Inhalation Anesthetics: New Aspects 2nd International Symposium

285 Pages·1987·9.314 MB·English

by  I. Rietbrock (auth.), Prof.Dr. Klaus Peter, Prof.Dr. Burnell R. Brown, Prof.Dr. Eike Martin, Prof.Dr. Olof Norlander (eds.)

185
Anaesthesiologie und Intensivrnedizin
Anaesthesiology
and Intensive Care Medicine
vormals "Anaesthesiologie und Wiederbelebung"
begründet von R. Frey, F. Kern und O. Mayrhofer
Herausgeber:
H. Bergmann' Linz (Schriftleiter)
J. B. Brückner . Berlin M. Gemperle . Geneve
W. F. Henschel . Bremen O. Mayrhofer . Wien
K. Meßmer . Heidelberg K. Peter . München
Inhalation
Anesthetics
New Aspects
2nd International Symposium
Edited by
K. Peter, B. R. Brown, E. Martin,
and o. Norlander
With 179 Figures and 51 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Prof. Dr. Klaus Peter Prof. Dr. Burnell R Brown
Prof. Dr. Eike Martin Prof. Dr. Olof Norlander
Institut für Anästhesiologie, Ludwig-Maximilians-Universität
Klinikum Groß hadern, Marchioninistraße 15, D-8000 München 70
ISB N -13 : 978-3-540-1657 5-0 e-ISB N -13 :9 78-3-642-712 32-6
DOI: 10.1007/978-3-642-71232-6
Library of Congress Cataloging in Publication Data.
Inhalationsanaesthetika. English. Inhalation anesthetics.
(Anaesthesiologie und Intensivmedizin; 185)
Translation of Inhalationsanaesthetika. Includes Index.
1. Inhalation anesthesia - Congresses. I. Peter, K., 1938. -
11. Title. III. Series. RD85.I48I5413 1987 617'.962 87-13107
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Preface
In 1981, the Institute of Anesthesiology at the Ludwig Maximil
ian University of Munich organized a first international sympo
sium on inhalation anesthetics. In 1982, the most important con
tributions were published in the series Anaesthesiology and Inten
sive Care Medicine. At that time, the interest of European anes
thesiologists was focused on isoflurane, which had just been in
troduced for clinical purposes. Studies on this product had al
ready been appearing for years in the American literature. This
book deals once more with all three inhalation anesthetics, but
places particular emphasis on isoflurane. In contrast to the situa
tion in 1981, extensive experimental and clinical investigations on
isoflurane have by now become available in the European litera
ture. From its conception, the objective of this symposium was
not to discuss the relative value of inhalation anesthesia (bal
anced anesthesia) as compared with intravenous anesthesia. On
the contrary, the major effects and interactions of isoflurane were
to be explored. The side effects and their relative significance in
different patient groups were also of interest. eurrent knowledge
concerning a range of topics related to inhalation anesthetics (es
pecially isoflurane) was to be presented in a comprehensive and
critical manner.
The effects of isoflurane on the cardiovascular system were the
focus of interest during the symposium and are accordingly dealt
with extensively in this volume. The comparative effects on cor
onary perfusion of isoflurane, enflurane, and halothane are de
scribed in detail. Several contributions attempt to determine
whether isoflurane has favorable or unfavorable effects on the
ischemic myocardium, a question of eminent clinical signifi
cance.
Isoflurane evidently leads to an impairment of poststenotic
myocardial function. However, due to its more intense peripheral
dilation and comparatively weak negative inotropic action, this
effect is less pronounced than with halothane and enflurane. At
present, question of whether isoflurane-induced deterioration of
poststenotic myocardial function is solely based on a decrease in
perfusion pressure or whether it is also induced by redistribution
VI Preface
phenomena or alterations in the microcirculation remains unan
swered.
The editors thank the chairmen and all those who presented
papers at the symposium, but special thanks go to the authors of
the papers included in this volume. Through their contributions,
they have made it possible to present the latest research findings
on this subject, and it is thus to be hoped that the book will at
tract widespread interest.
The editors thank H.-J. Dieterich and B. Kolber for their valu
able assistance in the production of the book.
The editors are also grateful to Springer-Verlag for their colla
boration in the publication of the book and to Deutsche Abbott
Ltd., Wiesbaden, for its generous support of the symposium.
