To test intramuscular premedication effect on serum CPK level in the aged, the authors examined serum CPK level before intramuscular injection and about one hour after injection.
265 aged patient (mean age=75) who underwent elective surgery were studied. Control group were unpremedicated (C group, n=80). PH group were injected by pentazocine 15-30mg and hydroxyzine 12.5-50mg (n=70). H group were injected by hydroxyzine 12.5-50mg (n=45). M group were injected by meperidine 17.5-35mg (n=70). Serum CPK measured by RATE method and normal range was 40-180 IU. The site of intramuscular injection was deltoid muscle. The patient complicated with neuromuscular disease and the patient showed abnormal CPK value (over 180 IU) before injection were excluded in this study.
Demography were not significantly different in the four groups. The CPK levels before intramuscular injection have no difference in every four groups.
ΔCPK levels ((post-injection value)-(pre-injection value)) in three injected groups were higher than that in non-injected group. With regard to the extent of increase in serum CPK level, the increase in the PH group and the H group was significantly higher than that in the M group.
These data suggest that intramuscular injection can cause serum CPK level for short duration (1 hour), and the extent of increase in CPK levels is related to the kinds of drugs. Therefore, the possibility of increase in the serum CPK level after intramuscular injection is taken into account in the evaluation of perioperative surum CPK level and perioperative myocardial damage in the elderly.

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The effects of nicardipine on blood pressure and renal function were compared to the diuretic action of furosemide under general anesthesia in hypertensive surgical patients. Systolic blood pressure decreased significantly from 166×16mmHg to 132×12mmHg due to nicardipine infusion during surgery. The urine flow and sodium excretion rate increased at almost the same grade following the administration of both drugs. On the contrary, fractional excretion of inorganic phosphate significantly increased from 9.6×5.8% to 28.4×10.6% due to nicardipine infusion, but did not change in furosemide group. Phosphate reabsorption is considered to occur largely at proximal renal tubule; its appearance in the urine in increased quantities suggest proximal activity of the drug, as neither GFR nor plasma phosphate concentration was affected.

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Ninety-six pediatric patients scheduled for elective outcome surgery under general anesthesia were involved in the prospective study. The patients were allocated to two groups: control (C) group received 0.5mg/kg diazepam rectal administration as premedication; famotidine (F) group, 0.5mg/kg diazepam and 1mg/kg famotidine rectal administration. There was no significant difference in the ratio between gastric volume and body weight expressed as me/kg. Rectal f amotidine reduced gastric volume to less than 0.4ml/kg in 57 patients (83.8%) in F group, and 20 (71.5%) in C group. Gastric content could not be obtained from 2 patients in C group, 13 in F group. We excluded these children from the evaluation on the effect of famotidine on pH. In F group, gastric pH was significantly higher than that in C group. A gastric pH of more than 2.5 was seen in 9 children in group C (34.6%), 51 in F group (92.7%). The number of patients at high risk of pulmonary aspiration according to the combined criteria of gastric pH <2.5 and gastric volume of >0.4ml/kg was reduced to 1.5% in F group. In conclusion, famotidine is effective for increasing the pH of gantric contents of preanesthetic pediatric patients. Rectal administration does not cause pain and we recommend rectal famotidine, 1mg/kg. Our method has proved very useful for reducing the risk of aspiration pneumonia, especially in pediatric outpatients.

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Twenty milligrams of famotidine, a histamine H₂ receptor antagonist, was intramuscularly administered to 35 patients undergoing cesarean section, and the famotidine concentration after delivery was measured. At 77.6×17.5 minutes after administration, the concentration was 259.7×85.3ng/me in maternal blood, 83.7×19.3ng/me in cord venous blood, 75.5×23.7ng/me in cord arterial blood, and 24.8×18.7ng/me in amniotic fluid. The placental transfer rate (concentration in cord venous blood/concentration in maternal venous blood) was 0.347×0.114. Neonates were examined in the following manner: Apgar score, body weight, jaundice, sucking strength, and neurological examination. There were no abnormal findings, and no difference was noted compared with 39 control neonates. Hence, preoperative administration of famotidine for prevention of aspiration pneumonia in cesarean section seems to be safe and to be without effect on the newborn.

