, Yoshiyuki Naito, Shoji Arisawa, Masahiro Ide, Susumu Nakano, Kazuo Yamazaki, Takae Kawamura, Noriko Nara, Reiji Wakusawa, Katsuya Inada, Robert J. Hudson, Karanbir Singh, Gary A. Harding, Blair T. Henderson, Ian R. Thomson, Christopher G. Wherrett, Donald R. Miller, Alan A. Giachino, Michelle A. Turek, Kelly Rody, H. Vaghadia, V. Chan, S. Ganapathy, A. Lui, J. McKenna, K. Zimmer, William D. Regan, Ross G. Davidson, Krista Nevin, Sergio Escobedo, E. Mitmaker, M. J. Tessler, K. Kardash, S. J. Kleiman, M. Rossignol, L. Kahn, F. Baxter, A. Dauphin, C. Goldsmith, P. Jackson, J. McChesney, J. Miller, L. Takeuchi, E. Young, Kristine Klubien, Edith Bandi, Franco Carli, Kathleen Dattilo, Doris Tong, Mohit Bhandari, Louise Mazza, Linda Wykes, L. Z. Sommer, J. Rucker, A. Veseley, E. Levene, Y. Greenwald, G. Volgyesi, L. Fedorko, S. Iscoe, J. A. Fisher, Guo-Feng Tian, Andrew J. Baker, F. X. Reinders, A. J. Baker, R. J. Moulton, J. I. M. Brown, L. Schlichter, Laurence Van Tulder, Stéphane Carignan, Julie Prénovault, Jean-Paul Collet, Stan Shapiro, Jean-Gilles Guimond, Louis Blait, Thierry Ducruet, Martin Francœur, Marc Charbonneau, Guy Cousineau, Daniel R. Wong, Michele McCall, Fergus Walsh, Regina Kurian, Mary Keith, Michael J. Sole, Kursheed N. Jeejeebhoy, E. Whitten, P. H. Norman, J. A. Aucar, L. A. Coveler, Rodney M. Solgonick, Y. Bastien, Bruce Mazer, Koji Lihara, Beverley A. Orser, Michael Tymianski, Brendan T. Finucane, Nuzhat Zaman, Ibrahim Kashkari, Soheir Tawfik, Yun K. Tarn, Peter D. Slinger, Karen McRae, Timothy Winton, Alan N. Sandier, J. E. Zamora, Mary Jane Salpeter, Donglin Bai, John F. MacDonald, Kelly Mayson, Ed Gofton, Keith Chambers, Susan E. Belo, J. Colin Kay, Sean R. R. Hall, Louie Wang, Brian Milne, Chris Loomis, Zhi He, Wichai Wougchanapai, Ing K. Ho, John H. Eichhorn, Tangeng Ma, Wichai Wongchanapai, John H. Eicnhorn, Damian B. Murphy, M. B. Murphy, Steven B. Backman, Reuben D. Stein, Brian Collier, Canio Polosa, Chi-Yuan Li, Tz-Chong Chou, Jia-Yi Wang, John Fuller, Ronald Butler, Salvatore Spadafora, Neil Donen, Laurence Brownell, Sandy Shysh, Keith Carter, Chris Eagle, Isabella Devito, Stephen Halpern, J. Hugh Devitt, Doreen A. Yee, John L. deLacy, Donald C. Oxorn, Gary F. Morris, Raymond W. Yip, M. G. Gregoret-Quinn, R. F. Seal, LJ. Smith, A. B. Jones, C. Tang, B. J. Gallant, L. A. Nadwidny, Gerald V. Goresky, Tara Cowtan, Hilary S. Bridge, Carolyne J. Montgomery, Ross A. Kennedy, Pamela M. Merrick, M. Yamashita, K. Wada, Sylvie LeMay, Jean-François Hardy, Pamela Morgan, Steven Halpern, Jana Evers, P. Ronaldson, F. Dexter, Desmond Writer, Holly Muir, Romesh Shukla, Rob Nunn, John Scovil, Jeremy Pridham, Ola Rosaeg, Allan Sandier, Patricia Morley-Foster, Simon Lucy, Lesley-Ann Crone, Karen Zimmer, Deborah J. Wilson, Robert Heid, M. Joanne Douglas, Dan W. Rurak, Anna Fabrizi, Chantal T. Crochetière, Louise Roy, Edith Villeneuve, Louise Lortie, Sandra Katsiris, Barbara Leighton, Donna Wilson, Jean Kronberg, Leszek Swica, Janet Midgley, Robert Nunn, Bruce Smith, Michael E. Rooney, David C. Campbell, Celina M. Riben, Ray W. Yip, Jo MacDonell, and Tracey Levine

Subjects
Sevoflurane, Anesthesiology and Pain Medicine, Morphine, Total Knee Arthroplasty, Pulmonary Capillary Wedge Pressure, Ropivacaine, General Medicine, Article
Published
1998

