Machame Anaesthesia Notebook for Medical Auxiliaries: With Special Emphasis on the Developing Countries

168 Pages·1982·4.43 MB·English

by  Georg Kamm

Georg Kamm Toni Graf-Baumann
Machame
Anaesthesia Notebook
for Medical Auxiliaries
With Special Emphasis
on the Developing Countries
With 89 Figures and 14 Tables
Springer-Verlag
Berlin Heidelberg New York 1982
GeorgKamm
Head ofDept. of Anaesthesia
Machame Hospital, Box 3044
Moshi, Tanzania
Toni Graf-Baumann
SIFKU-Institut, Holtenauerstraße
0-2300 Kiel
CIP-Kuntitelaufnahrne der Deutschen Bibliothek
Kamm, Georg:
Maehame anaesthesia notebook for medical auxiliaries: with special emphasis
on the developing countries / Georg Kamm; Toni Graf-Baumann. - Berlin;
Heidelberg; New York: Springer, 1982.
ISBN-13: 978-3-540-09055-7 e-ISBN-13: 978-3-642-67101-2
DOI: 10.1007/978-3-642-67101-2
NE: Graf-Baumann, Toni
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© Springer-Verlag Berlin Heidelberg 1982
The use ofregistered names, trademarks, ete. in this publication does not imply,
even in the absence of a specifie statement, that such names are exempt from
the relevant protective laws and regulations and therefore free for general use.
Printing and binding: K. Triltsch, Würzburg
2127/3140-543210
To Professor Dr. Rudolf Frey
and to all Tanzanians who joined with me in
striving for the one and main purpose in
performing anaesthesia under the motto:
Divinum est seda re dolorem
It is divine to abolish pain
Foreword
The advances in the field of anaesthesiology and reanimation have
contributed in all developed countries to the decrease in deaths
occurring on the operating table (exitus in tabula), from the ratio
1: 100 (in the nineteenth century) down to approximately 1: 1000
(in the first half of the twentieth century) and finally to approxi
mately 1: 10 000 (nowadays).
Numerous human lives were saved not only through the intro
duction of new medicine and methods but even more so by better
training for the doctors and nurses who apply these new techni
ques.
I am happy about the splendid initiative of my student and
friend Georg Kamm, which has now made these advances acces
sible to the developing countries. He knows very well how to
make his colleagues understand the theory and the practical side
of modern anaesthesiology, under the most difficult conditions
and in a completely different world, to such an extent that to
day in his country all of his patients are given the benefit of the
advances of medicine.
There is nothing more rewarding for an academic teacher
than to see how his students continue developing his ideas and
spread them far and wide. I am therefore happy and proud to
write this foreword for Georg Kamm, one of the pioneers of
anaesthesiology in Africa.
R. Frey
Preface
The intention of this book is to give the necessary knowledge for
medical auxiliaries performing anaesthesia, with special empha
sis on developing countries. I do not want to provide another
textbook on anaesthesia; this should be a work manual. I have
only included the information which from my experience is abso
lutely necessary for any medical auxiliary to assist with, or in per
forming, anaesthesia.
I t is my hope that this booklet will bring understanding of the
drugs and agents used, and will help in the training and in the per
formance of different techniques, with the aim of achieving prac
tical, simple and safe anaesthesia.
G.Kamm
Acknowledgements
Through the continuous support and encouragement of my
esteemed teacher and friend Prof. Rudolf Frey F.F.A.R.C.S.,
I have been in the position to start and successfully finish this
handbook on anaesthesia. It is in my sincere gratitude that it is
dedicated to him with thanks. To all my other teachers who hel
ped to build up my knowledge and my personality I also extend
my sincere thanks.
I am indebted to many of my colleagues and friends. My little
booklet has greatly profited from the experience and masterful
corrections of Mr. Peter Bewes of the K.C.M.C., Moshi, who pro
vided much constructive critisism. I want to thank Peter Timmer
manns, Ruediger Kilian, F. Finsterer and M. Scudder for giving
their expert advice and many practical comments.
