Continuous warm blood cardioplegia has been reported as a new strategy for better myocardial preservation in adult heart surgery. There are, however, few reports on its application in congenital heart surgery. We compared 17 cases of congenital heart surgery using this new method (warm group) with clinically similar.28 cases using conventional intermittent cold cardioplegia (cold group). Blood levels of creatine kinase of MB isozyme (CK-MB) on the first postoperative day were significantly lower in the warm group than in the cold group (37.3±19 IU/l vs. 495.9±2, 089 IU/l, p<0.01), even though the duration of aortic cross clamp was not different between the two groups. The combined maximum dose of dopamine and dobutamine needed for the intraoperative and postoperative periods was also significantly lower in the warm group (2.8±2.6mcg/kg/min vs. 5.8±2.6mcg/kg/min, p<0.01). These findings suggest that continuous warm blood cardioplegia offers better myocardial preservation during congenital heart surgery. Continuous warm blood cardioplegia also offers a number of advantages, including the possibility to operate on the heart in either a beating of arrested state and to minimize the amount of lysing of adhesions caused by previcus operations.

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We studied the efficacy of a new triple breath vital capacity rapid inhalation induction (VCRII) method which uses 5% sevoflurane in oxygen. The study was performed in 18∼54-year-old ASA class I patients. All patients were premedicated only with famotidine at 20mg per os 90min before the operation. In this triple-breath method, patients take three consecutive breaths, the first two with two seconds of inhalation and one second of exhalation, and the last breath is held at the end of inhalation as long as possible. The mean induction time from the beginning of VCRII to the disappearance of eyelash reflex was 44∼11 sec (mean∼SD). Induction of anesthesia was smooth with no complications such as coughing, laryngospasm, breath holding, or limb movement in any patients. During the induction of anesthesia, blood pressure decreased significantly (p<0.05), while heart rate showed no changes. In conclusion, we suggest that vital capacity rapid inhalation induction with a triple-breath method using 5% sevoflurane in oxygen is a smooth, useful and rapid induction technique in cooperative adult patients.

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Coronary Risk Index (CRI) is a newly invented scoring system designed to predict the morbidity and severity of coronary stenosis which consists of patients' clinical history, ECG, chest X-P and laboratory data (Ishiguro T, et al.: MASUI 44, 1995). We evaluated the efficacy of CRI by comparing its scores with the extent of stenosis obtained from coronary angiography (CAG) performed preoperatively in forty-one patients. CRI scores and the results of CAG showed significant correlation in this study. We concluded that CRI is a useful index for predicting the morbidity and severity of coronary stenosis.

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We anesthetized a patient with suspected primary pulmonary hypertension for cesarean section. The patient's PaO₂ was 28mmHg and she was orthopneic. She was given fentanyl and droperidol intermittently, and dobutamin, amrinone and PGE₁ continuously.
The cardiac performance and volume loading were monitored with trans-esophageal echo cardiography during the operation with successes. The trunk of the pulmonary artery was found to be 5cm I.D., and 2cm thick thrombi were observed.
Before the insertion of a catheter for monitoring pulmonary arterial pressure, we must check for the presence of thrombi in the pulmonary artery and weigh the advantages of this procedure against its risks.

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A 61-year-old female was scheduled for segmental hepatectomy. When a right subclavian central venous catheter was inserted on the day before surgery, she experienced slight shoulder pain. There were, however, no abnormal findings on chest X-ray or any other signs of pneumothorax. Anesthesia was induced with thiopental, fentanyl and vecuronium and maintained with oxygen (50%), nitrous-oxide (50%) and sevofluren. Twenty minutes after the operation was started, oxygen saturation decreased from 99% to 95%, and PaO₂ decreased to 74.5mmHg although the peak airway pressure remained less than 20cmH₂O. The surgeon pointed out bulging in the right diaphragm and suspected tension pneumothorax. Shortly after chest drainage, oxygen saturation returned to 100%. Subclavian central venous cannulation performed on the day before surgery and positive ventilation with nitrous-oxide during surgery might have led to tension pneumothorax. Bulging of the diaphragma into the abdominal surface may be an early warning sign of tension pneumothorax.

