The present report describes a case of coronary artery spasm which developed ventricullar fibrillation during upper abdominal surgery under epidural anesthesia. A 58-yr-old male patient with esophageal cancer was scheduled for radical resection and reconstruction of esophagus. He gave no history of ischemic heart disease.
A thoracic epidural block from T₂ to L₃ was performed with 2% mepivacaine and the trachea was intubated with intravenous administration of droperidol (7.5mg), thiopental (175mg) and succinylcholine (60mg). Fifty five minutes after the communication of surgery the electrocardiogram suddenly showed elevation of the ST segment in lead II. Five minutes after elevation of ST segment, ventricullar tachyarrhythmia and ventricullar fibrillation followed.
After cardiopulmonary resuscitation, serial electrocardiograms showed within normal limits. Serum enzymes (GOT, GPT, LDH, CPK) were elevated but the isozyme patterns suggested that the elevation of these enzymes was induced by cardioversion.
Coronary arteriography demonstrated narrowing in the left and right coronary artery without total obstruction.

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We have experienced 55 cases of ruptured ectopic pregnancy since Jan. 1978 to Dec. 1980. Anesthetic management was discussed.
The degree of intraabdominal bleeding was more correlated to a decrease in blood pressure than to a reduction of Hct.
Therefore, mean arterial pressure at first examination was useful to estimate patients severity preoperatively.
As for an anesthetic management, we obtained good results by preoperative administration of plasma expander and balanced technique using GO-Ketamine or GO-Fentanyl.

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It is common nowadays that burn patients in a building fire sustain inhalation injury due to inhalation of toxic gas and smoke generated from incomplete combustion of treated plywood.
Inhalation injury is drawing interest because, in association with not only extensive burns but minor ones involving small extent of body surface, it worsens postburn course and makes patients condition unsatisfactory even after a successfull reversal of shock state, if present.
Five cases of moderate burns (involving 6 to 35% of the total body surface) with inhalation injury are described with an emphasis on diagnosis and airway maintenance based on pathologic, respiratory and bronchoscopic findings.

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A hundred and twenty-four patients of herpes zoster who were treated by nerve blocks within one month after beginning of the disease were analyzed with the questionnaire and from their clinical charts.
The results showed that (1). Slight to moderate pain remained in 21% of the 124 patients. (2). Pain recured in 16 cases who relieved their pain completely. (3). it is emphasized that nerve blocks have to be started quiclky as soon as possible after finding the disease, and the block should be continued till two weeks later than their pain relief. Some problems related the prognosis such as affected areas, character of pain and age of the patients were also discussed.

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One case of mannitol-indused hypotension and life threatening arrhythmia was experienced. The hemodynamic influence of mannitol was examined in 18 patients undergoing neurosurgery and mannitol-induced change in the plasma level of histamine was examined in other 6 patients. In 18 patients pulmonary arterial, pulmonary capillary wedge, central venous pressures and cardiac output were increased, while systemic vascular resistance and pulmonary vascular resistance were decreased. Significant decrease in arterial pressure was not obserbed. Increase in plasma histamine levels was not obserbed. The rapid administration of mannitol does not cause severe heart failure due to fluid overload. It is concluded that hypotension following the rapid administration of mannitol is not due to myocardial depression but due primary to decrease of systemic vascular resistance.

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It has been well recognized that certain antibiotics have a neuromuscular blocking property.
We report prolonged respiratory depression following intrathecal irrigation of polymyxin B in surgical patient anesthetized G-O-halothane-d-Tc.
A laminectomy was performed for 66 years female. After incision of dura surgical wound was irrigated with 1, 000, 000U. of polymyxin B in 500ml. of normal saline solution. After operation the respiration was obviously depressed. Ten hours after irrigation with polymyxin B, the serum concentration of polymyxin B was found to be 0.5U/ml. This block was not antagonized by either neostigmine or Ca²⁺. The artificial ventilation was necessitated for seventy-two hours.
Polymyxin B potentiates the neuromuscular blockade from d-Tc but the mechanism of this action is largely unknown. It is routine practice clinically to administer neostigmine to antagonize a nondepolarizing neuromuscular blockade from d-Tc. However, in the presence of polymyxin B, neostigmine blockade should be allowed to terminate spontaneously with ventilation controlled. The neuromuscular effects of antibiotics will be accentuated when they are used in conbination with muscle relaxants.

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We evaluated statistically the outcome of surgery and anesthesia in 44 patients over 80 years of age who underwent various surgerys under general anesthesia in the last 16 years at Hirosaki University Hospital. Overall postoperative death rate was 13.6%. Consequently ASA preoperative evaluation scale significantly correlated with postoperative death rate-4% of class 2 patients died, 25% of class, 3, and 33% of class 4. The postoperative death rate after emergency surgery was significantly higher than that following elective surgery-11% of elective surgery and 31% of emergency surgery resulted in postoperative death respectively. But age and duration of the operation did not appear to be factors in affecting outcome of surgery. Halothane was most frequently (58%) used anesthetic for these patients without significant difference in postoperative death rate compared with other anesthetics. Frequent preoperative complications included pulmonary and cardiac diseases which appeared to result in major causes of postoperative death. But objective evaluation method of each preoperative associated disease or other influential factor, besides ASA preoperative evaluation scale, remains to be explored to predict the postoperative prognosis of sick and elderly patients.

