The differences in hemodynamic effects of colforsin daropate hydrochloride between the colforsin group and the control were evaluated by using a thermodilution catheter after cardiopulmonary bypass in pediatric cardiac surgery. In the colforsin group, the percent decrease of cardiac output was smaller than the control. A significant SVR reduction was obtained in the colforsin group. Colforsin can maintain cardiac output by decreasing systemic vascular resistance after pediatric cardiac surgery. There were no major side effects such as severe tachycardia and arrhythmia in our study. In conclusion, colforsin is a useful drug especially after pediatric cardiac surgery.

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Maintenance electroconvulsive therapy (mECT) is an outpatient procedure for patients who have already exhibited satisfactory improvement with a conventional course of ECT and who have previously failed or do not tolerate maintenance drug therapy. We evaluated the safety of ambulatory anesthesia for mECT using the traditional ECT apparatus available in Japan. Eleven depressive patients were enrolled, and the mECT schedule provided treatment once a week for the first month, twice a month for the second month, and once a month thereafter for up to 12 times. Under propofol anesthesia, an electrical stimulus was delivered at a 110 volt setting for 7 sec. In every treatment, neurological findings, cognitive function and side effects after ECT were evaluated. All the patients recovered from anesthesia and showed complete cognitive recovery within 2 hours of ECT, and they left the hospital without any major problems 3 hours after ECT. Although the traditional sine wave curve stimuli were used in this study, our method of ambulatory anesthesia for maintenance ECT proved its safety when the subjects were strictly regulated.

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During a preoperative anesthetic machine check, moist air was found when a OR nurse connected ahose to a wall-outlet for compressed air. Since we saw some water in the water-trap of two anesthetic machines, we thought that the trouble originated in the central gas supply system. A system engineer who was called in detected failure of the auto-drainage system. The system was repaired by replacing a valve, and fortunately no clinical trouble or accidents occurred.
From our experience, we would recommend that the hose for compressed air should be transparent so that we can easily check for the presence of water inside. We also recommend that all anesthetic machines be equipped with a water-trap.
Regarding of condensed water, medical synthetic air system may be superior to compressed air. As anesthesists who use medical gases daily, we should have adequate knowledge of central gas supply system and its inheritant problems.

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We report three cases of hemodialysis (HD) patients who underwent coronary artery bypass grafting. These patients suffered from diseases like severe diabetes and malignant hypertension which are frequently associated with impaired peripheral circulation. The early postoperative course of each patient was uneventful, and all patients were discharged from the ICU within a few days. Then, they developed intestinal ischemia, and required surgical treatment. Two of them received extensive resection of the necrotized intestine, but they died of multiple organ failure. Another patient showed mucosal ischemia, and survived due to an ileostomy. Mesenteric vasoconstriction due to low cardiacoutput, intestinal hypoxia induced by hypotension during HD, mechanical compression of the intestineduring peritoneal dialysis, and bowel distension due to reduced intestinal motility are thought to be responsible for induction and exacerbation of impaired intestinal circulation, resulting in the severe intestinal ischemia.

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Costello syndrome is an inherited disease and characterized by postnatal growth deficiency, coarse face, papillomata, and redundant skin. There is limited information available on the anesthetic management of a patient with Costello syndrome. We report the anesthetic management of an 11-year-old girl with Costello syndrome who underwent transurethral resection of a bladder tumor. Anesthesia was induced with sevoflurane in nitrous oxide and oxygen. During induction of general anesthesia, face mask ventilation was easily performed. We tried to intubate the trachea with muscle relaxation, but it was impossible to identify the larynx. After several unsuccessful attempts, the trachea was intubated blindly. Anesthesia was uneventful using sevoflurane and nitrous oxide.On the 13th postoperative day, she underwent an operation for bladder tamponade. In view of the difficult intubation and the occurrence of papillomata related to the endotracheal stimulation, anesthesia was completed using a breathing mask. The considerations regarding the difficult airway and the occurrence of papillomata are essential in the anesthetic management of a patient with Costello syndrome.

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The patient was a 51-year-old man with renal cell carcinoma. Magnetic resonance imaging revealed a tumor thrombus extending into the inferior vena cava (IVC) below the hepatic veins.Left nephrectomy and thrombectomy were scheduled. To prevent pulmonary embolism, temporary vena cava filter was placed via the right subclavian vein before induction of anesthesia in order to manipulate with sterile technique during surgical procedures if needed. Transesophageal echocardiography (TEE) detected migration of the thrombus during operation. The anesthesiologist pushed the filter with the thrombus caudad using sterile technique, then the thrombus was extracted from the incision of the IVC by surgeons.

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NMDA receptor antagonists are effective for the treatment of neuropathic pain. We used 45mg of dextromethorphan p.o. followed by 15mg of ketamine i.v. to a 40-year-old woman with phantom pain caused by amputation of the right arm. This treatment made delayed her awakening for about 12 hours. As her phantom pain reduced during 2 days after this combined therapy, we reduced the dosage of both medicines and continued the treatment. Even 30mg of dextromethorphan p.o. combined with 1mg of ketamine i.v. put her into a dreamy state for about 8 hours. We determined that dextromethorphan increased the anesthetic effects of ketamine.

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