Total intravenous anesthesia (TIVA) is one of the most recommended anesthetics in respect to the prevention of air pollution. However intermittent administration of anesthetic agents may have a disadvantage concerning the emergence time. As it takes a longer emergence time when inexperienced residents apply TIVA with larger doses of drugs to stabilize vital signs, we suggest a method of TIVA with constant infusion of propofol, ketamine, pentazocine and vecuronium (PKPz).
In this study, we compared the emergence times of subjects who underwent general anesthesia with PKPz. After induction with propofol (2mg•kg-1), ketamine (0.5mg•kg-1), pentazocine (0.6mg•kg-1) and vecuronium (0.1mg•kg-1), the subjects were maintained with continuous intravenous administration of Propofol (2-10mg•kg-1• h-1), ketamine (240•g•kg-1•h-1), pentazocine (120μg•kg-1•h-1) and vecronium (80mg•kg-1•h). The emergence time was evaluated by Op time (the end of operation to awareness), Pr time (the time propofol was stopped to awareness), and An time (pentazocine cut-off to awake-awareness).
The emergence time of Op was 7.5±5.4min, Pr was 8.3±5.8min and An was 23.8±6.8min. Elder patients took more An time than the younger ones. The patients under anesthetic for a long time took more An time than the shorter time. No patients had recall or a bad dream during anesthesia.
We concluded that TIVA with constant infusion of PKPz is a useful anesthetic technique from the view of emergence time and the prevention of air pollution. Patient's age and the anesthetic time influence emergence time from the end of drugs infusion.

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Although it has been in several studies documented that the use of epidural analgesia increased maternal temperature during labor, it is controversial whether it may adversely affect the fetal outcome. In this study, we evaluated the effect of epidural bupivacaine concentrations on maternal axillary temperatures during labor, we reviewed 1, 532 consecutive deliveries under epidural analgesia and 61 parturients with the induction-delivery time over 8 hours were enrolled retrospectively. The temperatures were studied according to the concentration of bupivacaine injected into the lumbar epidural space; 0.125% bupivacaine with fentanyl, 0.375% or 0.5% bupivacaines respectively. Temperatures increased significantly, about 1°C at 8 hours after the establishment of epidural analgesia compared with baseline values irrespective of the bupivacaine concentration and were restored next morning after delivery. Incidence of maternal pyrexia (_??_38°C) was 35-47%, however, no clinical evidence of infection was noted. Further studies are needed to clarify the clinical significance of maternal fever.

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We investigated the effectiveness of epidural administration of droperidol for postoperative nausea and vomiting (PONY) and pain in thoracic surgery.
Seventy-five ASA physical status I or h patients undergoing thoracic surgeries under general anesthesia with epidural analgesia were divided into three groups. In the bolus administration group (n=25), droperidol (1.5-3mg) was administered at the end of the surgery. In the continuous administration group (n=25), following the bolus administration of the same dose of droperidol, 0.12-0.2mg•h-1 of droperidol was continuously administered for 48h. In the control group, none was epidurally administered. In all three groups 0.25% bupivacaine (1ml•h-1) and 2-12μg•h-1 of buprenorphine were epidurally administered during the postoperative 48h. In these three groups, we investigated the occurrence of PONY, pain complaints, the need for additional antiemetics and supplemental analgesics for 48h. Total incidence of PONY was 56% in the control group, 28% in bolus group and 4% in the continuous administration group. The need of analgesics was the least in continuous administration group. In conclusion, continuous epidural administration of droperidol decreased not only PONY, but also the need for analgesics.

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Intervertebral epidural blocks were performed in 1, 287 patients under the age of 16 years during 1980-1995. The patients' ages ranged from 5 months to 15 years 9 months and weights from 6.51 to 89.5kg.
Complications included dural puncture in 17 patients, blood reflux in 5, suspected local anesthetics toxicity in 4, and epidural abscess in 1. Neither total spinal block nor neurological damage were noted.
A 20-gauge Tuohy needle was used in 10 of the 17 dural punctures. The high incidence of dural puncture in these cases may be related to the unskilled handling of this size of needle.
The epidural abscess occurred in a patient suffering from herpes zoster. The abscess might have been due to insufficient sterilization of the skin around the epidural catheter.
In this case, laminectomy and drainage were needed but the patient was discharged without any neurological sequelae. As the number of cases of pediatric intervertebral epidural anesthesia has increased rapidly in recent years, procedures should be carried out carefully and prudentially.

