Effects of prostaglandin E₁ (PGE₁) on systemic and pulmonary hemodynamics were investigated during infusion of PGE₁, in doses of 50, 100, 150ng/kg/min, in surgical patients under nitrous oxide-oxygen-enflurane anesthesia (N=7).
PGE₁ at 50ng/kg/min decreased significantly mean arterial pressure (MAP) 20min later, whereas doses of 100 and 150ng/kg/min did not significantly decrease MAP, when compared to 50ng/kg/min. MPAP decreased significantly only at 100ng/kg/min. CI increased significantly. SVR and PVR decreased. Pao₂ decreased but not significantly. Pvo₂ increased markedly.
Sixty min after cessation of infusion of PGE₁, MAP gradually returned toward control level. CI remained higher and SVR remained lower than control significantly, while MPAP remained slightly higher than control, but not significantly. Pao₂ and Pvo₂ increased significantly.
These results suggest that PGE₁ may act mainly on systemic artery, but not dosedependently, and its effect may continue for a long time after cessation of its infusion. Effects of PGE₁ on pulmonary hemodynamics and blood gas may be due to an increase in CI and pulmonary vessel dilatation.

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Fourteen adult non-diabetic patients undergoing elective major abdominal surgery were divided into 2 groups. One group received epidural and general anesthesia, and a mixture of 0.125% bupivacaine and 2mg of morphine was administered epidurally about 30 minutes before the end of general anesthesia for relief of post surgical pain. The other control group received general anesthesia only with nitrous oxide, oxygen and enflurane.
Flow directed pulmonary arterial and radial arterial catheters were inserted preoperatively, and hemodynamic and respiratory variables were measured serially. Blood was drawn serially and catecholamines, cortisol, aldosterone, insulin, blood sugar, free fatty acid and ketone bodies were measured. The data were compared before and after recovery stage of general anesthesia.
In control group, epinephrine level at the recovery stage of anesthesia increased about 5 times compared to the anesthetic stage. Oxygen consumption and oxygen extraction ratio were increased and mixed venous oxygen saturation was decreased significantly. There was a close linear correlation between oxygen consumption (Y) and epinephrine (X) level. That is, Y=285.7X+90.5 (p<0.01), and correlation coefficient was 0.72.
On the other hand, plasma epinephrine, oxygen consumption and mixed venous oxygen saturation did not change significantly in epidural analgesia group at the recovery stage of general anesthesia. There was also a close linear correlation between oxygen consumption (Y) and oxygen delivery (X). That is, Y=0.22X-32.0 (p<0.01), and correlation coefficient was 0.89. It was demonstrated that oxygen supply demand balance was kept smoothly.
We consider that the pain induced by surgical stress and the subsequent increase in plasma epinephrine may seriously influence tissue oxygenation and metabolic variables, and that epidural analgesia at the recovery period of anesthesia may have favorable effect in maintaining stable conditions.

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We studied the hemodynamic responses to continuous positive pressure ventilation (CPPV) under various states of dehydration in dogs. Dehydration states were induced using diuretics by stepwise cumulative withdrawal of body water, equivalent to 5 and 10% of the estimated body fluids (acute dehydration group), and the use of 48-hour starvation (subacute dehydration group).
Intramuscular water, used as an indicator of dehydration, decreased in accordance with a theoretical calculation in the acute dehydration group, whereas it did not change significantly in the subacute dehydration group. Mean arterial pressure remained practically unchanged in the 5%-loss state, but dropped significantly in the 10%-loss state. Cardiac output (CO) and stroke volume (SV) decreased in both (5 and 10%) acute dehydration states, especially in the 10%-loss state.
In the subacute dehydration group, the central venous pressure (CVP) remained unchanged, so CVP was not useable as an indicator of the degree of dehydration. The degree of decrease in CO and SV in response to CPPV was greater in the subacute group than in the acute dehydration group. The magnitude of respiratory fluctuations of arterial pressures, pulmonary arterial pressures, pulmonary capillary wedge pressures and CVP under CPPV did not correlate well with the degree of dehydration.
The results of the present study can be legitimately extrapolated to clinical situations. The degree of dehydration of patients undergoing operations under CPPV should not be judged by respiratory fluctuations in blood pressures, but should be estimated at the same time by CVP, Hct, history, present status, and other factors.

