In the past 17 years, we treated 817 cases of facial palsy in our clinic, including 57 cases (7.0%) of recurrent facial palsy. There was no sex predominance. Eighteen of these 57 patients had homolateral palsy, 33 had contralateral type and 6 were of unknown type. The intervals between the first and 2nd onset of facial palsy ranged from 7 months to 32 years, and facial palsy in about 50% of cases recurred within 5 years. The peak age at the onset of palsy was 40-59 years, and the recurrent peak age was 40-69 years. Incidence of family history of facial palsy was 10.5% in patients with recurrent facial palsy and 5.8% in patients with nonrecurrent palsy. Respectively, incidence of hypertension, liver dysfunction and diabetes mellitus was 19.3%, 8.8% and 7.0% in patients with recurrent facial palsy and 10.7%, 1.7% and 5.5% in patients with nonrecurrent palsy. In our opinion, the etiological factors of recurrent facial palsy include a genetic factor, hypertension and liver dysfunction.

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We measured plasma concentrations of mepivacaine in 32 pediatric patients who were administered postoperative-epidural analgesia after epidural anesthesia. A continuous infusion of 1% mepivacaine was initiated at a rate of 0.2ml/kg/hr (maximum 8ml/hr) for postoperative analgesia. Blood samples were taken before starting infusion and 6, 18, 24 and 48 hrs thereafter. Concentrations of mepivacaine at each time point were 3.2±0.9μg/ml (n=32), 2.0±0.6μg/ml (n=22), 2.4±0.5μg/ml (n=23), 2.6±1.3μg/ml (n=9) and 2.7±1.5μg/ml (n=7). Concentrations of mepivacaine in blood samples at 6hrs were significant-ly lower than those taken before infusion, and plasma levels increased gradually thereafter. mepivacaine remained below the toxic level at all timepoints.

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We compared left ventricular function using transesophageal echocardiography (TEE) in 11 patients undergoing laparoscopic cholecystectomy (LSC) inflated by carbon dioxide (inflation group) and 9 patients undergoing LSC by abdominal wall lifting (lifting group). The TEE probe was inserted after anesthesia induction and anesthesia was maintained with nitrous oxide-oxygen-isoflurane. We measured blood pressure, heart rate, stroke volume (SV), left ventricular ejection fraction (EF), E wave velocity, A wave velocity and A/E ratio by TEE at the following time points, after induction, after gas inflation (abdominal wall lifting), after head-up position, 30min after inflation (lifting), and 10min after deflation (falling).
Inflation in groups SV and EF significantly decreased compared to control values and the lifting group during inflation and head-up position. A/E ratio significantly increased compared to control values and the lifting group 30min after inflation. The simple regression coefficients between SV and A/E ratio were -0.451 (p<0.01) in the inflation group and -1.191 (p=0.2099) in the lifting group. A though many factors (eg. carbon dioxide, reduced venous return etc.) affect cardiac function in LSC, in this study we suggest that LV diastolic dysfunction during carbon dioxide inflation LSC may contribute to the reduction of SV.

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We compared the cephalad spread of analgesia using two methods of combined spinal epidural anesthesia (CSE) for cesarean section (c-section). All patients receiving CSE had good analgesia. Although patients receiving epidural injection just after spinal anesthesia had significantly higher cephalad spread of analgesia than patients receiving epidural injection 10min after spinal anesthesia, cephalad spread of analgesia after epidural injection was almost the same in both groups. There were no significant differences in the incidences of hypotension, nausea and dyspnea between groups. In conclusion, epidural injection just after spinal anesthesia is safe and preferable in c-section.

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Abnormal movements, posturing and frank seizure activity have been widely reported in association with propof of anesthesia.
We report one case of seizure at the end of propofol anesthesia.
A 24-year-old woman (weight 50kg) underwent thyroidectomy for Basedow's disease. She had no history of epilepsy. She received fentanyl 200μg, propofol 80mg and vecuronium 8mg for induction of anesthesia. Anesthesia was maintained with propofol (total 1, 010mg), nitrous oxide 50% in oxygen and fentanyl (total 500μg). At the end of surgery, nitrous oxide and propof of were discontinued. Atropine sulfate and neostigmine were administered intravenously to reverse neuromuscular blockade. As she opened her eyes and could maintain adequate spontaneous ventilation, the tracheal tube was extubated. After a few minutes, she developed tonic-clonic seizures for about one minute. Seizure recurred three times over the course of ten minutes. The seizures stopped without treatment. An electroen-cephalograph performed after surgery was normal.

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A 3.5-month-old infant girl developed severe lobar emphysema in the middle and lower lobes of the right lung after repair of right congenital diaphragmatic hernia. She was ventilated with high frequency oscillation plus intermittent mandatory ventilation. Pulmo-nary function, however, deteriorated, and PaO₂/FIO₂ went below 80mm Hg while PaCO₂ went above 100mm Hg. She was scheduled for right middle and lower lobectomy. We used extracorporeal lung assist (ECLA) with a heparin-bonded membrane lung intra-and postoperatively. Heparin was administered with an initial dose of 80 units•kg^-1 and a maintenance dose of 11∼22 units•kg^-1•h^-1 to maintain activated clotting time at 120∼140 sec. Normal blood coagulation was maintained during the course of ECLA. Pulmonary vessels were inadvertently severed during lobectomy, and massive amounts of blood flowed into the healthy left lung. Pulmonary gas exchange was severely disturbed, and most of the O₂ supply and CO₂ elimination were performed with an artificial membrane lung. Perioper-ative use of heparin-bonded ECLA proved to be essential to sustaining the life of this patient.

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We reported the anesthetic management of a 64yr-old-male patient during pulmonary resetion associated with intraoperative asthmatic attack. We continuously monitored PaO₂ and PaCO₂ using an intravascular blood gas monitoring system (Paratrend 7TM, Biomedical Sensors Co.). Although ETCO₂ remaind constant, PaO₂ declined and PaCO₂ increased imme-diately. We treated the asthmatic attack while monitoring PaO₂ and PaCO₂, and the operation was completed successfully. This method of monitoring offers advantages over blood gas analysis and transcutaneous oxygen saturation monitoring because it measures the absolute values of PaO₂ and PaCO₂ continuously.

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The mechanisms and effects of severe hypoxemia in the early postoperative period have been well documented and intensive care is routinely extended to the first to second postoperative days with adequate monitoring. Less well recognized and consequently less appreciated, however, are the effects of severe oxygen desaturation in the late postoperative period which is called episodic hypoxemia because of its on and off nature. Episodic hypoxemia occurs in association with an abnormal sleep pattern in which intense REM sleep or"REM rebound", reappears and is often accompanied with apnea in the second to fourth postoperative nights following the disappearance in the first night. Although the desatura-tion usually lasts less than two minutes, it frequently repeats and the total time of oxygen desaturation may occupy 80% of night sleep. This new type of hypoxemia has been implicated in severe postoperative complications such as myocardial infarction and delir-ium. All clinicians involved in postoperative care need to recognize the problem and should try to identify the patients at risk for whom appropriate monitoring and oxygen therapy may well be provided.

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