Innovations in Physiological Anaesthesia and Monitoring

180 Pages·1989·6.5 MB·English

by  H. P. Koepchen

R. Droh R. Spintge (Eds.)
Innovations in Physiological
Anaesthesia and Monitoring
With 98 figures
Springer-Verlag Berlin Heidelberg New York
London Paris Tokyo Hong Kong
Dr. med. R. Droh
Dr. med. R. Spintge
Sportkrankenhaus Hellersen
Paulmannshoher StraBe 17
D-5880 Liidenscheid, FRG
ISBN-13: 978-3-540-50331-6 e-ISBN-13:978-3-642-74114-2
DOl: 10.1007/978-3-642-74114-2
Library of Congress Cataloging-in-Publication Data
Innovations in physiological anaesthesia and monitoring 1 R. Droh. R. Spintge (eds.) p. cm.
ISBN-13:978-3-S40-S0331-6 (U.S.: alk. paper)
1. Anesthesia. 2. Patient monitoring. I. Droh, R. (Roland)
II. Spintge, R. [DNLM: 1. Anesthesia. Monitoring, Physiologic. WO 200 158] RD82.I53
1989 617.9'6--dc20 DNLMlDLC for Library of Congress 89-21627
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Preface
At present there are going on decisive developments in the introduc
tion of physiological thinking into anaesthesiological practice. These
innovative motion comprises applications taken from space physiolo
gy, closed-circuit ventilation systems, neurophysiologic control of cir
culation and ventilation together with innovative aspects of circulation
physiology and respiration physiology. Involved are innovative aspects
of neuromuscular blockade, volatile anaesthetics, cardiorespiratoric
monitoring, haemodilution and blood substitution.
Special emphasis is put on demonstrating the closed circuit system
as a combination of anaesthesia system and monitoring system in daily
clinical routine. Additional knowledge and investigation are stimu
lated in the fields of anaesthesia, neurophysiology, pharmacology,
space medicine and metabolic physiology using non-invasive methods
of monitoring like the evaluation or the neurovegetative status of man
and its addaptive changes. Combining these aspects and systems will
provide a quite new analytic and synergetic power in the direction of
physiological anaesthesia and monitoring which finally will result in a
totally new system of a physiological "micro-anaesthesia".
We recommend this bock therefore to all anaesthetists, clinical
physiologists and pharmacologists as well as to physicists and engi
neers interested in innovative and non-invasive methods in physiologi
cal anaesthesia with special emphasis to the use of closed systems.
The editors
Contents
Terrestrial And Extraterrestrial Applied Physiology . . . . 1
Physiological Concepts of Cardiovascular and Respiratory
Control: Theoretical Basis and Applicability in Man
H. P. KOEPCHEN, H.-H. ABEL and D. KLUBENDORF .... 3
New Approach to Analysing the Neurovegetative State in Man
H.-H. ABEL, D. KLUBENDORF and H.-P. KOEPCHEN ..... 21
Rhythms of Eating and Drinking in Sportsmen and Possible
Applications in Space Medicine
K. A. KIRSCH and L. ROCKER . . . . . . . . . . . . . . . . . . . 35
Closed-Circuit System . . . . . . . . . . . . . . . . . . . . . 41
The Closed-Circuit System - A Perfect Anesthesia and
Monitoring Unit
R. DROH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Determination of Anesthetics in Aqueous Solution by Infrared
A TR Spectrometry
R. WYZGOL, P. HEINRICH, B. SCHRADER and D. W. LUBBERS 89
Experiences with a New Wavelength Scanning Oximeter
D. W. LUBBERS, U. MERSCHEBROCK and H. P. KELLER. . . . 97
Innovative Aspects in Ventilation and Lung Function . . . . . 105
Use of the VG Spectralab-M Quadrupole Mass Spectrometer
in the Determination of Breath-by-Breath Gas Uptake
