The limited normovolemic hemodilution with massive hydroxyethyl starch (HES 6% M.W=30, 000-40, 000, DN=0.55) was successfully applied to 14 patients who had unpredicted massive blood loss during surgery. The average intraoperative blood loss was 9, 510ml (rang 3, 080ml to 23, 000ml). On the average 6, 200ml(1, 500ml-13, 700ml) of crystaloid fluid and 3, 500ml (1, 000ml-10, 000ml) of HES were infused to maintain adequate perfusion pressure and urine output, and the amount of blood transfusion was 63% of blood loss during surgery.
Massive HES infusion maintained vital sign including arterial blood pressure and pulse rate stable, and urinary output 2ml/kg/hr. Pulmonary was exchange ability was kept well, and pulmonary A-V shunt inclined to decrease. No dilutional pulmonary edema was noticed. Fresh blood transfusion contributed to the increase of the number of platelets which was decreased by hemodilution, though recovery of platelet adhesion ability was delayed.
Hemorrhagic diathesis was not recognized, although activated partial thromoboplastin time and prothromobin time were prolonged temporarily duting the state of severe hemodilution.
We conclude that this limited normovolemic himodilution technique is very useful to maintain circulatory blood volume when bleeding is much more than expected.

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The cause of postoperative prolonged disturbance of consciousness is mainly due to many organic diseases and its related disorders and is rarely based on psychogenic reaction. A 32-year-old female underwent a lumbar laminectomy for lumbar disc hernia under general anesthesia. Without intraoperative accidents, the successful operation was done. After operation she was comatose during 27 postoperative hours. During her comatose state any examinations revealed no evidence of organic abnormality, and especially E.E.G. findings on 20th postoperative hour showed awakening pattarn, besides, her neurological findings were inconsistent with her symptoms. Therefore we suspected that her disturbance of conciousness (comatose state) was psychogenic responselessness.
As we refered some previous references, in our report, we shall discribe some diagnostic problems of psychogenic responselessness, and mainly neurological differentiation of it from organic disordors.

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There have been various problems in the management of the patient who has stenosis in his trachea, especially, the method of ensuring air way and how to ventilation. We have investigated about the usefulness of the jet ventilation method for the tracheal stenotic dog experimentally. And, we have recognized that the jet ventilation method has been very usefull for their respiratory management. Recently, we have had three clinical cases who have been needed the respiratory management with jet ventilation. And we have got the surpassing result in their management and there had been found no especial complication. Clinically, jet ventilation, for tracheal stenotic patient, has been found very suitable and safety method during operation, too. So, we have reported about them.

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The anesthetic management of a patient with HOCM is described.
In HOCM, the characteristic abnormality of hemodynamics is a subaortic stenosis to left ventricular ejection. So, light anesthesia resulting in tachycardia and increased cardiac contractility is undesirable.
In anesthesia in the patient with HOCM, it is thought that narcotic and cardiodeprssant agent like enflurane or halothane are useful.
In this patient, propranolol, CoEQ and calcium antagonist were given until the day before the operation.
After premedication with diazepam and pentazocine, induction of anesthesia was with thiamylal and halothane, and maintenance was with nitrous oxide, halothane and morphine.
During maintenance, tachycardia was treated by propranolol and, phenylephrine was administered for hypotension.
In general, couse of anesthesia was uneventful.

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High frequency jet ventilation (HFJV) was used to treat 11 patients for pneumonectomy and lobectomy. The epidural was used as part of the anesthetic technique in all cases where the catheter was inserted prior to induction. Anesthesia was induced with diazepam given intravenously and nitrous oxide, followed by pancuronium bromide. Endobronchial intubation was performed with double lumen tube. During maintenance, the patients were ventilated by HFJV (IDC, VS 600) at surgical side (Frequency of 100/min., Driving gas pressure 15psi, Inspiration time %: 50%) and IPPV at other side. Anesthesia was maintained with an oxygen/nitrous oxide and epidural anesthesia with 2% Mepibacaine. During anesthesia, no remarkable change were found with respect to arterial pressure and central venous pressure, and repeated blood gas analysis showed normocarbia and adequate oxygen tension in spite of compression of the exposed lung. With the compression of lung, surgeons could proceed smoothly procedures. In postoperative recovery, as soon as nitrous oxide had been discontinued, patients awaked and were able to take deep breaths without chest pain. This study has demonstrated that, with open chest, HFJV could provid efficient aeraion and ventilation, and optimal condition for surgeous.

