We measured changes in the pressure of liquid-inflated endotracheal tube cuff under general anesthesia with nitrous oxide in 60 adult patients. Anesthesia was induced with thiamylal 5 mg/kg and 6-8mg of vecuronium. Immediately after intubation of endotra-cheal tube (Portex Blue Line^®), the cuffs of the tube were inflated with air (n=20) or liquid (normal saline: n=20; lactated Ringer's solution: n=20). The volumes of air or liquid injected into the cuff were determined by the minimum airway pressure to seal the trachea during controlled ventilation. The size of the endotracheal tube for each patient was selected according to the diameter of bronchus shown by chest X-ray. Anesthesia was maintained with 60% nitrous oxide in oxygen and either sevoflurane or isoflurane.
Cuff pressures were measured before exposure to anesthetic gases (baseline measure-ments), and were then measured every hour with a standard pressure transducer attached to the tip of the inflating tube.
The volumes of air and liquid initially injected into the endotracheal tube cuff were 5.74±1.69 and 6.33±1.71ml, respectively (p%lt;0.05). No significant differences were observed in the baseline values of cuff pressure after inflation of each volume of air and liquid (11.2±3.3 and 10.5±3.5mmHg, respectively). After exposure to 60% nitrous oxide, the pressure of the air-inflated endotracheal tube cuff rapidly increased. However, a gradual decline in pressure was observed in the liquid-inflated endotracheal tube cuff during general anesthe-sia with nitrous oxide. Although changes in the pressure of the liquid-inflated endotracheal tube cuff were observed in patients anesthetized with nitrous oxide, the minimum airway pressure required to cause gas leakage around the cuff showed no significant change in any patient during the study.
In conclusion, our results demonstrated that inflation of the endotracheal tube cuff with liquid minimized change in the pressure of the endotracheal tube cuff during nitrous oxide anesthesia.

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Cerebral damage after general anesthesia at a university hospital over a 20-year period was studied retrospectively. There were 14 cases of cerebral damage associated with intra-or post-operative events among 32, 642 anesthetic cases (excluding cardiovascular surgery patients). The average age was 60 years (range 1-80 years). As for the surgical site, five cases were abdominal, three were intrathoracic, three were cervical, two were spinal operations and one was a pediatric bronchoscopy. The most frequent cause of cerebral damage was ventilatory insufficiency (seven patients). Other causes were circulatory insufficiency (four patients), cerebral infarction (two patients), and cerebral hemorrhage (one patient). Six cases (42%) were judged to be mainly due to anesthesia, four cases (29%) to the surgery, and four cases (29%) to the patients' condition. Cardiac arrest occurred in eight patients. Four patients died, four patients suffered from mild permanent neurologic deficits, and six patients fully recovered. To avoid cerebral sequelae, adequate preanesthe-tic assessment and preparation and pen-anesthetic management are vital. The development of a non-invasive monitoring device for cerebral circulation and metabolism is also urgently needed.

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We evaluated the effect of reduced blood pressure by trimetaphan (TMP), PGE₁ and thoracic epidural block (TEB) on portal venous oxygenation in patients with hypertension during gastrectomy. The patients studied were divided into three groups: a TMP group (n=7), PGE₁ group (n=7), and TEB group (n=7). Catheterization of the portal vein via the umbilical vein was performed for portal blood sampling. Mean arterial blood pressure was reduced to 70% of the pre-treatment value. A significant but small decrease in CaO₂ was observed after administration of vasodilators or TEB. In the TMP and TEB groups, portal venous PO₂ (PPVO₂) and CO₂ (CPVO₂) were significantly reduced and CaO₂-CPVO₂ was significantly increased with reduced blood pressure, probably due to the decrease in portal venous blood flow. However, no significant changes in PPVO₂, CPVO₂ or CaO₂ -CPVO₂ were obseved in the PGE₁ group, suggesting that portal venous blood flow is maintained by reduced blood pressure with PGE₁. Careful attention is needed to ensure that hypotension induced by TMP or TEB does not reduce the oxygen supply to the liver.

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Spirometry (%VC and FEV_1.0%) and arterial blood gas analysis (pH, PaO₂ and PaCO₂) were performed in 90 smokers (55±11 years old) and 90 non-smokers (57±15 years old) who were scheduled for general anesthesia, Although %VC did not differ significantly between smokers and non-smokers (97±17% vs 99±17%), FEV_1.0% of in smokers was signifi-cantly lower than in non-smokers (76±11% vs 83±6%, p<0.01). In arterial blood gas analysis, no significant differences in pH and PaCO₂ between smokers and non-smokers were seen (7.40±0.02 vs 7.40±0.04 in pH, and 41.4±3mmHg vs 41.1±3 mmHg in PaCO₂). PaO₂ was standardized as %PaO₂ by the equation, 100×PaO₂/(102.5-0.22×age), using the PaO₂ regression value of Conway et al. Smokers had significantly lower %PaO₂ than non-smokers (92±15% vs 99±10%, p<0.05). In addition, both FEV_1.0% and %PaO₂ in smokers decreased significantly related to Brinkman's smoking history index, the number of ciga-rette smoked per day×the duration of smoking in years. We concluded that smokers had lower PaO₂ as well as lower FEV_1.0% and need more intense respiratory care in the perioper-ative period.

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In the past 5 years, six patients visited our pain clinic with complaints of pain and/or dysesthesia in regions where they received iv catheters or needles for iv injections, blood sampling or local anesthesia. Each patient suffered from burning pain, numbness and/or a cold sensation accompanied by sensory disturbances such as hypesthesia and/or al-lodynia of the forearm after receiving venopuncture or local anesthesia. We consider infiltration of a local anesthetic with steroids and oral NSAIDs useful for treating these symptoms.
Psychological factors such as discontent and resentment at the management received during the early stage of injury also seem to contribute to the intensity and duration of pain.

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There have been few reports on anesthetic management for caesarean section in women with Ebstein's anomaly. A 34-year-old pregnant woman with Ebstein's anomaly compli-cated with Wolff-Parkinson-White syndrome underwent caesarean section under epidural anesthesia using lidocaine. Managing the patient as non-invasively as possible, we did not use a central line or pulmonary artery catheter in the perioperative period (This catheter can cause arrythmias, paradoxical emboli leading to stroke, and bacterial endocarditis). We monitored her continuously using a pulse oximeter. ECG and arterial blood pressure were also monitored. Her intra- and postanesthetic course was uneventful.

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We report a case of HELLP syndrome complicated with psychotic symptoms and marked hypernatremia.
The patient was a 27-year-old woman at the 37th week of gestation of her second pregnancy, who showed the trias of HELLP syndrome and psychotic symptoms including delirium and hallucinations. She underwent emergency cesarean section under general anesthesia.
We transfused platelet and plasma and administered gabexate mesilate for the treatment of DIC. Hemodialysis was conducted in order to prevent renal insufficiency, and direct hemoperfusion was undertaken with steroid pulse therapy in order to treat persistent hyperbilirubinemia and hepatic encephalopathy. She recovered uneventfully and was discharged with her baby on the 40th hospital day.

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