Inhalation Anaesthesia Today and Tomorrow

257 Pages·1982·8.11 MB·English

by  I. Rietbrock (auth.)

150
Anaesthesiologie und Intensivmedizin
Anaesthesiology
and Intensive Care Medicine
vormals "Anaesthesiologie und Wiederbelebung"
begrundet von R. Frey, P. Kern und O. Mayrhofer
Herausgeber:
H. Bergmann· Linz (Schriftleiter)
lB. Bruckner· Berlin M. Gemperle . Geneve
W.P. Henschel· Bremen O. Mayrhofer . Wien
K. Peter· Miinchen
Inhalation Anaesthesia
Today and Tomorrow
Edited by
K Peter and F. Jesch
With 126 Figures and 19 Tables
Springer-Verlag
Berlin Heidelberg New York 1982
Prof. Or. K. Peter
Ludwig-Maximilians-Universitat MUnchen
Klinikum GroBhadern
Institut fUr Anaesthesiologie
MarchioninistraBe 15
0-8000 MUnchen 70
Federal Republic of Germany
PO Or. F. Jesch
Ludwig-Maximilians-Universitat MUnchen
Klinikum GroBhadern
Institut fUr Anaesthesiologie
MarchioninistraBe 15
0-8000 Munchen 70
Federal Republic of Germany
ISBN-13: 978-3-540-11757-5 e-ISBN-13: 978-3-642-68713-6
DOl: 10.1007/978-3-642-68713-6
Library of Congress Cataloging in Publication Data
Main entry under title: Inhalation Anaesthesia Today and Tomorrow.
(Anaesthesiologie und Intensivmedizin; 150)
Bibliography: p. Includes index.
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Preface
In clinical anaesthesiology the inhalation anaesthetics halothane
(fluothane), enflurane and - in recent times - forane got a
renaissance in clinical application. The reasons are not only the ad
vantages of volatile anaesthetics, but also the fact that the investi
gations of pharmacodynamics and pharmacokinetics of Lv. narcot
ics showed negative aspects. It was the aim of the organizers of the
symposium to give a survey of the present state of knowledge on
inhalation anaesthetics, which is as up-to-date, critical as well as
detailed as possible. Furthermore it was the intention to evaluate
the recent advances made in the field of basic research. The first
section of the symposium in particular enters into the question
of the toxicity of volatile anaesthetics as well as their mechanisms
of action. In a second main part the influences on cardiovascular
system and on microcirculation are discussed. Apart from the
extensive discussion of the advances in knowledge in the field of
cardiovascular pathophysiology, the focal point of the contribut
ions is made up of those with anaesthesia in coronary heart disease
and cardiac insufficieny as well as the contribution on interactions
of inhalation anaesthetics with cardiovascular drugs.
In the third and fourth section the influences of volatile
anaesthetics on cerebral, hepatic, renal and pulmonary function are
dealt with as well as questions concerning the clinical application.
Particular attention is given to the important problems of indicat
ion in patients belonging to the extreme age groups. The article
"Balanced anaesthesia as an alternative concept" evaluates the role
of volatile anaesthetics retrospectively as well as their future status.
The editors appreciate the work of the chairman and the
speakers of the various sessions.
F or their valuable assistance in the completion of this book
the editors are particularly grateful to Dr. C. Brendel, to Dr. C.
Sirtl, and to Mrs. B. Seidel. We are also indebted to Springer-Verlag
for the cooperation in preparing this book and to Deutsche Abbott
GmbH, Wiesbaden, for generously sponsoring the symposium.
K. Peter, F. Jesch
Table of Contents
Basics of Biotransformation (I. Rietbrock) ........... .
