Bronchoscopies performed in the conscious state cause extreme discomfort in patients with respiratory and/or circulatory complications.
Recently, the laryngeal mask airway (LMA) was developed to circumvent this problem, the prevailing method being to secure the airway under general anesthsia. We have used LMA in 86 patients who underwent bronchoscopy under general anesthesia with controlled ventilation. Breath-holding, bucking, laryngospasm, laryngeal edema, airway obstruction and increase in P_ETCO₂ were observed in a few patients. The surgeons in charge reported that LMA provided a superior view from the larynx to the upper trachea compared to tracheal intubation. We consider LMA to be a useful anesthetic method for bronchoscopy.

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We evaluated the protective effect of prostaglandin E, (PGE₁) on hepatic circulation during cardiopulmonary bypass (CPB) in 17 patients scheduled for elective aortic valve replacement. Effective hepatic blood flow was measured by detecting the plasma clearance rate of indocyanine green (KICG) using the finger-piece method. Patients were divided into two groups: a control group (without PGE₁) and the PGE₁-treated group (PGE₁ 0.025μg•kg^-1•min^-1 was administered intravenously from the start of CPB). The mean value of KICG decreased significantly, by 59.9%, in the control group and decreased by 33.7% in the PGE₁-treated group. As the KICG value has been believed to represent hepatic blood flow, our results suggest that administration of PGE₁ during CPB maintains hepatic blood flow and protects hepatic function.

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We experienced anesthetic management of a bronchial foreign body in a 10-month-old infant using the laryngeal mask airway. At first, we tried to remove the foreign body using a rigid ventilation bronchoscope. However, the foreign body was in the left upper lobe bronchi, which could not be reached by the rigid bronchoscope.
Therefore, we decided to employ a flexible fiberoptic bronchoscope for removal of theforeign body while ventilation was supported by the laryngeal mask airway.
After anesthesia was induced with thiamylal and maintained with oxygen and sevoflurane, a size-2.5 laryngeal mask airway was inserted. The flexible bronchoscope was inserted through the laryngeal mask airway but could not be advanced to the foreign body because of stenosis in the left main bronchus.
Therefore, we tried a 1.8mm-external-diameter flexible bronchoscope with extraction forceps, resulting in successful advance into the left main bronchus and removal of the foreign body.
Because of the relatively widediameter of conventional endotracheal tubes, the use of the laryngeal mask airway for fiberoptic bronchoscopy should be considered in infants.

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Blood products are usually transfered by sea to Hyogo Prefectural Awaji Hospital, which is located on Awaji Island. In order to use the blood products more effectively, we introduced our Maximum Surgical Blood Order Schedule (MSBOS) and Type & Screen (T&S) in June, 1994. These improved our C/T ratio from 3.1 before introduction to our current 1.5. The Great Hanshin-Awaji Earthquake on January 17, 1995 destroyed the blood transport system in this area, and the Japanese Red Cross Hyogo Blood Center could not supply any blood products to our hospital. But thanks to MSBOS and T&S and the support of other prefectural blood centers, we had no shortage of blood products following the disaster. Though MSBOS and T&S have many advantages, they should not be introduced until all medical personnel thoroughly understand the blood transfusion system in the hospital. It is especially important to ensure a variety of supply routes for blood products in case of disasters such as the Great Hanshin-Awaji Earthquake.

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During operations under general or spinal anesthesia, blood transfusions were performed in 6.2% of cases, and among them 44% received autologous transfusions. Thirty-three percent of homologous blood transfusions were carried out during emergency operations. The homologous transfusions were used in cases of older patients with lower hematocrit (Ht) values and lower body weights. During surgery, the transfusion was started when either Ht dropped to 27% or the amount of bleeding exceeded 600ml, and the Ht value at the end of the operation was 30-32%. Among the cases who received autologous transfution during surgery, 20% received postoperative homologous transfusion. Homologous transfusion should decrease with the general advance of autologous transfusion and with change in blood transfusion criteria.

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A 16-year-old female with fibromuscular dysplasia (FMD) underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. Her pulse was weak and her peripheral arteries tended to occlude. Blood pressure and waveform were therefore continuously monitored by arterial tonometry to avoid intraarterial cannulation during anesthesia, and the procedure was completed without complication. Arterial tonometry was useful for monitoring blood pressure and waveform in a case of FMD.

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We experienced a case of membranous tracheal damage in transhiatal (blunt) esophagectomy without thoracotomy. We tried to advance the endotracheal tube into the bronchus, but could not. Hence, the damaged portion was closed up to ventilate the lungs by surgeon's fingers and then gauze. After repositioning for right thoracotomy, ventilation was failed again because the gauze on the damaged portion slipped off and we had not advanced the endotracheal tube into the distal bronchus. 100% oxygen flush-flow had been given to the patient until the thoracotomy was finished, it is essential that a endotracheal tube be advanced into the distal trachea or bronchus when a tracheal injury occurs.

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A 14-year-old girl was scheduled to have a hemangioblastoma of the right cerebellar hemisphere removed. She was placed in a prone position without difficulty following induction of anesthesia. The operating table was reset with rightward rotation. Minor difficulties occured with the use of both arterial and venous catheters in the left upper arm, but these events did not appear to be significant. When she was subsequently turned to the supine position after the operation, we discovered extensive swelling of her upper left arm. The edema in her arm improved without complication with palliative treatment alone. Physical examination subsequently revealed a slightly positive Halsted's test, which is used to diagnose thoracic outlet syndrome. We believe that the obstruction of venous return from the upper left arm was caused primarily by thoracic outlet syndrome and the rightward rotation of the operating table during anesthesia in addition to her prone position. Body position during anesthesia and the particular features of each patient are important factors to consider in attempting to prevent complications during anesthesia.

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