APPENDIX

R»SUM»S OF PAPERS DISCUSSED IN THE XIX CONGRESO LATINOAMERICANO DE ANESTESIOLOGIA


 

I. EFFECTS OF THE TECHNIQUES OF ANAESTESIA WITH GASES ON THE AUTONOMOUS-AUTOMATISM OF THE RESPIRATORY FUNCTION AND ON HOMEOSTASIS. ARTIFICIAL RESPIRATORS.

 

A.GonzŠlez-Bogen. Ex-Professor of the University Central of Venezuela.

INTRODUCTION.

Experimental studies performed during more than fifteen years*
allowed me to discover the "RESPIRATORY PULSE", as the Resultant, in the pleural
space, of the Pulmo-thoracic Dynamics; the analysis and reinterpretation of the
Respiratory Function, as well as the role of the lungs as integrator of the whole Organic-Dynamics, in itself as in its functional integration with the atmosphere. The New Knowledge obliges the critical] analysis of techniques and proceedings currently used in Medical practice, to introduce necessary or advisable rectification.

NEW FUNDAMENTAL CONCEPTS.

The Respiratory Function is a complex autonomic process, regulated by the Central Nervous System and automatically accomplished by a chain of vegetative and vegetative-somatic reflexes, in two different kinds of cyclic actions:

a) Ventilatory Cycle, which accomplishes renewal of the used air from the atmosphere and simultaneously, the regulation of the organic fluids circulation, and especially blood circulation, as a factor for homeostasis.

b) Lobular-alveolo-capillary Cycles, with parallel rhythm to that of the heart, for the specific interchange of gases with the blood and the simultaneous balance of the blood circulation between right and left cavities.

METHOD.

Graphs of the Respiratory Pulse and Abdominal Aortic Pulses are analysed, both during free respiration and under the action of mechanical respiratory devices.

CONCLUSIONS.

Mechanical Respirators, no matter what models and calibrations interfere with the Vegetative Dynamics as expanded above, being also capable of generating irreversible damage. The gas mixtures employed are also, by themselves, factors of pulmonary and general risk.

RECOMMENDATIONS.

Anaesthetists must critically evaluate the scientific contribution of the New Theory of Respiratory Dynamics and to adopt the RESPIRATORY PULSE as a fundamental parameter for the appreciation of the effects produced by techniques and chemical products in vital functions.

Respiratory airways and lungs must be avoided as a way for mechanical introduction of anaesthetic agents and development of products to be used by other ways must be promoted.

The lungs are delicate viscera, unknown up to now, which play the most important function for Life in the atmosphere of the world.

 


II. EFFECTS OF PARALYSING DRUGS. THE "VAGAL-SOMATIC ACETYLCHOLINE WORKING SYSTEM" AS A COORDINATOR OF PULMONARY-VENTILATORY DYNAMICS AND CIRCULATION.

A.GonzŠlez-Bogen. Ex-Professor of the University Central of Venezuela.

 

INTRODUCTION.

1. The Ventilatory Cycle is initiated by VAGAL IMPULSES, to produce broncho-constriction (with the exclusion of the lobuli)*, for the displacing and pressurisation of intra-pulmonary air and retraction of the lungs.

This lung's retraction pull of the Diaphragm to stimulate the phrenic nerve for Diaphragm's contraction once bronchorelaxation begins, both for expansion of the intra-pulmonary air, the intake of a Volume-mass of atmospheric air and the expansion of the lungs towards the abdomen.

The Diaphragm's contraction pull of its periphery, innervated by intercostals, for their stimulation and contraction of the muscles innervated by them, to expand costal wall, widening the pericardial space and simultaneously pressing the abdominal content by the parieto-abdominal muscle's contraction, aiding blood circulation.

Meanwhile, the lungs retract elastically before a new vagal discharge is enhanced to start a new cycle.

METHODS.

d-Tubo-curarine is injected and effects observed at:

RESPIRATORY PULSE (simultaneously detected at the base and lateral face of the lungs).

Abdominal Aortic Pulse.

The Neumogram.

CONCLUSIONS.

d-Tubo-curarine produce apnoea, since compete with acetilcholine as mediator of the Parasympathetic and somatic nerve impulses.

Abdominal press fails and blood floods the abdomen with shock effect (apart from activity on heart and vessels).

The lobuli remain working while blood circulates and 02 in the recycling of retained air are exhausted and C02 rises. This is proof of the Parasympathetic not being the controller of the lobular dynamics, neither is it controller of the heart dynamics.

Artificial ventilators help, transitorily, to save life by removing the used air and helping with abdominal-press effect.

RECOMMENDATIONS.

To re-evaluate, for refusal, the use of paralysing drugs.

The use of the RESPIRATORY PULSE as the utmost parameter for this re-evaluation.

Anaesthesia, as any medical act, must be respectful of the autonomous dynamics, since this is guarantee of LIFE AND HEALTH.

