Cardiovascular Measurement in Anaesthesiology

341 Pages·1982·11.48 MB·English

by  C.-A. Andreae (auth.)

Cardiovascular
Measurement in
Anaesthesiology
Edited by
C. Prys-Roberts and M. D. Vickers
With 179 Figures and 68 Tables
Springer¥erlag
Berlin Heidelberg New York 1982
European Academy of Anaesthesiology Vol. 2
Professor C. Prys-Roberts
University of Bristol
Sir Humphry Davy Departement of Anaesthesia
Royal Infrrmary
Bristol BS2 8HW
United Kingdom
Professor M.D. Vickers
Department of Anaesthetics
Welsh National School of Medicine
Heath Park, Cardiff CF4 4XN, United Kingdom
ISBN-13: 978-3-540-11719-3 e-ISBN-13: 978-3-642-68690-0
DOl: 10.1 007/978-3-642-68690-0
Library of Congress Cataloging in Publication Data
Main entry under title: Cardiovascular Measurement in Anaesthesiology. (European
Academy of Anaesthesiology"; v. 2) Proceedings of the 3rd meeting of the European
Academy of Anaesthesiology, held in Vienna, 1981. Includes bibliographies and index.
1. Anaesthetics-Physiological effect-Measurement-Congresses. 2. Anaesthesiology
Congresses. I. Prys·Roberts, Cedric. II. Vickers, M. D. (Michael Douglas), 1929·.
III. European Academy of Anaesthesiology. IV. Series: European Academy of Anaesthesio·
logy (Series) ; v. 2. [DNLM: 1. Anaesthesiology-Congresses. 2. Anaesthesiology
Instrumentation-Congresses. WI EU612 v. 2 1 WO 200 M592 1982]
RD78.4.M47 1982 617' .96 82·10466
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.
broadcasting, reproduction by photocopying machine or similar means, and storage in data
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private use a fee is payable to "Verwertungsgesellschaft Wort", Munich.
© Springer¥erlag Berlin Heidelberg 1982
The use of general descriptive names, trade marks, etc. in this publication, even if the
former are not especially identified, is not to be taken as a sign that such names, as
understood by the Trade Marks and Merchandise Marks Act, may accordingly by used
freely by anyone.
2119/3140·543210
Acknowledgements
The editors would like to express their wannest appreciation to
the following: Dr. J.N. Lunn, Senior Lecturer and Dr. P.J. Slat
tery, Lecturer, Welsh National School of Medicine for help with
sub-editing, Miss S.E. Marshall for checking the references and
general manuscript management, and to our secretaries, Miss
M.M. Wall and Miss K.R. Prys-Roberts for handling all the sec
retarial and typing work associated with the preparation of the
manuscripts. The abstracts on pages 20,80,85,91,249,256,
268,269,285,287 and 316 are reprinted from the British
Journal of Anaesthesia with the permission of the copyright
holder.
C. PRys-RoBERTS
M.D. VICKERS
Opening Address
European Academy 01.10.1981
Mr. President of the W.F.S.A., Mr. President of the Academy,
distinguished guests, members of the Academy, dear friends and
colleagues, ladies and gentlemen!
May I, on behalf of the Organising Committee, welcome you
to the 3rd Meeting of the Academy here at the Auersperg Palais
in Vienna. As some of you may know, this wonderful Palais was
once the property of the Rofrano family; those familiar with
Hugo v. Hoffmannsthal's libretto for Richard Strauss' opera
"Der Rosenkavalier" will recall that the name of the young
"Chevalier de la Rose" was Count Quinquin (or Octavian)
Rofrano. I should therefore like to bid you a most cordial wel
come, not under the auspices of a poppy head - so familiar to
our profession - but under the sign of the silver rose in this his
toric place. We preferred this Palais to the Hilton and other com
peting locations b~cause we wished to offer you as much Aus
trian "flair" as possible during these days.