4. Relationship of fat embolism to haemodynamic and echocardiographic changes during cemented arthroplasty

Author

J. Brendan Mullen, J. Colin Kay, Patricia M. Murphy, Gerald Edelist, and Robert J. Byrick

Subjects
Pulmonary Circulation, Medullary cavity, medicine.medical_treatment, Hemodynamics, Blood Pressure, Embolism, Fat, Pulmonary Artery, Arthroplasty, Dogs, medicine, Animals, Ventricular Function, Fat embolism, business.industry, Respiratory disease, Central venous pressure, Stroke Volume, General Medicine, Stroke volume, medicine.disease, Pulmonary embolism, Anesthesiology and Pain Medicine, Anesthesia, sense organs, Lung Volume Measurements, business, Echocardiography, Transesophageal
Abstract

Pressurisation of the medullary cavity during cemented arthroplasty causes "intravasation" of marrow fat. The purpose of this study was to examine the relationship between the amount of pulmonary intravascular fat and the haemodynamic and echocardiographic changes.Anaesthetised mongrel dogs (n = 16) underwent bilateral cemented arthroplasty (BCA) to create a large embolic load. Haemodynamic measurements included blood pressure (BP), pulmonary artery pressure (PAP), right atrial pressure and cardiac output as well as transoesophageal echocardiographic (TEE) assessment of right ventricular (RV) and left ventricular (LV) areas. Using quantitative morphometry on postmortem lung specimens, the proportion of lung tissue occluded by fat was measured.Mean BP decreased within one minute of BCA, coinciding with the appearance of echogenic material in the RV. The RV area increased by 56% (P0.05) and LV area decreased by 34% (P0.05) while PAP increased from 15 +/- 3 mmHg to 39 +/- 10 mmHg within one minute (P0.001). The PAP remained elevated throughout the study (30 min). Stroke volume decreased in 14/15 dogs, yet cardiac output was maintained by increased heart rate. There was a curvilinear relationship (r = 0.87) between the maximum increase in PAP and the proportion of lung occupied by fat.In this model, stroke volume decreased within one minute of BCA when fat embolism accompanied prosthesis insertion. The TEE detected an increased RV area and reduced LV area associated with decreased stroke volume. The maintenance of cardiac output after intraoperative fat embolism depends primarily on the ability to increase heart rate.

