To place a catheter to the central vein(CV), we devised and investigated a new puncture technique of the distal femoral vein by using ultrasound guidance. Positions of the femoral artery and vein, distance from the skin to the vein, the time required for the catheterization and incidence of complications due to catheterization were investigated. After the induction of general anesthesia, the femoral vein was punctured by a staff anesthesiologist who was familiar with standard femoral venous access methods. The distance from the inguinal ligamentum to the actual puncture site was 12.5±2.2 cm (mean±SD), and the depth from the skin to the vein at the puncture site was 2.4±0.6 cm (that of at the inguinal region was 1.6±0.4 cm). The femoral arteries were overlying on the femoral veins at the puncture site in all patients. The time required for the catheterization was rapidly decreased after the first three cases. Another operator who had been instructed by the staff anesthesiologist could acquire this technique in a shorter period. This new technique was easy to be mustared and no complication was occured. This new technique of CV access may be useful in practice.

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the changes in phosphoenergetic state and intracellular pH(pHi) of skeletal muscle of two male malignant hyperthermia-suspected patients and four healthy volunteers were measured using ³¹P nuclear magnetic resonance (NMR) spectroscopy. The phosphoenergetic state was evaluated from the changes in phosphocreatine (PCr) and inorganic phosphate (Pi) levels. pHi was caluculated from the chemical shifts between Pi and PCr. The spectrum of all persons were not different in the rest condition. However, the phosphoenergetic metabolism of CHCT-positive patient was remarkably decreased during and after exercise compared to those of CHCT-negative patient and of the healthy volunteers. Intracellular acidosis were prominent in CHCT-positive patient. NMR spectroscopy provides real-time informations about phosphoenergetic metabolites in a non-invasive manner. These results suggest that NMR spectroscopy of skeletal muscle might be an effective examination to diagnose predisposition of MH

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We anesthetised cardiac surgery for replacement of mitral valve replacement and coronary artery bypass graft surgery with endovascular cardiopulmonary bypass system, Heartport System^TM. The Heartport system^TM is composed of 5 main cannulae and catheters, endoarterial return cannula, endovenous drainage cannula, endovascular aortic clamp catheter, endovascular pulmonaryy artery vent and endovascular coronary sinus catheter.
The anesthesia was induced by fentanyl and maintained with isoflurane oxygen air anesthesia. After the endotracheal intubation with Bronchocath^TM, they were inserted coronary sinus catheter, central venous catheter, pulmonary artery vent from internal jugular vein. The placement of the coronary sinus catheter was confirmed by transesophageal echography and angiography.
A common femoral artery and vein were cannulated for femoro-femoral cardio-pulmonary bypass. The surgical procedures were performed under endoscopic surgery, deflating one lung.
Cardioplegia was infused through the coronary sinus catheter or from the tip of the arterial cannula placed in the ascending artery by occluding the balloon.
After that the surgical procedures were almost the same as that of conventional cardiac surgery by femoro-femoral cardiopulmonary bypass.
Cardiac surgery with this system reduced some invasion for the patients by minimizing the surgical woonds, blood loss, infection, post operative pain.
We anesthesiologists have to do one lung ventilation, insert three canulae for endovascular cardiopulmonary bypass. It took more time to begin the surgery than the conventional procedure; The time to start surgery must be shortened. We have to pay attention to anatomical difference from patient to patient for the placement of coronary sinus catheter. Cardiac surgery under this endovascular cardio pulmonary bypass reduced surgical woonds, invasion and relieved postoperative pain and is beneficial for the patients.

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We present the anesthetic management of a patient with depression of bone marrow elements due to neoadjuvant chemotherapy. A 70-year-old woman was scheduled for resection of carcinoma of the bucca. We took part in the preoperative treatment because she had anemia, neutropenia and thrombocytopenia. Two units of erythrocyte concentrate, GCSF 150μg and 10 units of platelet concentrate were administered preoperatively. Following recovery of her bone marrow depression, she underwent surgery. Anesthesia was maintained with isoflurane, midazoram and fentanyl, without the nitrous oxide which induced the depression of bone marrow elements. The intraoperative and postpoerative courses were uneventful. We conclude that anesthesiologist should take part in preoperative treatment for depression of bone marrow elements due to neoadjuvant chemotherapy and decision a schedule of operation.

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A 84-year-old woman underwent femoral neck prosthetic replacement for the left femoral neck fracture. Anesthesia was maintained with nitrous-oxide and sevoflurane in oxygen. Immediately after bone cement was injected into the femoral canal and the implant was inserted, the patient became hypotensive and cardiac arrest ensued. The patient was successfully resuscitated, but the cardiovascular status remained unstable and large doses of epinephrine and dopamine were needed to maintain blood pressure. Her circulatory status gradually deteriorated despite of aggressive intervention, and she eventually died 9 hours after the cardiac arrest. Postmortem examination revealed massive pulmonary embolism of bone marrow and fat, while no evidence of an acute myocardial infarction was found.

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