Hepatic Oxygenation and Fluoride Release During Halothane
Anaesthesia (L. Irestedt) ........................ 11
Current Status of Hepatotoxicity of the Halogenated
Inhalation Anaesthetics (B.R. Brown Jr.) ............. 13
Present Status of Chronic Exposure to Trace Concentrations
of Volatile Anaesthetics (H. Stoeckel, P.M. Lauven) ...... 19
Aspects of Possible Health Hazards from Traces of Waste
Anaesthetic Vapours and Gases (K. Taeger) . . . . . . . . . . .. 27
The Kinetics of the Uptake and Elimination of Halothane
and Enflurane (H. Schmidt and R. Dudziak) ........... 31
Molecular Basis for Unitary Theories of Inhalation
Anaesthesia (J.R. Trudell) ....................... 45
Clinical Implications of the Pharmacodynamics of Inhalation
Anaesthetics (G. Torri, C. Martani, and V. Perotti) ... . . .. 53
Advances in Cardiovascular Pathophysiology (B.E. Strauer). 59
Anaesthesia in Coronary Heart Disease (G. Smith) ....... 79
The Anaesthetic Management of Coronary and Cardiac
Surgery (D.G. Lappas) . . . . . . . . . . . . . . . . . . . . . . . . .. 87
Influence of Inhalation Anaesthetics on the Autonomic
Nervous System (M. Gothert) . . . . . . . . . . . . . . . . . . . .. 97
Interactions of Cardiovascular Drugs with Inhalational
Anaesthetics (P. Foex, G.R. Cutfield, and C.M. Francis) . . .. 109
Microcirculatory Effects of Halothane and Enflurane
(N. Franke, B. Endrich, and K. MeBmer) . . . . . . . . . . . . .. 129
Distribution of EEG Frequency Bands as Revealed by Factor
Analysis During Anaesthesia with Halothane and Enflurane
(H. Schwilden and H. Stoeckel) . . . . . . . . . . . . . . . . . . .. 137
VIII Table of Contents
The Effects of Inhalational Anaesthetics on the Brain
(p.A. Steen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 147
The Effects of Inhalation Anaesthetics on Intracranial
Pressure (G. Cunitz) ........................... 151
The Effects of Inhalation Anaesthetic Agents on Liver Blood
Flow and Hepatic Oxygen Consumption (W. Fitch,
R.L. Hughes, I. Thomson, and D. Campbell) ........... 159
Total Effect of Repeated Anaesthetics on Liver Function
(J.F.H. Fee, G.W. Black, and J.W. Dundee) ............ 165
The Effect of Inhalation Anaesthetics on Pulmonary
Ventilation and Perfusion (L.J. Bjaertnaes) .. . . . . . . . . .. 167
Effects of Inhalation Anaesthetics on Renal Function
(P.-O. Jiirnberg) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 177
The Effect of Inhalational Anaesthetics on Skeletal and
Smooth Muscle (J.K. Crul) . . . . . . . . . . . . . . . . . . . . . .. 183
Inhalational Anaesthesia and Endocrine Disease (S. Jeretin) 187
Concept in Patients with Hypertension and Coronary Heart
Disease - Clinical and Experimental Aspects (K. van Ackern,
U. Mittmann, U.B. Bri.ickner, H.O. Vetter, Ch. Madler, and
H. Victor) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 205
Inhalation Anaesthetics as Hypotensive Agents: Controversial
Aspects (0. Hilfiker, D. Kettler, R. Larsen, J. Teichmann,
and H. Sonntag) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 219
Inhalation Anaesthesia in Paediatrics (J.C. Rouge and
G. Gemperle) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 233
Inhalation Anaesthesia in Geriatric Patients (G. Haldemann) 239
