Panel Discussions: Third World Congress of Anaesthesiology São Paulo, Brazil · September 1964

183 Pages·1966·5.58 MB·German

by  R. Frey (auth.)

Anaesthesiology and Resuscitation
Anaesthesiologie und Wiederbelebung
Anesthesiologie et Reanimation
8
Edito res
Prof. Dr. R. Frey, Mainz · Dr. F. Kern, St. Gallen
Prof. Dr. 0. Mayrhofer, Wien
Third World Congress
of Anaesthesiology
Sao Paulo, .Brazil· September 1964
Panel Discussions.
Edited by
P.R. Bromage, J. E. Eckenhoff, R. Frey,
T. Cecil Gray, M. Digby Leigh,
J.
Sir Robert R. Macintosh, L. E. Morris, A. Nesi,
C. R. Ritsema van Eck, M. Zindler
Springer-Verlag Berlin Heidelberg GmbH 1966
ISBN 978-3-662-23209-5 ISBN 978-3-662-25215-4 (eBook)
DOI 10.1007/978-3-662-25215-4
All rights, especially that of translation into foreign languages, reservf'd. It is also forbidden
to reproduce this book, either whole or in part, by photomechanical means (photostat micro·
film and/or rnicrocard) or by other procedure without written permission from
Springer-Verlag Berlin Heidelberg GmbH.
© by Springer-Verlag Berlin Heidelberg 1966.
Urspriinglich erschienen bei Springer·V erlag Berlin Heidelberg New York 1966
Library of Congress Catalog Card Number 66-2:;390
The use of general descriptive names, trade names,
trade •narks, etc. in this publication, even if the former are not espceially identifif'd, is not
to be taken as a sign that such names, as understood by the Trade Marks and Ml'rchandise
Marks Act, may accordingly be use freely by anyone. Title No. 7443
Preface
The official papers of the Third World Congress of Anaesthesia
logy appeared during the Congress at Sao Paulo 1964. All participants
appreciated highly the immense editorial work done by the Congress
President Dr. Rodriges Alves and the Secretary, Doctor Carlos Parsloe,
Hospital Samaritano, Sao Paulo, Brazil.
The 10 panels of the World Congress created much interest. Not
only the scientific committee, but also many anaesthesiologists all
over the world requested that a report of these discussions on re
markable points of interest be made available.
The editors of "Anaesthesiology and Resuscitation" therefore
collected all material available. They want to thank all chairmen and
members of the panels for their help and advice, Doctor Carlos Parsloe
from Sao Paulo and his colleagues of the Committee for the Third
World Congress at Sao Paulo for their valuable assistance, and last not
least their publisher for his untiring cooperation.
Mainz, 1966
RUDOLF FREY
Contents
A. Catecholamines and their significance in anaesthesia (R. FREY, Mainz)
I. Principles and observations . . . . . . . . . . . . . . . . . . . 1
a) Opening of the panel (R. FREY, Mainz) . . . . . . . . . . . 1
b) Basic anatomy and physiology of the sympathetic nervous system
(N. M. GREENE, New Haven). . . . . . . . . . . . . . . . . 2
c) Metabolic effects of catecholamines (N. M. GREENE, New Haven) 3
d) Changes in catecholamine levels in response to premedication, an-
aesthesia and surgery (R. FREY and F. W. AHNEFELD, Mainz). . . 5
e) Sympathomimetic drugs and their relation to the catecholamines
(R. KucHER, Wien) . . . . . . . . . . . . . . . . . 6
f) Catecholamines and shock (F. W. AHNEFELD and R. FREY) 9
g) Discussion (W. FILL) 10
II. Praxis and application . 11
a) Catecholamines dans l'hypothcrmie ct !'hibernation provoquee
(L. LARENG, Toulouse) . . . . . . . . . . . . . . . . . . . 11
b) Use and abuse of catecholamines in local and regional anaesthesia
(R. KucHER, Wicn) . . . . . . . . . . . . . . . . . . . . . 15
c) Usc and compatibility of catecholamines during general anaesthesia
(S. R. 0ECH, Philadelphia) . . . . . . . . . . . . . . . . 18
d) Catecholamines in cardiac resuscitation (J. BEARD, London). 22
III. References . . . • . . . . . . . . . . . . . . . . . 24
B. Clinical use of halogenated agents (L. E. MoRRIS, Seattle) - Dis-
cussion . . . . . . . . . . . 27
C. Pediatric anaesthesia for correctable congenital anomalies (M. DIGBY
LEIGH, Los Angeles) -Discussion . . . . . . . . . . . . . 61
D. The mechanism of action of local anaesthetics (P.R. BROMAGE,
Montreal) - Discussion . . . . . . . . . . . . . . . 86
E. Necessity and functions of an autonomous department of an
aesthesiology (J. A. NESI, Caracas) -Discussion . . . . . . . . 138
F. Anaesthesia for cardiovascular Surgery (T. CECIL GRAY, Liverpool)-
Report ........................ 164
G. Recent advances in intravenous anaesthetics for ambulatory patients
(M. ZINDLER, Dusseldorf)-Report . . . . . . • . . 169
H. Hypotension (J. E. ECKENHOFF, Philadelphia) -Report • • • • • 171
I. Neuroleptanalgesia (C. R. RITSEMA VANECK, Groningen)- Report 172
J. Problems of anaesthetics in developing regions (Sir RoBERT R. MAc
INTOSH, Oxford) - Report . . . . . . . . . . . . . • • • . 173
Participants
AMARAL, R. V. G., M.D., Sao Paulo, Brazil
ARTUSIO, J. F., M.D., Anaesthesiologist-in-Chief, The New York Hospital -
Cornell Medical Center, New York, U.S.A.
