Cardiac arrests, excluding those associated with cardiac surgery, occurred in 29 (0.087%) of 33, 194 non-cardiac surgery cases out of 36, 159 patients who had general, spinal and/or epidural anesthesia in our hospital during the ten years from 1981 to 1990. Twenty-five of them were successfully resuscitated without any complications, while the remaining four patients died. The causes of cardiac arrest in the 29 patients were as follows: possible coronary artery spasm due to preoperative unstable angina in two;preoperative hypovolemia in three; massive bleeding in nine; anaphylactic shock in six; intravenous injection of epinephrine in two; hypotension due to deep anesthesia in two; hypoventilation in one; and unknown causes in four.
During anesthesia and surgery, we must comstantly be on the lookout for the first signs of cardiac arrest and treat in the early phase. Anesthetists should always use adequate instrumentation, such as pulse oximeter and capnometer, for the management of anesthesia.

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In order to evaluate patients with reflex sympathetic dystrophy (RSD) quantitatively, the pressure-pain threshold of limbs was measured before and after treatment using an algometer. The pressure-pain threshold on the affected side was significantly lower than on the contralateral unaffected side in ten patients with RSD. Furthermore, the ratio of the pressure-pain threshold on the affected side to the unaffected side in the RSD patients was significantly lower than in normal volanteers. This ratio in RSD patients has significantly recovered after treatment in good correlation with the recovery of visual analogue scale. These results suggest that measurement of pressure-pain threshold in RSD patients using an algometer is useful for quantitative evaluation of both the severity of RSD and the effectiveness of treatment.

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The effect of rectal midazolam on preanesthetic sedation was examined in 109children aged from one to six years. Children were divided into eight groups by administration timing (30 and 60 min before induction of anesthesia), dose (0.2 and 0.4 mg/kg) and age group (1-3 and 4-6 y. o.). To analyse the usefulness of rectal midazolam in each group, we used a five-step sedative score and dafined score 1 as "uneffective"(agitated during induction of anesthesia), score 2-4 as "effective"and score 5 as "over-sedated". In both groups in which midazolam were administered 30 or 60 min before induction of anesthesia, the percentage of "effective"in age group of 4-6 y. o. was 92-100% and significantly higher than that in age group of 1-3 y. o. (54-58%)regardless of the dose. These results suggest that rectal midazolam of 0.2-0.4mg/kg 30-60 min before induction of anesthesia is useful for preanesthetic sedation in pre-school children (4-6 y. o.), while in a lower age group (1-3 y. o.) it is unsatisfactory.

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A clinical study was performed to evaluate midazolam with combined use of barbiturate for the induction of anesthesia, as well as to determine the optimal dosage of midazolam. Ninety-three patients for general anesthesia were randomly divided into three groups, and 2mg, 5mg or 8mg of midazolam, respectively, was administered intravenously. One minute after the administration of midazolam, 50mg of barbiturate was intravenously administered as an initial dose and an appropriate dose was added if necessarily. The similtaneous administration of barbiturate and midazolam is useful for the induction of anesthesia in spite of non fixed dose of body weight base of patients. We concluded that 5mg of midazolam was considered appropriate.

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A total of 52 patients who underwent coronary artery bypass surgery was divided into two groups according to age, under 69-years-old (n=34) and over 70-years-old (n=18). These two groups were compared with each other. There were no significant differences in numbers of diseased coronary artery, involvement of left main coronary artery and left ventricular ejection fraction between the two groups. There was preoperative prevalence of hypertension and arteriosclerosis obliterans in the older group, and of smoking and obesity in the younger group. Hemodynamic status during the operation was stable in both group. Postoperative complications occurred in 87.8% of older patients. Sepsis and congestive heart failure were more common in these patients. Mortality was 2.9% in the younger group and 16.7% in the older group. We conclude that preoperative risk analysis should be made more precisely and more cautious perioperative management is needed in older patients.

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A 61-year-old male with dilated cardiomyopathy (DCM) underwent total gastrectomy. Anesthesia was induced with fentanyl and midazolam and maintained with additional fentanyl, midazolam, and 66% nitrous oxide. Pen-operative hemodynamic changes were monitored by a Swan-Ganz catheter. We used dobutamine to enhance cardiac contractility, dopamine to increase renal blood flow, and prostaglandin E₁ to decrease afterload. Cardiac output was maintained at adequate level. Neither circulatory failure nor other major complications were observed throughout the anesthetic course and thereafter.

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Nine cases of primary spinal cord tumor were observed in the course of 12 years in our pain clinic. Six were male and 3 female. Mean age was 48.8 years. Three cases were in cervical region, 2 in thoracic, and 4 in lumbar. Chief complaints were neck and shoulder pain in 2 cases and low back, hip, and leg pain in 7 cases. Six of the 9 cases complained of night pain, and all 6 cases complained of severe epidural injection pain.
Six cases were operated on successfully, and all cases were intradural and extramedural tumors.
It seems that night pain and pain during epidural injection are important clinical signs for diagnosis of primary spinal cord tumor.

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ALS patients may carry a poor prognosis and have various anesthetic problems such as respiratory failure caused by muscle weakness and atrophy, and abnormal response to muscle relaxantes.
A 65-years-old patient with ALS underwent a right adnexectomy under spinal anesthesia without any perioperative clinical deterioration.
In the anesthtic management for the patient, we have to understand the condition of the disease, and as long as the patient is made aware of the risk/benefit factors and agrees to spinal anesthesia, there might be no contraindication to the use of this anesthesia.

