We evaluated the effects of abdominal wall lift (Group L: n=5) and CO₂ insufflation method (Group G: n=5) on respiratory functions in ovarian tumor patients of ASA physical status 1 or 2 who underwent gynecological laparoscopic surgery.
Group G had significantly higher peak inspiratory airway pressure and end-tidal carbon dioxide pressure, than Group L at 10, 30 and 60 min after insufflating. Group G had significantly higher levels of PaCO₂ from 10 min after insufflating to releasing of Insufflation and significantly higher volumes in one second at 30 and 60 min after insufflation. Moreover, Group G was significantly lower in compliance at 10, 30 and 60 min after insufflation and in pH from 10 min after insufflating to releasing of insufflation.
From these results, we conclude that the abdominal wall lift method is much safer than the CO₂ insufflation method for the management of anesthesia.

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We investigated stress responses during gynecological laparoscopic surgery. After informed consent, 10 adult female patients, ASA physical status I-II, were randomly divided into two groups of 5 each: an abdominal wall lift (L) group and a CO₂ insufflation (G) group. Blood was sampled 7 times, and blood sugar, dopamine, adrenaline, noradrenaline, adrenocorticotropic hormone (ACTH), cortisol, and antidiuretic hormone (ADH) were measured.
Noradrenaline during pnermoperitoneum, ADH 60 min after insufflation, dopamine right after desufflation and blood sugar level at the end of surgery were significantly increased in the G group compared with the L group. In both groups, ACTH and cortisol were signifi-cantly increased during laparoscopic surgery, with no significant difference between the two groups. No significant changes in catecholamines in the L group were observed.
From these results, we conclude that the abdominal wall lift method is physiologically superior to the CO₂ insufflation method.

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Rapid anesthesia induction obtained with combined administration of midazolam and vecuronium followed by a low dose of thiamylal was studied in 300 patients. The patients were divided into three groups (100 patients, each). Group 1 received midazolam 3mg and vecuronium 3mg, group 2 received midazolam 4mg and vecuronium 4mg, and group 3 received midazolam 5 mg and vecuronium 5mg. All patients were administered thiamylal 125mg. Bucking reaction at the time of endotracheal intubation occurred in 39% of group 1, 34% of group 2 and 15% of group 3. Flumazenil was required for reversal of midazolaminduced postoperative hypnosis in 9% in group 1, 11% in group 2 and 16% in group 3. Blood pressure and pulse rate were significantly changed during induction of anesthesia, although the changes were within 20mmHg and 20bpm, respectively.
From these findings, combined administration of midazolam and vecuronium (especially midazolam 4mg and vecuronium 4mg) and subsequent administration of a low dose of thiobarbiturate is suggested to be a reliable technique for rapid and safe induction, regardless of the patient's body weight and age.

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During anesthesia, the state of oxidation reduction (redox state) in the liver may be influenced by many factors such as preoperative starvation, liver blood flow and metabolic malfunction resulting in surgical diabetes.
It is well known that redox state and arterial ketone body ratio (AKBR) correlate to each other. However, acetone, which is one of the ketone bodies, has not been taken into account in previous research due to the difficulty in measuring patients' expired gas.
Therefore, we established a method for detecting acetone in expired gas and found a negative correlation between acetone in expired gas and AKBR.
Finally, we conclude that real-time liver function can be noninvasively assessed during anesthesia by measuring acetone in expired gas.

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We report two anesthetic cases of pulmonary hypertension who were treated with prostaglandin E₁ (PGE₁), dobutamine (DOB), or tolazoline, conversely worsening the pulmonary hypertension.
Case 1 was a 45-year-old female with chronic pulmonary thromboembolism. At the beginning of a total hysterectomy, her mean pulmonary arterial pressure (PAP) was 40mmHg, although cardiac output (CO) was 3.9l/min, and her systemic arterial blood pressure (AOP) was 85mmHg. PGE₁ (0.02μg/kg/min) was administered to treat the pulmonary hypertension. CO increased to 5.3l/min, corresponding with an increase in PAP to 60mmHg, whereas AOP decreased to 50mmHg. These hemodynamic changes were normalized by replacing PGE₁ with nitroglycerin (TNG) (0.5μg/kg/min).
Case 2 was a 28-year-old male with primary pulmonary hypertension. During surgery for subdural hematoma, his PAP and AOP were 60mmHg and 85mmHg, respectively. Administration of DOB (5μg/kg/min) caused an increase in CO to 12l/min as well as associated elevation of PAP (75mmHg). Additional administration of tolazoline (5μg/kg/min) resulted in further elevation of PAP, thus exceeding AOP. These hemodynamics normalized following the discontinuation of the drugs.
It is suggested that PGE₁, DOB or tolazoline exerted a greater effect on increasing CO than on reducing pulmonary vascular resistance in these two cases. The excessive increase in CO overloaded the right ventricle and lead to an elevation in PAP. Careful selection of cardiotonic drugs is needed in the treatment of pulmonary hypertension.

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The fractional contributions of surgical and anesthetic procedures to total hospital income have rarely been calculated from the financial standpoint. This study was conducted to clarify the fractional costs in operating rooms using invoice records of 2, 038 patients in Ibaraki Prefectural Central Hospital during 1995. In accordance with the Cost Regulations of National and Social Health Insurance issued by the Health and Welfare Ministry, the total cost was broken down into costs of surgery, anesthesia, drugs, and specified materials. Their fractional costs were 57%, 17%, 11%, and 14%. The costs of anesthesia climbed to 25% when combined with that of drugs for anesthesia. The fractional cost of surgery (1) and profitabilites (mean cost of surgery per hour (2) and per case (3)) in each department showed large discrepancies: (1) 84 to 33%, (2) 267, 000 to 61, 000yen/hr, (3) 405, 000 to 87, 000yen/case (max to min department), respectively. The costs of drugs and materials, which are regarded as non-profiting, accounted for 30% of the total cost.

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