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Nineteen upper abdominal surgery patients were anesthetized with one of the two different modified neuroleptanesthesia (NLA), employing buprenorphine or pentazocine, and their comparative effects on cardiovascular parameters and postoperative analgesia were analysed.
(1) Cardiovascular effects of buprenorphine 6μg/kg (nine patients) and pentazocine 1mg/kg (ten patients)
Swan-Ganz catheter were placed to measure pulmonary artery pressure (PAP), pulmonary capillary wedge pressure and cardiac output at 0, 5, 10, and 15 minutes after the intravenous administration under spontaneous air breathing. Significant changes were observed in PAP, among other parameters. Pentazocine significantly elevated PAP, beyond the normal range. Buprenorphine elevated the PAP, within normal range. The elevated PAP returned to the normal range as soon as the trachea was intubated and controlled respiration was started.
(2) Cardiovascular changes during the modified NLA.
Abrupt and significant elevation of the arterial blood pressure was seen in almost every patient of pentazocine NLA as soon as the peritoneum was opened. Trimetaphan was effective to control the systolic arterial pressure within 170 to 120mmHg, but there were no signifficant differences in the required doses of agent among the two different NLA.
(3) Postoperative analgesia.
Buprenorphine gave a prolonged postoperative analgesia for 72 hours, except two patients to whom rectal indomethacine (50mg) was given twice. Analgesics were given 12 times to seven patient during the 72 postoperative hours after the modified NLA with pentazocine.

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Low flow nitrous oxide and enflurane anesthesia were studied in 100 patients undergoing elective surgery. The other ten patients were maintained with the conventional high flow anesthesia. In the low flow group the anesthesia was maintained through a circle system with the high flow method for about forty minutes aftre the induction. Then, the fresh gas flow rate was reduced to 0.5l/min of nitrous oxide and 0.5l/min of oxygen. Enflurane was administered through a VOC similarly to the high flow system. After the induction to the low flow anesthesia, the inspired oxygen concentration reached to approximately 40% in 15-30 minutes, and was almost stable for three hours. This oxygen concentration was nearly equal to the values which were calculated by the predictions of several investigators. The setting of vaporizer was 1.9-2.7% during the low flow anesthesia. These values were higher than that of the group of the high flow anesthesia. However, the end-tidal enflurane concentration during the low flow anesthesia was equivalent to that of the high flow group, which was approximately 1.5%. In conclusion, the above method requires no special equipments and techniques, and is assured of safety and stability.

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The conventional ventilatory circuit has trouble with respiratory management, such as heavy weight and inadequate humidification. In order to improve these problems, we designed new single breathing circuit with coaxial dual flow, and ascertained from basic and clinical tests that this circuit is fully applicable for clinical use.
Increase of flow resistance was observed in this circuit due to small sectional area of inspiratory limb, but its degree was negligible in clinical use.
As characteristics of dual construction in this circuit, temperature and humidity in inspired gas is maintained, there is less temperature gradient between proximal portion (outlet of heated humidifier) and distal portion (connection side to patient), and rainout (accumulated water in circuit) is remarkably low. In addition, this circuit is light-weight, simple around patient, and disposable to prevent respiratory infection.

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An apparatus has been devised to control halothane anesthesia. It was designed that according to the change of blood pressure, the concentration of halothane vapor changed automatically.
The procedure of anesthesia was stable while variations of blood pressure was a little, but it was diffcult to control anesthesia when blood pressure was fluctuated widely. So further improvement was felt to be necessary.

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We investigated the usefulness of butorphanol as an assistant drug of balanced anesthesia with N₂O, a barbitulate and muscle relaxtant. The results showed that 0.05mg/kg for the first administration and 0.025mg/kg for an additional administration of butorphanol were optimal doses for this method of balanced anesthesia. No special side effects were observed. The occurrence of side effect was not dose-dependent. Most side effects occurred at 0.04mg/kg for the first administration and 0.02mg/kg for an additional administration.
According with the above results, we estimated the usefulness of butorphanol as an assistant drug of balanced anesthesia. In the future, we must experience more clinical use and confirm more adequate administration method.

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