Closed-Circuit System and Other Innovations in Anaesthesia

259 Pages·1986·7.39 MB·English

by  R. Droh (auth.)

Closed-Circuit System
and Other Innovations
in Anaesthesia
Edited by
R. Drah and R. Spintge
With 167 Figures
Springer-Verlag Berlin Heidelberg New York
London Paris Tokyo
Dr. med. Roland Droh
Chefarzt der Anaesthesiologie
Arztlicher Direktor des
Krankenhauses fiir Sportverletzte
Hellersen
Paulmannshoher StraBe 17
D-5880 Liidenscheid
Dr. med. Ralph Spintge
Krankenhaus fiir Sportverletzte
Hellersen
PaulmannshOher StraBe 17
D-5880 Liidenscheid
ISBN-13: 978-3-540-16691-7 e-ISBN-13: 978-3-642-71328-6
001: 10.1007/978-3-642-71328-6
Library of Congress Cataloging in Publication Data.
Oosed-circuit system and other innovations in anaesthesia.
"Papers presented at the II. International Symposium on Innovations in Management,
Technology and Pharmacology held on 26-28 May 1984 in Liidenscheid" - Pref.
Includes bibliographies and index.
1. Anesthesiology - Apparatus and instruments - Congresses. 2. Anesthesia - Congresses.
I. Droh, R. (Roland). II. Spintge, R. III. International Symposium on Innovations in
Management Technology, and Pharmacology (2nd: 1984: Liidenscheid, Germany)
[DNLM: 1. Anesthesiology - instrumentation - congresses. WO 240 C645 1984]
RD78.8.C56 1986 617'.96 86-21959
ISBN 0-387-16691-2 (U.S.)
This work is subject to copyright. All rights are reserved, whether the whole or part of the
material is concerned, specifically those of translation, reprinting, re-use of illustrations,
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than private use, a fee is payable to "Verwertungsgesellschaft Wort", Munich.
© Springer-Verlag Berlin Heidelberg 1986
The use of registered names, trademarks, etc. in this publication does not imply, even in the
absence of a specific statement, that such names are exempt from the relevant protective
laws and regulations and therefore free for general use.
Product Liability: The publisher can give no guarantee for information about drug dosage
and application thereof contained in this book. In every individual case the respective user
must check its accuracy by consulting other pharmaceutical literature.
Typesetting: Briihlsche Universitiitsdruckerei, Giessen
Offsetprinting: Saladruck, Berlin. Bookbinding: B. Helm, Berlin
2119/3020-543210
Contributors
J. Chrubasik, Dept. of Anaesthesia, University Hospital, Hugstetter StraBe 55,
7800 Freiburg, Federal Republic of Germany
J. C. Dorlas, Institute of Anaesthesiology, AZG, Oostersingel 59,
9713 EZ Groningen, The Netherlands
R. Droh, Anaesthesiologie, Sportkrankenhaus Hellersen, 5880 Liidenscheid,
Federal Republic of Germany
W. L. den Dunnen, Dept. of Anaesthesia, Municipal Hospital Dordrecht,
Dordrecht, The Netherlands
W. Erdmann, Dept. of Anaesthesia, Erasmus University, 3000 DR Rotterdam,
The Netherlands
C. E. Essed, Dept. of Pathology I, Erasmus University, 3000 DR Rotterdam,
The Netherlands
N. S. Faithfull, Dept. of Anaesthesia, Erasmus University, 3000 DR Rotterdam,
The Netherlands
M. Fennema, Dept. of Anaesthesia, Erasmus University, 3000 DR Rotterdam,
The Netherlands
K. W. Fritz, Institut fiir Anaesthesiologie, Medizinische Hochschule Hannover,
3000 Hannover
G. Garcia, Institute of Bloodless Medicine and Surgery, 707 E. Chapman Ave.,
Fullerton, CA 92631, USA
G. Jibelian, Medical Research, Institute of San Francisco, 2200 Webster Street,
San Francisco CA 94115, USA
T. Jin, Anaesthesia Division, Akita Red Cross Hospital, Akita, Japan
H. Jshihara, Dept. of Anaesthesiology, Hirosaki University, School of Medicine,
Hirosaki Aomori-Ken, Japan
D. Klaus, Dept. of Cardiology, Stiidtische Krankenanstalten Dortmund,
4600 Dortmund, Federal Republic of Germany
G. Klein, ZAW, Klinikum der J. W. Goethe-Universitiit, 6000 Frankfurt,
Federal Republic of Germany
A. Kok, Dept. of Anaesthesia and Pathology I, Erasmus University,
3000 DR Rotterdam, The Netherlands
v
S. Kunke, Max-Planck-StraBe 60, 6500 Mainz
B. Lachmann, Dept. of Anaesthesiology, Erasmus University, 3000 DR Rotterdam,
The Netherlands
R. Lapin, Institute of Bloodless Medicine and Surgery, 707 E. Chapman Ave.,
Fullerton CA 92631, USA
R. Lemke, Dept. of Cardiology, Stadtische Krankenanstalten Dortmund,
4600 Dortmund, Federal Republic of Germany