I would also like to acknowledge here the 12 years of colla
boration with my colleague Dr. Rudolf Schmidt of Machame
Hospital, who from the very beginning of my career as an anaes
thetist at this hospital never failed to help me with indispensable
advice and valuable contributions to attain today's success, as
well as my friends Mr. J. Urasa and E. Msuya.
I wish to thank Mrs. Renata Kuehne from Jena, DDR, for her
skill and patience in transferring the jungle of my papers into
plain and acceptable language and for typing it all on stencils.
Many thanks also to Mrs. Lilian for copying the many stencils
that make up this book.
Finally my heartiest thanks to Maria, my dear wife, for
helping me in ever so many ways.
G.Kamm
Table of Contents
Chapter 1. A Short Review of the Anatomy and Physiology
of the Respiratory System. . . . . . . . . . . . . . .. .. 1
1.1 Anatomy .............................. .
1.2 Physiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2
1.2.1 Upper Respiratory System. . . . . . . . . . . . . . . . .. 2
1.2.2 Lower Respiratory System .................. 2
1.2.2.1 Larynx ................................. 2
1.2.2.2 Trachea ................................ 3
1.2.2.3 Bronchi ................................ 3
1.2.2.4 Lungs .................................. 3
1.2.3 Mechanism of Ventilation .................. 4
1.2.4 Regulation of Respiration. . . . . . . . . . . . . . . . .. 4
1.2.5 Normal Respiratory Rate. . . . . . . . . . . . . . . . .. 5
1.2.5.1 Ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 6
1.2.5.2 Diffusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 7
1.2.5.3 Perfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 7
1.3 Oxygen ................................ 8
1.4 Anatomy and Physiology of the Autonomic
Nerve System. . . . . . . . . . . . . . . . . . . . . . . . . . .. 9
Chapter 2. Pharmacology of General Anaesthesia ......... 10
2.1 Inhalation Anaesthesia. . . . . . . . . . . . . . . . . . .. 11
2.1.1 Ether. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11
2.1.1.1 Effects on the Central Respiratory System (CRS) 12
2.1.1.2 Effect on the Cardia-Vascular System (CVS) ... 12
2.1.1.3 Muscle Relaxation. . . . . . . . . . . . . . . . . . . . . .. 12
2.1.1.4 Disadvantages of Ether .................... 12
2.1.1.5 Advantages of Ether. . . . . . . . . . . . . . . . . . . .. 13
2.1.1.6 Dosage of Ether. . . . . . . . . . . . . . . . . . . . . . . .. 13
2.1.2 Halothane. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 13
XI
2.1.2.1 Effect on the CRS . . . . . . . . . . . . . . . . . . . . . .. 13
2.1.2.2 Effect on the CVS . . . . . . . . . . . . . . . . . . . . . .. 13
2.1.2.3 Excretion and Fate ....................... 14
2.1.2.4 Disadvantages of Halothane ................. 14
2.1.2.5 Advantages of Halothane. . . . . . . . . . . . . . . . .. 14
2.1.2.6 Clinical Use ............................. 14
2.1.2.7 Dosage ................................ 14
2.1.3 Trilene ................................ 14
2.1.4 Gas ................................... 15
2.1.4.1 Use ................................... 15
2.2 Intravenous Anaesthesia. . . . . . . . . . . . . . . . . .. 15
2.2.1 Barbiturates. . . . . . . . . . . . . . . . . . . . . . . . . . .. 15
2.2.1.1 The Effect on the CNS . . . . . . . . . . . . . . . . . . .. 16
2.2.1.2 Effects on the CRS . . . . . . . . . . . . . . . . . . . . . .. 17
2.2.1.3 Effect on the CVS ........................ 18
2.2.1.4 Metabolisation . . . . . . . . . . . . . . . . . . . . . . . . .. 18
2.2.1.5 Advantages of Barbiturates ................. 18
2.2.1.6 Disadvantages of Barbiturates ............... 19
2.2.1.7 Contraindications . . . . . . . . . . . . . . . . . . . . . . .. 19
