We evaluated the validity of Cole's formula (tube size=age/4+4) for the prediction of endotracheal uncuffed tube size, and devised a new formula, the multiple regression formula for predicting the most appropriate size with a statistical method using age, height and weight of 604 pediatric patients. In 96 cases the tube size actually used deviated by 0.5mm or more from the tube size predicted by Cole's formula. The multiple regression formula between tube size and two combined factors, age and height, was "tube size=0.101×age+0.023×height+2.487". These two combined factors showed the highest correlation coeffi-cient (r=0.879) with the actual tube size. The actual tube size deviated by 0.5mm or more from the tube size predicted by this multiple regression formula in 71 cases. The difference in number between the 71 cases and the 96 cases is significant. We conclude that this multiple regression formula is more useful than Cole's formula for the prediction of uncuffed endotracheal tube size.

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We evaluated the effects of human atrial natriuretic peptide (hANP) on the recipients of living-related kidney transplantation. Anesthesia was maintained with epidural me-pivacaine and nitrous-oxide and isof lurane in oxygen. The recipients were divided into two groups: the hANP group (n=6) received continuous infusion of hANP (0.13μg/kg/min.), the control group (n=6) received no hANP infusion.
Intravenous hANP infusion was started at the loading time of fresh frozen plasma with the recipients until the end of the operation.There were no differences between the groups with regards to age, height, body weight, changes in heart rate and mean arterial pressure. The hANP group showed significant increases in the cardiac index, urine volume and decreases in the values of central venous pressure and pulmonary capillary wedge pressure compared with the control group. We concluded that continuous i.v. hANP infusion in the recipients of living-related kidney transplantation was useful for sufficient urination and prevention of heart failure of lung edema.

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We report nine patients (four with mitral valve disease, three with aortic valve disease, one with atrial septal defect, and one with left atrial myxoma) who underwent minimally invasive cardiac surgery.
The minimally invasive surgery is characterized by the avoidance of full sternotomy and the minimal operative incision. In our cases, this approach provided less incisional pain and hospital stay, but needed a longer period of cardiopulmonary bypass compared to the traditional surgical technique. The advantages of this approach include less postoperative discomfort, earlier mobilization and discharge.
We experienced two cases that demonstrated complications with this approach. This approach provides limited surgical access, which may cause a prolonged cardiopulmonary bypass period, and hinder control of bleeding or arrhythmias, especially in emergency situations. Defibrillator-pacemaker pads that allow for defibrillation, cardioversion and pacing are recommended. The limited surgical exposure can also prevent the surgeon from adequate evacuation of intracavitary air. Therefore, intraoperative transesophageal echocardiography is required to assess intracardiac air removal. In addition, the anesth-esiologist can not directlty observe left ventricular contractility and filling, thus transeso-phageal echocardiography is essential and useful for the separation from cardiopulmonary bypass.

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We evaluated the usefulness of prophylactic diltiazem on the incidence of intraoperative myocardial ischemia in patients with known or suspected coronary artery disease who underwent noncardiac surgery. Patients were randomly assigned to either a control group (n=7), a group to receive 1μg/kg/min (D1, n=12) or one to receive 2μg/kg/min (D2, n=13) of intravenous diltiazem. Diagnosis of myocardial ischemia was based on electrocardio-gram recording and scoring of segmental wall motion abnormality (SWMA) at the left ventricular short axis view by transesophageal echocardiography (TEE).
Arterial pressure and heart rate did not change in the three groups. Myocardial ischemia occurred more frequently in the control group than the D1 and the D2 groups. Intraoper-ative average score of SWMA in the control group worsened significantly than the preoper-ative value. Among the three groups, the score of SWMA in the control group worsened than those of the D1 and D2 groups. There was no significant difference in the intraoperative scores of SWMA between the D1 and the D2 groups. Left ventricular ejection fraction (LVEF) decreased in the D1 and the D2 groups compared with the preoperative values. The LVEF of the D2 group decreased more rapidly than the D1 group during the intraoperative period.
In conclusion, the administration of diltiazem prevented the intraoperative myocardial ischemia in these patients. and a dose of diltiazem 1/μg/kg/min infusion is better than 2μg/kg/min in maintenance of the LVEF.