Published
1997
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5. Abstracts

Author

W. A. C. Mutch, I. W. C. White, N. Donen, I. R. Thomson, M. Rosenbloom, M. Cheang, M. West, Greg Bryson, Christina Mundi, Jean-Yves Dupuis, Michael Bourke, Paul McDonagh, Michael Curran, John Kitts, J. Earl Wynands, Alison S. Carr, Elizabeth J. Hartley, Helen M. Holtby, Peter Cox, Bruce A. Macpherson, James E. Baker, Andrew J. Baker, C. David Mazer, C. Peniston, T. David, D. C. H. Cheng, J. Karski, B. Asokumar, J. Carroll, H. Nierenberg, S. Roger, A. N. Sandier, J. Tong, C. M. Feindel, J. F. Boylan, S. J. Teasdale, J. Boylan, P. Harley, Jennifer E. Froelich, David P. Archer, Alastair Ewen, Naaznin Samanani, Sheldon H. Roth, Richard I. Hall, Michael Neumeister, Gwen Dawe, Cathy Cody, Randy O’Brien, Jan Shields-Thomson, Kenneth M. LeDez, Catherine Penney, Walter Snedden, John Tucker, Nicolas Fauvel, Mladen Glavinovic, François Donati, S. B. Backman, R. D. Stein, C. Polosa, C. Abdallah, S. Gal, A. John Clark, George A. Doig, Tunde Gondocz, E. A. Peter, A. Lopez, A. Mathieu, Pierre Couture, Daniel Boudreault, Marc Derouin, Martin Allard, Gilbert Blaise, Dominique Girard, Richard L. Knill, Teresa Novick, Margaret K. Vandervoort, Frances Chung, Shantha Paramanathar, Smita Parikh, Charles Cruise, Christina Michaloliakou, Brenda Dusek, D. K. Rose, M. M. Cohen, D. DeBoer, George Shorten, Earnest Cutz, Jerrold Lerman, Myrna Dolovich, Edward T. Crosby, Robert Cirone, Dennis Reid, Joanne Lind, Melanie Armstrong, Wanda Doyle, S. Halpern, P. Glanc, T. Myhr, M -L. Ryan, K. Fong, K. Amankwah, A. Ohlsson, R. Preston, Andor Petras, Michael J. Jacka, Brian Milne, Kanji Nakatsu, S. Pancham, Graeme Smith, Kush N. Duggal, M. Joanne Douglas, Pamela M. Merrick, Philip Blew, Donald Miller, Raymond Martineau, Kathryn Hull, C. M. Baron, S. Kowalskl, R. Greengrass, T. Horan, H. Unruh, C. L. Baron, Patricia M. Cruchley, K. Nakajima, Y. Sugiura, Y. Goto, K. Takakura, J. Harada, Robert M. K. W. Lee, Angelica M. Fargas-Babjak, Jin Ni, Eva S. Werstiuk, Joseph Woo, David H. Morison, Michael D. McHugh, Hanna M. Pappius, Hironori Ishihara, Yuki Shimodate, Hiroaki Koh, Akitomo Matsuki, John W. R. Mclntyre, Pierre Bergeron, Lulz G. R. DeLima, Jean-Yves Dupuls, James Enns, J. M. Murkin, F. N. McKenzie, S. White, N. A. Shannon, Wojciech B. Dobkowski, Judy L. Kutt, Bernard J. Mezon, David R. Grant, William J. Wall, Dennis D. Doblar, Yong C. Lim, Luc Frenette, Jaime R. Ronderos, Steve Poplawski, Dinesh Ranjan, L. Dubé, L. Van Obbergh, M. Francoeur, C. Blouin, R. Carrier, D. Doblar, J. Ronderos, D. Singer, J. Cox, B. Gosdin, M. Boatwright, Charles E. Smith, Aleksandr Rovner, Carlos Botero, Curt Holbrook, Nileshkumar Patel, Alfred Pinchak, Alfred C. Pinchak, Yin James Kao, Andrew Thio, Steven J. Barker, Patrick Sullivan, Matthew Posner, C. William Cole, Patty Lindsay, Paul B. Langevin, Paul A. Gulig, N. Gravenstein, David T. Wong, Manuel Gomez, Glenn P. McGuire, Robert J. Byrick, Shared K. Sharma, Frederick J. Carmicheal, Walter J. Montanera, Sharad Sharma, D. A. Yee, Basem I. Naser, G. L. Bryson, J. B. Kitts, D. R. Miller, R. J. Martineau, M. J. Curran, P. R. Bragg, Jacek M. Karski, Davy Cheng, Kevin Bailey, S. Levytam, R. Arellano, J. Katz, J. Doyle, Mitchel B. Sosis, William Blazek, G. Plourde, A. Malik, Tammy Peddle, James Au, Jeffrey Sloan, Mark Cleland, Donald E. Hancock, Nilesh Patel, Frank Costello, Louise Patterson, Masao Yamashita, Tsukasa Kondo, M. R. Graham, D. Thiessen, David F. Vener, Thomas Long, S. Marion, D. J. Steward, Berton Braverman, Mark Levine, Steve Yentis, Catherine R. Bachman, Murray Kopelow, Ann McNeill, R. Graham, Norbert Froese, Leena Patel, Heinz Reimer, Jo Swartz, Suzanne Ullyot, Harley Wong, Maria A. Markakis, Nancy Siklch, Blair D. Goranson, Scott A. Lang, Martin J. Stockwell, Bibiana Cujec, Raymond W. Yip, Lucy C. Southeriand, Tanya Duke B. Vet, Jeisane M. Gollagher, Lesley-Ann Crone, James G. Ferguson, Demetrius Litwin, Maria Bertlik, Beverley A. Orser, Lu-Wang Yang, John F. MacDonald, Gary F. Morris, Wendy L. Gore-Hickman, J. E. Zamora, O. P. Rosaeg, M. P. Lindsay, M. L. Crossan, Carol Pattee, Michael Adams, John P. Koller, Guy J. Lavoie, Wynn M. Rigal, Dylan A. Taylor, Michael G. Grace, Barry A. Flnegan, Christopher Hawkes, Harry Hopkins, Michael Tierney, David R. Drover, Gordon Whatley, J. W. Donald Knox, Jarmila Rausa, Hossam El-Beheiry, Ronald Seegobin, Georgia C. Hirst, William N. Dust, J. David Cassidy, D. Boisvert, H. Braden, M. L. Halperin, S. Cheema-Dhadli, D. J. McKnight, W. Singer, Thomas Elwood, Shirley Huchcroft, Charles MacAdams, R. Peter Farran, Gerald Goresky, Phillip LaLande, Gilles Lacroix, Martin Lessard, Claude Trépanier, Janet M. van Vlymen, Joel L. Parlow, Chikwendu Ibebunjo, Arnold H. Morscher, Gregory J. Gordon, H. P. Grocott, Susan E. Belo, Georgios Koutsoukos, Susan Belo, David Smith, Sarah Henderson, Adriene Gelb, G. Kantor, N. H. Badner, W. E. Komar, R. Bhandari, D. Cuillerier, W. Dobkowski, M. H. Smith, A. N. Vannelli, Sean Wharton, Mike Tierney, E. Redmond, E. Reddy, A. Gray, J. Flynn, R. B. Bourne, C. H. Rorabeck, S. J. MacDonald, J. A. Doyle, Peter T. Newton, Carol A. Moote, R. Joiner, M. F. X. Glynn, Vytas Zulys, M. Hennessy, T. Winton, W. Demajo, William P. S. McKay, Peter H. Gregson, Benjamin W. S. McKay, Julio Militzer, Eric Hollebone, Raymond Yee, George Klein, R. L. Garnett, J. Conway, F. E. Ralley, G. R. Robbins, James E. Brown, J. V. Frei, Edward Podufal, Norman J. Snow, Altagracia M. Chavez, Richard P. Kramer, D. Mickle, William A. Tweed, Bisharad M. Shrestha, Narendra B. Basnyat, Bhawan D. Lekhak, Susan D. O’Leary, J. K. Maryniak, John H. Tucker, Cameron B. Guest, J. Brendan Mullen, J. Colin Kay, Dan F. Wigglesworth, Mashallah Goodarzi, Nicte Ha Shier, John A. Ogden, O. R. Hung, S. Pytka, M. F. Murphy, B. Martin, and R. D. Stewart