2.2.2 Ketalar ................................ 20
2.2.2.1 Effects on the CVS ....................... 20
2.2.2.2 Effects on the CRS ....................... 20
2.2.2.3 Reflexes and Muscle Tonus ................. 20
2.2.2.4 Laboratory Analysis ...................... 21
2.2.2.5 Dosage and Du~ation of Action. . . . . . . . . . . .. 21
2.2.2.6 Clinical Use of Ketalar . . . . . . . . . . . . . . . . . . .. 21
2.2.2.7 Disadvantages of Ketalar . . . . . . . . . . . . . . . . .. 21
2.2.2.8 Contraindications. . . . . . . . . . . . . . . . . . . . . .. 21
2.2.3 Propanidid (Epontol) ..................... 21
2.3 Neuromuscular Blocking Drugs ........ , . . .. 22
2.3.1 Non-depolarising Muscle Relaxant. . . . . . . . . .. 23
2.3.1.1 Dosage and Duration of Action. . . . . . . . . . . .. 23
2.3.2 Depolarising Relaxant (Succinyl bicholine) . . .. 24
2.4 Other Drugs Used in Anaesthesia. . . . . . . . . . .. 25
2.4.1 Atropine. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 25
2.4.2 Analgetica . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 26
24.2.1 Mechanism of Action. . . . . . . . . . . . . . . . . . . .. 26
2.4.2.2 Effects of Analgetics . . . . . . . . . . . . . . . . . . . .. 27
2.4.2.3 Dosages of the Different Agents ............. 27
2.4.3 Narcotic Antagonists. . . . . . . . . . . . . . . . . . . .. 28
2.4.4 Neuroleptica ............................ 28
XII
2.4.5 Diazepam (Valium) . . . . . . . . . . . . . . . . . . . . .. 28
2.4.6 TranquiIisers (promethazine) . . . . . . . . . . . . . .. 29
2.5 List of Drugs Commonly Used in Anaesthesia.. 29
Chapter 3. Pre-operative Examination. . . . . . . . . . . . . . . .. 30
3.1 History of the Patient. . . . . . . . . . . . . . . . . . .. 30
3.2 Clinical Examination. . . . . . . . . . . . . . . . . . . .. 30
3.3 Laboratory Investigations. . . . . . . . . . . . . . . .. 30
3.4 Summary............................. 30
3.5 Comments. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 33
3.6.1 Cyanosis ............................... 33
3.6.2 Tumours, etc. . . . . . . . . .. ................ 33
3.6.3 Lung Disease. . . . . . . . . . . . . . . . . . . . . . . . . .. 33
3.6.4 Circulation Problems. . . . . . . . . . . . . . . . . . . .. 34
3.6.5 Hypotension. . . . . . . . . . . . . . . . . . . . . . . . . .. 34
3.6.6 Hypertension .......................... , 34
3.6.7 Arrhythmia. . . . . . . . . . . . . . . . . . . . . . . . . . .. 35
3.6.8 Tachycardia. . . . . . . . . . . . . . . . . . . . . . . . . . .. 35
3.6.9 Bradycardia. . . . . . . . . . . . . . . . . . . . . . . . . . .. 35
3.6.10 Hepatomegaly and Ascites. . . . . . . . . . . . . . . .. 35
3.6.11 Temperature. . . . . . . . . . . . . . . . . . . . . . . . . .. 35
3.6.12 History of Drug Taking. . . . . . . . . . . . . . . . . .. 36
3.7 Laboratory Investigation. . . . . . . . . . . . . . . . .. 36
3.8 Remember. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 36
Chapter 4. Premedication ........................... 38
4.1 Lowering of Reflex Activity ................ 38
4.2 Sedation and Reduction of Anxiety ......... , 39
4.2.1 Neuroleptics ............................ 39
4.2.2 Sedative Analgetics ....................... 39
4.2.3 Tranquiliser ............................ 40
4.3 Premedication for Children and Infants ...... , 40
4.4 Summary .............................. 40
Chapter S. Maintenance of the Airway ................. 42
5.1 Causes of Respiratory Obstruction in the Patient 43
5.1.1 Loose Teeth. . . . . . . . . . . . . . . . . . . . . . . . . . .. 43
5.1.2 Tumours. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 43
5.1.3 Stenosis ............................... 44
5.1.4 Pharynx ............................... 44
XIII