Blood is often collected from an arterial pressure monitoring kit connected with an intraarterial indwelling catheter for the purpose of examining plasma electrolytes, hematocrit titer and blood gas analysis during and after operation.
It is necessary to drain the amount of dead cavity between the site of puncture and site of collection before collecting the sample. But the amount of dead cavity may exert an influence on accuracy of test values. The authors studied the relationship between the amount of dead cavity and the amount of drain using values of electrolyte, hematocrit and blood gas analysis with commercially available infusion preparations. As a result, it was found that the amount of drain is required more than 4 times the amount if dead cavity for obtaining accurate values when a commercially available monitoring kit was used. In this study, a tube of a small diameter was used for the part of the dead cavity and accurate values were obtained with smaller amount of drain even where the amount of the dead cavity was the same. The above findings have revealed that in order to obtain accurate blood test values, we must have less amount of the dead cavity, and use a monitoring kit with a slender tube.

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Ketosis is one of problems due to preoperative starvation. The levels of blood glucose, blood ketone body, plasma free fatty acids (NEFA) and urine ketone body were measured in 69 children aged from 8 months to 11 years before and after glucose infusion. Blood glucose levels before infusion in the afternoon groups, whose operation started at 13:00, tended to be lower than that of in morning groups, whose operation started at 9:00. In the afternoon groups, levels of blood ketone body and plasma NEFA were significantly higher than those of the morning groups.
Hypoglycemia was found in one child, and blood glucose level before infusion in 3 afternoon cases were below 50 mg/dl with ketosis. Blood glucose levels after infusion were below 70mg/dl. In 4 afternoon cases the urine ketone body was detectable. The levels of blood ketone body and plasma NEFA was decreased by glucose infusion. There were no correlation between duration of starvation and blood glucose levels, but there was a positive significant correlation between blood ketone body levels and plasma NEFA. There were negative correlation between blood ketone body levels and ages, or body weights.
These findings suggested that preoperative starvation induced lipolysis particularly in afternoon cases, and preoperative levels of blood glucose and ketone body were affected by the time of operation, age, and body weight rather than the duration of starvation. Therefore we would consider the infusion rate of glucose with findings of this study.

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To 23patients in good health who were scheduled for orthopaedic surgery of lower extremity a relation between the spread of spinal analgesia and the distance between a spinous process of C7 to the inter space of L4-5 (the C7-L14 distance) were examined. After measureing the C7-L4 distance, subarachinoid puncuture was performed using a standard midline aproach with a 25gauge spinal needle and 2.1ml of 0.3% dibucaine was administrated in 15seconds. The segmental spread of analgesia was studied by pinprick stimulation.
The patients with high hight had a long C7-L4 distance and anequation of [hight]=1.3×[C7-L4 distance]+107.67 was obtained. There was a regression between the segmental spread of analgesia and the C7-L4 distance. The spread of analgesia at 30 minitues after subarachinoid puncuture was extended up to about one thoratic vertebra than that of 5minitues. The authors concluded that measurement of the C7-L4 distance before spinal anesthesia was meaningful.

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In 909 children aged between 1 and 11 years, scopolamin (0.015mg/kg)+hydroxyzine (1mg/kg)were injected intramuscularly. The sedative effect of this combined medication was analyzed in relation to age, by dividing the patients into 11 age groups, for the purpose of assessing the significance of agerelated stratification of children. Thirty minutes after treatment, the anesthesiologist in charge assessed the effects as ineffec-tive (level 1) or effective (level 2∼4). The Sperman's ranked correlation coefficient was highly significant between ages and the percentage of patients in whom sedation was effective. By Mann-Whitney U test, children were stratified into five groups: age 1, 2∼3, 4∼5, 5∼7 and 7∼11 years. The strong influence of age on the sedative effect, suggests the necessity of grouping children by their ages.

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The many serum parameters were measured to examine the sympathetic nervous system after hemorrhagic shock in rabbits. The plasma epinephrine faster responded to blood loss. It increased one hundred times from control state, when blood loss reached to 15mg/kg body weight.
On the other hand, norepinephrine began to decrease at 15∼20ml/kg of blood loss and drastically increase again in blood loss over 25mg/kg. The plasma concentration of lactic acid, glucose, osmolality and potassium were elevated, and pH and sodium decreased over 20ml/kg of blood loss. The 20ml/kg of hemorrhage without infusion led to the "sick cell". The blood loss beyond 35ml/kg was lethal in rabbits and almost all parameters were abnormal.
In summary, according to the change of plasma norepinephrine, sympathetic nervous system may be depressed at relatively early stage during hemorrhagic shock.

