The Non-invasive Cardiac Output (NICO) monitor (Novametrix medical Systems Inc., Wallingford, CT, U.S.A.) utilizes a minimally-invasive partial CO₂ rebreathing method to determine cardiac output by means of a differential form of the Fick equation. We evaluated the NICO monitor by comparing its output (NCO) with those obtained by bolus thermodilution (TCO) and continuous thermodilution (CCO) using a Baxter Vigilancemonitor (Baxter Healthcare Corporation, Irvine, CA). Seven patients undergoing cardiovascular surgery were included in this study. A total of 53 comparisons were made with TCO ranging from 3.4 to 13.2l•min-1. Regression analysis between NCO and TCO gives a correlation of r=0.783 with a slope of 0.72 and an offset of 1.16l•min-1. The linear regression coefficient between CCO and TCO was 0.909 with a slope of 0.88 and an offset of 0.30l•min-1. Bland-Altman analysis between NCO and TCO resulted in a bias of -0.65l•min-1 with precision of 1.48l•min-1. The bias and precision between CCO and TCO was -0.42±0.97l•min-1.

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The sentinel lymph node is the first drainage lymph node. To search this lymph node, the dyeguided method or gamma probe method have been the techniques in general use. Among some kinds of dye-guided methods, patent blue is one of the most useful dyes for this technique, especially in the patient with breast cancer.
The purpose of this study was to investigate whether the patent blue injection into the peripheral skin of the breast cancer influenced the pulse oximetry readings for exploring this lymph node during the operation.
The pulse oximetry readings significantly declined 30 minutes after the patent blue injection. This reduction lasted for 90 minutes after dye injection.
The principle of the pulse oximetry reading is to analyze the ratio of absorbency by oxyhemoglobin between a wavelength of 660nm of red rays and 940nm of infrared rays. There is the strongly absorbing effect of patent blue on red rays around a wavelength of 640nm. On the other hand, oxyhemoglobin has the weakest absorbing effect on red rays around this wavelength. This characteristic of patent blue on red rays will mislead the pulse oximetry readings. Therefore, we should monitor not only the pulse oximetry but also the arterial oxygen tension through a direct arterial catheter for successful anesthetic management when patent blue is used during the operation.

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A 29-year-old woman was referred to our hospital for monitoring of her twin pregnancy at 26 weeks' gestation. Bleeding, decreased platelet, and increased fibrin degradation product and d-dimer were observed at 29 weeks' gestation. Coagulation study showed out of scale from the lower levels of protein S activity. Protein S is decreased during pregnancy and anti-coagulant therapy. Also an exact diagnosis cannot be made until after delivery and discontinuation of anti-coagulant therapy. However, we assumed that she had congenital protein-S deficiency due to the coagulation data and family history. Anti-coagulant therapy was started immediately after confirmation of the lack of deep vein thrombosis and no pulmonary embolism. We continued the anti-coagulant therapy and physical therapy during and after pregnancy for 6 weeks. She did not have any clinical signs of deep vein thrombosis, and coagulation studies showed in a normal range throughout the pregnancy and after delivery. Anesthesia for cesarean section was managed by combined spinal epidural anesthesia at 37 weeks of gestation, and continuous epidural morphine infusion (2.5mg•day-1 0.7ml•hr-1) was used for her early ambulation. There were no complications due to bleeding and no other symptoms during the peri-operative period. We strongly suggest anti-coagulant and physical therapy for patients with congenital protein-S deficiency. A definite diagnosis should be made after delivery after stopping anti-coagulant therapy.

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Omphalopagus twins were delivered by cesarean section at 35 weeks' gestation. Preoperative evaluation revealed no abnormalities in the visceral organs except for a small portion shared liver. Enhanced CT was carried out to rule out the existence of cross circulation between the twins. Contrast medium injected into the vein of twin I did not appear in the ciculation of twin II for 30 minutes. Surgical separation was scheduled for the 56th day after birth. Before the surgery, a dress rehearsal and joint conferences with anesthesiologists, surgeons and nurses were performed. Anesthesia was induced using sevoflurane with a mask in twin II. Following confirmation of mask ventilation without difficulties, tracheal intubation was facilitated with vecuronium. Twin I was intubated in a similar manner. Anesthesia was maintained with Air-O₂-Sevoflurane and intemittent doses of fentanyl and vecuronium. The perioperative course was uneventful and the twins were discharged on the 13th day after the operation.
We conclude that preoperative evaluation of the medical condition of babies and making sure of perioperative procedures through discussion and dress reheasal among the staff are important in performing the separation of conjoined twins.

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A case of a 35-year-old pregnant woman who underwent cesarean section is presented. The patient had mitral stenosis, which had not been diagnosed until 31 weeks' gestation. It had not been treated by medication. She had severe heart fairure at 33 weeks.
An elective cesarean section was performed successfully under epidural anesthesia. For the worst hemodynamic change during the operation, we inserted catheters for PCPS just before the operation.

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