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The incidence of vocal cord paralysis following endotracheal intubation was retrospectively studied in Akashi municipal hospital. Ten cases of vocal cord paralysis not originating in surgical procedures (such as thyroidectomies, thoracotomies, craniotomies, etc.) were encountered from April 1988 to December 1995. There were four males and six females aged 34 to 67 years who were intubated from 1.7 to 19.2 (mean 5.8) hours. Eight patients suffered from left side paralysis, and two suffered from right side paralysis. Nine of ten patients recovered within three months but one patient complained hoarseness for one year. We compared these ten patients with 3, 641 others who had been anesthetized with endotracheal intubation during the same period and hospitalized more than two weeks after operation. Among the 3, 641 patients, there was no operative risk of laryngeal nerve injury. Regression analyses showed that the duration of intubation was one of the risk factors for vocal cord paralysis.

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A 77-year-old woman with septic shock due to sigmoid colon perforation underwent direct hemoperfusion with Polymyxin B-immobilized fiber (PMX) and continuous hemodi-afiltration (CHDF) following surgery. Her APACHE-2 score was 32, and her septic severity score was 34. Intraoperative endospecy and toxycolor values were 710.3pg/ml and 740.2pg/ml, respectively. Hemodynamic parameters and the relationship between oxygen demand and supply remarkably improved after PMX therapy. After PMX treatment, we were able to decrease the amount of catecholamines. β-D glucane remained high despite treatment with PMX and CHDF, indicating fungal infection. Because of her history of hypotension due to septic shock and renal dysfunction, CHDF was commenced to stabilize renal function and hemodynamic parameters.We conclude that PMX and CHDF should be considered in patients in whom gram negative bacteremia and hemodynamic instability are suspected despite fluid resuscitation and catecholamines administration.

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An eighty-three-year-old male underwent transurethral resection of the prostate (TUR-p) under spinal anesthesia. Using a core thermometer (Coretemp® ; Terumo CTM-205), "deep" forehead temperature was measured as the core temperature, and "deep" palm and "deep" foot temperature as the peripheral temperatures. During the operation, palm temper-ature declined gradiently, but it rose drastically to the same level as forehead temperature after bottoming out at 34.8°C. Despite the fact that the patient was asymptomatic, serum Na was 99 mEq/l. After hypertonic saline and furosemide were administered, serum Na was 120 mEq/l at the end of the operation. Presumably, the absorption of the warm irrigant transferred heat to the patient's body and elevated his peripheral temperature. The monitoring of core and peripheral temperature was useful for detecting hyponatremia during TUR-p.

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Anesthetic management of thirteen Wilson's disease patients was retrospectively studied. The age range of the patients was 3 to 30 years, and the time range of the anesthesia was 90 to 165 minutes. Anesthesia was mainly maintained with nitrous oxide-isof lurane or nitrous oxide-sevoflurane in oxygen. Muscular relaxation was obtained by vecuronium. Surgery proceeded uneventfully in all patients, and parameters, including liver function, were normal.Based on these results, it may be concluded that anesthesia with isoflurane and sevoflur-ane are a safe choice for patients with Wilson's disease.

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The present study was performed to elucidate the usefulness of TRACHLIGHT^TM as a light-guided nasotracheal intubating device in clinical settings where the use of muscle relaxants are contraindicated. Twenty-five out of 28 cases were intubated with the device, of which 15 cases were in the first trial. Complications during the procedure included migration of the tube tip to either the vallecula, the esophagus or the unilateral laryngeal wall due to contralaterally swollen tonsils. In one case (a 9-year-old boy), the tube migrated to the right main bronchus. Three out of 5 devices used in the study were accidentally broken in a similar manner. Nasotracheal intubation with TRACHLIGHT^TM seems useful in emergency settings such as waking intubation, but the device needs further structural improvement.

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A 28-year-old woman with quadruplets was scheduled for cesarean section. She felt chest discomfort when in a supine position because of a huge uterus. Hypoxemia and hypotension were anticipated if anesthesia was induced in a supine position. We, therefore, induced her anesthesia in a lateral position. After intratracheal intubation in a lateral position, she was set in a supine position. One of the operators maintained continuous left uterine displace-ment to minimize aortocaval compression. As a result, hypoxemia and hypotension did not occur. We used epidural anesthesia with in haled anesthetics because using only inhaled anesthetics may necessitate deepening anesthesia to avoid unfavorable hypertension or intraoperative awareness, and this deeper anesthesia may result in depressed fetuses. Our combination of anesthesia was satisfactory.

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