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1994
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6. Abstracts

Author

E. T. Crosby, S. Halpern, K. M. Bill, R. J. Flynnn, J. Moore, C. Navaneelan, A. Cunningham, P. Y. H. Yu, D. R. Gamling, G. H. McMorland, C. Perreault, J. Guay, P. Gaudreault, C. Hollman, R. Meloche, T. Hackman, S. B. Sheps, W. B. Murray, P. A. Heiman, P. Slinger, W. Triolet, U. Jain, T. L. K. Rao, M. Dasari, R. Pifarre, H. Sullivan, D. Calandra, R. M. Friesen, J. Bjornson, G. Hatton, J. L. Parlow, W. F. Casey, L. M. Broadman, L. J. Rice, M. Dailey, W. R. Andrews, S. Stigi, V. Jendrek, K. Shevde, D. E. Withington, A. Tazi Saoud, J. G. Ramsay, J. Bilodeau, D. Johnson, I. Mayers, R. J. Doran, P. Y. Wong, Brendan J. Mullen, D. Wigglesworth, R. J. Byrick, J. Colin Kay, J. F. Stubbing, B. P. Sweeney, E. Dagher, L. Dumont, G. Lagace, C. Chartrand, N. H. Badner, A. N. Sandier, L. Leitch, G. Koren, R. F. Erian, L. Bunegin, D. L. Shulman, F. Burrows, K. O’Sullivan, D. Bouchier, B. A. Kashin, J. E. Wynands, E. Villeneuve, G. Blaise, M. J. Guerrard, J. Buluran, E. Effa, H. Vaghadia, L. C. Jenkins, T. Janisse, C. H. Scudamore, P. M. Patel, W. A. C. Mutch, T. S. Ruta, B. R. McNeill, J. M. Murkin, A. W. Gelb, J. K. Farrar, G. D. Johnson, M. A. Adams, D. P. Lillicrap, T. Lindblad, W. S. Beattie, D. N. Buckley, J. B. Forrest, M. R. Lessard, C. A. Trépanier, J. P. Baribault, J. G. Brochu, C. A. Brousseau, J. J. Cote, P. Denault, P. Whang, G. C. Moudgil, N. Daly, D. H. Morrison, R. Ogilvie, J. Man, T. Ehler, L. F. Leitch, J. Y. Dupuis, R. Martin, J. M. Tessonnier, A. W. Barry, B. Milne, L. Quintin, J. Y. Gillon, J. F. Pujol, F. DeMonte, C. Zhang, J. T. Hamilton, Y. Zhou, G. Plourde, T. W. Picton, A. Kellett, M. A. Pilato, B. Bissonnette, J. Lerman, K. A. Brown, J. W. Dundee, M. Sosis, F. Dillon, J. B. Stetson, W. D. Voorhees, J. D. Bourland, L. A. Geddes, W. E. Shoenlein, G. O’Leary, S. Teasdale, R. L. Knill, E. A. Rose, S. L. Berko, C. E. Smith, J. M. Sadler, J. C. Bevan, F. Donati, D. R. Bevan, J. Tellez, D. Turner, Y. J. Kao, V. Salidivia, L. Roldan, H. Orrego, F. J. Carmicheal, A. P. Kent, C. J. R. Parker, J. M. Hunter, G. A. Finley, G. V. Goresky, K. Klassen, C. McDiarmid, E. Shaffer, M. Vaughan, J. Randolph, J. E. Szalados, V. A. Lazzell, R. E. Creighton, A. O. Poon, B. Mclntyre, M. J. Douglas, J. E. Swenerton, D. F. Farquharson, D. Landry, F. Petit, D. Riegert, J. P. Koch, R. Maggisano, J. H. Devitt, H. G. Jense, S. A. Dubin, P. I. Silverstein, N. Rodriguez, M. L. Wakefield, R. Williams, S. Dubin, J. J. Smith, V. C. Hofmann, A. P. Jarvis, R. B. Forbes, D. J. Murray, J. B. Dillman, D. L. Dull, M. M. Cohen, C. B. Cameron, R. G. Johnston, E. Konopad, K. Jivraj, D. Hunt, R. Eastley, L. Strunin, M. J. Fairbrass, S. Laganiere, M. McGilvery, B. Foster, P. Young, D. Weisel, L. Parra, B. A. Suarez Isla, J. R. Lopez, R. I. Hall, R. Hawwa, H. Kashtan, G. Edelist, J. Mallon, D. Kapala, M. Saeed