We prospectively evaluated the effect of a history of upper respiratory tract infection (URI) preceding surgery on intra-and postoperative complications in children. The study enrolled 306 pediatric patients aged seven or less who underwent elective surgery under general anesthesia.
Using Satoyoshi's score, the patients were divided into three groups. In group Ia (n=53), the patients had a history of URI within two weeks preceding surgery and their scores were three or more. In group Ib (n= 64), the patients had a history of URI as group Ia and their scores were two or less. In group II (n=189), the patients had no history of URI preceding surgery.
The incidence of intraoperative respiratory complications in group Ia and Ib was significantly higher than in group II. The incidence of intraoperative hypoxia (SpO₂<95) in group Ia was particularly significantly higher.
The incidence of postoperative respiratory complications in group Ia was significantly higher than in groups Ib and II, but there was no significant difference between group Ib and II.
In conclusion, elective surgery should be postponed in pediatric patients who have a history of URI within two weeks preceding surgery in association with active (and severe) symptoms. If the symptoms are mild, however, it is not always necessary to postpone surgery, even though patients have a history of URI. Synthetic judgement, of course, is desirable.

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Stellate ganglion block (SGB) was effective in reinitiating menstrual cycle regularity in patients with amenorrhea of hypothalamic origin. Four patients whose initial complaints had been headache or other non-gynecological problems underwent stellate ganglion block as a primary therapeutic regimen. The effect, we suspect, was due to SGB-induced alteration of blood flow to and thus temperature of the hypothalamus. This in turn corrected a more general endocrinological disturbance. Other possible causes may include amelioration of headache or related other problems with resultant improvememt in overall condition or other nonspecific effects.

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Hemodynamic responses to infrarenal aortic cross-clamping during abdominal aortic aneurysm surgery have been reported. However, no studies have reported on right ventricular performance during aortic cross-clamping. In this report, the effect of infrarenal aortic cross-clamping on right and left ventricular performance with prosta-glandin E₁ (PGE₁) or nitroglycerin (TNG) was examined with the right ventricular ejection fraction/volumetric catheter (Baxter). PGE₁ attenuated increase of systemic vascular resistance and decrease of cardiac output due to increase of afterload during aortic cross-clamping. PGE₁ also maintained right ventricular end systolic and end diastolic volume. TNG decreased right ventricular end diastolic volume by decreasing venous return and did not attenuate increase of systemic vascular resistance during aortic cross-clamping. Our findings suggest that PGE₁ be commonly recommended during infrarenal aortic cross-clamping, and TNG is useful for patients with augmented right ventricular volume.

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The effects of high thoracic epidural anesthesia on autonomic nervous system activity were studied by measuring heart rate and systolic blood pressure variabilities using power spectral analysis. In the analysis of heart rate variabilities, frequency compo-nents were divided into two factors, Low Frequency ComponentRR (LFCRR: 0.03Hz 0.15Hz) and High Frequency ComponentRR (HFCRR: 0.15Hz-0.4Hz). LFCRR/HFCRR as the index of sympathetic tone decreased significantly under epidural anesthesia. HFCRR increased significantly under epidural anesthesia. In the analysis of systolic blood pressure variabilities, frequency components were divided into two factors, Low Fre-quency Componentsys (LFCsys: 0.03Hz-0.1Hz) and High Frequency Componentsys (HFCsys: 0.2Hz-0.3Hz). LFCsys decreased significantly under epidural anesthesia. We also measured the temperature of the thumb and great toe. The temperature of the thumb increased significantly after epidural anesthesia, indicating suppression of thor-acic sympathetic tone. It has been reported that the change of HFCRR and LFCsys is induced by the activity of the parasympathetic nerve and the sympathetic nerve, respectively. Therefore, the analysis of circulation variabilities is useful for the determination of autonomic nerve activity, and our data confirmed that high thoracic epidural anesthesia accelerates parasympathetic tone and suppresses sympathetic tone.

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Effect of a lower dose of clonidine on the MAC (ED50) of isoflurane and perioperative hemodynamics was investigated in 25 patients aged 56∼80 undergoing elective abdominal surgery. Patients were premedicated with 1.5∼3.0, μg/kg clonidine PO 90 minutes before arriving in 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 0.744±0.030%, 29.2% below the previously reported value without clonidine, and 0.943%. 28% of the patients had hypotension (systolic arterial pressure <80mmHg) in the preincision period. Only one patient required atropine for the treatment of severe bradycardia (heart rate <40bpm) during abdominal manipulation. The lower-dose clonidine was less likely to produce hypotension and bradycardia in the perioperative period. We concluded that the lower-dose clonidine (1.5∼3.0μg/kg) may be more appropriate as premedication for the elderly.