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We described repeated septic shock after endoscopic lithotripsies and extracorporeal shock wave lithotripsy (ESWL) for a stagharn calculus in a patient with dilated car-diomyopathy. A 47-year-old woman with bilateral infected staghorn caliculi underwent percutaneous nephrolithotomies (PNL) three times, transureteral lithotripsy (TUL) once, and ESWL nine times. For these procedures, anesthesia including general, epidural, and spinal anesthesia was successfully performed five times under monitoring with a pulmonary arterial catheter or a central venous catheter. Although there were no intraoperative complications, circulatory collapse developed three times after the surgeries;PNL under general anesthesia, ESWL nder epidural anesthesia, and TUL under spinal/epidural anesthesia. Endoscopic lithotripsy and ESWL have made treatment of urinary tract stones possible for patients in poor condition, but we should remember that septic shock is a serious complication when it occurs.

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The authors descrive three patient with postoperative transient common peroneal nerve palsy, who received surgery in the supine position. All three patients were discharged within 3 weeks after surgery without any neurological disorder. We suspected an intraoperative overstretch of the knee joint as the main cause of the peroneal nerve palsy. We have inproved the intraoperative fixing state of the knee joint by putting a sponge pad beneath the thigh instead of the knee joint and by applying a surrounding belt a little loosely on the thigh or the leg but not on the knee joint. Since then we have not seen peroneal nerve palsy after surgery in the supine position.

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We describe two cases of cardiac arrest due to hyperkalemia following transfusion of irradiated packed red cells. Case 1: Because sudden, rapid and massive hemorrage occurred in a 69-year-old male patient undergoing the left lobectomy of the liver, 8 units of irradiated packed red cells were rapidly transfused, the patient developed cardiac arrest. Serum kalium concentration after transfusion was 7.6m Eq/l. Case 2: A 7-month-old girl scheduled for closure of a ventricular septal defect, developed cardiac arresst due to hyperkalemia at the start of cardioplumonary bypass. The extracorporeal circuit was primed with 6 units of irradiated packed red blood cells. Serum kalium concentration immediately after the start of cardiopulmonary bypass was 10.6m Eq/l. Analysis of kalium concentration in the pilot tubes of the same packs revealed 56∼61m Eq/l. These case reports suggest that fresh irradiated packed red cells should be transfused during massive bleeding and for pediatric patients to prevent severe hyperkalemia.

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We experienced 2 cases of ventilatory disturbances which suddenly occurred following the use of a Jackson-Bees circuit combined with a heat and moisture exchanger (HME). In the first case, ventilation was immediately disturbed after an HME was connected to the anes-thesia circuit. Simultaneously, hypotension and bradycardia were observed, and the patient's neck began to swell. Pneumothorax was found via a chest X-Ray examination after su-rgery. In the second case, the similar ventilatory disturbance occurred when an HME was connected to the anesthesia circuit. The anesthesiologist found that the tjp of the fresh gas-line of the Jackson-Rees circuit was tightly stuck to the port of the HME, therefore, the patient's expiration was completely blocked. This similar obstruction also most likely induced ventilatory disturbance in the first case.

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A 72-year-old male, 45kg in weight, underwent anterior and posterior fixations of the lumbar vertebra. Preanesthetic blood chemistry was within normal range. Following trans-fusion of 400ml of RC-MAP in two hours (11 days after blood collection and 2 days after irradiation at a dose of 20Gy), and then another 100ml of 400ml RC-MAP (12 days after blood collection and 2 days after irradiation at a dose of 20Gy), the patient's serum kalium value increased from 4.8 to 5.5mEq/l. Even though the transfusion was immediately discontinued, the level continued to rise to 6.0mEq/l. It subsequently fell to the normal level with glucose-insulin therapy.
The hyperkalemia in this case could have been attributable to the period of storage after irradiation, the transfusion of salvaged autologous blood, and the storage state of RC-MAP.However, since the kalium values of RC-MAP and the salvaged autologous blood were not measured in this case, the exact cause was unknown.
In conclusion, hyperkalemia can occur in patients during transfusion of irradiated blood.Therefore, kalium levels should be monitored carefully.

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