P. C. W. BEATTY, B. KAy and T. E. J. HEALY. . . . . . . . .. 107
Critial Oxygen Delivery Levels During Shock
N. S. FAITHFULL and S. M. CAIN ... 117
Highly Efficient Jet Ventilation
W. L. DEN DUNNEN and T. MOSTERT . 125
VIn Contents
Innovative Aspects in Circulation . 135
Physics of the Circulatory System
T. MOSTERT and W. L. DEN DUNNEN . 137
The Effect of Peripheral Vascular Resistance on the Systolic
Blood Pressure Difference Along an Extremity
J. C. DORLAS and A. W. CUIPER ............... 143
Haemodilution and Myocardial Ischaemia - Studies with
Fluorocarbons and Dextran in Pigs
N. S. FAITHFUL, M. FENNEMA and W. ERDMANN .. 151
Innovative Aspects in Different Medical Specialities 159
Sevofturane - A New Inhalant Anesthetic Agent
T. MURAKAWA, Y. SATOH, A. MATSUKI and T. OYAMA. 161
Magnetic Resonance Imaging of the Peridural Space
H. LAUBOECK and W. ISCHEBECK ............ . 165
Hepatic Drug Metabolism in Multiple Organ Failure
W. SCHREGEL, H.-D. KUNTZ and M. VITI ....... . 171
List of Contributors
H.-H. ABEL, Institut fur Physiologie der Freien Universitat Berlin,
Arnimallee 22, 1000 Berlin (West) 33, Germany
P. C. W. BEATIY, Regional Department of Medical Physics and
Bioengineering, University Hospital of South Manchester, Withington,
Manchester M20 8LR, UK
S. M. CAIN, Department of Physiology and Biophysics, University of
Alabama at Birmingham, Alabama 35294, USA
A. W. CUIPER, Institute of Anaesthesiology, Oostersingel 59, 9713-EZ
Groningen, The Netherlands
W. L. DEN DUNNEN, Department of Anaesthesia, Municipal Hospital
Dordrecht, Dordrecht, The Netherlands
J. C. DORLAS, Instituut voor Anaesthesiologie, Academisch Ziekenhuis
Groningen, 9700 RB Groningen, The Netherlands
R.DRoH, Sportkrankenhaus Hellersen, Paulmannshoher Str. 17,
5880 Liidenscheid, FRG
W. ERDMANN, Department of Anaesthesiology, Erasmus University,
Academisch Ziekenhuis, Molewaterplein 40, 3015-GD Rotterdam, The
Netherlands
N. S. FAITHFULL, Department of Anaesthesia, University of Manchester,
Manchester, UK
M. FENNEMA, Department of Anaesthesiology, Erasmus University,
Academisch Ziekenhuis, Molewaterplein 40, 3015-GD Rotterdam, The
Netherlands
T. E. J. HEALY, Department of Anaesthesia, University Hospital of South
Ma,nchester, Withington, Manchester M20 8LR, UK
P. HEINRICH, Institut fur Physikalische und Theoretische Chemie, Universitat
Essen, 4300 Essen 1, FRG
W. ISCHEBECK, Neurochirurg. Abteilung und Institut fur
Kernspintomographie, Gemeinschaftskrankenhaus Witten/Herdecke,
5804 Witten/Herdecke, FRG
X List of Contributors
B. KAy, University Department of Anaesthesia, University Hospital of South
Manchester, Withington, Manchester M20 8LR, UK
H. P. KELLER, Universitatsklinik Wiirzburg, 8700 Wiirzburg, FRG
K. A. KIRSCH, Institut fur Physiologie der Freien Universitat Berlin,
Arnimallee 22, 1000 Berlin (West) 33, Germany
D. KLUBENDORF, Institut fur Physiologie der Freien Universitat Berlin,
Arnimallee 22, 1000 Berlin (West) 33, Germany
H.-P. KOEPCHEN, Institut fur Physiologie der Freien Universitat Berlin,
Arnimallee 22, 1000 Berlin (West) 33, Germany
H.-D. Kuntz, Abteilung fur Gasteroenterologie und Hepatologie,
Medizinische Universitats-Kliniken, Bergmannsheil Bochum, 4630 Bochum,
FRG
H. LAUBOECK, Zentrale Anaesthesieabteilung, Bergmannsheil Bochum,
4630 Bochum, FRG
D. W. LUBBERS, Max-Planck-Institut fur Systemphysiologie,
Rheinlanddamm 201,4600 Dortmund, FRG
A. MATsuKI, Department of Anaesthesiology, Hirosaki University School of
Medicine, Hirosaki, Aomori-Ken, Japan
U. MERSCHEBROCK, Max-Planck-Institut fur Systemphysiologie,