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An attempt has been done to calculate the non-nutrient blood flow (%NNBF) by using the mathematical formula instituted by Farrell K. J. in septic patients. We tried to determine whether the calculation of %NNBF in the septic patients might be one possible parameter which shows the more precise oxygen transport in the tissues, comparing with other parameters of the oxygen transport system. %NNBF showed the lineal regression interrelationship with Pvo₂, SVo₂ and O₂ extraction ratio and the quantitative level above or under the normal value of these parameters, calculation of the %NNBF might be a new parameter to estimate the more precise oxygen transport status in the patients with sepsis.

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Autologous blood transfusion is performed substituting for homologous blood transfusions and avoiding its complications. Procedure of hemodilutional autotransfusion (HAT) is so simple and so easy that it should be widely applied to various types of surgical operation. We attempted to use HAT for the case of arthroplasty and studied its availabilities. The anesthesia for blood collection (600-1, 000ml) was maintained with ketamine, and blood collection was safe and quick even if in the aged patients.
We concluded that the HAT was capable to minimize homologous blood transfusions, and that there were no abnormal value of postoperative GOT and GPT in the nontransfusion group. Furthermore no abnormalities in postoperative blood coagulation were detected in any patients with HAT. Homologous blood transfusion, nevertheless, was necessitated for postoperative bleeding in some cases even with HAT. Therefore either preoperative preserving or intraoperative salvaging technique should be used additively in those cases and also application of hypotensive anesthesia should be considered for complete autotransfusion in the future.

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A clinical study of 17 Patients was undertaken to evaluate intranasal administration of nitroglycerin (TNG) during general anesthesia. The group of one time administration (8 patients) received 5 μg/kg of TNG in bolus. The group of two times administration (9 patients) received an initial dose of TNG followed by 2.5μg/kg of TNG after 2 min. Plasma TNG levels were determined by gas chromatography using the negative ion chemical ionization SIM method.
The arterial revel of TNG, which appeared 20 sec after administration, reached a peak of 8.28±3.05ng/ml after 2 min in the group of one time administration. On the other hand, TNG level showed two peaks of 10.52±4.93ng/me after 1 min and 11.20±5.61ng/ml after 4 min in the group of two times administration. Systolic blood pressure was decreased from 40 sec to 10 min. Diastolic blood pressure was also decreased from 2 to 5 min, whereas heart rate rose a little.
This study suggested that the arterial levels of TNG were increased readily and rapidly following the intranasal administration and maintained by the additional administration after 2 min. We conclude that this method of TNG administration is easy and effective in patients with either the episode of heart attack or unexpected hypertension during perioperative period.

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The magnetic resonance imaging (MRI) has been widely used for noninvasive visualization of internal anatomic structures. It gives an excellent spatial resolution of human bodies, while it requires patients to be motionless for a considerable time during the examination. For the patients with neurological diseases and infants, it is difficult to stand still during the MRI examination. They may need a heavy sedation or general anesthesia with artificial ventilation. Providing for such cases, the system of cardiopulmonary monitoring and the method for artificial ventilation during the MRI examination were investigated in this study.
The measurement of indirect blood pressure and oxygen saturation were successfully carried out using conventional appratuses with minor modifications, while the monitoring of electrocardiogram was impossible without specific devices for the MRI machine. The simulation study performed in the patient under general anesthesia revealed that the high-frequency jet ventilation was available in the case of MRI.
These findings are useful to care not only the patients who are not co-operative to the MRI examination but also the ordinary patients who need sedatives to diminish their anxiety during the stressful MRI examination.

