Every specialist, at present, is confronted with the fact that it is continually becoming more difficult to remain 'up to date'. The areas in which he must read are expanding while the individual publications are becoming greater in number, larger in content and appear more frequently. The choice of the subject was not easy. This time we have selected the pharmacological aspects of anaesthesiology as our main topic, as a continu ation of the Boerhaave course in 1971. Although we know that a drug works, the mechanism behind this action is of great importance. The pharmacokinetics and side effects of the drugs we administer affect not only our patients, but also ourselves, our children, and the personnel under our care. In a special section we draw attention to this subject. We fervently hope that this symposium will further enrich your knowledge of anaesthesia and that through this enrichment you will derive more pleasure from the profession you have chosen and that in the end this will lead to even better care and treatment of the patients entrusted to us. We wish to express our thanks to Prof. C. M. Conway, Dr. D. T. Popescu, and Prof. D. M. E. Vermeulen-Cranch for their assistance in the editing of some of the chapters in this book."

During the past twenty years there has been a rapid evolution in anaesthesia, so much so, that we stand on the brink of a major change in the role of the anaesthetist in medicine. Anaesthesia has now emerged from being a craft speciality, obsessed with details of techniques, to become a science concerned with the maintenance of life. As a result of our better understanding of the physiological and pharmacological effects of anaesthesia and surgery, new opportunities have been created for anaesthetists to apply their particular knowledge, not only to provide better and safer conditions for surgery, but also in resuscitation, ventilatory and circulatory support and in the treatment of chronic pain. This has resulted in the recognition of the anaesthetist as a physician specialising in applied physiology and clinical pharmacology. The 1971 Boerhaave Course in Anaesthesia has deliberately tried to reflect this scientific basis of the speciality of anaesthesia by selecting for presenta tion in this book, subjects in which recent investigations have provoked new concepts and ideas. We are most grateful to our colleagues who presented a paper and to the secretary-staffs of our departments of anaesthesia in Leiden and London. Also thanks are extended to Mrs. Bongertman for the preparation of the proofs. Department of Anaesthesiology 10han Spierdijk University Hospital, Leiden Department of Anaesthetics Stanley Feldman Westminster Hospital, London v CONTENTS Preface . . . V Contributors . VIII PART ONE ANAESTHESIA AND THE HEART Alpha and beta blockers in anaesthesia . 3 H. LABORIT 18 Advantages and disadvantages of isoprenaline ."

This book reflects the proceedings of the Boerhaave Course, "Developments in drugs used in Anaesthesia", held on r'lay 7th and 8th 1981 at Leiden University. The goal of the organizers of the course was to obtain a better under standing of the pharmacological and clinical applications of the drugs used in the field of Anaesthesiology. In my opinion, there is a constant need for post-graduate teaching not only on a clinical basis, but also in the so-called "basic sciences". This especially applies to anaesthetists. I would like to express my thanks to the speakers, who were all so kind as to send their manuscripts in time for publishing, and to thank the co-editors of this book, as well as rtr. B.P. Ccmnandeur, from r'lar tinus Nijhoff Publishers for their fruitful co-operation. Last but not least, I would like to thank the secretarial staff of my depar~ent for all the work they did arranging for manuscripts to be in the right places at the right times. Joh. Spierdijk THE USE OF H2 BLOCKERS T.H. STANLEY In the last decade a new important histamine receptor, H2 receptor, has been discovered which has major importance in gastric acid production. In addition, a new drug Cimetidine (Tagamet) which blocks the H2 receptor has been synthesized. The object of this presentation will be to discuss the possible role of this interesting drug (Cimetidine) before and during operation and possible postoperatively as well.