Rheinlanddamm 201, 4600 Dortmund, FRG
T. MOSTERT, Department of Anaesthesia, Municipal Hospital, Dordrecht,
The Netherlands
T. MURAKAWA, Department of Anaesthesiology, Hirosaki University School
of Medicine, Hirosaki, Aomori-Ken, Japan
T. OYAMA, Department of Anaesthesiology, Hirosaki University School of
Medicine, Hirosaki, Aomori-Ken, Japan
L. ROCKER, Institut fiir Physiologie der Freien Universitat Berlin,
Arnimallee 22, 1000 Berlin (West) 33, Germany
Y. SATOH, Department of Anaesthesiology, Hirosaki University School of
Medicine, Hirosaki, Aomori-Ken, Japan
B. SCHRADER, Institut fur Physikalische und Theoretische Chemie, Universitat
Essen, 4300 Essen 1, FRG
W. SCHREGEL, Abteilung fur Anaesthesie und operative Intensivtherapie,
Knappschaftskrankenhaus Bochum-Langendreer, Universitats-Klinik, In der
Schornau 23-25, 4630 Bochum, FRG
M. VITI, Abteilung fur Anaesthesie und operative Intensivtherapie,
Knappschaftskrankenhaus-Universitats-Klinik, In der Schornau 23-25,
4630 Bochum, FRG
R. WYZGOL, Institut fur Physikalische und Theoretische Chemie, Universitat
Essen, 4300 Essen 1, FRG
Terrestrial And Extraterrestrial
Applied Physiology
Physiological Concepts of Cardiovascular and
Respiratory Control: Theoretical Basis and
Applicability in Man
H.P. KOEPCHEN, H.-H. ABEL and D. KLUSSENDORF
Introduction
Key concepts of the present symposium are: anaesthesia - physiology -
internal medicine - innovation. What are the relationships among these
concepts? We believe one of the innovations to lie precisely in their com
bination. Internal medicine, and especially anaesthesia, is to a consider
able extent applied physiology. The still too rigid borders between the
disciplines, especially in Germany, must be overcome to make the con
cepts and methods developed in one field fruitful for application in other
fields. This is especially important for the application of basic physiologi
cal concepts to man. In this context we will confine our attention to one
central point of view, that of neurovegetative regulation, in particular of
the cardiovascular and respiratory systems. The term neurovegetative
means neuronal regulation of the functions of vegetative organs and organ
systems. Within this general framework the cardiovascular and respiratory
regulatory systems form part of an interacting complex of many kinds of
regulatory processes.
The special importance of cardiovascular and respiratory regulation in
this context is based on several facts. Circulation and respiration are
basic, vital functions of the body. Their adequate maintenance is one of
the most important aims of the anaesthesiologist. In this area there is
therefore a convergence of the interests of physiology and those of practi
cal medicine. Both functions are dependent on central control systems
which are intimately linked with the functional-state of general brain
function. This is true even during rest and anaesthesia. In addition, these
control systems are influenced by higher cortical functions during wakeful
ness, mental load and exertion, i.e. during the different degrees of human
activity. The consequence is that the behaviour of respiratory and cardio
vascular parameters mirrors the state of central nervous regulations and
can be used as an indicator of them.
Modern techniques allow one (a) to record these parameters continuously
without harm to the patient and (b) to evaluate automatically correlations
between single parameters so as to reveal their time structures and to process a
great amount of data within a short time.