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We studied the effects of flumazenil on the levels of consciousness during the recovery period from a modified NLA with a benzodiazepine and pentazocine in 123 gynecological laparotomy patients (53 with the preliminary test and 70 with the multiclinical test) who still were deeply sedated at the end of anesthesia. Anesthesia was induced with i. v. injection of one of the benzodiazepines (diazepam 0.3mg/kg, flunitrazepam 0.03mg/kg or midazolam 0.3mg/kg) and pentazocine 1mg/kg, and maintained with nitrous oxide, oxygen and additional pentazocine or a benzodiazepine when needed. At the end of each operation, 0.3mg flumazenil was administered intravenously. If the effect was insufficient at 4 minutes following flumazenil administration, additional 0.1 mg flumazenil was administered. At one minute after the administration of flumazenil, 83.3 and 90.0% of patients in the diazepam group, 100.0 and 70.8% in the flunitrazepam group, and 87.5 and 76.9% in the midazolam group, showed complete consciousness with preliminary and multi-clinical test, respectively. The effects of the drug on restoring cognizance and orientation were excellent, but there was a slight effect on anterograde amnesia. No side effects were encountered.

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Recently hyperbaric oxygen therapy (HBO) has been applied effectively to improve clinical outcomes of retinal artery occlusive diseases (RAO), and a potential benefit for retinal vein occlusive diseases (RVO) has been reported. Cervico-thoracic sympathetic blocks (CTSB), such as thoracic epidural block (CEB) or stellate ganglion block (SGB) are also used as the effective therapy for these diseases. We assumed that those blocks which dilate peripheral vessels may potentially counteract the vasoconstrictive effect due to HBO and may improve the outcome.
In patients with RAO, HBO combined with CTSB improved visual acuity. In patients with RVO, HBO improved visual acuity. With the combination of CTSB, additional benefical effects were obtained in visual acuity and retinal edema.

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We have evaluated the effect of benzodiazepine antagonist "Flumazenil" by observing swallowing reflexes.
Swallowing reflexes were induced by the injection of distilled water into the epipharynx, and recorded as electromyogram (EMG) of geniohyoid muscle. Their latent time, height of the integrated EMG activity and the number of swallows were evaluated between the two groups, namely, flumazenil group and control group.
Compared with the control group, latent time returned to its preinduction value with Flumazenil. But EMG activity was depressed as much as the control group. Number of swallows increased after Flumazenil administration.
Swallowing reflexes observed after the administration of Flumazenil were qualita-tively different from those of the control group clinical importance of the fact is yet to be followed, but there seemed a need for close watch after the arousal by Flumazenil.

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We have disigned a computer control system of applying anesthesia using fuzzy logic for operation. We collected the data from instructive anesthesiologists' thinking patterns and reconstructed their methods in the computer using fuzzy logic. A separate measuring device input blood pressure measurements automatically. The computer then automatically determines the correct dosage of anesthesia. <Results> 1. We can successfully use this system during the operation to control blood pressure for actual patients. 2. We can successfully simulate a particular doctors actual case results using the data from his records. However when we combine this doctors actual case with another doctor's thinking the success rate of the simulation falls.

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Cardiopulmonary bypass (CPB) has many factors of generating free radical. It is difficult to detect directly intrinsic free radical in clinical spot. Vitamin E, bilirubin and uric acid are recognized as intrinsic radical scavengers. We examined the change of these intrinsic radical scavengers to prove indirectly the evidence of free radical generation during CPB.
Twenty patients received cardiac surgery were divided into bubble oxygenator group and membrane oxygenator group. Blood samples were obtained at 15min after starting of CPB and at 15min after reperfusion of coronary artery. In bubble oxygenator group, vitamin E level at reperfusion phase was significantly decreased compared from the level during CPB. There were no significant changes in other radical scavengers of both groups. Vitamin E is a peroxil radical trapping and chain-breaking antioxidant in the lipid membrane of cells. Therefore, we suspected that a decrease of vitamin E during CPB with bubble oxygenator demonstrated the evidence of free radical generation.

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We have investigated 103 emergency cases of neurosurgery retrospectively on diagno-sis, pre-and intraoperative complications and Stress Index in order to determine the relation between these factors and neurological prognosis.
Although initial inflictions on brain were found to be the most influential factor on the neurological outocome, our study showed that perioperative hemodynamic change due to depletion of intravascular blood volume caused by dehydration and/or bleeding also could place additional untoward effect on the development of brain injury.