Dhamee, A. C. Reynolds, T. Olund, J. Entress, J. Kalbfleisch, S. D. Bell, M. E. Goldberg, B. J. Bracey, D. R. Goldhill, M. H. Bennett, R. S. Emmott, R. F. Innis, P. M. Yate, P. J. Flynn, S. S. Gill, P. R. Saunders, A. H. Geisecke, J. M. Feldman, M. J. Banner, S. A. Siriwardhana, A. Kawas, J. L. Lipton, A. H. Giesecke, D. J. Doyle, G. A. Volgyesi, S. C. Hillier, J. Gallagher, K. Hargaden, M. Hamil, A. J. Cunningham, W. A. C. Scott, D. Sielecka, L. H. Illing, K. Jani, M. Scarr, J. R. Maltby, J. Roy, S. E. McNulty, M. Torjman, C. Carey, B. Bracey, K. Markham, J. Durcan, D. Blackstock, C. A. DaSilva, P. D. Demars, C. J. Montgomery, D. J. Steward, D. I. Sessler, P. Laflamme, S. McDevitt, G. D. Kamal, T. Symreng, D. J. Tatman, J. Durcharme, F. Varin, J. G. Besner, J. B. Dyck, F. Chung, R. Arellano, G. Lim, D. G. Bailey, C. D. Bayliff, D. G. Cunningham, A. Ewen, S. D. Sheppard, L. T. Mahoney, G. S. Bacon, L. R. Rice, K. Newman, W. Loe, M. Toth, M. Pilato, K. Classen, C. McDiamid, F. A. Burrows, C. L. Irish, W. Casey, G. J. Hauser, M. M. Chan, F. M. Midgley, P. R. Holbrook, M. E. Elliott, W. K. Man, B. A. Finegan, A. S. Clanachan, R. J. Hudson, I. R. Thomson, P. M. Burgess, M. Rosenbloom, J. M. Fisher, J. P. O’Connor, F. E. Ralley, G. R. Robbins, C. A. Moote, P. H. Manninen, M. English, C. Farmer, A. Scott, I. W. C. White, D. Biehl, N. Donen, J. Mansfield, M. Cohen, J. G. Wade, C. Woodward, J. Ducharme, A. Gerardi, A. Mijares, W. E. Code, L. Hertz, A. Chung, H. M. R. Meier, E. Lautenschlaeger, C. Seyone, M. R. Wassef, F. H. Devitt, D. C. H. Cheng, B. Dyck, V. W. S. Chan, F. M. Ferrante, G. R. Arthur, L. Rice, R. H. Annallah, R. C. Etches, D. Loulmet, P. Lacombe, C. Hollmann, M. Tanguay, G. A. Blaise, S. G. Lenis, D. W. Fear, S. A. Lang, H. C. Ha, H. Germain, A. Neion, P. Dorian, D. Salter, C. Pollick, F. Cervenko, J. Parlow, J. Pym, K. Nakatsu, D. Elliott, D. R. Miller, R. J. Martineau, D. Ewing, J. W. D. Knox, D. C. Oxorn, D. G. Whalley, K. H. Rogers, J. C. Kay, C. D. Mazer, S. E. Belo, P. Hew-Wing, E. Hew, J. M. Tessonier, G. Thibault, E. Testaert, D. Chartrand, J. R. Cusson, O. Kuchel, P. Larochelle, and J. Couture

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1989
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7. Fine structural changes in haemodynamic pulmonary oedema

Author

J. Colin Kay, William H. Noble, and Kalman Kovacs

Subjects
Indicator Dilution Techniques, Hemodynamics, Blood Pressure, Pulmonary Edema, Pulmonary oedema, Positive-Pressure Respiration, chemistry.chemical_compound, Animals, Medicine, Cardiac Output, Positive pressure ventilation, Lung, Electron microscopic, Blood Volume, business.industry, Dextrans, General Medicine, Oxygenation, Oxygen, Pulmonary Alveoli, Microscopy, Electron, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Dextran, chemistry, Anesthesia, Indicator dilution technique, business
Abstract

Pulmonary oedema was induced in dogs by dextran overload and the amount of fluid quantitatively assessed by using a double indicator dilution technique (ETVL). Changes in ETVL and arterial oxygenation were related to light and electron microscopic alterations of lung in early oedema and in gross oedema before and after continuous positive pressure ventilation (CPPV) was applied.

