Table Of ContentCARDIAC ANAESTHESIA: PROBLEMS AND INNOVATIONS
DEVELOPMENTS IN CRITICAL CARE
MEDICINE AND ANESTHESIOLOGY
Prakash, O. (ed.): Applied Physiology in Clinical Respiratory Care. 1982.
ISBN 90-247-2662-X.
McGeown, Mary G.: Clinical Management of Electrolyte Disorders. 1983.
ISBN 0-89838-559-8.
Scheck, P.A., Sjostrand, V.H., and Smith, R.B. (eds.): Perspectives in High
Frequency Ventilation. 1983. ISBN 0-89838-571-7.
Stanley, T.H., and Petty, W.C. (eds.): New Anesthetic Agents, Devices and Mo
nitoring Techniques. 1983. ISBN 0-89838-566-0.
Prakash, O. (ed.): Computing in Anesthesia and Intensive Care. 1983.
ISBN 0-89838-602-0.
Stanley, T.H., and Petty, W.C. (eds.): Anesthesia and the Cardiovascular
System. 1984. ISBN 0-89838-626-8.
Van Kleef, l.W., Burm, A.G.L., and Spierdijk, l. (eds.): Current Concepts in
Regional Anaesthesia. 1984. ISBN 0-89838-644-6.
Prakash, O. (ed.): Critical Care of the Child. 1984. ISBN 0-89838-661-6.
Stanley, T.H., and Petty, W.C. (eds.): Anesthesiology: Today and Tomorrow.
1985. ISBN 0-89838-705-1.
Rahn, H., and Prakash, O. (eds.): Acid-base Regulation and Body Temperature.
1985. ISBN 0-89838-708-6.
Stanley, T.H., and Petty, W.C. (eds.): Anesthesiology 1986.
1986. ISBN 0-89838-779-5.
de Lange, S., Hennis, P.l., and Kettler, D. (eds.): Cardiac Anaesthesia: Prob
lems and Innovations. 1986. ISBN 0-89838-794-9.
CARDIAC ANAESTHESIA:
PROBLEMS AND
INNOVATIONS
edited by
S. DE LANGE, P.J. HENNIS
Department of Anaesthesiology
Leiden University Hospital, Leiden
The Netherlands
and
D.KETTLER
Georg-A ugust-Universitiit, Gottingen
Federal Republic of Germany
1986 MARTINUS NIJHOFF PUBLISHERS ~.
a member of the KLUWER ACADEMIC PUBLISHERS GROUP ...
DORDRECHT I BOSTON I LANCASTER .~
Distributors
jor the United States and Canada: Kluwer Academic Publishers, 190 Old Derby
Street, Hingham, MA 02043, USA
jor the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited,
Falcon House, Queen Square, Lancaster LAI lRN, UK
jor all other countries: Kluwer Academic Publishers Group, Distribution Center,
P.O. Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
Cardiac anaesthesia.
(Developments in critical care medicine and
anaesthesiology)
Based on a Boerhaave symposium entitled "Recent
advances in cardiac anaesthesia," held May 9-10, 1985
in Leiden, Netherlands; organized by the Faculty of
Medicine, University of Leiden.
Includes bibliographies and index.
1. Anes':hesia in cardiology--Congresses. 2. Heart-
Surgery--Congresses. 2. Heart--Surgery--Congresses.
I. Lange, S. de. II. Hennis, P. J. III. Kettler,
Dietrich. IV. Rijksuniversiteit te Leiden. Faculteit
der Geneeskunde. [DNLM: 1. Anestheslology--congresses.
2. Heart--drug effects--congresses. 3. Monitoring,
Physiologic--congresses. WG 460 C2675 1985]
RD87.3.H43 1986 617'.967412 86-856
ISBN -13: 978·94-010-8394-2 e-ISBN·13: 978-94-009-4265-3
DOl: 10.1007/978-3-94-009-4265-3
ISBN-13:978-94-010-8394-2 (this volume)
Book information
This publication is based upon a Boerhaave Symposium, organized by the Facul
ty of Medicine, University of Leiden.
Copyright
© 1986 by Martinus Nijhoff Publishers, Dordrecht.
Softcover reprint of the hardcover 1st edition 1986
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical,
photocopying, recording, or otherwise, without the prior written permission of
the publishers,
Martinus Nijhoff Publishers, P.O. Box 163, 3300 AD Dordrecht,
The Netherlands.
PREmCE
In the past decade there has been a spectacular increase in the number
of q:JE!n heart q:JE!rations perfonred. '!his is largely due to the increased
demand for coronary artery bypass grafting procedures. In response,
cardiac anaesthesiologists have had to adapt established anaesthetic
techniques and also develop new ones in order to provide safe and stress
free anaesthesia for this type of surgery. Advances in diagnostic
techniques and rronitoring have made a great inpact on these developnents.
In Europe, different centres have evolved various new anaesthetic and
mcnitorinJ teclmiques to meet this challenge. Unfortunately, national and
language barriers have resulted in a relatively lew information exchange
between these centres. In contrast, national meetings in the United
States ensure that their cardiac anaesthesiologists are prOI!ptly infonred
alx::.ut new developnents.
A symposium entitled: "Recent Advances in Cardiac Anaesthesia" was
held on May 9-10, 1985 in Leiden, '!he Netherlands, in order to to rectify
this situation so that there 1NOuld also be a free exchange of new ideas
and methods in Europe. This book contains the papers presented at this
meeting. In addition to the problems and innovations of cardiac
anaesthesia and monitoring that were discussed, it was also proposed that
these meetings should be held annually in different European countries
under the guidance of an informal work group of cardiac
anaesthesiologists. With this purpose in mind, the European Association
of cardiothoracic Anaesthesiologists was fonred during the syI!p)sium.
