Epidural infusions of buprenorphine (18μg•ml^-1) combined with bupivacaine (2.3mg•ml^-1) at 1 ml •h^-1 were compared with those of buprenorphine (9μg•ml^-1) combined with bupivacaine (2.4mg•ml^-1) at 2ml•h^-1 for postoperative analgesia in 80 patients after elective major abdominal surgery. There were no significant differences between the two groups in supplementary analgesics, pain score and visual analogue scale.

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The effect of incentive spirometry on respiratory function after upper abdominal surgeryin 26 patients with continuous epidural analgesia was assessed and compared with that of deep breathing exercises. Patients were prospectively randomized into one of three groups the DB group (9 patients) carried out deep breathing exercises 10 times daily, while the TFI group (8 patients) and the TF II group (9 patients) were treated with incentive spirometry for 5min 5 and 10 times daily, respectively, through the third postoperative day. Respiratory function was evaluated by spirometry and BGA. Pain score based on Prince Henry pain scale and visual pain scale showed good analgesia in the 3 groups without any significant differences through the third postoperative day. Among the 3 groups, no significant statisti-cal difference was observed in VC, FEV_1.0 or PEFR, which decreased to 50% of the preoper-ative value on the first postoperative day and gradually recovered to 80% of the preoper-ative value by the tenth postoperative day. PaO₂ decreased more in the DB group and the TF II group than in the TF I group through the third postoperative day, but there was no significant difference between the 3 groups. The effect of incentive spirometry on respira-tory function in patients after upper abdominal surgery may show no difference whether 5 times or 10 times daily, and may be similar to that of deep breathing exercises under the condition of sufficient analgesia by continuous epidural analgesia.

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During closed-circuit anesthesia, an inhalational anesthetic has traditionally been administered by injecting a liquid agent directly into the anesthetic circuit using a syringe. This bolus injection method causes wide fluctuations in anesthetic concentration, which frequently leads to undesirable hemodynamic instability. To overcome this problem, we devised a new inhalational anesthetic vaporizer, which combines a continuous infusion pump with an in-circuit vaporizing chamber. The vaporizing chamber, with a heater incorporated to facilitate vaporization of the inhalational agent, is attached to the expiratory limb of the anesthesia circuit. The inhalational anesthetic of choice is continuously delivered in liquid form to this chamber by an infusion pump, and the rate of infusion can be adjusted by an anesthetist. We used this devise for clinical cases of closed circuit anesthesia and found that it could respond promptly to changes in anesthetic requirements during induction and periods of intense stimuli, while providing a smooth course for maintenance. In conclusion, this new vaporizer makes closed circuit anesthesia easier and safer.

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We report a case in which onset time of succinylcholine (SCC) was normal but recovery from SCC-induced paralysis was delayed after administration of neostigmine to reverse the action of vecuronium. A 59-year-old woman who had chronic tonsillitis was scheduled for an elective tonsillectomy. The patient had no complications and was not under medication before the operation. Pre-operative examination showed no abnormal findings except premature ventricular contractions. Anesthesia was induced with thiamylal and vecuronium. After endotracheal intubation, anesthesia was maintained using sevoflurane in nitrous oxide and oxygen (GOS). The operation ended uneventfully and the endotracheal tube was removed after reversal of neuromuscular block with neostigmine. Sustained bleeding in the oral cavity was observed after extubation, so the surgeons decided to perform a hemostatic operation. Before re-operation, neuromuscular function was monitored and evaluated by measuring single twitch and train-of-four (TOF). The TOF was 100% before re-operation, which meant full recovery from the vecuronium-induced block. The orotracheal tube was placed with adequate muscle relaxation following crash induction with thiamylal at 250mg and SCC at 60mg. The anesthesia was maintained with GOS. During re-operation, the monitor showed prolonged neuromuscular blocking effect of SCC. The first twitch of the TOF reached 25% and 75% of the control value after 20min and 25min, respectively. We suggest that the prolonged paralysis following SCC administration may be mainly due to the neostigmine-induced reduction of pseudocholinesterase activity. We recommend monitoring neuromuscular function when administering SCC following the reversal of non-depolarizing block with neostigmine (anti-chE).

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We examined the clinical usefulness and efficacy of hemodilutional autologous bloodtransfusion (HAT) in 10 patients in whom radical prostatectomy was performed. The patients were divided into two groups: Group A, composed of 5 cases without HAT and Group B, composed of 5 cases with HAT. No severe problem occurred in either group, except for anemia in Group B. HAT is useful for eldery patients in whom massive bleedingis expected.

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Fifteen cases with motor paresis were operated on to implant electrodes for functional electrical stimulation. Motor paresis were caused by cerebral infarction (6 cases), intracere-bral hemorrhage (3 cases), spinal cord injury (4 cases), amyotrophic lateral sclerosis (2 cases). In every case with a distinct origin of paresis, depolarizing muscle relaxants may induce dangerous hyperkalemia. In cases with lower motor neuron lesions, non-depolariz-ing muscle relaxants may cause prolonged neuromuscular blockade. Further, care should be taken regarding cardiovascular changes due to autonomic nervous system disorders ac-companying to motor neuron lesion.

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A 75-yr-old male was scheduled for ileocecal resection for polyposis. Preanesthetic airway examination showed no abnomalities. Direct laryngoscopy after a rapid-sequence induction of anesthesia revealed enlarged lingual tonsils. The arytenoids and epiglottis could not be seen, even with a fiberscope. Maintaining ventilation by mask was difficult, so an LMA was used. An attempt at fiberoptic endotracheal intubation through the LMA failed because hypertrophic tonsils interfered with fiberoptic exposure. Fiberoptic retro-grade endotracheal intubation was successful even when ventilating with an LMA.

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We experienced three cases of stunned myocardium after abdominal surgery. All three cases were females in their 60s who underwent resection of rectum, resection of ileocecum, and right hemicolectomy with partial hepatectomy, respectively. They were diagnosed as stunned myocardium mainly from hemodynamic changes, ECG, and echocardiography. Intraoperative hemodynamic instability and shivering at the time of emergence from anesthesia might have led to the stunned myocardium, we thought. We thought that coronary spasm was responsible in one patient, but in the other two cases the causes were unclear. Though stunned myocardium is basically reversible, it may become irreversible if management is inappropriate. The relation between stunned myocardium and perioperative myocardial infarction needs to be further elucidated.

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