B. Lemmer, Center of Pharmacology, J. W. Goethe University,
Theodor-Stern-Kai 70, 6000 Frankfurt/Main 70, Federal Republic of Germany
C. Y. Lin, University of Chicago, Dept. of Anaesthesiology,
5841 South Maryland Ave., Box 428, Chicago Illinois 60637, USA
D. W. Lubbers, Max-Planck-Institute, Rheinlanddamm 201, 4600 Dortmund,
Federal Republic of Germany
K. Lundin, Medizinische Hochschule Hannover, Dept. of Anaesthesia, Section 1,
3000 Hannover
T. Mostert, Dept. of Anaesthesia, Municipal Hospital Dordrecht, Dordrecht,
The Netherlands
J. Mottner, Justus Liebig-Universitat GieBen, Dept. of Anaesthesia,
6300 GieBen, Federal Republic of Germany
T. Murakawa, Anaesthesia Division, Akita Red Cross Hospital, Akita, Japan
T. Oyama, Dept. of Anaesthesia, Hirosaki University, School of Medicine,
Hirosaki, Japan
M. Paloheimo, Dept. of Anaesthesia, Helsinki University, Central Hospital,
00290 Helsinki 29, Finland
D. Patschke, Justus Liebig-Universitat GieBen, Dept. of Anaesthesia,
6300 GieBen, Federal Republic of Germany
G. Rolly, Dept. of Anaesthesia, University of Ghent, Academic Hospital,
De Pintelaan 185, 9000 Ghent, Belgium
R. Spintge, Anaesthesiologie, Sportkrankenhaus Hellersen, 5880 Ludenscheid,
Federal Republic of Germany
M. Tabbert, Justus Liebig-Universitat GieBen, Dept. of Anaesthesia,
6300 GieBen, Federal Republic of Germany
B. Taylor, Medical Research Institute of San Francisco, 2200 Webster Street,
San Francisco CA 94115, USA
A. Varenne, 03 Cardiology, 6 Rue Spitailerie, 06000 Nice, France
L. Versichelen, Dept. of Anaesthesia, University of Ghent, Academic Hospital,
De Pintelaan 185, 9000 Ghent, Belgium
P. D. Wagner, Dept. of Medicine M-23, Section of Physiology, University
of California, San Diego, La Jolla, CA 92093, USA
VI
C. F. Wallroth, Drager-Werk AG, Moislinger Allee 53, 2400 Lubeck,
Federal Republic of Germany
C. Wright, Institute of Bloodless Medicine and Surgery, 707 E. Chapman Ave.,
Fullerton CA 92631, USA
M. Yamashita, Dept. of Anaesthesia, Ibaraki Children's Hospital, Futabadai,
Mito 311-41, Japan
G. Yates, Medical Research, Institute of San Francisco, 2200 Webster Street,
San Francisco CA 94115, USA
T. van der Zee, Dept. of Anaesthesia, Albany Medical College, Albany,
NY 12208, USA
K. Zettergren, Dept. of Anaesthesia, Justus Liebig-Universitat GieSen,
6300 GieSen, Federal Republic of Germany
M. Zia, Institute of Bloodless Medicine and Surgery, 707 E. Chapman Ave.,
Fullerton CA 92631, USA
VII
Preface
This volume contains the lectures and discussion papers presented at the II. In
ternational Symposium on Innovations in Management, Technology and Phar
macology held on 26-28 May 1984 in Liidenscheid. This symposium delt with fur
ther developments in the sector of the closed-circuit system; non-invasive mea
surement and monitoring systems; new aspects of cardiovascular and pulmonary
physiology; oxygen-transporting substances; and particular questions in pharma
cology. The purpose of this meeting was to allow a mutual international exchange
of news on interesting new developments, particularly as these relate to the
closed-circuit system, and the encouragement of further scientific developments.
It must be made clear that the large-scale introduction of the closed-circuit sys
tem has to be the occasion of completely new quality standards both in anesthesia
and in all related technological sectors, combined with the highest demands in
terms of precision and measuring techniques. The conventional and still quite
crude clinical anesthetic procedures will have to make way for much more phys
iological, micromolecular precision techniques, which will compare with our
present methods rather in the same way as a microelectrode to a spear and will
allow new levels of achievement in anesthesiology. All our tasks will need to be
rethought and thoroughly understood from these aspects. Some anesthesists,
physiologists and engineers already see the closed-circuit system as a challenge,
while for others this system will still mean a great deal of work and creativity be
fore the problems are finally solved in the future. Those who meet this challenge
with an attitude offUll acceptance, however, will soon fall under its particular spell
and will thus find new joy and satisfaction in the practice of anesthesia in all its
subspecialties.