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The clinical study about post-ten years' prognosis of ten cases who have been performed bronchial lavage followed intratracheal intubation from 1967 to 1973 in past fifteen years of our inhalation therapy clinic was undergone.
The items of nineteen bronchial lavages for ten cases contained eleven urgent lavages performed in the cases of status asthmaticus and eight elective lavages under inhalation anesthesia intended to prevent asthma attack in daytime when they have no dyspnea. These severe asthmatics had died of 70 percent during ten years due to disturbance followed asthma, and that periods were two and falf years in average. While, in survived cases, pulmonary function grew worse year by year. However, the bronchial lavage relief them from the threatening disturbance, and is significant method for these intractable asthmatics in company with IPPB physio-inhalation therapy that may keep pulmonary reserving function and prevent acute exacerbation.

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The Wolff-Parkinson-White (WPW) syndrome is an important clinical entity because of its recurrent tachyarrythmia attack. Recently surgical procedure, division of the accessory pathway, has been conducted for the treatment of this syndrome. In the anesthetic management of this procedure, it was required that prevention of the re-entrant tachycardia which reduce blood pressure and preservation of the delta wave during the epicardial mapping to determine the precise localization of accessory pathway.
Present retrospective study was aimed at evaluating the anesthetic method for the surgical procedure performed in the past 8 years. Sixty cases of the anesthesia were investigated and following results were obtained.
(1) Re-entrant tachycardia episodes in GOF anesthesia were less frequent than those in GO-Diazepam-Ketamine anesthesia.
(2) As far as delta wave was concerned, it was well preserved in GODK anesthesia, however, it was disappeared about 20% of the GOF cases before epicardial mapping.
Since re-entrant tachycardia could be easily suppressed by the overdrive pacing employing pace maker, it was no more big problem to manage this syndrome. Therefore GODK anesthesia would be recommended as the anesthetic method for this surgical procedure because delta wave was essential to determine the precise localization of the accessory pathway.

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Anesthesia or surgical operation has high risk of re-infarction in acute phase of post myocardial infarction (MI) period (Steen & Tarham 1978). When emergency operation becomes necessary in these critically ill patients, proper evaluation of patient cardiac state is required to avoid the recurrence.
Cardiac reserve index (CRI) score, comprising patient physical activity and stress testing, was examined in 9 patients with early stage of MI (within 6 months) to evaluate the revasculization. ECG was monitored on ST segment changes during the test. If impossible to test, daily changes of ST segment were substituted for the test. In this assessment, all the patients were scored 1 to 2 and had no recurrence of MI after operation. The results, suggesting that there is a significant correlation between the CRI score and re-infarction, warrant this scoring as a first test for acute MI patient prior to anesthesia. Furthermore, we noted the efficacy of vasodilators, e. g. nitroglycerin, or nifedipine. This agrees to the latest reports on those pharmaceutical effect. These drugs should be used in anesthesia as prophylaxis.

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Present study was designed to evaluate the stability of perfluorochemicals emulsion (Fluosol-DA^®; FDA) from biodegradation and to investigate the adverse effects of FDA on renal function in man.
During surgery, 500ml of FDA were administered as a blood substitute. For the purpose of estimating the degree of biodegradation of FDA, the plasma inorganic fluoride concentration and 24-hour urinary inorganic fluoride excretion were determined, and also serum electrolytes, serum creatinine, serum uric acid, BUN, 24-hour urinary output and urinary specific gravity were examined to evaluate renal function following FDA administration.
The following results were obtatined:
1 Both plasma fluoride concentration and urinary fluoride excretion were slightly increased after FDA administration. The clinical implication, however, might not be significant.
2 Alkaline phosphatase activity was reduced after FDA administration. The cause might be attribute to the slight elevation of the plasma fluoride concentration after FDA administration.
3 From our observation, total urinary fluoride excretion by biotransformation of FDA was less than 100μEq which corresponded to 0.0025% of the given dose of FDA.
4 No adverse effects on the renal function were observed in this study.

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A method for placing the central venous catheter using intravascular electrocardiography (ECG) was studied. For the connection of central venous catheter and ECG chest lead, a connecting tube adaptor with alligator clip was devised, which was sterile and disposable. The stable intravascular ECG could be easily recorded by filling the tube adaptor and central venous catheter with heparinized saline. The intravascular ECG derived from the central venous catheter was characteristic in wave form. As the catheter tip approached to the right atrium, the amplitude of negative P-wave showed a gradual increase. At the junction of the superior vena cava and the right atrium W-shaped P-wave was inscribed. Within the cavity of the right atrium the amplitude of the P-wave almost exceeded that of QRS complex. When the catheter tip was positioned in an inappropriate way, such as jugular vein or peripheral vein, the characteristic wave form did not appear and no chest rentogenography was required for confirming it.

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Chemotaxis ability of leukocytes was investigated in 14 elective surgical patients (major surgery group-9 cases, minor surgery group-5 cases) according to the modified method described by Boyden. Samples were obtained at the preoperative period, immediate post-operative period (one hour after completion of surgery), Ist, IVth, and VIIth postoperative days. Significant depression of leukocyte chemotaxis was revealed at the Ist post-operative day in major surgery group. Anesthetic method was the same between the major surgery group and minor one. Leukocyte chemotaxis was depressed by the emergence of circulating immunosuppressant during surgery, and at the same time leukocytes were activated by the stimulation by chemotactic factors liberated from surgical procedure. It is supposed that this is the reason why leukocyte chemotaxis is not depressed at the immediate post-operative period and depressed at the Ist post-operative day. It is important that leukocyte chemotaxis is depressed according to the extent of surgical invasion, although the surgical procedure was well prepared and aseptically performed.

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Radiolucent endobronchial foreign bodies are common in children and may be undetected because of normal physical findings and usually minimal X-ray abnormalities, thus delaying their removal.
Recently we experienced 8 clinical cases in which the presence of radiolucent endobronchial foreign bodies were first suggested by the findings on the perfusion lung scanning.
We can conclude that the perfusion lung scanning is useful in the diagnosis of foreign body aspiration in infants and children.

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