Balanced Anaesthesia as an Alternative Concept
(0. Norlander) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 247
SubjectIndex ............................... 251
Contributing Authors
Van Ackern, K., Professor, Institut flir Anaesthesiologie, Klinikum
GroBhadern, D-8000 Munchen 70, Federal Republic of Germany
Bjaertnaes, L., M.D., Institut of Physik, University of Oslo, Karl
Johans-Gate 47, Oslo l/Norway
Black, G.W., M.D., FRCPI, FFARCS, Consultant Anaesthetist,
The Royal Belfast Hospital for Sick Children, Belfast DT 12 6BE
Northern Ireland
Brown, B.R., Jr., M.D., Ph.D., Professor and Head, Department of
Anaesthesiology, University of Arizona, Health Sciences Center,
Tucson, Arizona 85724/USA
Bruckner, U., Professor, Abteilung fiir Experimentelle Chirurgie,
Chirurgisches Zentrum, Ruprecht-Karls-Universitat Heidelberg,
1m Neuenheimer Feld 347, D-6900 Heidelberg 1, Federal Republic
of Germany
Campbell, D., Professor, Institut of Anaesthesia, University of
Glasgow, Hon. Consultant Anaesthesist, Royal Infirmary, Glasgow,
Great Britain
Crul, J.F., M.D., Professor and Head, Dept. of Anaesthesiology,
Akademisch Ziekehuis, Radbout, Geert Grooteplein zuid 12 Nijme
gen, N-6525 GA-Nijmegen, Netherlands
Cunitz, G., Professor, Knappschaftskrankenhaus, Klinikum der
Ruhr-Universitat, Bochum-Langendreer, D-4630 Bochum 7,
Federal Republic of Germany
Dudziak, R., Professor, Zentrum fur Anaesthesiologie der Universi
tatskliniken Frankfurt, Theodor-Stern-Kai 7, D-6000 Frankfurt 70,
Federal Republic of Germany
Dundee, J.W., Professor, Institut of Anaesthetics, Queen's Universi
ty of Belfast, Northern Ireland
x
Contributing Authors
Endrich, B., M.D., Institut flir Chirurgische Forschung der Universi
tat Mtinchen, Klinikum Gro~hadern, D-8000 Mtinchen 70, Federal
Republic of Germany
Fee, J.P.H., M.D., FFARCS, The Royal Belfast Hospital for Sick
Children, Belfast BT12 6BE Northern Ireland
Fitch, W., M.D., FFARCS, Institut of Anaesthesia, University of
Glasgow, Royal Infirmary, Glasgow/Great Britain
Foex, P., M.D., Nuffield Dept. of Anaesthesiology, Radcliffe Infir
mary, Oxford/Great Britain
Franke, N., M.D., Institut fur Anaesthesiologie der Universitat
Mtinchen, Klinikum Gro~hadern, D-8000 Mtinchen 70, Federal
Republic of Germany
Gemperle, M., Professor, Institut universitaire d' Anesthesiologie,
Hopital Cantonale de Geneve, CH-1211 Geneve, Switzerland
Gothert, M., Professor, Universitatsklinikum der Gesamthochschule
Essen, Pharmakologisches Institut, D-4300 Essen 1, Federal
Republic of Germany
Haldemann, G., M.D., Institut fur Anaesthesiologie und Intensiv
medizin, Kantonspital Aarau, CH-5000 Aarau, Switzerland
Hilfiker, 0., M.D., Zentrum fur Anaesthesiologie der Universitat
Gottingen, Robert-Koch-Str~e 40, D-3400 Gottingen, Federal
Republic of Germany
Irestedt, L., M.D., Department of Anaesthesia, Karolinska Institu
tet, S-10401 Stockholm, Sweden
Jaernberg, P.O., M.D., Department of Anaesthesia, Karolinska
Institutet S-10401 Stockholm, Sweden
Jeretin, St., M.D., Klinik Center Ljubljana, Ferberjeva 37, Ljublja
na/Jugoslavia
Kettler, D., Professor, Institut flir Anaesthesiologie d. Universitat
Gottingen, Robert-Koch-Stra~e 40, D-3400 Gottingen, Federal