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Pharmacokinetics of sevoflurane and isoflurane were investigated in this study by concurrently administering 1.0% sevof lurane and 0.6% isof lurane to 7 healthy male volunteers. End tidal (FA), mixed expired (FM) and inspired (FI) concentrations of sevoflurane and isoflurane, and minute ventilation were measured during administration and after termination of administration for 6∼7 days. FA/FI for sevoflurane and isoflurane were 0.85±0.02 (mean±SD) and 0.73±0.03, respectively, after 30 min of administration. FA/FA0 (FA0=last FA during administration) for sevoflurane and isoflurane were 0.16±0.02 and 0.22±0.02, respectively, 5 min after termination of administra-tion. These data were fitted into a 5-compartment mammillary model, and mammillary time constants for the lungs, vessel rich group, muscle group, 4th-compartment and fat group were estimated. There was no difference between sevoflurane and isoflurane in the time constants with the exception of the lungs where the time constant for sevoflurane was smaller. The results suggest that uptake and elimination of sevoflurane from the body are more rapid than that of isoflurane, but the rate of elimination from the tissues do not differ as predicted by their solubilities in blood and tissues.

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Anesthesia and surgery for the geriatic patient is increasing gradually. The most important age-related physiologic changes are those occured in the cardiovascular system. When anesthetizing elderly patients, the anesthetist should lesson the severity of the cardiovascular responses.
At induction of anesthesia, we compared in this case, effect of laryngeal mask airway (LM) insertion and orotracheal intubation on the cardiovascular system. LM insertion caused more little change to heart rate, systolic blood pressure and rate pressure product than orotracheal intubation did.
LM insertion with the aid of topical anesthesia caused much smaller change to hemodynamic parameter.
X-ray and dye studies of aspiration model revealed that LM probably preventsmassive aspiration.
This unique airway should be widly used.

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We investigated the utility of tofisopam administered for about 1 week after admission in reducing preoperative anxiety. Twenty-one patients were randomly classified into those treated with tofisopam and controls. State anxiety and trait anxiety were evaluated upon admission and on the day of operation using the State-Trait Anxiety Inventory (STAI). Controls showed no change in trait anxiety but increased state anxiety, suggesting that the STAI test is a valid method of evaluating preoperative anxiety. In those treated with tofisopam, trait anxiety did not change but state anxiety significantly decreased. We conclude that tofisopam, which induces few side effects, may be useful in the treatment of anxiety in patients anticipating an operation.

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F-PEEP is a newly developed PEEP in which end-expiratory pressure(EEP) is periodically changed within a certain range. We carried out a comparative clinical trial of F-PEEP and conventional PEEP (C-PEEP). In two cases of relatively localized lung injury of aspiration pneumonia, PaO₂ was rapidly and more increased creased by FPEEP than by C-PEEP. However, in a case of diffuse lung injury of bacterial pneumonia, F-PEEP failed to achieve better pulmonary oxygenation. The periodical changes in EEP, which is the major difference of F-PEEP against C-PEEP, may prevent a sustained overinflation of some alveoli with high compliance, and an desirable shift of blood flow to poorly ventilated alveoli. Although the entire mechanism for this enhanced improvement remains to be clarified, we believe that F-PEEP is a simply applicable and useful therapeutic maneuver in the management of acute hypoxic respiratory failure with an uneven distribution of lung injury. These phenomenon have been supported in our some canine models of asymmetrical lung injury already reported.

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A combined epidural and general anesthesia could prevent a renal dysfunction associated with infrarenal abdominal aortic aneurysmectomy. To test this hypothesis, continuous epidural anesthesia obtaining an analgesic level to T4 was maintained with light general anesthesia (EP: n=16). During and immediately after surgery, creatinine clearance and urinary water and solute excretion were significantly increased in this group, but without any differences between those in moderate dose of fentanyl and halothane anesthesia groups. Although EP produced more stable hemodynamics and reduced stress response in sympatho-adrenal and renin-angiotensin systems during surgery, secretion of vasopressin was remarkably increased, resulting in decreased free water clearance. Further study is required to elucidate the mechanism involved in this excessive secretion of vasopressin during abdominal aneurysmectomy under EP.

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Recently, in animal experiments, it has been reported that CPB can effect reperfusion and assist in circulation, thereby enhancing survival and neurological recovery rates after prolonged cardiac arrest.
Over the past 3 years, resuscitation of 16 patients of CPR-resistant cardiac arrest have been performed, using stand-by CPB. The time from cardiac arrest to admission ranged from 15 min to 30 min, and the time from admission to the start of CPB ranged from 19 min to 70 min.
In 7 of 14 patients (50%), neurological state was improved. In 13 (81%), spontaneous circulation was restored. Only 4 of them, however, were successfully weaned from CPB. In total, 2 patients were revived by the resuscitation, and one of them recovered with no neurological deficits in spite of a-40 min CPR-resistant cardiac arrest.
In conclusion, there are many advantages and usefullness of CPB in patients of CPR-resistant cardiac arrest. With the use of CPB, cerebral and coronary reperfusion can be optimized, blood temperature can be controlled promptly, and various agents (ex. drugs) can be delivered safety and accurately for the prevention and amelioration of postischemic cerebral injury.

