Continuous spinal anesthesia was attempted in 2, 023 cases from September 1981 to February 1989. Hip surgery accounted for 61% of all cases. A 20-gauge catheter was inserted 6cm cephalad into the subarachnoid space through 17-gauge or 18-gauge Tuohy needle. Depending on the surgical procedure and on the patient's position, hypobaric solution of tetracaine or hyperbaric Neo-percamin S was administered respectively. Blood pressure was maintained with phenylephrine infusion. The patients were consoled throughout the surgical procedure listening to their favorite music tapes.
We encountered no complication except post spinal headache in sixteen patients. The success rate of continuous spinal anesthesia was 99.5% in the present study.The Journal of Japan Society for Clinical Anesthesia Vol. 13 No.1, 1993

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Homologous blood transfusion has the risk of infections such as hepatitis and AIDS, or GVHD. Autologous blood transfusion is considered the safest and most preferable method. But it is not widely used particularly with children because of the complicatedness of the system. We applied autologous transfusion to children for the purpose of decreasing the need for homologous transfusion.
Predeposit and salvaging autotransfusion were used in 22 patients, ages 4 to 18, undergoing open heart surgery. 50-1, 600ml blood was drawn from them preoperatively, and 16 patients received only this autologous blood during operation and postoperative period.
Hemodilutinal autotransfusion was used in 10 patients, ages 5 to 16, undergoing orthopedic and general surgery. Only one patient required homologus blood transfusion postoperatively.
If preoperative donation and hemodilution, intra/postoperative salvage, and hypotensive anesthesia are all employed in combination, homologus transfusion and its complications are avoidable. Autologous blood transfusion in children should be applied more widely, because of their greater life expectancy.

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The effects of preoperative administration of recombinant human erythropoietin (EPO) were studied on perioperative erythropoiesis in patients with hemodilutional autotransfusion (HAT).
At first, 21 hysterectomy scheduled patients (Hb_??_10g/dl) were divided into the EPO group (N=9) and the control group (N=12). The EPO group patients received EPO (3, 000 units) intravenously every other day for 12 days preoperatively and all patients received iron sulfate. In both groups, preoperative hemoglobin (Hb) levels were observed.
Secondly, 19 hysterectomy patients (Hb_??_11g/dl) with HAT were divided into the EPO group (N=5) and the control group (N=14). In these groups, postoperative Hb levels were observed.
There were no adverse reactions to EPO. The preoperative administration of EPO resulted in significant increase in preoperative Hb levels, and also tended to increase Hb levels postoperatively. We concluded that the administration of preoperative EPO promoted the erythropoiesis effectively on the perioperative anemia with HAT.

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Forty-eight healthy patients undergoing elective abdominal surgery were studied to evaluate the effect of clonidine on the MAC (ED50) of isoflurane and perioperative hemodynamic variables. These patients were divided into two groups: the first group consisted of 24 patients with age of 31-55 years, and the second group 24 patients with age of 56-80 years. Patients were premedicated with 4.0-5.5μg/kg clonidine PO 90 minutes before arriving at the operating room. Anesthesia was induced with isoflurane, oxygen and nitrous oxide and maintained with isoflurane and oxygen until the skin incision was made.
ED50 and ED95 were 0.825±0.017% and 0.926% in the younger group and 0.703± 0.018% and 0.816% in the elder group. Anesthetic requirements were reduced by 28.3% for the younger group and by 33.0% for the elder group compared with the previously reported values without clonidine. Reductions of both systolic and diastolic arterial pressure were observed 90 minutes after premedication in the younger group only, while the elder group remained the same. No change in heart rate occured in both groups. Hypotention was common after induction of anesthesia prior to the skin incision in both groups. Severe bradycardia (heart rate<40bpm) during abdominal manipulation occured more frequently in the elder group than in the younger group. We conclude that clonidine reduces isoflurane MAC by approximately 30%, but the high incidence of severe bradycardia may limit the administration of clonidine as premedication for the elderly.

