Heat and moisture exchangers (HME) are used to prevent a loss of heat and moisture in the anesthetized patients. We compared the efficiency of HME (Gibeck Humid-Vent 1 Port, Gibeck Humid-Vent Filter Compact, DAR Hygrobac "SM", PALL HME 15-22, PORTEX FILTERD HEAT & MOISTURE EXCHANGER). Gibeck Humid-Vent Filter Compact is most efficient in maintaining temperature and humidity in inhaling anesthetic gas. However, the measured values were lower than the ideal values (airway temperature 32-34°, humidity 30-35mg•l^-1), suggesting that the ability of available HME has limitation.

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There are three types in traumatic diaphragmatic hernia (DH), that is acute, chronic, and obstructive phase. We reported three different types of DH. In acute type, pen-operative management was very difficult for flail chest, pulmonary injury and multiple organ dysfunction. In chronic type, there was gastrointestinal symptom, namely ileus and strangulated hernia. We paid attention to the aspiration pneumonia, but it was difficult to fix the double lumen intubation tube. The thoracic abscess and sepsis that were secondary to the intestinal necrosis were severe complications in obstructive type. The re-operation for incomplete intestinal suture was needed in our this type. During the operation of these three cases, the respiratory distress and circulatory failure due to the prolapse of abdominal organs into thoracic cavity was the main patho-physiological change. For the prevention of these complications, both the epidural anesthesia and the one-lung ventilation should be better method for the anesthetic management of DH.

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