New Aspects in Regional Anesthesia 4

1. Front Matter

   Pages I-XV

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2. Tachyphylaxis in Long-Term Epidural Analgesia

   1. Front Matter

      Pages 1-1

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   2. Tachyphylaxis in Regional Anesthesia: Can We Reconcile Clinical Observations and Laboratory Measurements?

      • L. E. Mather

      Pages 3-9

   3. No Tachyphylaxis with Prolonged, Continuous Bupivacaine

      • P. P. Raj, D. D. Denson, R. H. De Jong

      Pages 10-19

   4. Tachyphylaxis and Local Anesthetics

      • D. B. Scott

      Pages 20-23

   5. Clinical Observations of Tachyphylaxis During Long-Term Epidural Analgesia

      • H. J. Wüst

      Pages 24-31

   6. Experimental Tachyphylaxis: Development of a Continuous Epidural Dog Model

      • M. d’Arcy Stanton-Hicks, H. J. Wüst, U. Koch, D. Weidlich, I. Düffel

      Pages 32-38

   7. Pharmacologic Regulation of Local Anesthetic Conduction Block by Cyclic AMP

      • B. J. Kraynack

      Pages 39-45

   8. Panel Discussion: Tachyphylaxis and Local Anesthetics

      • Hans Joachim Wüst, M. d’Arcy Stanton-Hicks

      Pages 46-49

3. Hypotension Induced by Major Conduction Blocks

   1. Front Matter

      Pages 51-51

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   2. Pathophysiology of Hypotension Induced by Spinal/Epidural Analgesia

      • S. Reiz

      Pages 53-55

   3. Vasovagal Syncope and Spinal Anesthesia: A Psychophysiologic Phenomenon

      • W. Tolksdorf, G. Merkel, H. Rehder, R. Mutschler, E. R. Rey, J. Berlin

      Pages 56-62

   4. Direct Vascular Effects of Some Local Anesthetics: A Mechanical and Electrophysiological Study

      • J. Riemer, K. Kölling

      Pages 63-68

   5. Subarachnoid Block Spares Visceral Blood Flow and Drug Elimination Capacity

      • L. E. Mather, W. B. Runciman

      Pages 69-71

   6. Severe Hypotension and Major Conduction Anesthesia

      • H. J. Hartung, P. M. Osswald, H. J. Bender, H. Lutz

      Pages 72-77

   7. Hemodynamic Effects of Different Vasopressors (Etilefrine, Norfenefrine, Akrinor, Amezinium Metilsulfate) During Hypotension Caused by Epidural Anesthesia

      • H. Müller, A. Brähler, M. Stoyanov, I. Gerlach, G. Hempelmann

      Pages 78-93

   8. Blood Volume Distribution Under the Influence of Dihydroergotamine (Dihydergot) and Etilefrine Hydrochloride (Effortil) During Epidural Anesthesia

      • K. D. Stühmeier, M. d’Arcy Stanton-Hicks, A. Höck, J. O. Arndt

      Pages 94-98

   9. Hemodynamic Effects and Mechanism of Action of Dihydroergotamine in Epidural Anesthesia

      • M. Zimpfer

      Pages 99-107

   10. Panel Discussion: Hypotension Associated with Local Anesthetics

       • Hans Joachim Wüst, M. d’Arcy Stanton-Hicks

       Pages 108-110

4. Epidural and Intrathecal Opioids in Acute and Chronic Pain Treatment

   1. Front Matter

      Pages 111-111

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Major conduction blocks utilizing local anesthetics or opiates are find­ ing ever increasing applications in daily routine. However, two serious drawbacks are associated with their use: hypotension during surgery and the development of tolerance in long-term epidural analgesia. When opiates are injected epidurally or intrathecally, numerous side effects such as itching, nausea and vomiting, or respiratory depression have been reported. The pathophysiology of complications arising during a major conduction block and measures to prevent them were discussed by 19 experts at the 4th International Symposium at DUsseldorf. This volume contains 21 papers presented on three topics: 1. tachyphylaxis in long-term epidural anesthesia, 2. hypotension due to epidural and spinal anesthesia, and 3. effects and dangers of epidural and intrathecal opiates. With regard to the safety of our patients during anesthesia, current practices of preventing complications were evaluated, and preliminary guidelines for a more rational approach toward prevention and treat­ ment based on a knowledge of pathophysiologic mechanisms were developed. It is our hope that the anesthesiologist will profit from the discussion of regional anesthesia contained in this volume, many aspects of which have never before been presented in such detail.

• Opiate
• complications
• pain
• pathophysiology
• prevention
• surgery

• Department of Anesthesiology, University Hospital, Düsseldorf, Germany

  Hans Joachim Wüst

• Department of Anesthesiology, University of Colorado H.S.C., Denver, USA

  M. d’Arcy Stanton-Hicks

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