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The effects of the administration of PGE₁ on shift of Oxygen Dissociation Curve (ODC) and functions of red blood cells were studied in 18 patients in whom mastectomy was performed. Intravenously administering a low dose of PGE₁i we measured blood gases, colloid and electrolyte osmotic pressure, sodium and potassium in serum, and red blood cell P₅₀, 2, 3-DPG, and deformability. During the administration of PGE₁, A-aDO₂, pottasium content, 2, 3-DPG, and P₅₀ increased, and deformability of red blood cell increased significantly.
This suggests that PGE₁ not only causes of microcirculation accompanying the vasodilation and disaggregation of platelets, but also causes a rightward shift in ODC, and may increase tissue oxygenation.

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We evaluated the analgesic efficacy and the incidence of side effects when a combination of morphine and fentanyl was administered epidurally. 28 patients who underwent gynecologic surgery were randomly assigned to recieve epidurally 2mg morphine alone (group M) or combined with 50μg fentanyl (group MF), dissolved in normal saline to a total volume 10ml. Pain scoring showed better analgesia in group MF at 1 and 2h after the epidural injection. The ratio of patients requiring supplement analgesics during 24h after the injection is higher in Mgroup (57%) than MF group (22%). Arterial blood pressure and respiratory rate were not changed significantly in both groups. There was no difference in the incidence of advers effects, including nausea. vomiting. and pruritus between both groups. We concluded that epidural administration of mixture of morphine and fentanyl was effective and safe for postoperative pain relief in low abdominal surgery.

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The influence of expiratory time on the arterial to end-tidal carbon dioxide tension difference was studied in eight human volunteers. A 24 gauge cannula was inserted into the radial artery and samples of expired gas were analyzed with Bruel Kjar 1304 capnometer. End-tidal carbon dioxide tension(P_ET CO₂) was calculated as F_ET CO₂×(barometric pressure -47). After lying down for 20 minutes, the supine subjects were asked to breath at the rates of 4, 6, 8, 10, 14, 16 and 20 breaths per minute, while watching the respiratory rate or the capnometer display for at least two minutes maintaining inspiratory/expiratory ratio, 1:2.
The correlation between arterial to end-tidal carbon dioxide tension differences, a-_ET PCO₂ (Y) and breathing frequencies (X) was Y=0.44X-5.6 (n=61, r=0.77). The evidence showed that a-_ET PCO₂ was smaller at lower frequencies and was negative at frequencies below 12 breaths per minute. The correlation between a-_ET PCO₂ (Y) and tidal volume Vt(X) was Y=-0.0047X+4.4 (r=-0.84).

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In order to elucidate the effects of CO₂ on the nasal reflexes, we investigated respiratory and circulatory responses to nasal irritation elicited by nasal insufflation of 5% isoflurane at resting P_ET CO₂ (P_ET CO₂=43.1×1.4mmHg: Mean×SE) and at hypercapnia (P_ET CO₂=57.8×0.7mmHg) in 13 lightly-anesthetized humans.
Nasal irritation at resting P_ET CO₂ caused an increase in expiratory time, a decrease in respiratory frequency, and increases in both heart rate and blood pressure. These responses were markedly reduced during hypercapnia.
Our results indicate that CO₂ exerts an inhibitory influence on the nasal reflexes.

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A patient with a tracheostomy, who had been performed middle and lower lobectomies of the right lung, was scheduled for a radical operation of right bronchial fistula and abscess. The patient was classified to an absolute indication of one lung anesthesia.
The angle between trachea and left main bronchus was more sharp than that of normal case because of the previous right lobectomies. So it was impossible for us to intubate a Broncho-Cath^® tube or a spiral tube to the left main bronchus guided by a broncho-fiberscope orally. However, we could insert a Laryngoflex^® to the left main bronchus guided by a broncho-fiberscope via the tracheostomy.
This method for one lung anesthesia using a Laryngof lex^® via a tracheostomy is supposed to be useful.

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A 19-year-old male with Gardner syndrome was admitted to have a giant tumor (25×23×17cm) on his back removed. Before anesthesia we decided that he should not be placed in the supine position for tracheal intubation because of the giant tumor. Therefore, following sedation with an intravenous pentazocine 30mg and diazepam 10mg, awake nasal intubation was performed in the lateral position by using a fiberoptic bronchoscope under local anesthesia. Endotracheal tube was easily inserted into the trachea at the first trial.
The intubation using fiberoptic bronchoscopy was very useful method for a patient with Gardner syndrome who had a giant tumor on the back.

