We investigated the effects of sevoflurane anesthesia and prostaglandin E₁ infusion on estimated hepatic blood flow by detecting the indocyanine green (ICG) clearance rate using the finger-piece method. Sixteen patients scheduled for arthroscopic knee surgery were randomly divided into two groups, an S-group (n=8) and a P-group (n=8). The eight patients in the S-group received only anesthesia of N₂O-O₂-1.7% sevoflurane, while the eight patients in the P-group received the same anesthesia and the intravenous drip administration of 0.05μg•kg-1•min-1 of prostaglandin E₁, simultaneously. The ICG clearance rate and cardiac output (CO) were measured before anesthesia and two hours after the start of anesthesia in both groups using the impedance method. The ICG clearance rate declined to 63% and CO decreased to 71% of the baseline values in the S-group. In the P-group, however, they were maintained at 91% and 100%, respectively, and were significantly higher than in the S-group. The results of the present study indicate that the administration of a small dose of prostaglandin E₁ during sevoflurane anesthesia has a protective effect of hepatic circulation probably by maintaining CO, whereas sevoflurane anesthesia alone decreased CO and estimated hepatic blood flow.

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We report two cases of circulatory collapse caused by retroperitoneal hemorrhage due to vascular injuries during laparoscopic surgery.
Case 1. A 47-year-old female underwent laparoscopic oophorocystectomy. A sudden circulatory collapse with an abrupt drop in end-tidal CO₂ occurred during insertion of a trocar. Although clinical signs suggested pulmonary emboli with CO₂, the cause of circulatory collapse was an injury to the left common iliac artery. Hypotension was treated successfully by inotropics and blood transfusion. Open laparotomy was performed and a 6, 000ml blood loss was observed.
Case 2. A 67-year-old male underwent laparoscopic partial gastrectomy. A sudden circulatory collapse occurred at the T-bar insertion to lift the stomach. Retroperitoneal hemorrhage around the aorta was found under direct vision. Hypotension was treated successfully by inotropics and blood transfusion.
In both cases, significant bleeding could not be identified through laparoscopy because blood mainly accumulated in the retroperitoneum.
We should take notice of retroperitoneal hemorrhage as a cause of circulatory collapse during laparoscopic surgery.

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