Published
1974
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8. Lung Water Increases with Fluid Administration during CPPV after Pulmonary Microembolization

Author

William H. Noble and J. Colin Kay

Subjects
Cardiac output, Pulmonary Edema, Hypoxemia, Positive-Pressure Respiration, Dogs, Oxygen Consumption, medicine, Animals, Cardiac Output, Lung, Respiratory Distress Syndrome, business.industry, Metabolic acidosis, medicine.disease, Pulmonary edema, Combined Modality Therapy, Pulmonary embolism, Oxygen, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Breathing, Vascular resistance, Fluid Therapy, Vascular Resistance, medicine.symptom, Pulmonary Embolism, business
Abstract

Hypoxemia created by pulmonary microemboli is improved by continuous positive-pressure ventilation (CPPV) but at a cost of reducing cardiac output (Q). In this high pulmonary vascular resistance (PVR), pulmonary edema setting, the authors attempted to increase the Q, which had been reduced by CPPV, with an infusion of dextran. In 14 dogs, 0.125 g/kg of starch microemboli (63-74 microns in diameter) were infused. CPPV at 15 cm H2O then was applied and PaO2 increased from 53 +/- 4 to 69 +/- 3 mmHg, but Q decreased from 2.9 +/- 0.2 to 1.7 +/- 0.2 1/min. Seven of these dogs (control group) were monitored for 3 h. In the remaining seven dogs (volume group), dextran 40 was infused until Q returned to pre-CPPV values, and monitoring was continued for 3 h. With return of Q to pre-CPPV levels, indices of tissue oxygenation (O2 transport, PVO2, O2 consumption and metabolic acidosis) were significantly improved. However lung water was increased significantly by the volume infusion, so that at 3 h lung water in the volume group was double the value in the control group. The authors conclude that volume infusion in the face of a high PVR may correct the reduced Q of CPPV and improve tissue oxygenation, but it also may increase pulmonary edema.

Published
1984
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9. Hypoxemia Following Pulmonary Embolism

Author

William H. Noble, J. Colin Kay, and Joseph A. Fisher

Subjects
medicine.medical_specialty, Lung, business.industry, respiratory system, medicine.disease, Pulmonary hypertension, respiratory tract diseases, Hypoxemia, Pulmonary embolism, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Embolism, Internal medicine, medicine.artery, Hypoxic pulmonary vasoconstriction, Pulmonary artery, Cardiology, Medicine, medicine.symptom, business, Perfusion, circulatory and respiratory physiology
Abstract

We studied the role played by a shift in perfusion to hypoxic lung areas after pulmonary embolism in pst embolic hypoxemia. A tracheal divider was used to separate hypoxic (N2 ventilated) from oxygenated (100 per cent O2 ventilated) lung in anaesthetized dogs. Relative perfusion was assessed from total 133Xenon (133Xe) exhaled from each lung area after intravenous infusions. When one lung area was ventilated with N2 and the other with O2 at a normal PaCO2 to allow hypoxic pulmonary vasoconstriction (HPV), there was a significant (P less than 0.001) shift away from the hypoxic side. Starch or blood clots were then infused to produce pulmonary emboli. Starch emboli were distributed predominantly to the oxygenated lung. After blood clot embolization in normocapnic dogs, pulmonary artery pressure increased 15 torr, perfusion to the hypoxic lung increased from 14 +/- 2 to 23 +/- 1 per cent, and PaCO2 fell from 278 to 186 torr. When the degree of HPV was reduced in another group of dogs by hypocapnea, a similar increase in pulmonary artery pressure (14 torr) created by blood clot embolism did not shift perfusion or create hypoxemia. In all dogs the perfusion shift to hypoxic lung was sufficient to account for all the post embolic hypoxemia. In this dog model, post embolic hypoxemia is explained by preferential distribution of emboli to oxygenated lung followed by perfusion shift to hypoxic lung as the effect of HPV is overcome by pulmonary hypertension.

