Tension pneumocephalus is a serious and life-threatening complication after craniotomy, and many cases have been reported after craniotomy in the sitting position. The definitive treatment is the surgical aspiration of air via burr holes. We report two cases of tension pneumocephalus after craniotomy in the supine position, whose neurological status improved prior to the surgical intervention.
One patient with metastatic brain tumor in the left frontoparietal lobe was operated on for the removal of the tumor in the supine position under neuroleptanesthesia. After the operation, the patient showed a delayed recovery, and an emergency CT scan revealed a large amount of bilateral subdural air. The other with infiltrating pituitary tumor was undewent the right frontotemporal craniotomy for the removal of the tumor under nitrous oxide and enflurane anesthesia. After full awakening from anesthesia, gradual deterioration in the neurological status needed an emergency CT scan, which showed air in the right frontotemporal epidural space with the midline shift to the left. The neurological status of the two patients improved fortunately prior to the surgical intervention, while receiving intravenous mannitol and steroids with continuous inhalation of oxygen. The postoperative repeated CT scans taken after one week showed only minimal cerebral edema without definite accumulation of air in both cases.

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ABM has been recently accepted as an anesthesia depth monitor, which is estimated by EMG, EEG, NMT, expiratory CO₂ and blood pressure. We used ABM during high dose fentanyl, GOE and GO plus epidural anesthesia. There were only small changes in EMG activity during the operation, but EEG was changed in its frequency and amplitude according to the kind of anesthetic agents, and depth of anesthesia. NMT was not reliable to decide the time of the additional administration of muscle relaxants. The depth of anesthesia has been inspected by anesthetic agents, blood pressure, heart rate, the size of pupil, mevements to surgical stimulations, et al.
ABM seems to give us useful information about the anesthetic depth.

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A 77 year old man was scheduled for reparing an abdominal aneurysm. He complained of sudden abdominal pain and a tumor mass in his abdomen. He had no prior episode of hypertension nor palpitation. An aortic aneurysm was suspected by the aortographic and CT examinations. On laparotomy, however, the tumor was noted not to communicate with the aorta. The surgical manipulation induced abrupt elevation in the arterial blood pressure and pulse rate, indicating pheochromocytoma. Phentolamine and propranolol iv were required intra-operatively to control the circulatory status, but not after removal of the tumor, and his postoperative course was uneventful. The histological examination indicated a para-aortic paraganglioma with pheochromocytoma: The incidence and basis of pathophysiology of unsuspected pheochromocytoma and its anesthetic problems were discussed.

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In the anesthetic management of critically ill patients, sequential and invasive monitoring system particulary for hemodynamic change of the patients are exceedingly needed and the monitoring equipments will require to maintain an electrical safety for the patients and to provide the definitely stable and accurate information of hemodynamic variables during surgery.
Therefore, we have studied about the electrical safety and clinical applicability of the fiber-optic electrocardio-graphy and blood pressure measuring system, and the following results were obtained;
1. It has been recognized that the fiber-optic method yields a high degree of an electrical isolation effect from the electromagnetic disturbances associated with use of electrosurgical unit.
2. It has been confirmed that this method are extremely useful for the electromechanical analysis of the sequential changes of the extremely amplified P-wave and right atrial pressure waves which were obtained during surgery.

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Serum zinc concentrations have been reported to be decreased during many acute disease states including burns, myocardial infarction, surgical trauma and various acute infectious illness. In this study, serum zinc was followed in 24 patients for 7 days after minor and major surgery.
Mean serum zinc concentrations in 16 major surgical patients fell from 101±15.5μg per 100ml preoperatively to the lowest level of 57±10.6μg per 100ml 2 hours postoperatively. Thereafter, serum zinc levels rose steadily to 94±24.6μg per 100ml on the third postoperative day. Mean serum zinc concentrations in 8 minor surgical patients fell from 104±22.8μg per 100ml preoperatively to the lowest level of 78±18.0μg per 100ml 24 hours postoperatively. Thereafter, serum zinc rose gradually to 84±16.7μg per 100ml on the third postoperative day. After one hour of operation and two hours postoperatively, the major surgery group has significant lower serum zinc level than the minor surgery group.
Thus the onset and degree of reduction in serum zinc levels appeared to be dependent upon the magnitude of the surgical stress. But the recovery of serum zinc level in the major surgery group occurs as quickly as in minor surgery group.

