Hemolysis in blood transfusion was studied in three different methods of transfusion. The evaluation of hemolysis was performed at the value of serum hemoglobin (Hb) level and the degree of membrane fragility of red blood cells. The membrane fragility of red cells was examined using a Coil Planet Centrifuge (CPC) method (osmolar resistance technique).
A rapid blood transfusion with a high delivery pressure brought about an increase of serum Hb level, however no effects on the membrane fragility of red cells were seen.
In the multiple blood transfusion (pack to pack blood mixture), hardly any changes on the membrane fragility of red cells were noted, but the serum Hb level had a tendency to increase.
After the transfusion with a CELL SAVER device, the value of serum Hb level decreased, however the degree of membrane fragility of red cells increased. Thus it was suggested that the CELL SAVER device for blood transfusion caused some damage to the membrane of red cells.
In conclusion, it is necessary to examine not only the value of serum Hb level, but also the degree of membrane fragility of red cells using a CPC method in case of suspected hemolysis in blood transfusion.

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The effect of acute hypocarbia on recovery from anesthesia was studied in twenty-nine patients under enflurane (2%)-nitrousoxide (50%) anesthesia. Patients were intubated with thiobarbiturates (4mg/kg), succinylcholine (1mg/kg) and after keeping stable condition of normocapnic or hypocapnic ventilation, blood gas was analysed. EEG monitoring was started from almost ten minutes before end of operation, blood gas (artery, juglar vein) was analysed and recovery time from anesthesia was counted.
Pjv O₂ (oxygen pressure of juglar venous blood) decreased during hypocarbia slightly when compared with normocarbia, while no significant difference of O₂ER (oxygen extraction rate) was observed between hypocarbia and normocarbia. On recovery phase after anesthesia, EEG showed the rise of a activity during normocapnia, but the decrease of a activity during hypocarbia. Recovery time from anesthesia was slightly shorter in the patients with normocarbia than that with hypocarbia. Which means that hyperventilation during anesthesia depressed the brain metabolism.Our results suggest that hyperventilation during anesthesia can prolong the recoveryfrom central nervous system depression.

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Eleven patients with eclampsia were treated in the past five years. Severe convulsive attacks clinically deteriorating despite intensive standard teatment, were treated with large doses of barbiturate in six out of the eleven patients during the postoperative period.
Neurological disturbances, such as consciousness disturbance, psycogenic disturbance and visual acuity, during the postoperative period were treated by a steroid and a glyceol administration, with hyperbaric oxygen (HBO) therapy in five out of the eleven patients. HBO therapy was carried out using a hyperbaric chamberKHO-200 (Kawasaki Co., Ltd.) at 2.8 ATA for 60 minutes once per day.
Clinically, these symptoms improved with HBO for one case in ten, but normalization of EEG and CT scans in two of the five patients treated with HBO required more than three weeks.
Therefore, because of the effectiveness of the HBO therapy, it is suspected that these neurologica disturbances of eclampsia were caused by cerebral edema and hypoxic brain damage resulting from cerebral vasospasms.

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For comparison of N₂O-O₂ enflurane anesthesia(GOE) with modified neuroleptanesthesia(m-NLA), we measured hemodynamics, oxygenation and metabolic changes in recovery period after operations of liver, biliary tract and pancreas. m-NLA using droperidol and pentazocine increased plasma catecholamines and oxygen consumption in the same degree as GOE at immediate post anesthetic period. There was a close relationship between oxygen consumption and plasma epinephrine level (Y=162.2X+103.9, r=0.641, p<0.05). In addition, m-NLA decreased mixed venous oxygen saturation and increased oxygen extraction ratio, in spite of increased oxygen delivery. The levels of plasma catecholamines and serum aldosterone rose from the beginning of operation, and continued to be higher than those in GOE. It seemed that neuroendocrine response was caused by surgical stress. We conclude that m-NLA is not stress-free for patients undergoing extensive upper abdominal surgery for hepato-biliary-pancreatic system. We also suspect that the postoperative analgesic effect may be weak.