Munich, October 1986 The Editors
List of Contents
Clinical Significance of Biotransformation
(I. Rietbrock) . . . . . . . . . . . . . . . . . 1
Uptake, Distribution, and Elimination of Volatile
Anesthetics (H. Schmidt) ............ . 8
Pharmacokinetics and MAC: Practical Implications
for Dosage of Volatile Anesthetics (H. Schwilden,
H. Stoeckel, P. M. Lauven, and J. Schüttler) . . . . . . . .. 17
Comparative Pharmacodynamics of Halogenated
Anesthetics: Quantitative EEG Analysis to Objectify
Central Nervous Effects (H. Stoeckel and H. Schwilden) . 26
Pharmacokinetics of Inhalation Anesthetics Studied
with a Feedback-Controlled Closed System
(0. Thomson, A. M. Zbinden, and D. Westenskow). ... 33
Metabolism and Acute Toxicity of Volatile Anesthetics
(V. Hempel, W. Heipertz, H.-V. Gärtner, and M. Schmelzle) 41
Present Status of Organotoxicity of Inhalation
Anesthetics (B. R Brown, jr.) ........ . .. 45
The Influence of Volatile Anesthetics on Cerebral Blood
Flow and Cerebral Autoregulation (H. Van Aken, G.-M.
Hauss, T. BTÜssel, and W. Fitch) . . . . . . . . . . . . . . .. 52
The Influence of Equipotent Concentrations of Inhalation
Anesthetics on the Human Electroencephalogram
(L. Brandt) ........................ 60
Anesthesia and the Kidney (M. Cousins) . . . . . . 73
Changes in Hemodynamics, Regional Organ Blood Flow,
and Tissue Oxygen Consumption Under Isoflurane and
Enflurane (P. Conzen, J. Hobbhahn, A. Goetz,
H. Habazettl, T. Granetzny, K. Peter, and W. Brendel) . .. 87
VIII List of Contents
Interactions of Volatile Anesthetics with Epinephrine,
ß-Receptor Antagonists and Calcium Channel Blockers
(c. Prys-Roberts) .................... .. 98
Inhalation Anesthetics and Malignant Hyperthermia
(J. Riemer) .................... . ... 108
Volatile Anesthetics and Their Effects
on the Respiratory System (L. J. Bjertnaes) .. 114
The Influence of Inhalation Anesthetics on Respiratory
Mechanics (T. Pasch, H.-D. Kamp,
H. Grimm, G. Habich, and H. Petermann) . . . . . .. .. 122
Aspects of the Effects of Enflurane on Cardiovascular
B.-A.
Control (D. Lundberg, B. Biber, Henriksson,
J. Martner, and J. Ponten) ................ .. 130
Cardiodynamics During Rapid Volume Expansion and
Function of Chronically Ischemic Myocardium Under
Isoflurane: A Study in Chronically Instrumented
Dogs (M. Zimpfer, N. Mayer, H. Gilly, E. Maurer,
and K. Steinbereithner) . . . . . . . . . . . . . . . . . . . . . 133
Effects of Inhalation Anesthetics on Coronary Blood Flow
and O Supply of the Myocardium
2
(H. Sonntag, R. Larsen, H. Stephan, D. Kettler,
and O. Hilfiker) ......................... 149
Effects of Isoflurane and Enflurane on Oxygen Supply
and Microcirculation of the Myocardium
(H. Vogel, H. Günther, D. K. Harrison, J. Höper,
M. Brunner, M. Kessler, and K. Peter) ...... . ... 161
Blood Flow and Oxygen Supply of the Myocardium
Under Isoflurane and Enflurane
(J. Hobbhahn, P. Conzen, A. Goetz, H. Habazettl,
T. Granetzny, W. Brendel, and K. Peter) . . . . .. . ... 171
Myocardial Ischemia During Inhalation Anesthesia
in Surgical Patients with Coronary Artery Disease
(S. Reiz, M. N. d' Ambra, and M. Östman) . . . . . . . . . . 187
Regional Changes During Myocardial Ischemia:
An Animal Experimental Study
(K. Van Ackern, M. Adler, U. B. Brückner, U. Buell, M.