Published
1981
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10. Pulmonary marrow embolism: A dog model simulating dual component cemented arthroplasty

Author

Robert J. Byrick, J. Colin Kay, Aimlt J. Brendan, and M. Mullen

Subjects
medicine.medical_specialty, Cardiac output, Joint Prosthesis, medicine.medical_treatment, Embolism, Fat, Prosthesis, law.invention, Hypoxemia, Intramedullary rod, Dogs, Bone Marrow, law, Intravascular volume status, Animals, Medicine, Fat embolism, Pulmonary Gas Exchange, business.industry, Bone Cements, Hemodynamics, General Medicine, medicine.disease, Arthroplasty, Surgery, Oxygen, Anesthesiology and Pain Medicine, Embolism, Anesthesia, medicine.symptom, Pulmonary Embolism, business
Abstract

The cardiopulmonary changes resulting from cemented arthroplasty procedures were monitored in 11 dogs with a single prosthesis implanted and nine dogs with a dual arthroplasty procedure. These changes were characterized by decreased BP, elevated PPA, and elevated PVR, associated with decreases in PaO2, cardiac output and mixed venous oxygen tension. All changes were more pronounced and prolonged in the dual component arthroplasty group. Histologic lung examination and morphometry demonstrated significant degrees of marrow (fat) microembolism in the dual arthroplasty model. Cardiopulmonary collapse has been associated with Guepar dual component arthroplasties clinically and these patients are at increased risk and should be monitored continuously. Prophylactic measures include meticulous lavage of the intramedullary cavity, increased FIO2, and maintenance of intravascular volume and cardiac output. The bilateral arthroplasty model is useful in investigating therapeutic interventions which may detect and prevent the marrow microembolism syndrome intraoperatively.

Published
1987
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11. Single versus multiple pulmonary emboli: Different haemodynamic and blood gas results

Author

William H. Noble, Yahaya Z. Kadiri, and J. Colin Kay

Subjects
Cardiac output, Multiple emboli, business.industry, Hemodynamics, Starch, General Medicine, medicine.disease, Pulmonary embolism, Dogs, Oxygen Consumption, Anesthesiology and Pain Medicine, Embolism, Embolus, Anesthesia, Total dose, cardiovascular system, medicine, Animals, cardiovascular diseases, Blood Gas Analysis, Cardiac Output, Pulmonary Embolism, business, Blood gas analysis
Abstract

We evaluated haemodynamic and blood gas changes following the intravenous infusion of starch microemboli (63-74 mu). Comparisons were made between dogs receiving a single embolus and dogs receiving an equal quantity of embolus divided into small doses given at 30 minute intervals (multiple emboli). The most significant finding was that the same quantity of embolus produces different effects. In the dogs receiving a single embolus of 150 mg kg-1 of starch. Pao2 fell from 11.3 to 7.6 kPa (85 to 57 torr)(p less than 0.025) and Qs/Qt increased from 11 to 34 per cent (p less than 0.01). In the multiple emboli dogs, after a total dose of 150 mg kg-1 of starch, there was a small but not significant fall in Pao2 from 11.6 to 10.8 kPa (87 to 81 torr), and Qs/Qt did not change significantly. In the single embolus dogs Q increased significantly after an embolus of 100 mg kg-1 of starch (p less than 0.05). after a single embolus of 150 mg kg-1, Q was variable; 3 dogs showed a decrease, and 2 an increase, however the mean change was not significant. In the multiple emboli dogs, Q decreased significantly (p less than 0.005).

Published
1981
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12. A comparison of thermal and dye dilution methods of determining cardiac output

Author

William H. Noble and J. Colin Kay

Subjects
medicine.medical_specialty, Cardiac output, Hot Temperature, Dilution curve, Catheterization, Pulmonary oedema, Dogs, Internal medicine, Methods, Animals, Edema, Medicine, Cardiac Output, Pentobarbital, business.industry, Dye Dilution Technique, Dye dilution, General Medicine, Carotid Arteries, Anesthesiology and Pain Medicine, Thermography, Anesthesia, Anesthesia, Intravenous, Cardiology, Thermodilution technique, business, Mathematics
Abstract

A method for measuring cardiac output by thermodilution is described. This method is compared with the dye dilution technique in normal dogs and in dogs with pulmonary oedema. There was good agreement between the two methods. In view of the advantages of the thermodilution technique it should be suitable for monitoring cardiac output in the clinical setting.

Published
1973
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13. The effect of PCO2 on hypoxic pulmonary vasoconstriction

Author

J. Colin Kay, William H. Noble, and Joseph A. Fisher

Subjects
Cardiac output, Pulmonary Circulation, Pulmonary Artery, pCO2, Dogs, Hypoxic pulmonary vasoconstriction, medicine, Animals, Cardiac Output, Hypoxia, Lung, business.industry, General Medicine, respiratory system, Carbon Dioxide, respiratory tract diseases, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Vasoconstriction, Anesthesia, Breathing, Limiting oxygen concentration, medicine.symptom, business, Perfusion, circulatory and respiratory physiology
Abstract