The Austrian Academicians are proud to have been entrusted
with the organisation of this meeting; it is our sincere hope that
we shall be able to live up to your expectations.
Various attempts to gain your approval have already been
made: for example, we have been able to import the President of
the W.F.S.A. and I want to express our gratitude to Professor
John Bonica who has kindly stopped in Vienna to address this
meeting on his way back home. In this context I should also like
to thank our honorary Academician, Professor Hans Killian, for
accepting our invitation to attend.
We have also "won" a charming interpreter of the otherwise
rather arid Financial Sciences as a guest lecturer, the new Rector
of Innsbruck University, Professor Clemens August Andreae; he
deserves our warm applause for having come in spite of a still on
going seminar in Bregenz directed and organised by him and his
Institute.
For the organisation of the seminar on "Invasive and Nonin
vasive Circulatory Measurements", a topic of universal interest,
we are greatly indebted to Professor Cedric Prys-Roberts, who
not only deserves our sincerest thanks, but also our respect for
having overcome so efficiently various obstacles in its preparation.
VIII Opening Address
As to the rest of the scientific programme, thanks to the kind
assistance of the reviewers (Professers Crul, Desmonts, Stoeckel
and Sykes) we have been able to select many papers of high
standard. Professor Alistair Spence has, once again, kindly dealt
with the linguistic problems associated with the preparation of
preprinted abstracts.
To help cement relations between the medical profession and
pharmaceutical industry, who are naturally keen to be in contact
with Europe's V.I.P's in An-aesthesiology, we have organised a
commercial exhibition for the first time. Professor Hans Berg
mann, has taken the major part in organising this. Unfortunately,
this may spoil somewhat this lovely site by blocking your view
of many old paintings but it is our sincere conviction that we
cannot achieve the Academy's aims without contacts like these
and thorough support from our industrial patrons.
Last but not least we have prepared a social programme with
the intention of showing you more of our cultural "ambience"
by chOOSing "Die Fledermaus" for the opera performance and
by selecting an uncommon site for the "Heurigen Party", far
from the usual Grinzing hustle and bustle. We shall also be show
ing you new places connected with the life of Joseph Hadyn,
who was not only an Austro-Hungarian composer but also an
Honorary Graduate of Oxford University. We believe that we
will deepen your understanding of our small country which has
been for centuries and still is an intersection of cultural move
ment and influence.
All this would hardly have been possible without the gener
osity of our sponsors to whom I should like to express our sin
cerest thanks in your name. I must also thank my colleagues on
the Organising Committee, Professor Mayrhofer and Professor
Bergmann, the staff of our departments, the staff of Mondial
Congress and of this house. Finally, may I thank all of your for
coming, thus demonstrating your interest in the Academy and
its future development.
To return to the Rosenkavalier story (and this very hall is
named the "Rosenkavaliersaal") when the young count handed
the silver rose to Sophie both fell in love almost instantaneously.
Our ambition is the same: beneath the emblem of the silver rose
we hope you will fall in love, not only with this city but with
Austria. Thank you and welcome again.