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Ventricular septal perforation is use to be severe life threatening complication of myocardial infarction.
We experienced the anesthetic management for partial colectomy 80 year-old male, diagnosed as ventricular septal perforation combined with myocardial infarction.
Anesthesia was induced by fentanyl and thiamylal, and maintained by 0.2∼0.5% sevoflurane in 50% of nitrous oxide and oxygen, in addition to epidural anesthesia with 1.5% mepivacaine.
Epidural injection of 6ml of 1.5% mepivacaine decreased pulmonary arterial pressure, and epidural anesthesia was considered useful for reduction of pulmonary arterial pressure in this case.
During anesthesia, we used an echofiberscope for abdominal organ, to observe myocardial wall motion. Although this apparatus was for abdominal organ, it was useful to detect abnormalities of the wall motion during anesthesia.
The operation has been done uneventfully. The patient was stable postoperatively and discharged on the 16 post-operative day without any major complications.

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A 4-year-old boy patient with Romano-Ward syndrome had right inguinal hernia. He was scheduled for radical operation under general anesthesia. Propranorol 5mg was orally given two hour prior to anesthesia and scopolamine 0.1mg im and secobarbital 70mg im were given one hour before anesthesia. He was well sedated while entering in the operating room. Anesthesia was induced with enflurane, nitrous oxide and oxygen by mask method. Left stellate ganglion block was performed with 3ml of 0.5% mepivacaine, caudal block was done with 12mg of 1% mepivacaine too. Anesthesia was maintained with GOEn. QTc was shortened from 0.51sec to 0.48sec after left stellate ganglion block. Perioperative and postoperative general condition of the patient was stable and uneventful with no dysrhythmia on ECG monitoring.

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A 18-month old girl was admitted with stridor and severe respiratory distress. On admission she was severely dyspneic and cyanotic and had no breath sounds audible over the left lung. Chest radiography showed atelectasis in the left lung. She diagnoted as a bronchial foreign body provisionally. Bronchoscopy was done under oxygenhalothane-fentanyl anesthesia, and we could successfuly remove bronchial cast from the left main bronchus under administration of bronchodilators. In case of severe respilatory distress like this, the bronchial cast must be removed immediately. However, because patients with mucoid impaction often have allergic conditions such as asthma, anesthesia must be done carefully. We used halothane, expected as bronchodilator. However, in point of arrhythmogenic activity and hepatotoxity, isof lurane may be more suitable than halothane.

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This is a report of acute epiglottitis seen in a 46-year-old male patient in December 1990. The patient exhibited a slight common cold syndrome, but otherwise he was generally healthy. At 9:30 in the morning, he began playing golf wearing a protective mask in order to avoid cold air inhalation. At about 14:00, he noticed a slight sore throat which developed into a moderate swallowing difficulty at 15:00. Because his phonation function was largely intact, his speech was understandable to his fellow players. He attempted to breathe air with his neck extended because he could not breathe smoothly when he was sitting. At 15:30, he came to our hospital extremely anxious about his condition and he was diagnosed as having croup. A massive dose of corticosteroid was administrated intravenously and epinephrine nebulization was attempted while x-ray films of the neck were being taken (16:00). Then he was diagnosed as having acute epiglottitis but these modalities did not improve his breathing difficulty. Meanwhile, our ENT surgeon decided to perform emergency tracheostomy. Immediately after the patient was transferred to the operating theater (16:15), he became completely choked, developed deep cyanosis and ultimately lost consciousness (16:50). Systolic blood pressure was 40mmHg and heart rate 40 beats per min. Emergency endotracheal intubation was attempted against the swollen larynx. Simultaneously, the ENT surgeon successfully made access to the trachea. That was just before cardiac standstill. Shortly after ventilatilation with ambu-bag, he recovered consciousness. The joint activity of anesthesiologists and ENT surgeons is important in such a clinical situation.

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As anesthesiolosists are expected to play an increasingly important role in spreadings the use of resuscitation skills. A two-hour class on emergency resuscitation skills was held for 298 physical education (P. E.) instructors. These P. E. instructors included swimming school coaches, scubadiving instructors, and junior and senior high school P. E. teachers. At the end of this class, participants completed questionnaires to determine how much was understood.
Results of this questionnaire revealed that there was little understanding of such medical terms as coma position and Jaw Thrust Maneuver and little knowledge of resuscitation techniques that combine artificial respiration and cardiac massage.
In the United States, emergency resuscitation skills are being introduced to the general public widely through the education. These skills are based on JAMA's guideline for CPR in 1984. The lack of similar guideline in Japan explains the slow spread of resuscitation skills in this country.
Another detrimental factor is the use of incomprehensible medical terminology.
It is advisable that instruction guidelines should be established and that the medical terminology used be standardized, so that trainees will be able to understand what is being taught. This plan will contribute to the future spread of resuscitation skills in Japan.

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