Coagulation-fibrinolysis systems were studied in two groups of 16 patients classified ASA 1-2 undergoing transurethral resection of prostate (TUR-P) during epidural anesthesia. Both coagulation and fibrinolysis were evaluated by measuring platelet aggregation in response to ADP and collagen, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombotest (TT), serum concentrations of fibrinogen, platelet counts in platelet-rich plasma, and hematocrit. Both systems were also evaluated by thrombelasto-graphy (TEG).
In the autologous blood transfusion group, first platelet aggregation in response to ADP was significantly decreased (p<0.05), which was considered due to the effect of stored blood, but there was no problem during the clinical course. We conclude that autologous blood transfusion pretreated with erythropoietin is safe and useful for management of TUR-P.

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A23187 is a secondary metabolic product called calcium ionophore that promotes the influx of calcium into cells.
We examined the effect of A23187 and nicardipine on the pain thresholds of 16 healthy adult volunteers during iontophoresis.
Pain thresholds rose in the patients who received only nicardipine, but there were no changes in the pain threshold of patients who were pretreated with A23187 before receiving nicardipine. In the group that received A23187 alone, pain thresholds did not rise.
In the patients who were pretreated with nicardipine before receiving A23187, pain thresholds continued to rise even after iontophoresis of A23187.
We think that the relationship between the pain threshold mechanism and calcium ions requires further investigation.

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We evaluated the efficacy of human recombinant erythropoietin (EPO) on autologous blood predonation in the case of 6 rheumatoid arthritis (RA) and 5 non-RA patients. Autologous blood was collected once a week for 3 weeks before surgery. All patients received oral ferrous sulfate 200 mg per day for 4 weeks before surgery, and were divided into 2 groups, one treated with 6, 000 units of EPO 3 days a week and one not treated. Hemoglobin recovery rate increased significantly in both RA and non-RA EPO treated groups compared to 33 non-treated groups, including 22 non-RA and 11 RA patients. No side effects occurred during EPO therapy.
We conclude that EPO is effective for non-RA patients, and also for RA patients with anemia.

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In order to examine cytokine production by the spleen under surgical stress in humans, we investigated changes of plasma cytokine levels in the arterial blood and the splenic vein blood in eight patients who underwent subtotal gastrectomy. Arterial blood was sampled 5 times: before induction, 1 and 2 hours after skin incision, and 1 and 5 days after the operation. IL-1, IL-6, endothelin, and nitrate were measured each time. Splenic vein blood was sampled twice: 1 and 2 hours after skin incision.
IL-1 was not detected in any samples. Arterial IL-6 levels increased at 2 hours and returned to control levels in 5 days. Levels of IL-6 in splenic vein blood were significantly higher than in arterial blood. Arterial endothelin levels increased at 2 hours and returned to control levels in 1 day. There was no significant difference between levels of endothelin in splenic and arterial blood. No change was detected in nitrate after skin incisions and no significant difference between levels of nitrate in splenic and arterial blood was seen.
These data suggest that the spleen produces IL-6 intensively under surgical stress.

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The incidence of postdural puncture headache (PDPH), number of failed punctures, reflux time of CSF and characteristic feeling of insertion of 27-gauge (G) Whitacre or 29-gauge Quincke needle in 551 patients undergoing spinal anesthesia were investigated. The inci-dence of PDPH was 0.4% in the 27G group and 0.3% in the 29G group. The failure rate was 1.3% in the 27G group and 4% in the 29G group. There were no significant differences in the incidence of PDPH and the failure rate between the two groups. We felt a characteris-tic "pop" feeling when penetrating the dura in 79% of patients using the 27G needle and in 31% using the 29G needle. The reflux time of CSF (the time from withdrawal of the stylet to collection of cerebrospinal fluid in the conical portion of needle hub) was 7 seconds in the 27G group and 16 seconds in the 29G group. These differences were statistically significant. The feeling of insertion and CSF reflux are important for correct spinal puncture. These results demonstrate that spinal puncture with a 27-gauge Whitacre needle is easier than with a 29-gauge Quincke needle, and that there is no difference between the needles in the incidence of PDPH.

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We retrospectively investigated the influence of eleven risk factors on postoperative hypoxemia. In 148 cases of major abdominal surgery, we analyzed the relation between postoperative AaDO₂ and eleven factors (age, preoperative serum albumin, % VC, FEV_1.0%, body mass index, preoperative AaDO₂, site of operation, duration of anesthesia, epidural analgesia, water balance during anesthesia, and water balance in ICU) by multiple regres-sion analysis. There was significant correlation between postoperative AaDO₂ and three factors (age, body mass index and preoperative AaDO₂), and weak correlation between postoperative AaDO₂ and two factors (duration of anesthesia and water balance in ICU).
Principal factors causing hypoxemia after major abdominal surgery were advanced age, obesity and preoperative hypoxemia.

