Enzymes in Anesthesiology

I. Basic Considerations.- 1. Structure of Enzymes.- Molecular Weight of Enzymes and Number of Peptide Chains in Them.- Primary Structure of Enzymes.- Secondary Structure of Enzymes.- Tertiary Structure of Enzymes.- Quaternary Structure of Enzymes.- References.- 2. Isolation of Enzymes.- Test Systems.- Extraction.- Fractionation.- References.- 3. Enzyme Kinetics.- General Consideration of Enzyme Kinetics.- Influence of Enzyme Concentration.- Influence of Substrate Concentration.- Influence of Activators or Inhibitors.- Influence of Temperature.- Influence of pH.- References.- 4. Enzymatic Catalysis.- Methods of Investigation of Enzyme-Catalyzed Reactions.- Chemical Methods.- Crystallographic Methods.- Kinetic Methods.- Factors Responsible for Enzymatic Catalysis.- Reaction Pathways of Enzyme-Catalyzed Reactions.- References.- 5. Enzyme Cofactors.- Coenzyme I and II.- The Flavin Coenzymes.- Pyridoxal Phosphate.- Thiamine Pyrophosphate.- Biotin.- Lipoic Acid.- Coenzyme A.- Glutathione.- Acyl Carrier Protein (ACP).- Tetrahydrofolic Acid.- Cobamide.- Nonheme Iron Proteins, Cytochromes, and Chlorophylls.- Metal Ions.- References.- 6. Immobilized Enzymes.- References.- 7. Classification of Enzymes.- Oxidoreductases.- Transferases.- Hydrolases.- Lyases.- Isomerases.- Ligases or Synthetases.- Reference.- II. Specific Enzymes.- 8. Enzymes of Acetylcholine Metabolism.- Choline Acetyltransferase.- Distribution.- Subcellular Distribution.- Synthesis.- Purification.- Physical and Chemical Properties.- Kinetics.- Inhibitors.- Physiologic Role.- Interaction with Anesthetics and Adjuvant Drugs.- Cholinesterases.- Acetylcholinesterase.- Distribution.- Subcellular Distribution.- Synthesis.- Purification.- Physical and Chemical Properties.- Kinetics.- Butyrylcholinesterase.- Distribution.- Synthesis.- Purification.- Physical and Chemical Properties.- Kinetics.- Genetically Determined Variants.- Acceleration, Inhibition, and Reactivation of Activity of Cholinesterases.- Acceleration of the Activity of Cholinesterases.- Inhibitors of Cholinesterases.- Kinetics of Cholinesterase Inhibition.- Representative Cholinesterase Inhibitors.- Reactivation of Inhibited Cholinesterases.- Aging.- Species Variation of Cholinesterase.- Influence of Physiologic States on Human Cholinesterases.- Influence of Pathologic Conditions on Cholinesterases.- Physiologic Functions of Cholinesterases.- The Role of Cholinesterases in Anesthesiology.- The Influence of Anesthetic and Adjuvant Drugs on Cholinesterases.- The Influence of Cholinesterases on the Metabolism of Anesthetic Drugs.- The Therapy of Anticholinesterase Intoxication.- References.- 9. The Interaction of Anesthetic Agents with Hepatic Microsomal Enzymes.- Pathways of Drug Metabolism.- Primary Pathways of Drug Metabolism.- Secondary Pathways of Drug Metabolism.- Conjugations (Phase 2 Reactions).- Properties of the Hepatic Microsomal Oxidase System.- Factors Affecting Metabolism of Anesthetic and Adjuvant Drugs.- Hepatic Enzyme Induction.- Inhibition of Drug-Metabolizing Enzymes.- Clinical Implications of Inhibition of Hepatic Microsomal Enzymes.- Influence of Biologic Factors on Hepatic Microsomal Metabolism.