 


III."THE SYMPATHETIC-ADRENALINE SUB-SYSTEM" AS INTEGRATOR OF THE CARDIO-LOBULAR DYNAMICS ON THE BASIS OF VAGAL-SOMATIC DYNAMIC INTEGRATION.

A. GonzŠlez-Bogen. Ex-Professor of the University Central of Venezuela.

 

INTRODUCTION.

As I have demonstrated in my books * and works to be published soon, the right ventricle of the Heart is a pump integrated to the ensemble of lobuli, for the simultaneous arrival to the alveolo-capillary units of a volume mass of air and a proportional volume of blood, for gas exchange, also favouring blood circulation through the lungs.

METHOD and PURPOSE'S.

To define the effects of the Sympathetic and its transmitter's actions on the "CARDIO-PULMO-CIRCULATORY INTEGRATED UNIT" by means of injections of: 1. Adrenaline. 2. Acetylcholine 3. d-Tubo-curarine.

CONCLUSIONS.

Adrenaline has inotropic and chronotropic effects on the ensemble of the lobuli, similar to that which it has on the Heart. This is a necessary condition for synchronisation and balance of forces in the alveolo-capillary units, for gas exchange in physiological proportions. Adrenaline injection greatly increases its physiological role, sometimes causing APNOEA and Death.

Acethylcholine, as an impulse transmitter is responsible for the Ventilatory Dynamics and general circulatory balance, as explained in paper II. Acethylcholine injection greatly increases its physiological role, sometimes causing APNOEA and Death by constriction in the ventilatory area.

The Sympathetic Adrenaline subsystem is responsible for the Resultant of the Cardio-Lobular joint Dynamics, and Circulatory-functional-integration, working on the basis co-ordinated by the Para-Sympathetic-Acetylcholine subsystem.

D-Tubo-curarine paralyses the Ventilatory-effectors leaving the sympathetic activity isolated for a seconds, leaving no doubt about its role.

RECOMMENDATIONS:

1.To re-evaluate the effects and clinical use of Sympathetic and Parasympathetic and antagonistic drugs, having as a fundamental parameter the RESPIRATORY PULSE and the Arterial Pulse.

To re-evaluate each and al] medical procedure in their effects in the RESPIRATORY PULSE as a Synthesis of the Organic-Dynamics in their integration to the Universal-Dynamics, for LIFE.AND HEALTH.

To promote discussions of the New Discoveries and Concepts, for the benefit of MAN.

 


IV. ROLE OF THE PULMONARY VENTILATORY DYNAMICS ON THE SIMULTANEOUS BALANCE OF m FLUIDS CIRCULATION IN GENERAL AND BLOOD CIRCULATION IN PARTICULAR.

A.GonzŠlez-Bogen. Ex-Professor of the University Central of Venezuela.

 

INTRODUCTION.

In previous papers I have expounded that "Vagal-somatic integrated Sub-system" is responsible for the achievement of the effects that configures each Ventilatory Cycle, initiated by vagal impulses. These programmed reflex are simultaneously accomplish co-ordinated actions in the Trunk as a whole, for a wider integrated cyclic result.

METHOD AND PURPOSE.

Analysis of simultaneous sequences of RESPIRATORY PULSES, Abdominal Aortic Pulses and the Pneumogram, to show variations of maximal and minimal pressure values during each ventilatory cycle.

CONCLUSIONS.

The pulmonary elastic-retraction that follows previous expansion, is suddenly completed by a brusque Vagal-induced broncho-constriction, which also pull from the Diaphragm, widening the capacity of the abdomen while its antero-lateral wall accomplishes the action of a press.

Simultaneously, costal expansion enlarges the Mediastinum for a wider diastolic expansion.

Broncho-relaxation and Diaphragm contraction that follow the initial vagal broncho-constriction, allows expansion of the previously pressurised air along the airways for lungs expansion and inspiration of a Volume-mass of atmospheric air

The lungs expand now towards the abdomen, the capacity of which is diminished.

Simultaneously, costal wall is retracted and pericardial space narrows.

Pulmo-diaphragmatic and intercostal reflexes follow one another in each ventilatory cycle and their effects aid blood circulation in opposite sense; therefore, completing a circular sequence which favours homogenisation of blood composition as a factor for homeostasis.

Thoracic and abdominal cavities are two chambers of the integrated pump, which is the Trunk, as responsible for the above reviewed circulation of fluids and blood homogenisation.

The capacity of the cavities, circulating fluid masses, -generated forces and tension- of structures are al] co-ordinated by the same events we have studied as a ventilatory cycle; therefore, air circulation and pressurisation along the airways and blood general circulation are results from the same dynamics.

The role of the integrated unit: Right Ventricle and Lobuli, is the balance of the fraction of fluids which arrive to the alveolo-capillary units for gas exchange.

The sequence of pressure-variations of the Aortic Pulses is evidenced on the upper and lower curves drawn by the sequence of the pulses.

 


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