BEARD, J., M.D., F.F.A.R.C.S., Department of Anaesthetics, Hammersmith and
National Heart Hospital, London, England
BIANHCETTI, L., M. D. (in absence of E. CmcATTO, M. D., Professor of Anaesthe
siology, University of Turin)
BROMAGE, P. R., M. B., B. S., F.F.A.R.C.S., Assistant Professor of Anaesthesia,
McGill University and Royal Victoria Hospital, Montreal, Canada
BROWN, A. S., M. B., Ch. B., F.F.A.R.C.S., Edinburgh, England
CIOCATTO, E., M.D., Professor of Anaesthesiology, University of Turin, Italy
CoNN, A. W., M. D., F.R.C.P. (C.), Anaesthetist-in-Chief, The Hospital for Sick
Children, Toronto, Canada
CoRSSEN, G., M. D., Professor of Anaesthesiology, University Hospital, Ann
Arbor, Michigan, U.S.A.
CRUL, J. F., M. D., Professor of Anaesthesiolgy, University of Nijmegen,
Netherlands
DOENICKE, A., M.D., Ass. Professor of Anaesthesiology, Head Department of
Anaesthesia, Chirurgische Poliklinik University of Munich, Germany
DUNDEE, J. W., M. B., B. Ch., F.F.A.R.C.S. Professor of Anaesthesia, Queen's
University of Belfast, Northern Irland
RITSEMA VAN EcK, C. R., M. D., Professor of Anaesthesiology, University of
Groningen, Netherlands
ECKENHOFF, J. E., M.D., Professor ofA naesthesiology, UniversityofPennsylvania,
Philadelphia, U.S.A.
ELLIS, S., M. D., Philadelphia, U.S.A.
ENDERBY, G. E. H., M. A., M.B., B.Ch., F.F.A.R.C.S., London, England
ERIKSSON, E. K., M.D., Upplands-Vasvy, Sweden
DE FREITAS L., BRANDAO, M. D., Professor of Anaesthesiology, Falculdade de
Medicina de Porto Alegre, Brazil
FREY, R., M. D., F.F.A.R.C.S Professor of Anaesthesiology, University of Mainz,
Germany
GAUTHIER-LAFAY, P. J., M.D., Departement d'Anesthesiologie, Universite de
Strassbourg, France
GEDDES, I. C., M.D., F.F.A.R.C.S., Department of Anaesthesia, University of
Liverpool, England
GEMPERLE, M., M. D., Head of the Department of Anaesthesia, University of
Geneva, Geneva, Switzerland
GHOSE, R., M. D., Addis Abeba, Africa
GoLDMAN, V., M.R.C.S., L.R.C.P., F.F.A.R.C.S., London, England
GoMEZ, Q. J., M.D., Manila, Philipines
GoRDON, R. A., M. D., Toronto, Canada
GRAY, T. C., M.D., F.F.A.R.C.S., Professor of Anaesthesia, University of Liver
pool, England
X Participants
GREENE, N. M., M.D., Professor of Anaesthesiology, Yale University,New Haven,
Connecticut
HAMILTON, W. K., M. D., Department of Anaesthesiology, University of Iowa,
Iowa City, U.S.A.
HENSCHEL, W. F., M. D., Head of the Department of Anaesthesia, Stadtische
Krankenanstalten, Bremen, Germany
HINGSON, R. A., M. D., L.L.D., D.H.L., Professor of Anaesthesia, Western Re
serve University, Cleveland, Ohio, U.S.A.
HOLMDAHL, M. H., M. D., Professor of Anaesthesiology, Akademiska Sjukhuset,
Uppsala, Sweden
HowELLS, T., D. A., F.F.A.R.C.S., Royal Free Hospital, London, England
ILLES, I. A., M. D., Illinois Masonic Hospital, Chicago, Illinois, U.S.A.
IwAI, S., M.D., Head, Department of Anaesthesiology, National Children's
Hospital, Tokyo, Japan
lwATSUKI, K., M.D., Professor of Anaesthesiology, Tohoku University School of
:Medicine, Sendai, Japan
JoHNSTONE, M. W., M. B., B. Ch., F.F.A.R.C.S., The University of Manchester,
The Royal Infirmary, Manchester, England
KEERI-SZANTO, M., M. D., Montreal, Canada
KoK, O.V.S., M. D., Professor of Anaesthesiology, University of Pretoria, South
Africa
KuCHER, R., M. D., Ass. Professor of Anaesthesiology, University of Vienna,
Austria
LARENG, L., M.D., Professeur d'A nesthesiologie, Universite de Toulouse, France
LEIGH, M. Digby, M. D., Head, Division of Anaesthesiology, Children's Hospital
of Los Angeles, California, U.S.A.