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The authors researched the possibility of predicting cervical dermato-epidural distance (C-DED), (the distance between skin surface and epidural space on the neck) by cervical circumference measurement.
In 37 subjects, cervical circumference was measured at the cricoid cartilage level, after C7/Th1 epidural anesthesia in the sitting position. Mean C-DED was 5.05cm, and it showed especially strong correlation with cervical circumference, body weight and body surface area.
Supposing that a cross-section of the neck was a circle, under π=3.14, C-DED was formularized as cervical circumference [cm]/7.4732. Cervical epidural space is not wide enough for safe anesthetic procedure, and the formula for C-DED prediction was just for reference in clinical practice, but it might possibly be a good reference guide for beginners in terms of education.

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A 76-year-old man had been schedul ed for total bladder removal under general anesthe-sia. His past history ineluded angina pectoralis, hypertension, and liver cirrhosis, and he was taking oral nitroglycerin and Ca-channel blocker medication. Preoperative treadmill ECG revealed ST elevation in lead V_1-3, ST depression in lead V_4-6, and multifocal PVC what study. Coronary angiography demonstrated severe stenoses in the right and left coronary arteries. The operation cancelled and the patient received PTCA therapy. He was died suddenly of myocardial infarction two months later. Correct evaluation of patient condition was extremely important in the anesthetic management of a patient with ischemic heart disease.

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We report a case of thoracoscopic Nd-YAG laser ablation of bullae in a patient with giant unilateral bullae and bilateral bullous emphysema. The patient was a 67-year-old man. He had very advanced emphysema with severe pulmonary dysfunction (Hugh-Jones IV), and required chronic home oxygen therapy. The patient's preoperative forced vital capacity was 1.3l (37% predicted value), forced expiratory volume in one second was 0.55l (42% predict-ed value), and PaO₂, PaCO₂, and pH were 73 mmHg, 47 mmHg, and 7.37, respectively. Anesthesia was maintained using isoflurane in 80-100% oxygen and additional fentanyl as required. A left-sided double-lumen endotracheal tube was inserted via direct laryngos-copy. Muscle relaxation was maintained with iv pancuronium. The lungs were ventilated using the Siemens Servo 900C ventilator, which provides pressure-controlled ventilation with high inspiratory flows. Continuous positive airway pressure of 1cm H₂O was applied to the non-dependent lung. The PaO₂ value was greater than 300 mmHg during surgery. Postoperatively, the patient was maintained on mechanical ventilation, and was successfully weaned from the ventilator 14 hours after surgery. On the 3rd postoperative day, when the patient coughed intensely to clear sputum, a large bronchopleural fistulae occurred. An emergency open thoracotomy was performed to seal the large bronchopleural air leaks. Anesthesia was maintained with sevoflurane in oxygen and thoracic epidural block (1% mepivacaine). A left-sided double-lumen endotracheal tube was extubated in the operating theater after surgery. The patient subsequently reported improvement in symptoms such as shortness of breath on exertion, and did not require supplementary oxygen.

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A 22-month-old female infant with tracheal stenosis due to pulmonary artery sling is reported. HFJV was applied when ventilation become difficult during operation. The patient was transferred to the intensive care unit and then treated using HFJV postoper-atively. Oxygen toxicity and barotrauma following conventional artificial ventilation could be avoided by using HFJV. We concluded that HFJV is useful for perioperative respiratory management in infants with tracheal stenosis.

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A 20-year-old man was scheduled for sagittal mandiblosteotomy. Prior to admission, he had undergone pharyngeal flap surgery for his persistent cleft palate. Avoiding injury of the pharyngeal flap during anesthetic procedures was therefore necessary. To avoid damaging the pharyngeal flap, nasoendotracheal intubation was performed fiberoptically with the patient awake, and anesthesia was completed uneventfully.

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A 70-year-old woman underwent emergency surgery for a ruptured aneurysm of the right middle cerebral artery. After neck ligation of the aneurysm, papaverine hydrochloride (40mg in 20ml of saline) was administered around the spastic portion of the peripheral middle cerebral artery. At the end of the surgery, hemimydriasis was observed without any other neural complication. Her pupils retured to normal size in 2 hours without visual disturbance. Local intracranial administration of an excessive amount of papaverine was considered to be the cause of transient mydriasis.

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A 74-year-old female with multiple severe stenosis in the aorta due to aortitis syndrome developed congestive heart failure caused by increasing afterload. She received various internal treatments, but her heart failure did not improve, so axillo-femoral bypass was conducted to decrease afterload. During this operation, she was administered vasodilators and catecholamines. Just after the operation, when she was wide awake, left heart failure occurred due to relative volume overload. Furosemide and increasing vasodilators (PGE₁, etc) improved the condition. It may be necessary to continue vasodilator therapy and appropriate preload during perioperative periods for patients with increased afterload due to aortitis syndrome.

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We report here the anesthetic management of intravesical Capsaicin (CS) injection to treat neurogenic bladder in a 24-year-old male with cervical cord injury. Anesthesia was induced with thiopental, and maintained with oxygen-nitrous-isoflurane. After the patient's vital signs became stable, his bladder was filled with normal saline (NS), CS and NS in turn. During the procedure, blood pressure, heart rate and bladder pressure were continuously recorded.
In this patient, there were more serious changes in blood pressure and heart rate due to chemical stimulation with CS injection than due to volume load with NS injection, and 2% concentration of Isoflurane was required to minimize these changes.

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