KARL STEINBEREITHNER
Table of Contents
Part I: Free Papers I
Comments on the Significance of Economic Arguments
in the Health-Care Sector (C.-A. Andreae) . . . . . . . . . . . 3
Comparative Pharmacokinetics of Fentanyl and Alfentanil
(CJ. Hull and S. Bower). . . . . . . . . . . . . . . . . . . . . .. 20
Pharmacokinetic Data of Fentanyl, Midazolam and
Enflurane as Obtained by a New Method for Arbitary
Schemes of Administration (H. Schwilden, H. Stoeckel,
J. Schuttler and P.M. Lauven) . . . . . . . . . . . . . . . . . .. 22
Disposition of Alfentanil, a New Analgesic Agent, in Man
(F. Camu, J. Heykants, E. Gepts and M. Rucquoi). . . . .. 30
Effect of Spinal Morphine on the Electrophysiological
Activity of the Ureter in the Rabbit (F. Magora, B. Beilin,
1. Shorr, B. Gonen and A. Magora) . . . . . . . . . . . . . . .. 34
Spinal Block with Lignocaine and Fentanyl for Ender
Nailing in the Elderly (J.C Otteni, T. Pottecher and
C Jeanpierre). . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 39
Epidural Morphine in Obstetric Analgesia (W. Dick,
F. Traub and R. Moller) ..................... '.. 45
Ventilatory Effects of Epidural Diamorphine -
A Comparison with Epidural Lignocaine (G.M. Cooper,
N. W. Goodman, C Prys-Roberts, L. Jacobson, G.A. Douglas
and J. Dye) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 51
Effects of Epidural Analgesia with Etidocaine and
Morphinics on Endocrine Function (J.L. Arroyo, L. Ponz,
F. Carrasco sa, R.P. Reiner, L. Lecron and M.A. NaIda). .. 60
x
Table of Contents
Respiratory Depression with Buprenorphine: Onset Time
and Reversal (P.J. Slattery, M. Harmer, M. Rosen and
M.D. Vickers). . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 68
Effects of Almitrine on Respiratory Depression During
Enflurane Anaesthesia (S. Armand, J.e. Jorrot, J. Leoni,
J.P. Morin and J. Lassner). . . . . . . . . . . . . . . . . . . . .. 74
Diazepam Reduces Lower Oesophageal Sphincter Pressure
(G. Smith, B.R. Cotton and D. Fell) . . . . . . . . . . . . . .. 80
Monitoring of the Electroencephalogram and
Electromyogram During Anaesthesia (A.I. Hollmen,
I. Sulg, P. Eskelinen and J. Arranto) . . . . . . . . . . . . . .. 81
Heterozygotes for Atypical Cholinesterase (H. Owen and
A.R. Hunter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 85
Intubating Conditions with Org NC 45: A Comparison
with Suxamethonium and Pancuronium (R.S.J. Clarke,
R.K. Mirakhur, I.M. Bali and J. W. Dundee). . . . . . . . . .. 86
:Reversibility by Neostigmine of an Org NC 45
Neuromuscular Blockade Under Halothane and Enflurane
Anaesthesia in the Cat (L. Booij, J.F. Crul and F. v.d. Pol). 91
Drug Interactions with Local Anaesthetics (G. Sprotte
and K.H. Weis) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 92
The Effect of Some Premedicants on the Cardiovascular
System (A. Fassoulaki, P. Kaniaris and S. Kotsanis) . . . .. 97
Althesin and Alfentanyl for Minor Surgery (E. Kay and
A.T. Cohen) . .............................. 104
Part II: Invasive and Non·invasive Circulatory Measurement
(C. Prys·Roberts)
Indices of Myocardial Performance (P. Foex) . . . . . . . .. 110
Direct Measurement of Arterial Pressure and Derived
Variables (e. Prys-Roberts and J.S.H. Curnow) . . . . . . .. 132
Direct Measurement of Left Ventricular Pressure in Man
(D. Kettler and O. Hilfiker). . . . . . . . . . . . . . . . . . . .. 142
Table of Contents XI
Swan-Ganz Catheterisation - Application, Interpretation
and Limitations (J. Tarnow) . . . . . . . . . . . . . . . . . . .. 152
Coronary Blood Flow - Inert Gas Methods (H. Sonntag). 167
Coronary Sinus Catheterisation and Measurement of
Coronary Sinus Blood Flow by the Continuous
Thermodilution Method (S. Reiz and S. Haggmark) . . . .. 174
Physical Principles of Ultrasonics in Cardiovascular
Measurements (P.N.T. Wells and R. Skidmore) . . . . . . .. 183
Clinical Applications of Echocardiography in Anaesthesia
(C. Prys-Roberts and R. Skidmore). . . . . . . . . . . . . . .. 198
Systolic Time Intervals - What Do They Really Measure?