R. Droh
IX
Contents
The Closed-Circuit Anaesthesia System. 1
The Closed Circuit: Past and Future
R. Droh ........... . 3
Practical Application of the Closed-Circuit System
R. Droh ................. . 8
Closed-Circuit Anaesthesia in Gynaecology and Obstetrics
R. Spintge, R. Droh, and G. Rothmann. . . . . . . . . . . . . . . 13
First Clinical Experiences with the Narcocon in Completely Computerized
On-Demand Closed-Circuit Ventilation
R. Spintge, R. Droh, and G. Rothmann. . . . . . . . . . . . . . . 16
Closed-Circuit Anaesthesia for Cardiac Patients
C.-Y. Lin . . . . . . . . . . . . . . . .. .......... 20
Closed-Circuit Anaesthesia for Paediatric Patients
C.-Y. Lin . . . . . . . . . . . . . . . . .. ......... 38
Integrated Monitoring of Closed-Circuit Anaesthesia
M. Paloheimo . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Monitors in Closed-Circuit Anaesthesia
M. Yamashita, H. Ishihara, and T. Oyama. . . . . . . . . . . . . . 49
Closed-Circuit Anaesthesia: Actual Inspired Gas Concentrations Measured
by Mass Spectrometer
G. Rolly and L. Versichelen . . . . . . . . . . . . . . . . . . . . 58
Can We Practise Safe, Simple Closed-Circuit Anaesthesia without Extensive
Monitoring or Calculus?
C.-Y. Lin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Estimation of Cardiac Output and Lung Tissue Volume in Closed-Circuit
(Rebreathing) Systems
P. D. Wagner . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Controlled Respiration with He-0 Mixtures Using a Semi-open
2
and a Closed System
K.-W. Fritz, K. Lundin, K. Zettergren, M. Tabbert, J. Mottner,
and D. Patschke . . . . . . . . . . . . . . . . . . .. ... 85
Technical Conception of an Anaesthesia System with Measurement
and Semiautomated Dosage of Gases and Vapours
c. F. Wallroth 96
Discussion I . . . . . . . . . . . . . . . . . 104
XI
Non-invasive Monitoring. . . . . . . . . . . . . . . . . . . . . . 111
Non-invasive Monitoring of tcp02 and tcpC02 in Patients with Normal
and Compromised Circulation
R. Lemke, D. Klaus, and D. W. Lubbers. . . . . . . . . . . . . . . 113
A Microsystem to Measure Respiratory and Anaesthetic Gases During
Surgery
G. Jibelian, G. Yates, and B. Taylor. . . . . . . . . . . . . . 120
On-Line Estimation of Cerebral Oxygenation
N. S. Faithfull, H. T. van der Zee, M. H. Kuypers, K. Dhasmana,
and W. Erdmann. . . . . . . . . . . . . . . . . . . .. ... 122
A Continuous Non-invasive Blood Pressure Measurement Which is
Controlled by Finger Plethysmography
J. C. Dorlas, J. A. Nijboer, W. T. Butijn, A. W. Cuiper, K. H. Wesseling,
G. M. A. van der Hoeven, and J. J. Settels . . . . . . . . . . . .. 129
A New Approach to Photoelectric Plethysmography
J. C. Dorlas, J. A. Nijboer, S. J. Edema, and J. O. J. Prins. . . . . . .. 136
High-Amplification Electrocardiography
A. Varenne . . . . . . . . . . . . . . . . . . . . . . . . .. 145
An Electronic Procedure and Device for Determining the Position of a
Catheter or a Probe
S. Kunke and V. Schulz . . . . . . . . . . . . . . 166
New Aspects of Respiration Physiology and Circulation . 171
Effect of Different Ventilator Settings and Surfactant Replacement on
Lung Function in Severe Respiratory Insufficiency
B. Lachmann . . . . . . . . . . . . . . . . . . . . . . .. . 173
Microphysiological Studies on Oxygenation of Normal or Ischaemic
Myocardium
N. S. Faithfull, W. Erdmann, M. Fennema, A. Kok, and C. E. Essed 188
Autotransfusion in Surgical Practice: An Update
R. Lapin, F. Garcia, M. Zia, and C. Wright . . . . . . . . . . 198
Changes in Important Biochemical Parameters Due to Extreme
Haemodilution with Cross-linked Stromafree Haemoglobin Solution
G. Klein, H. Ferber, U. Ottermann, and H. Forster . . . . . . .. 211
Physical Aspects in Peripheral Perfusion
T. Mostert and W. L. den Dunnen ...... . 214
Pneumatically Controlled Circulation in Peripheral Vascular Diseases
W. L. den Dunnen and T. Mostert . 219
DiscussionII. . . . . . . . . . . . . . 225
New Aspects of Pharmacological Treatment . . 229
Importance of Chronopharmacology in Medicine
B. Lemmer ................ . . 231
Analgesic Effect of Continuous Intrathecal Beta-Endorphin in Cancer
Patients
XII
T. Jin, T. Murakawa, and T. Oyama. . . . . . . . . . . . . . . . . 242
Epidural, On-Demand, Low-Dose Infusion of Morphine and Postoperative
Pain Relief
J. Chrubasik . 245
Discussion III 249
Subject Index . 253
XIII