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An 81-year-old woman was admitted to our hospital and diagnosed with Guillain-Barre syndrome. She was immediately intubated with a tracheal tube and given artificial ventilation. We started her respiratory training with the ON and OFF method when she began to breathe spontaneously after 3 months of CPPV. We measured her respiratory functions with a respiratory monitor and diaphragmatic movements with ultrasonography (USG) . Duration of the ventilator's "OFF" mode was gradually prolonged and she was completely weaned from the ventilator after 9 months. Degree of recovery in respiratory muscles was different among the components of the respiratory system and USG was useful for monitoring the diaphragmatic movements separately. It was difficult to assess respiratory muscle fatigue from a variety of her respiratory patterns but it seemed that end-tidal CO₂ was a more reliable indicator of muscle fatigue.

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This case is of a patient who underwent sigmoidectomy for colon cancer under general plus thoracic epidural anesthesia. His post-operative course was uneventful until the next day when paralysis and hypesthesia occurred in his right lower leg in the evening. The CT and MRI revealed multiple spinal bone metastasis of cancer. The spinal bone metastasis were thought to be the cause of this neurological disturbance because the patient had pain in his right and left limbs afterwards. As spinal bone metastasis in patients with colon cancer is rare, preoperative bone scanning is seldom conducted. But attention had been paid to bone metastasis in patients suffering from colon cancer with metastasis to other organs. We should keep in mind that spinal bone metastasis is one of the causes of neurological disturbance when neurological disturbance of lower limbs occurs after an operation for colon cancer with metastasis to other organs.

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A54-year-old male with an undiagnosed extra-adrenal pheochromocytoma and unstable angina was treated uneventfully with an aortocoronary bypass grafting at first and with an operation of the resection of the tumor thereafter. Anesthesia for the coronary surgery was performed with propofol and fentanyl. To control hypertension during the operation, nicardipine and prostagrandin E₁ were infused. After the coronary bypass surgery, blood chemistry and MIBG synchigraphy revealed a retroperitoneal pheochromocytoma. Anesthesia for the resection of the pheochromocytoma was performed with propofol and epidural anesthesia. There were no cardiac ischemia and arrhythmia during the two operations. The advantages of propofol anesthesia for these operations are stated in this paper.

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The purpose of this study was to test the newly developed humidifier HUMMAX^®, by Metran Corporation Japan, that has mesh-like holofibers covering a heating wire without a water chamber. Water is supplied through the holofibers. Methods: Temperature, absolute humidity (AH), and relative humidity (RH) were measured at the exit of the inspiratory limb of HUMMAX^® under a unidirectional constant flow (10, 20, 30l•min-1). The temperature settings were 35, 37, and 39°C and the heating wire outputs were 20, 26, and 30V. Results: Although gases were above 85% RH and 32mg• l-1 AH in all settings, RHs were slightly lowered at a heating wire output of 30V. Discussion: As water is supplied into the holofiber and vaporized according to the temperature set by the heating wire, the high RH is consequently assured at any temperature. The AHs observed here almost satisfied the ISO's minimum criterion of 33mg•l-1. Conclusion HUMMAX^® had sufficient performance capability in supplying high RH (91-99%) and AH (35-44mg•l-1) at 26V of heating wire electrical output.

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Surgical procedures can be delayed and canceled because of inadequate preoperative assessment and preparation. In order to prevent such inappropriate patient care, we evaluated whether our preanesthetic clinic worked properly. We describe here the pattern of case referrals and the efficiency of our consultation clinic. Data were collected retrospectively of 432 patients at Keio University Hospital from September 1996 to February 1997. The majority of referrals were regarding patients undergoing otolaryngological, orthopedic, general surgical, or obstetric and gynecological procedures, and the distribution for these four departments was 67.4%. The primary reason for referral was related to the cardiovascular involvement in 34%, respiratory involvement in 19%, and endocrine involvement in 12% of referral cases. Eighty-eight percent of referrals were considered as appropriate, while the remaining 12% of consultations seemed inappropriate, including almost healthy patients, or the patients without enough data for appropriate preoperative evaluation. In order to make the preanesthetic consultation clinic more effective, we plan on a guideline for preoperative evaluation. We believe that this new system of the consultation clinic should be established for better perioperative management, including education of surgeons regarding preoperative patient care.

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