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In order to evaluate the accuracy of cardiac output (CO) measured by the transtracheal Doppler method (TTCO), we compared TTCO with CO measured by thermodilution method (TDCO). Simultaneous measurements of TTCO and TDCO were repeated in 8 patients undergoing general surgery. In each patients, correlation of TTCO to TDCO was assessed by least squares linear regression method. TTCO showed good correlation to TDCO in each patients (p<0.05). Transtracheal doppler method was concluded to be a useful method to monitor the change in CO during general anesthesia.

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High frequency positive pressure ventilation (HFPPV) was used with thirty-four patients to minimize the movement of kidney or ureter stones during the extracorporeal shock wave lithotripsy (ESWL) under enflurane anesthesia. The patients were subdivided into four groups according to settings of HFPPV for respiratory rate(RR) and tidal volume (V_T): Group 1, RR 100/min and V_T2.5ml/kg; Group 2, 100/min and 3.0ml/kg; Group 3, 150/min and 2.0ml/kg; Group 4, 150/min and 2.5ml/kg. The range of stone movement during HFPPV averaged 0.7 to 1.1mm in the four groups, which was significantly less than 7.6 to 9.3mm during intermittent positive pressure ventilation (IPPV). The Paco₂ level during HFPPV in Groups 1, 2 and 4 was lower than before anesthesia. The peak airway pressure significantly increased in Group 4 during HFPPV with the increase in the end-expiratory pressure. The settings 2.5 or 3.0ml/kg tidal volume, with 100/min respiratory rate (Groups 1 and 2), produced minimum stone movement and adequate ventilation.

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We report here on the anesthesia in three different surgical procedures: angiography, subtotal pancreatectomy, and nearly total pancreatectomy, all on an 8-month-old male with infantile hyperinsulinism. The patient had a normal delivery. But on his first day of birth, he experienced a hypoglycemic attack (blood sugar 15mg/dr). He was given glucose, steroids and diazoxide. Nevertheless, dangerously low blood glucose levels persisted. To reverse this hypoglycemia, the patient was scheduled for a pancreatectomy under general anesthesia, with nitrous oxide and halothane.
After the operation, the hypoglycemia returned and the second operation, nearly total pancreatectomy was scheduled, using the same anesthetic approach. After the procedure, the overall blood glucose level was kept in a normal range.
In general anesthesia in an infant with hyperinsulinism, it is of primary importance to control blood glucose levels before, during and after surgery. Particular caution should be taken in controlling the effects of anesthetic agents on blood glucose levels and possible interaction of anesthetic agents with diazoxide. Since an infant with this condition may have to undergo repeated surgical procedures in a short period of time, it is also important to be conservative in the administration of anesthetic agents.

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During epidural anesthesia for a caesarean section, symptomes considered to be an acute toxic reaction of the local anesthetic (lidocaine) were observed inadvertently. The effects of the local anesthetic concentration in arterial blood and the electro-encephalogram (EEG) were studied. An epidural puncture was performed at the 2nd/3rd intervertebral space and the catheter was inserted 3-4 centimeters toward the head. A local anesthetic of 2% lidocaine solution 12ml (including test dose 2 ml) was injected at the rate of 5 ml/min. Three minutes after the injection (the concentration of the lidocaine in blood was estimated to be 4-5 microgram/ml according to the values examined), a descent in consciousness, loss of eye rash reflex and an elevation of blood pressure were observed. Five minutes after the injection (the concentration of lidocaine in blood was 3.81microgram/ml), an EEGwas recorded showing dominancy of the slow wave.When the umbilical cord was ligated, the lidocaine concentration in the umbilical vein was 1.21 microgram/ml. The apgar score of the newborn was 8 points at one minute after birth. We discussed the relationship between the lidocaine concentration in blood and the clinical symptomes that were observed.

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