- Pharmacogenetics.- Sex Differences.- Age.- Pathologic and Environmental Factors.- References.- 10. Enzymes of Synthesis and Degradation of Catecholamines and 5-Hydroxytryptamine.- Biosynthesis and Degradation of Catecholamines.- Effects of Anesthetics on the Catecholamine System.- Enzymes for the Biosynthesis and Catabolism of Catecholamines.- Tyrosine Hydroxylase (TH, EC 1.1.4.3).- Tyrosine Hydroxylase Inhibitors.- Aromatic l-Amino Acid Decarboxylase (AADC, EC 4.1.1.26).- Inhibitors of Aromatic l-Amino Acid Decarboxylase.- The Use of l-Dopa and AADC Inhibitors in the Treatment of Parkinsonism.- Dopamine-?-Hydroxylase (D? H, EC 1.14.17.1).- Dopamine-?-Hydroxylase Inhibitors.- Phenylethanolamine-N-Methyltransferase (PNMT, EC 2.1.1. —).- Monoamine Oxidases (MAO, EC 1.4.3.4).- Monoamine Oxidase Inhibitors (MAOI).- Catechol-O-Methyltransferase (COMT, EC 2.1.1.6).- Biosynthesis and Degradation of 5-Hydroxytryptamine.- Tryptophan Hydroxylase (EC 1.99.1.4).- Tryptophan Hydroxylase Inhibitor.- Concluding Remarks.- Acknowledgment.- References.- 11. The Cyclic AMP System.- The Cyclic AMP System.- Hormonal Effects Mediated by cAMP.- ACTH and Steroidogenesis.- Antidiuretic Hormone (ADH).- Nervous System.- Heart.- Smooth Muscle.- Anesthetic Agents.- References.- 12. Effect of Anesthetic Drugs on Respiratory Enzymes.- Metabolic Pathways.- Inhibition of Oxygen Transport by Anesthetics.- Factors Controlling Respiratory Rate.- Conformational Changes.- References.- 13. Creatine Phosphokinase.- Properties and Enzymologic Characteristics.- Enzymologic Classification.- Molecular Weight.- Specificity.- Cofactors.- Inhibitors.- Protein Structure.- Active Centers.- Measurement of Activity.- Enzymologie Basis.- Preparation and Preservation of Samples.- Storage.- Reproducibility.- Incubation Time.- Dilution Effect.- Temperature Effect.- Hemolysis and Other Possible Sources of Errors.- Isoenzymes: Their Tissue Distribution and Function.- Types of Isoenzymes.- The Brain-Type Isoenzyme.- The Heart Muscle-Type Isoenzyme.- The Sketetal Muscle-Type Isoenzyme.- Isoenzymes of Various Tissues.- Methods for the Determination of Isoenzymes.- Electrophoresis.- Chromatography.- Factors That Alter Creatine Phosphokinase Activity.- Physiologic Factors.- Age.- Sex.- Race.- Body Weight and Height.- Pregnancy.- Physical Fitness and Exercise.- Pathologic Conditions.- Diseases of the Nervous System.- Diseases of the Heart Muscle.- Diseases of the Skeletal Muscle.- Iatrogenic Factors.- The Effect of Drugs on Creatine Phosphokinase.- Surgery.- Anesthetic Agents.- Malignant Hyperthermia and Creatine Phosphokinase.- Genetics, Symptomatology, Therapy.- Malignant Hyperthermic Myopathy and Creatine Phosphokinase.- Malignant Hyperthermic Myopathy and Other Myopathies.- Malignant Hyperthermic Myopathy and Myotonias.- Malignant Hyperthermie Myopathy and Denervation Myopathies.- Age Distribution of Malignant Hyperthermic Myopathy.- Consanguinity and Malignant Hyperthermic Myopathy.- Possible Etiology and Pathogenesis of Malignant Hyperthermia.- Diagnostic Tests for Malignant Hyperthermia.- Summary.- Acknowledgments.- References.- Author Index.