Haller, U. Mittmann, M. Ragaller, E. Raithel, H. Vetter,
and W. Wöllner) . . . . . . . . . . . . . . . . . . . . . . 196
Volatile Anesthetics and Heart Failure (P. Foex) ..... 207
List of Contents IX
Inhalation Anesthesia and Myocardial Function:
Pharmacodynamic and Pharmacokinetic Aspects
(So Fitzal) 219
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Treatment of Hypertensive Crisis (Ho Bergmann) 0 227
Inhalation Anesthetics in Vascular Surgery
(Eo Schmitz, Eo Martin, Uo Jensen, Ho Forst, Bo Pollwein,
and Eo Ott) 236
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Inhalation Anesthesia in Geriatrie Patients
(R Larsen and Go Stephan) 0245
0 0 0 0 0 o
Volatile Anesthetics in Paediatrics,
Today and Tomorrow (Wo So Wren) 0254
0 0 0 0 o
Volatile Anesthetics for Combination with Epidural
Anesthesia (Ho Gerber) 0260
0 0 0 0 0 0 0 0 0 0 0 0 0 0 o
Volatile Anesthetics in Pregnancy and Obstetries
(Jo So Crawford) 0264
Subject Index 0271
List of Contributors
Prof. Dr. H. Bergmann
Institut für Anästhesiologie (Blutzentrale), Allgemeines Öffent
liches Krankenhaus, Krankenhausstraße 9, A-4020 Linz
Prof. Dr. L. J. Bjertnaes
Department of Anesthesia, N-9012 Regionsykehuset, Tromsö
Priv.-Doz. Dr. L. Brandt
Institut für Anästhesiologie des Klinikums der Johannes
Gutenberg-Universität Mainz, Langenbeckstraße 1
D-6500 Mainz
Prof. Dr. Dr. B. R. Brown, jr.
Department of Anesthesiology, The University of Arizona
Health Sciences Center, Tueson, AZ 85724, USA
Dr. P. Conzen
Institut für Chirurgische Forschung der Ludwig-Maximilians
Universität München, Klinikum Großhadern
Marchioninistraße 15, D-8000 München 70
Prof. Dr. M. Cousins
Department of Anesthesia and Intensive Care, Flinders Medical
Centre, Bedford Park, South Australia 5042
Prof. Dr. J. S. Crawford, F.F.A.R.C.S., F.R.C.O.G.
The Birmingham Maternity Hospital, Queen Elizabeth Medical
Centre Edgbaston, GB-Birmingham B 15276
Frau Univ.-Doz. Dr. S. Fitzal
Klinik für Anästhesiologie und Allgemeine Intensivmedizin
der Universität Wien, Spitalgasse 23, A-1090 Wien
Dr. P. Foex
Nuffield Department of Anaesthetics, The Radcliffe Infirmary
University of Oxford, GB-Oxford OX2 6HE
XII List of Contributors
Priv.-Ooz. Or. H. Gerber
Oepartment Anaesthesie der Universität Basel
Kantonsspital Basel, CH- 4031 Basel
Prof. Or. V. Hempel
Zentralinstitut für Anästhesiologie, Eberhard-Karls-Universität
Tübingen, Calwer Straße 7, 0-7400 Tübingen
Or. J. Hobbhahn
Institut für Anästhesiologie der Ludwig-Maximilians-Universität
München, Klinikum Großhadern, Marchioninistraße 15
0-8000 München 70
Priv.-Ooz. Or. R. Larsen
Zentrum Anästhesiologie, Universität Göttingen
Robert-Koch-Straße 40,0-3400 Göttingen
Prof. Or. O. Lundberg
Oepartment of Anesthesiology, University Hospital
University of Lund, S-22185 Lund
Prof. Or. T. Pasch
Institut für Anaesthesiologie der Universität Erlangen-Nümberg
Maximiliansplatz 1,0-8520 Erlangen
Prof. Or. C. Prys-Roberts
Oepartment of Anaesthesia, Royal Infirmary
GB-Bristol BS2 8HW
Prof. Or. S. Reiz
Oepartment of Anesthesia and Critical Care Medicine
University of Umeä, S-Umeä
Priv.-Ooz. Or. J. Riemer
Institut für Anästhesiologie der Ludwig-Maximilians-Universität
München, Klinikum Großhadern, Marchioninistraße 15
0-8000 München 70
Frau Prof. Or. I. Rietbrock
Klinikum der Landeshauptstadt Wiesbaden
Ludwig-Erhard-Straße 100,0-6200 Wiesbaden
Priv.-Ooz. Or. H. Schmidt
Zentrum für Anästhesiologie der Universitätskliniken Frankfurt
Theodor-Stem-Kai 7, 0-6000 Frankfurt 70
Or. E. Schmitz
Institut für Anästhesiologie der Ludwig-Maximilians-Universität
München, Klinikum Großhadern, Marchioninistraße 15
0-8000 München 70