(W.F. List). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 207
Possibilities and Limitations of Thoracic Impedance
Cardiography (W. Bleicher) . . . . . . . . . . . . . . . . . . . .. 212
Noninvasive Measurement of Pulmonary Blood Flow and
Tissue Volume Using the Inert-Gas Technique
(A.R. Aitkenhead). . . . . . . . . . . . . . . . . . . . . . . . . .. 235
Part III: Free Papers II
Plasma Catecholamine Concentrations and Haemodynamic
Studies During Phaeochromocytoma Resection (J. Marty,
J.M. Desmonts, M. Fischler,. G. ChaTaux, F. Michon and
E. Comoy). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 249
The Effects of Thiopentone on Pulmonary Circulation
(D. DoTar and S. Sun). . . . . . . . . . . . . . . . . . . . . . . .. 251
Obstetric Analgesia with Fentanyl-Bupivacaineby the
Extradural Route (M.A. NaIda, F. Campo and 1. Burzaco). 256
Etodolac in Postsurgical Pain: Double-Blind,
Dose-Ranging Efficacy Study with Aspirin and Place bo
(P. Bilsback, G. Rolly, L. Versichelen, M. Merlo and
L. Joubert). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 257
Plasma and Cerebrospinal Fluid Amino Acid Distribution
Rations in Hypercapnia (c. Manni, S.L Magalini, R. Proietti
and D. Camaioni) . . . . . . . . . . . . . . . . . . . . . . . . . .. 261
XII Table of Contents
Anaesthesia in Patients with Obstructive Jaundice
(K. Hutschenreuter). . . . . . . . . . . . . . . . . . . . . . . . .. 266
Radiocarctiography in the Intensive Care Unit:
Preliminary Report (R. Szulc, W. Jurczyk, L. Wolowicka,
C. Smarsz and S. Poradowski) .................. , 268
Pharmacokinetics of Fentanyl in Children (C. Saint-
Maurice, J.P. Loose, C. Meistelman and M.M. Delleur) . .. 269
EEG Analysis and the Clinical Effects of Levonantradol
in Human Volunteers (J. Lassner and N. Sansoy). . . . . .. 270
Echocardiographic Assessment of Left Ventricular Func
tion Following Induction of Anaesthesia with Althesin
(J.P. Caramella, J.P. Lehner and JM. Desmonts) . . . . . .. 272
Relationship Between End-diastolic Cardiac Size and
Ventricular Function Under Increasing Doses of Enflurane
in Intact, Chronically Instrumented Dogs
(K. Steinbereithner, H. Gilly and M Zimpfer) . ....... , 277
Dextran vs Albumin Haemodilution in Hip Surgery
(E. Couderc, J.M. Desmonts, G. Barbier-Bohm,
M. Videcoq and J.L. Berger) . . . . . . . . . . . . . . . . . . .. 285
Microcirculatory Effects of Deliberate Hypotension
(N. Franke, B. Endrich, K. Messmer and K. Peter) . . . . .. 287
Arterial Hypertension as a Contributory Factor to the
Risks from Anaesthesia and Surgery in Patients with
Myocardial Infarction (A.A. Triantaphyllidis and
V. Chimonitsy-K.ypriou). . . . . . . . . . . . . . . . . . . . . .. 289
Continuous Recording of the Transcutaneous Po 2 in
Paediatric Anaesthesia (M.D. Ghnassia, A. Rosenberg-
ReinerandL. Delegue) . ....................... 297
Cardiovascular Responses to Combined Apnoea and Face
Immersion in Exercising Man (J.L. Bjertnaes, A. Hauge,
J. Kjekshus and E. S~yland) . . . . . . . . . . . . . . . . . . .. 307
The Syndrome of Pulmonary Fat Embolism: Clinical,
Physiopathological and Therapeutic Considerations
(P.M. Giugiaro, P. Bossone, P. Roggero and G.P. Zocche). 309