LEWIS, G. B., jr., M. D., Children's Hospital of Los Angeles, U.S.A.
Sir MACINTOSH, Robert R.,D. M., F.R.C.S., F.F.A.R.C.S., Nufficld Professor of
Anaesthetics, Oxford, England
MoRRIS, L. E., M. D., Director, Anaesthesia Research Laboratories, Providence
Hospital, (and) Clinical Professor, University of Washington, Seattle, U.S.A.
MusHIN, W. W., M. A., M. B., B. S., F.F.A.R.C.S., Professor of Anaesthetics,
Welsh National School of Medicine, University ofWales, Cardiff, U.K.
NESI, J. A., M.D., Professor of Anaesthesiology, University of Caracas, Venezuela
NILSSON, E., M.D., Professor of Anaesthesiology, Lasarettet, Lund, Sweden
OnuRo, K. A., M.D., Accra, Ghana/Africa
0ECH, St. R., M.D., Department of Anaesthesiology, Lankenau Hospital, Philadel
phia, Pennsylvania, U.S.A.
0RGANE, G. S. W., M.D., F.F.A.R.C.S., Professor of Anaesthesia, Westminster
Hospital, London, England
PAYNE, J._P., M. B., Ch. B., F.F.A.R.C.S., Professor of Anaesthesia, Hammersmith
Hospttal, London, England
PouLSEN, H., M.D., Professor of Anaesthesiology, University of Aarhus, Denmark
REEs, G. J., M. B., Ch. B., F.F.A.R.C.S., Department of Anaesthesia The Uni-
versity of Liverpool, England '
Participants XI
RADNAY, P. A., M.D., Rockland State Hospital, New York, U.S.A.
SANKAWA, H., M.D., Division of Anaesthesiology. Children's Hospital, Los
Angeles, U.S.A.
SELLICK, B. A., M. B., B. S., F.F.A.R.C.S., London, England
SMITH, R. M., M. D., The Children's Hospital Medical Center, Boston, Mass.,
U.S.A.
STEAD, A. L., M. B., Ch. B., F.F.A.R.C.S., Liverpool, England
STEPHENS, K. F., 0. B. E., M. B., B. S., F.F.A.R.C.S., London, England
TRUANT, A. P., Ph. D., Laboratory of Biological Research, Astra Pharmaceutical
Products, Inc., Worcester, Mass., U.S.A.
UsuBIAGA, J. E., M.D., Hospital Rivadavia, Buenos Aires, Argentina. (Present
address: Jackson Memorial Hospital, Miami, Florida, U.S.A.)
WAKAI, I., M. D., Nagoya, Japan
WOLFE, L., M. D., Ph. D., Chief of Neurochemistry, McGill University and Mon
treal Neurological Institute, Montreal, Canada
Y AMAMURA, H., M. D., Professor of Anaesthesiology, Tokyo University Hospital,
Bunkyo-ko, Tokyo, Japan
ZINDLER, M., ~1. D., Professor of Anaesthesiology, University of Dusseldorf,
Germany
Introduction to the panel on catecholamines and
their significance in anaesthesia
R. Frey
For many years catecholamines and sympathomimetic drugs have been
used to combat certain types of cardiac depression and hypotension. The
development of very sensitive methods for the determination of catechol
amine levels in urine, plasma and tissue now allows us to study the normal
response of the body to different anaesthetics and to the challenges of surgical
trauma. Many new drugs employed in the treatment of arterial hypertension
profoundly affect the sympathetic nervous system by many mechanisms and
we, therefore, meet in our hypertensive patients new and difficult problems
during anaesthesia and postoperatively. In addition to all this, drugs like
epinephrine have strong metabolic effects. Thus, there are many old and
new reasons for a discussion of catecholamines in anaesthesia.
Panel Discussions on
A. Catecholamines and their significance in
anaesthesia
Chairman: R. FREY, Mainz
Members: J. BEARD, London; P. J. GAUTHIER-LAFAY, Villeneuve-Sur-LoT;
N. M. GREENE, New Haven; R. KucHER, Vienna; L. LARENG, Toulouse;
St. R. 0EcH, Philadelphia.
I. Principles and observations
a) Opening of the panel
Chairman: The adrenergic (ergotropic) responses of the body to
psychological and/or physiological stress ("aggression") are influenced not
only by the Nervous System, but also humoral factors: The HORMONES.
They are absolutely necessary for fight or flight and intensive studies are
mandatory in the future.
The object of our panel is:
To show the problem,
to ask questions and to be critical of the dogmas of the past I
Anaesthesiolocie UDd WiederbelebUDg, Band 8, Third World Coacress of Anaestbesiology