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We examined the influence of a pulmonary lobectomy under general anesthesia with epidural blockade on the changes of lymphocyte subpopulations (CD3, CD4, CD8, CD16, CD20).
Number of CD4-positive lymphocyte decreased significantly from the intraoperative period, whereas the numbers of other subpopulations except CD20 decreased significantly after operation.
Postoperatively, number of CD4-positive lymphocyte recovered first, and followed by CD8-positive lymphocyte, and CD16-positive lymphocyte.
But the significant decrease in these numbers of subpopulations continued until 7th postoperative day, which returned to preoperative value at the 1st postoperative month.
Judging from the decrease of the number of these lymphocyte subpopulations, postoperative immunosuppression may continue at least 1 week after pulmonary lobectomy.
Null cells, which seems to correlate with the extension of trauma, increased significantly from intraoperative period to 3rd postoperative day.

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In this article, we described anesthetic management for orthotopic liver transplantation, pre-and intraoperative management, as it is performed at the University of Nebraska Medical Center in the United States. A thorough understanding of the pathophysiology of end-stage liver disease as well as an understanding of the intraoperative events which impact on the anesthetic management are essential to optimal intraoperative care to the hepatic transplantation recipient.
Further, We discussed the timing of liver transplantation and a new preservation solution, Uiversity of Wisconsin (UW) solution. Earlier consideration of the patients with progressive and irreversible liver disease for liver transplantation can improve transplant outcome. Extended preservation by UW solution has allowed liver transplantation to be semi-elective procedure and increased the safety of liver transplantation.

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We have experienced a patient with an infrarenal abdominal aortic aneurysm, who has been dependent on a hemodialysis for a long term and have a surgery of substitution for an artificial vessel.
Hemodynamic variables and changes in arterial and mixed venous oxygen partial pressure during this particular operation were discribed, in which in addition to the common anesthetic problems on hemodialysis-dependent patients we encountered a marked hemodynamic alteration and an extensive bleeding. To avoid increasing pottasium level with massive transfusion of stored blood, an autologous blood recovering system was used. However, this system turned out to be difficult in estimating the accurate blood loss and in shortening the time of preperation of recovering blood, which resulted in the severe and meticulous anesthetic management.

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A 4 year-old boy with a laryngeal papilomatous granuloma was scheduled for the removal of the tumor. Though his trachea was extremely narrow, we were able to successfully intubate it with a special J tube (O.D.: 2.4mm).
During the operation, the patient was ventilated with HFJV using a VS600 in the manual mode, and his arterial Pao₂ remained between 210-250 mmHg, while the Paco₂ remained between 36-42mmHg (Fio₂_??_0.4).
We successfully anesthetized him three times by using the special J tube and HFJV without complication. This method appears to be clinically useful for patients with tracheal stenosis.

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Fifty five years old woman was undergone the varicose vein operation of the right lower extremity, with epidural anesthesia and light sedation. About 2 hours after anesthetic procedure, she complained the chest discomfort and dyspnea, without hypotention and dysrythmia. These symptoms suggested us the onset of the pulmonary embolism. The diagnosis was establisched by scintigram and digital subtraction angiography (DSA) of pulmonary blood flow. The Swan-Ganz catheter was inserted through the internal jugular vein, for the measurement of pulmonary arterial pressure and the infusion route of thrombolitic and anticoagulating agents, such as urokinase and heparine. The general condition and the picture of the pulmonary scintigram was recovered gradually, in spite of the withdrawal of these therapies because of bleeding from the surgical wound on the two days after operation.
We could suggest that DSA might be the first choice examination for the diagnosis of pulmonary thromboembolism, because of its lower invasiveness and the ability of immediate application, espessialy in a patient with cadiovascular depression.

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Sleep apnea syndrome has recently been paid attention because of its respiratory-circulatory disturbances such as snoring, hypoxemia, hypercarbia, arrhythmias, hyper-tension and cardiac arrest during sleep. The obstructive type occupies 85% to 95% of all patients with sleep apnea. We experienced anaesthesia for six patients with obstructive sleep apnea who were undergone uvuloplalatopharyngoplasty (UPPP).
The most important point in the anaesthetic management for the patients with sleep apnea might be careful observation of the respiratory status in the perioperative period. The nasopharyngeal obstruction, obesity and small chin should be carefully examined prior to the operation for the airway security. Sedatives and analgesics should be administered under careful observation in perioperative period. The inhalational anaesthetics are better of choice for these patients than intravenous anasthetics, because postoperative respiratory depression will possibly be accentuated by the intravenous drugs, or hidden central type factors will be actualized after operation. For the same reason mentioned above, non-depolarizing muscle relaxants should be avoided. Pulseoxymetry was useful for monitoring respiratory condition.

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