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We investigated 95 cases who underwent laparoscopic guided cholecystectomy (LGC) regarding operation time, anesthesia time, P_ET CO₂, PaCO₂, pH and perioperative complications in comparison to those in open cholecystectomy. Furthermore, transeso-phageal echocardiography (TEE) was employed to detect gas emboli in the right atrium in 26 patients during laparoscopy.
P_ET CO₂, PaCO₂ and pH changed significantly 30 minutes after pneumoperitoneum was established. More cardiovascular instability and complications, such as subcutaneous emphysema, were observed in LGC than in open laparotomy. Abnormal gas shadows which were suspected venous gas emboli were detected by TEE in eleven cases (42.3%). Besides cardiovascular instability (side effect) and hypercapnia during laparoscopy, gas embolism caused by carbon dioxide should be considered as a serious complication during anesthesia of LGC.

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A pregnant woman with eclampsia and abruptio placentae underwent cesarean section under general anesthesia with O₂-N₂O-sevoflurane and vecuronium. For control of hypertension, continuous infusion of nitroglycerin before birth was applied following the administration of PGE₁ after birth. Her serum magnesium level was increased, and action of vecuronium was prolonged.

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We report a case of pulmonary air embolism which occured during cortisone treatment by local injection in unicameral bone cyst of the proximal femur under general anesthesia using mask. The air, in an amount of approximately 50ml, was injected in an attempt to clarify the location of the bone cyst under an image intensifier without any warning to the anesthesiologist. Immediately after the air injection, the patient had a severe cough followed by bradycardia, which were effectively treated with hyperventilation with oxygen and intravenous administration of atropine. Arterial oxygen saturation measured by pulseoxymeter decreased only slightly for a few minutes. The remaining anesthetic and postoperative courses were uneventiful, and the patient showed no neurologic deficit or pulmonary complications. Although serious complications were not encounterd, this report emphasize again the hazard of air injection into bone marrow.

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A 65-yr-old patient suffered swelling of the bilateral parotid gland after cholecystectomy following general anesthesia. One day after operation the bilateral parotid glands swelled and the serum amylase, salivary isozyme predominant, increased extremely. These swelling were not associated with inflammatory symptom and diminished spontaneously over the next six days. The treatment included topical cooling of parotid glands and administration of antibiotics and intravenous infusion according to usual postoperative management. Congestion of the venous drainage of the glands because of straining and coughing is presented as a possible cause. Furthermore an overactive pharyngeal reflex, stimulated by endotracheal intubation, probably caused vasodilatation and hyperemia of the glands. Although postoperative parotid swelling are not a common complication, the anesthesiologist should be aware that it could be caused by usual anesthesia management.

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A 66-year-old male with bronchial asthma was scheduled for retropubic prostatectomy under general anesthesia. The patient developed anaphylactoid shock at reversal of neuromuscular blockade. The clinical manifestations were cardiac arrest following circulatory collapse, generalized erythema, facial edema and subcutaneous vasodilatation. Systemic vascular resistance was then low and bradykinin concentration was elevated. CPR with administration of noradrenaline was effective to overcome the shock state. In conclusion, bradykinin may be an important mediator of the pathophysiology of anaphylactoid shock in this case. Further, care has to be taken in using anesthetic drugs for patients with allergic history.

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We performed anesthesia on a 50-year-old man with superior vena cava syndrome caused by the invasion of lung tumor in the superior vena cava and the right atrium. preoperatively, he showed mental disturbances due to elevated intracranial pressure. Considering the high possibility of respiratory and circulatory malfunctions during induction of general anesthesia, we placed a temporary bypass between the right axillary vein and the right femoral vein under local anesthesia to reduce venous pressures in the upper part of the boby. Pressure in the right jugular vein decreased after the temporary venous bypass and did not increase after the induction of general anesthesia. We conclude that a temporary axillo-femoral venous bypass is effective in the management of patients with severe superior vena cava syndrome.

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A 58-yr-old woman with a malignant tumor of the renal pelvic and ureter was scheduled for a nephroureterectomy at the flexed lateral position. Preoperatively her general condition was good except for right shoulder pain. The operative course was uneventful during anesthesia. On the first operative day she began to complain of severe pain on the right shoulder and the claviclar portion. Roentgenogram revealed a fracture of her right clavicle. In the preoperative chest X-rays, osteolytic metastasis on the right clavicle was present. Consequently, we diagnosed this case as a pathological fracture. Extreme care must be taken with anesthetized patients, who require position change during surgery in order to minimize the incidence of trauma to pathological bones.

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We reported four cases of anesthetic management on hepatectomy under hemodialysis. In all cases, dialysis was performed on the day of surgery. During surgery, they were controlled with anesthetics and intravenous electrolyte solutions based on monitored hemodynamic parameters, such as arterial pressure, heart rate and pulmonary artery pressure. Of the 4 cases, 2 died and 2 survived after the surgery. Since the preoperative complications, the history of dialysis and the water eliminations, did not differ between the non-survival group and the survival group, the survival or death of patients seems to be associated with the extent of hepatectomy, differences in the volume of intravenous electrolyte solution infused during surgery (6.0 or 8.0ml/kg/hour in the survival group and 1.5ml/kg/hour in the non-survival group), Prostaglandin E₁ was use of in 2 cases during surgery. These results suggest that hepatectomy of patients on hemodialysis will be favorably affected by sufficient intraoperative fluid therapy, continuous prostaglandin E₁ treatment for liver protection during surgery, and appropriate perioperative management.

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