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Wegener's granulomatosis is a distinct clinical form of systemic necrotizing vasuculitis consisting of (a) necrotizing granulomatous vasculitis of the upper and lower respiratory tracts, (b) focal necrotizing glomerulonephritis, and(c)systemic small vessel vasculitis involving numerous organ systems.
For a 66-Year-old female with Wegener's ranulomatosis, the nasal plastic surgery was planned for her saddle nose. She presented granulomatosis in the nasal cavity, wheezing and renal dysfunction. To avoid the complications of the airway during insertion of the endotracheal tube and the ventilatory failure under general anesthesia, we waited 0for 3 months to have anesthesia until her respiratory function was improved by steroid medication.
After NLA induction, anesthesia was maintained with nitrous oxide, oxygen and isof lurane. We had no trouble during anesthesia including respiratory condition.
Although the patient of this disease has many problems for periopoerative general management, we must pay special attention to respiratory involvement including assessment for upper and lower respiratory tracts.

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We have reported, a case of galactosemia who showed frolonged apnea following to an ophthalmic operation. The patient was 2-year-old, 72cm in height and 13kg in weight. He had been treated with galactose-free milk for a long time and preoperative examination of liver function was in normal range except for elevated γ-GTP (116).Premedications were hydroxyzine hydrochloride 30mg, triclofos sodium (tri- Na) lg and atropione sulphate 0.3mg given 90 minutes before induction of the anesthesia. The trachea was intubated with 50mg of thiamyral and 1mg of vecuronium. Following to the end of operation, the patient was ventilated manually with pure oxygen for 2 hours without no spontaneous respiration. Reversal of muscle relaxant also failed to appear the spontaneous respiration despite of vigorous movement of his extremities. After the two days of mechanical ventilation, the trachea was extubated. As the cause of prolonged apnea, the delayed metabolism of tri-Na was suspected. Because, this drug shows its sedative effect after the degradation for trchlor ethanol, and finally, it was conjugated by glucuronic acid in the liver. In conclusion, in case of well-controlled galactosemia, we should be more prudent, especially for the use of liver-metabolized drugs.

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An 84-year-old, 62kg, male with severe aortic stenosis, old myocardial infarction, and AV block (II°) was scheduled for balloon dilation for urethral stenosis. The patient had a history of Adams-Stokes disease and transient cerebral ischemic attack (TIA). The patient was received 1.5mg of diazepam intramuscularly. His blood pressure and heart rate were 160/80mmHg and 70bpm when he arrived at the operating room. After the sacral cornua were identified, a 22-gauge needle was inserted into sacral canal through the sacral hiatus in the prone position. After confirming negative aspiration for blood nor cerebrospinal fluid, 2ml of 1% lidocaine with 1: 200, 000 epinephrine was injected for a test dose. The test dose produced no signs of either systemic or subarachinoid injection. An additional 16ml of 1% lidocaine with 1: 200, 000 epinephrine was injected 2min after the injection of the test dose. Soon after the injection, the patient was placed in the supine position. Five min after the injection, the patient was developed to be drowsy, and heart rate decreased to 38bpm from 70bpm. However, there was no changes in artrial blood pressure. Ten min after the injection, he lost consciousness and became apnea. The trachea was intubated immediately and a manual ventilation was started. Blood pressure and heart rate were 128/62mmHg and 34bpm, respectively. Heart rate increased to 68bpm after the injection of 0.3mg of atropine. Spontaneous breathing appeared about 1hr after the injection of lidocaine with epinephrine. The patient recovered consciousness 2hr after the injection, and had no neurological deficits. There were no abnormal findings on the electroencephalography and the cranial CT next morning. The plasma concentrations of lidocaine showed 4.3 μg/ml and 1.6μg/ml, 15min and 2hr after the injection of lidocaine, respectively.
It was presented that the causes of apnea and loss of consciousness were due to intoxication of lidocaine. Further, we should take great care in appearances of local anesthetic intoxication when elderly patients with severe cardiac diseases undergo caudal anesthesia.

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