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Hepatic oxygen status was monitored by hepatic venous oxygen saturation (ShVO₂) in 11 patients who underwent hepatic lobectomy. Fiberoptic pulmonary catheters (7.5Fr) were placed into the hepatic vein before anesthesia. Eight patients showed a marked decrease in ShVO₂ during temporary occlusion of the hepatic artery and portal vein, with a correlated rise in arterial lactate concentration (r=0.66, p<0.01) indicating hep-atocellular hypoxia, and a rise in postoperative GOT and GPT. Meanwhile in the remaining 3 patients, little or no changes in ShVO₂ were observed during temporary cessation of hepatic blood flow suggesting the catheter tip was placed into the unresect-ed hepatic lobe.
We concluded that ShVO₂ is a valuable indicator when continuously monitoring hepatic oxygen status during a hepatectomy, and that intraoperative decreases in ShVO₂ are likely to be related to postoperative hepatic dysfunction. Placement of the catheter tip should be carefully selected according to anatomy of the liver, resected side or unresected side.

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In order to assess 1) the time-dependent depression of neuromuscular transmission in constant depth of enflurane anesthesia and 2) the effects of differences in clinical and immunological characteristics of myasthenia gravis (MG) on the pattern of neuromus-cular responses, we examined the electromyographic responses to ulnar nerve stimula-tion in eight MG patients and seven healthy control subjects. Train-of-four (TOF) stimulation with 20-s interval was continuously applied for 120 minutes while maintain-ing end-tidal enflurane concentration constant (2.5%). Enflurane exerted a much greater neuromuscular depressant effect in MG than in normal controls. Despite the fact that alveolar concentration of enflurane was held constant, both first-twitch response (T1) and TOF ratio (TR) markedly and progressively decreased in seven of the eight MG patients. This suggests that enflurane rapidly supresses not only postjun-ctional but also prejunctional function in MG patients. The other MG patient developed no TOF-fade with inhalation of enflurane. The individual variation of neuromuscular responses to inhaled anesthetics may indicate heterogeneity of MG. However, none of the parameters, including acetylcholine receptor antibodies, clinical classification of Osserman and Genkins, Ooshima's severity grade, disease duration, and preoperative prednisolone dosage, could successfully predict the neuromuscular responses induced by enflurane. The responses were also unrelated to thymic histological findings.

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A 45-year-old male patient with asymptomatic pheochromocytoma was anesthetized for the surgical removal of the tumor. The tumor was unexpectedly discovered by abdominal echography. The patient had received medication for the control of hyper-glycemia but there was no sign of hypertension.
During surgery, we achieved stable circulation by routine preoperative and intra-operative anesthetic procedures used for patients with symptomatic pheo-chromocytoma. After surgery, glucose tolerance was improved.
The present case suggests that, even if asymptomatic, the same preoperative manage-ment procedures used for the removal of symptomatic pheochromocytoma are desir-able.
We propose a classification of pheochromocytomas useful for anesthetic management during surgical removal.
It is suggested that the degree of difficulty in intra-operative anesthetic management depends on the type and concentration of plasma catecholamines.

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Kabuki make-up syndrome is a rare congenital malformation syndrome. The patient has several abnormalities which include the peculiar-looking face similar to Japanese Kabuki player, skeletal anomalies, dermatoglyphic abnormalities, mild to moderate mental retardation, and postnatal growth retardation. The problems regarding anes-thetic management are difficulties in tracheal intubation, epidural catheter placement, and vulnerability to bacterial infection. We experienced five anesthetic managements in two patients with this syndrome. In the first case, intra-and post-operative hypo-xemia developed, due possibly to pleuritis attributable to immuno-deficiency and impaired pulmonary function. In the second case, anesthetic courses were uneventful.

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This report describes the application of anesthesia during induced intrathoracic hyperthermia. The hyperthermia was performed on a 71-yr-old woman with pleural dissemination of lung cancer after a lobectomy; the anesthesia chosen was a thoracic epidural block and isoflurane in oxygen and nitrous oxide. When 2, 000 ml of warmed saline were injected into the pleural space, her blood pressure fell to 75/45mmHg, but recovered after we reduced the volume of injected solution. We irrigated with normal saline kept at 45° C for two hours. During irrigation her body temperature increased to 39°C, and as a result, heart rate and cardiac output respectively increased 68% and 54% over control values. This result showed that the hyperdynamic state appears in intrath-oracic hyperthermia, even under general anesthesia combined with thoracic epidural block.

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A 44-yr-old man with subarachnoid hemorrhage was scheduled for emergency clip-ping. At 9:00 a.m. he was intubated following the intravenous administration of 0.5mg of fentanyl and 8mg of vecuronium. Anesthesia was maintained with N₂O and 0.2 ∼0.4% of isoflurane. At 10:00 ETCO₂ increased to 46mmHg and rectal temperature rose to 38.2°C. ETCO₂ was normalized by increasing tidal volume of respirator. Rectal temperature rose to 39.1°C at 10:30 and 40°C at 10:55, then we suspected of MH. All anesthetics were discontinued and dantrolene administration (total 240mg), cooling of the body and ventilation with 100% O₂ were started. ETCO₂ started to decrease 15min after dantrolene administration and it was normalized in 30min (from 80mmHg to 34mmHg), but the decline of the temperature which marked peak value of 41.7°C at 11:30 delayed for 15min than ETCO₂ and sustained above 40°C for 1.5 more hours. The operation was limited to placing a drainage tube. The patient died of rerupture of aneurysm on 3rd postoperative day. Our case showed that changes in ETCO₂ precedes that in temperature in MH, indicating the usefulness of ETCO₂ monitoring in MH susceptible patient and treatment of MH.

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