Simon de Lange
VII
TABLE OF CCNI'ENI'S
-Preface V
-List of contri.l:utors IX
-What should the cardiac anaesthesiologist know about
heart catheterization?
A.V.G. Brusdce
-Transesophageal 2-D echocardiography: a new dimension in
clinical care
N.P. de Bruijn. F.M. C1enents 8
-'!he EEG and evoked potentials
J.G. Bovill 14
-Precperative nedication: ITB.intenance or modification?
P.J. Hennis 26
-Precperative evaluation of the patient with mitral valve
disease
B. AllBri. M. Merli. C. Cattani 38
-The use of invasive monitoring techniques in cardiac
surgery
Th.U. Stanley 48
-Inotropic agents/Vasoactive agents
G. HBlpelDann. E. SeidelJmyer 64
-Techniques of anesthetic administration: are they more
irrportant than choice of anesthetic agent?
Th.H. Stanley 76
-Detection of myocardial ischemia during anesthesia
S.~. S.~~.G.J~.M.Qrt&m. E.~ 93
-The management of intraoperative myocardial ischemia and
hypotension
C.C. Hug. Jr 102
-l-letabolic changes and interpretation of blood gas analysis
during hypothennia
D. Kettler. E. TUJ:ner 107
-Profound hypothermia and circulatory arrest: studies of
intracperatieve netabolic changes and late postoperative
intellectual development after correction of congenital
heart disease
J .A. Richter. R. Kunkel 117
VIII
-F1ONS and pressures during cardiopulnonary bypass
G.F. Karliczek 123
-Promoting cardiac metabolism before and after
cardiopullronary J:¥pass ( CPB)
w. Haider. G. Krieger 137
-Coronary circulation and myocardial metabolism during
anaesthesia
H. SaJntag. R. Larsen. H. Stephan 149
-Sequential myocardial depressant and non-depressant
anaesthesia for coronary artery surgery
G. Sett:eJ:gren 159
-COntinuous arterial Iii-monitoring following coronary artery
J:¥pass surgery
P.J.A. van der Starre. J.E. Harindt-de Weerd. S.J. Schepel 163
-The management of cardiac emergencies - cardiac tamponade
s. de Lange 171
-Leaking prosthetic valves
J .G. BaI7il.l.
181
-Massive pulmonary eni:x:>lism
P.J.A. van der Starre
186
-Ruptured coronary artery following angioplasty
N.P. de Bruijn. F.M. Clements 191
-Index 193
IX
CCNI'RIBU'roRS
Dr. B. ADari
III Servizio di Anestesia e Rianimazione
Centro A. De Gasperis
ca
Ente Ospedaliero Granda-Niguarda
Milano 20162
Italy
Dr. J.G. Bovill
Afdeling Anaesthesiologie
Academisch Ziekenhuis Leiden
Rijnsburgerweg 10
2333 AA Leiden
The Netherlands
Dr. N.P. de Bruijn
Departrrent of Anesthesiology
Duke University Medical Center
Durham, North Carolina 27710
U.S.A.
Dr. A.V.G. Bruschk.e
Afdeling Car.diologie
Academisch Ziekenhuis Leiden
Rijnsburgerweg 10
2333 AA Leiden
The Netherlands
Dr. W. Haider
Klinik fUr An&thesia
der Universit1l.t Wien
Spitalyc:.sse 23
1090 Wien
Austria
x
Dr. G. Henpelnan
Abteilung fUr Anaesthesiologie und Intensivrnedizin
des KlinikuIllS der Justus-Liebig Universit~t
Klinikstrasse 29
0-6300 Giessen, F.R.G.
Dr. P .J. Hermis
Afdeling Ana.esthesiologie
Academisch Ziekenhuis Leiden
Rijnsburgerweg 10
2333 AA Leiden
The Netherlands
Dr. C.C. lhlg Jr.
Departrrent of Anesthesiology
Emory University Clinic
1365 Clifton Foad NE
Atlanta, Georgia 30322
U.S.A.
Dr. G.F. Karliczek
Afdeling Anaesthesiology
Academisch Ziekenhuis Gromngen
Cbstersirgel 59
9713 EZ Gromngen
The Netherlands
Dr. D. Kettler
Georg-August-Universit~t
Fobert Koch Strasse 40
0-3400 Gattingen, F.R.G.
XI
Dr. S. de Lange
Afdeling Anaesthesiologie
Academisch Ziekenhuis Leiden
Rijnsburgerweg ... 0
2333 M Leiden
The Netherlands
Dr. S. Reiz
Department of Anaesthesia
University Hospital
90185 Umea
S\<;eden
Dr. J.A. Richter
Deutsches Herzcentrum Mtlnchen
Lothstrasse 11
8000 Mfinchen 2, F.R.G.
Dr. G. Sett.ergren
Departrrent of Anaesthesia
Karolinska Hospital
Box 60500
5-104 01 Stockholm
S\<;eden
Dr. H. Sormtag
Georg-August-UniversitMt
Robert Koch Strasse 40
0..3400 OOttingen, F.R.G.
Dr. T.B. Stanley
Departrrent of Anesthesiology
School of Medicine/Medical Center
50 North Medical Drive
Salt Lake City, Utah 84132
USA