Republic of Germany
Lappas, D., Professor and Head, Department of Anaesthesiology,
Medical School, Aristoteles University, Thessaloniki/Greece
Larsen, R., Professor, Institut fUr Anaesthesiologie der Universitat
Gottingen, Robert-Koch-Str. 40, D-3400 Gottingen, Federal Repu
blic of Germany
Lauven, P., M.D., Institut fur Anaesthesiologie, Universitat Bonn,
Rheindorfer Stra~e 50, D-5300 Bonn, Federal Republic of
Germany
Contributing Authors XI
Madler, Ch., Dr., Institut fur Anaesthesiologie der UniversiHit Mun
chen, Klinikum GroBhadern, D-SOOO Munchen 70, Federal Repu
blic of Gennany
Martani, C., Dr., Ospedale San Raffaele, Via Olgettina, 1-20134 Mi
lano, Italy
MeBmer, K., Professor, Abteilung fUr Experimentelle Chirurgie,
Chirurgisches Zentrum, Ruprecht-Karls-Universitat Heidelberg, 1m
Neuenheimer Feld 347, D-6900 Heidelberg 1, Federal Republic of
Gennany
Mittmann, U., Professor, Fa. Dr. Karl Thomae GmbH, Biologische
Forschung, Birkendorferstr. 65, D-7950 Biberach a.d. RiB, Federal
Republic of Gennany
Norlander, 0., M.D., Professor and Chairman, Department of
Anaesthesia, Karolinska Institutet, S-10401 Stockholm, Sweden
Perotti, V., Dr., Ospedale San Raffaele, Via Olgettina, 1-20134 Mi
lano, Italy
Rietbrock, I., Professor, Institut fUr Anaesthesiologie, Universitat
Wtirzburg, Josef-Schneider-StraBe 2, D-S700 Wurzburg, Federal
Republic of Germany
Rouge, J.C., M.D., Institut universitaire d'Anesthesiologie, Hopital
Cantonal de Geneve, CH-1211 Geneve 4, Switzerland
Schmidt, H., Privatdozent, Zentrum fUr Anaesthesiologie der Uni
versitatskliniken Frankfurt, Theodor-Stern-Kai 7, D-6000 Frank
furt 70, Federal Republic of Gennany
Schwilden, H., M.D., Institut fUr Anaesthesiologie, Universitat
Bonn, Rheindorfer StraBe 50, D-5300 Bonn, Federal Republic of
Gennany
Smith, G., M.D., Professor of Anaesthesia, Leicester General
Hospital, University of Leicester, Leicester/Great Britain
Sonntag, H., Professor, Institut fur Anaesthesiologie der Universitat
G6ttingen, Robert-Koch-Str. 40, D-3400 G6ttingen, Federal Repu
blic of Gennany
Steen, P.A., M.D., U1levaal Hospital, Bjerkebakken 69 E, Oslo 7/
Norway
Stoeckel, H., Professor, Institut fUr Anaesthesiologie der Universi
tat Bonn, D-5300 Bonn-Venusberg, Federal Republic of Germany
Strauer, B., Professor, Medizinische Klinik I, Klinikum GroBhadern,
D-SOOO Munchen 70, Federal Republic of Germany
XII Contributing Authors
Taeger, K., M.D., Institut fur Anaesthesiologie, Klinikum GroB
hadern, D-8000 Munchen 70, Federal Republic of Germany
Teichmann, J., Professor, Institut fur Anaesthesiologie der Uni
versitat G6ttingen, Robert-Koch-Str. 40, D-3400 G6ttingen,
Federal Republic of Germany
Torri, G., Professor, Ospedale San Raffaele, Via Olgettina,
1-20134 Milano, Italy
Trudell, J.R., M.D., Department of Anaesthesiology, Stanford
University, School of Medicine, Stanford, California 9430S/USA
Vetter, H.O., Dr., Institut fUr Anaesthesiologie der Universitat Miln
chen, Klinikum GroBhadern, D-8000 MUnchen 70, Federal Repu
blic of Germany
Victor, H., Dipl.-Phys., Abteilung fur Experimentelle Chirurgie,
Chirurgisches Zentrum, Ruprecht-Karls-Universitat Heidelberg, 1m
Neuenheimer Feld 347, D-6900 Heidelberg 1, Federal Republic of
Germany