Lung areas with a low V/Q ratio cause hypoxaemia. The low alveolar oxygen concentration may cause local hypoxic pulmonary vasoconstriction (HPV) which reduces perfusion, raises the V/Q ratio, and hence reduces the tendency to a low Pao2. By changing Pco2, the HPV response can be altered. We examined this relationship in anaesthetized dogs by using a tracheal divider to separate hypoxic (nitrogen ventilated) from oxygenated (100 per cent oxygen ventilated) lung. Relative perfusion was assessed from total133Xe exhaled from each lung area after intravenous infusions. When PaCO2 was changed by changing ventilation, we found that an increasing PaCo2 increased HPV and also Pao2. At a Paco2 of 3.3 kPa, HPV was abolished and Pao2 fell. We also changed PaC02 by altering PiCO2 to one or both lung areas while ventilation remained constant throughout the experiment. Again as PaCO2 increased, HPV and Pao2 increased. When PaC02 fell and end tidal carbon dioxide in the hypoxic lung (Petco2) remained elevated (by maintaining Pico2 in the hypoxic lung and removing CO2 from the oxygenated lung)HPV was maintained. Thus it is the alveolar concentration of CO2 in the hypoxic lung which is important in modifying HPV. We conclude that in this model a low PetCO2(3.3 kPa) in hypoxic lung will reduce HPV, and will result in more severe hypoxaemia. This may have relevance in both anaesthetized and intensive care unit patients when a higher Pao2 may be obtained by increasing hypoxic lung Petco2. The effect of PetC02 on Pao2 will be influenced by other variables, but when hypoventilated or hypoxic lung areas exist, increasing PetCO2 may reinforce hypoxic pulmonary vasoconstriction and thus may increase Pao2.

Published
1981

14. Effect of cardiac output on extravascular lung water measurements made with the thermoconductivity method

Author

J. Colin Kay and William H. Noble

Subjects
Cardiac output, medicine.medical_specialty, Dogs, Body Water, Internal medicine, medicine, Methods, Animals, Cardiac Output, Lung, biology, business.industry, Fissipedia, Isoproterenol, Thermal Conductivity, Injectate temperature, biology.organism_classification, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Lung water, cardiovascular system, Cardiology, Halothane, business, Mathematics, medicine.drug
Abstract

The authors tested the effects of injectate temperature and of changing cardiac output on the measurement of lung water by the thermoconductivity technique (ETVL). Cardiac output in dogs was increased and decreased with isoproterenol and halothane, respectively. Post mortem extravascular lung water (pulmonary extravascular tissue weight [PETW] was determined using a weighing technique. Cardiac output varied between 0.7 and 8.8 l/min and did not influence the ETVL measurement. The authors conclude ETVL measured by the thermoconductivity technique is not influenced by large changes in cardiac output.

Published
1986

15. Cardiac catheterization in dogs

Author

J. Colin Kay and William H. Noble

Subjects
medicine.medical_specialty, Cardiac Catheterization, Time Factors, business.industry, Pain medicine, medicine.medical_treatment, Left heart catheterization, General Medicine, Anesthesiology and Pain Medicine, Dogs, Internal medicine, Anesthesia, Anesthesiology, Heart catheterization, Cardiology, Medicine, Animals, business, Cardiac catheterization
Abstract

Techniques for right and left heart catheterization in dogs are described which have proven safe and reliable without altering the physiological state.

Published
1974

17. THE EFFECTS OF CONTINUOUS POSITIVE PRESSURE VENTILATION ON PULMONARY OEDEMA, GAS EXCHANGE AND LUNG MECHANICS

Author

William H. Noble, Jiri Obdrzalek, and J. Colin Kay

Subjects
Pulmonary Circulation, medicine.medical_specialty, Pain medicine, Dextran 40, Blood Pressure, Pulmonary Edema, Pulmonary oedema, Positive-Pressure Respiration, Hemoglobins, Dogs, Oxygen Consumption, Anesthesiology, Internal medicine, medicine, Animals, Cardiac Output, Positive pressure ventilation, Lung, Lung Compliance, Blood Volume, business.industry, Respiration, Lung mechanics, Dextrans, Organ Size, General Medicine, Carbon Dioxide, Respiratory Function Tests, Oxygen, Anesthesiology and Pain Medicine, Anesthesia, Cardiology, business
Abstract

The effect of continuous positive pressure ventilation was studied in 23 dogs in whom pulmonary oedema was induced by rapid intravenous infusion of dextran 40. CPPV slowed but did not prevent the formation of oedema. CPPV prevented or reversed the formation of liver-like areas in the dependent lobes, maintaining the oedematous lung compliant and aerated. This led to a reduction of shunt and an increase in PaO2. The use of CPPV decreased cardiac output and body oxygen consumption. Mixed venous oxygen tension was higher in dogs ventilated by CPPV and these dogs tolerated fulminant frothy oedema without distress.

Published
1976
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