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This time, we studied the influence of the hypotensive anesthesia using nicardipine (NIC) and trinitroglycerine (TNG) into functions of circulatory system and endocrine metabolic systems. The platelet function was studied only in NIC group.
The mean dose was 3.56±0.72μg•kg^-1•min^-1 in NIC group and 3.14±0.24μg•kg^-1•min^-1 in TNG group to induce hypotensive anesthesia.
From the result, no significant change was noted in HR in NIC group during hypotensive anesthesia, while significant elevation was noted in TNG group. In the endocrine system during hypotensive anesthesia, change of AD was less in both groups, while NAD and PRA was larger in TNG group than NIC group. In the metabolic system during hypotensive anesthesia, lactic acid increased significantly in both groups. However, L/P increased similarly in both groups, while remarkably increased in TNG group. Moreover, both blood glucose and NEFA during hypotensive anesthesia increased markedly in TNG group more than NIC group. Platelet function is not influenced by hypotensive anesthesia using NIC. It was concluded that influence of the hypotensive anesthesia using NIC into function of endocrine-metabolic systems is lesser than using TNG.

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Atlanto-Axial Rotatory Fixation (AARF) would occur with many causes including minor trauma to the neck and infection and so on. We experienced a case of AARF which developed in course of the treatment of Herpes Zoster. A 12 years old girl was transfered our Pain Clinic because she complained neck pain and torticollis associated with severe moving pain two weeks after the development of Herpes Zoster in the left C2 region. The etiologic factor of AARF in this patient could be refractory fixation and minor trauma associated with HZ-induced pain and infiltration caused by HZ virus. The patient responded very well to nerve block therapy including cervical epidural block and rehabilitation, AARF resolved with in a month.
Since the early diagnosis and therapy of this disorder is important especially in young patient, we should be aware that patient with HZ of cervical region may develope AARF due to pain and refractory fixation and infiltration of HZ virus itself.

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We reported the anesthetic management of three patients with polymyositis/dermatomyositis.
Case 1: 60-year-old man who was suffered from dermatomyositis, interstitial pneumonia and gastric cancer was scheduled for partial gastrectomy under general anesthesia. Anesthesia was induced and maintained with GOF. Pancuronium bromide was used for intubation only 4 mg and was reversed with atropine and neostigmine postoperatively, but extubation was done after four hours' careful observation.
Case 2: 63-year-old man who was diagnosed as acute appendicitis was emergently operated for appendectomy under spinal anesthesia. Polymyositis was suspected preoperatively, but confirmed postoperatively.
Case 3: 58-year-old woman who was treated for polymyositis and rheumatoid arthritis was diagnosed as ovarial tumor and was scheduled for transabdominal hysterectomy and bilateral adnexectomy under epidural anesthesia. Thoracic and lumbar epidural catheters were inserted. The tumor was revealed as ovarial cancer and additional omentectomy was done under epidural anesthesia uneventfully
Polymyositis/dermatomyositis affects not only the systemic muscles but also the laryngopharyngeal muscles, cardiac muscles and interstitium of the lung. Therefore, careful preoperative evaluations for these organs should be needed. And then decision making for optimal anesthetic regimen including in the choice of anesthesia, anesthetics and the use of muscle relaxants, and for postoperative care should be done.

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A 61-year-old woman with the benign tumor of thyroid was scheduled for the right hemithyroidectomy under general anesthesia. Trachea was gently intubated with a cuffed endotracheal tube and operation was done under the position of backward flection of the neck for about two hours thirty minutes. After the operation she complained of hoarseness, and was diagnosed as the left vocal cord paralysis. One month later it was fully recovered. We speculated that endotracheal tube, its cuff and backward flection of the neck caused traction and compression of the left recurrent nerve and its adjacent tissues. As the result, the temporal vocal cord paralysis may be occurred due to ischemia of the recurrent nerve supply.

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We experienced a case in which respiratory care was complicated by a continuous tracheal bleeding and air leakage from the trachea after radical operation of esophageal cancer. They were supposedly brought by wide resection of lymph nodes and supportive tissue around the trachea. To prevent the influx of blood into bilateral bronchi and to rest the damaged trachea we devised a double lumen tracheostomy tube (DLTT) which has cuffs at each distal tip of the tube. The exact length of the tube was determined by measuring the distance from the carina to each upper lobe bronchus by use of fiberscope. By using this tube respiratory status of the patient improved and we succeeded in weaning the patient from respirator.

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