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Platelet counts of 22 adult patients with liver cirrhosis were examined before esophagectomy and splenectomy, 1hr and 2-3hr after the operation. The average preoperative platelet count was (7.1±2.5)×10⁴/mm³. Since a certain correlation seemed to exist between the platelet count and the K value of the ICG test performed on each patient, the patients were divided into two groups according to the K value of each patient. The patients with a K value larger than 0.08 had higher preoperative platelet counts and showed an increase of platelets after the operation by as much as (7.8±2.7)×10⁴/mm³ to (10.3±3.4)×10⁴/mm³. In the other patients with a K value less than 0.08, no immediate increase of platelets was found.
To prevent massive bleeding often seen during and after this kind of operation on patients with severe thrombocytopenia and liver injury, indicated by a low K value of less than 0.08, platelet enriched human plasma should be prepared for transfusion.

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Introduction:
Cmplement system is now the area of interest for those concerned with anesthesia on the patient's immunity.
We examined the effect of blood and transfusion on complement system pre, during, (pre, after, blood transfusion) and after the operation.
Subjects.
The subjects of this study include 55 patients, who underwent elective surgery were categorized into four (4) groups according to the following criteria.
Group 1: Blood loss less than 10% circulating blood flow (CBF)
Group 2: Blood loss less than 20% CBF
Group 3: Blood loss less than 30% CBF
Group 4: Blood loss more than 30% CBF
Measurements and Methods:
1. vital sign: MAP PR Hb Ht:
2. CH50 (Mayer's method)
ACH 50 (Anano's method)
C1q, C4, C3, C5, C9, Clinactivator, Factor B
(single radial immunodiffusion method)
3. Albumin BCG method
Results and Discussion
We corrected our results with albumin levels since the dilution of blood by the infusion of fluid.
Only C3 component has declined in every Groups, significicant changes in G3, G4, . Another measurements have no significant change in every groups.
Authors propose three possible explanation to this phenomenon. (1) dilution of C3, (2) enhancement of C3 turnover, (3) decreased C3 supply due to macrophage dysfunction.

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A new and simple method was established to measure the tidal volume of preterm and term neonates ventilated with a Servo 900C ventilator on pressure control pattern. The expiratory tidal volume (Vte) measured by the ventilator consists of the true tidal volume (Vt) and the compressible volume (Vc) in the patient circuit. If Vte is correct and Vc is known, Vt is calculated as Vte-Vc.
The accuracy of Vte of a Servo 900C in small tidal volume area was tested injecting known volume of air (Vinj) into the expiratory inlet of the ventilator during the expiratory phase; Vinj=0.73×Vte-1.01 (γ=0.997). On the ventilator at the ordinary working condition (pressure control pattern, f=40b/m, insp. time%=50%) with closing the Y-piece of the patient circuit, the relation between Vc measured as Vte on the ventilator and the end inspiratory and end-expiratory pressure (EIP and EEP, respectively) on a mingograph was studied; without PEEP Vc=0.31×(EIP-EEP)-1.19 (γ=0.995), and with PEEP Vc=0.26×EIP=0.99 (γ=0.992). These results suggest that Vt can be calculated with Vte, EIP and EEP. Measurement of tidal volume was performed on a test lung model of premature baby ventilated with the ventilator, and the result was compared with that of the simultaneously performed bodypletysmography. Vt measured by our method varied from 4.1-13.2ml and the difference between paired measurements was 0.02±0.51ml (mean±SD) with a muximum difference of 1.0ml.
It is concluded that using our method, the small tidal volume measurement can be performed with a satisfactory accurancy and without disturbing the ordinary ventilation nor the safety of the baby.

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The effects of changes in position on systemic and cerebral circulation were studied in nine patients undergoing cervical spine operation in the sitting position under neuroleptanesthesia supplemented with diazepam and nitrous oxide, 50% in oxygen. Hemodynamic variables which include cardiac output, mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure, and internal jugular venous pressure were measured and cerebral circulatory index (CCI) was calculated from arterial-jugular venous oxygen content difference before and after changes in position. When patients were placed to the sitting position from supine position before surgery, cardiac index (CI) decreased by 11% and systemic vascular resistance (SVR) increased by 34%. Cerebral perfusion pressure (CPP) and CCI were 82±5 (means±SEM) mm Hg and 17±1ml blood/ml O₂ in the supine position, and 76±4mmHg and 15±1ml blood/ml O₂ in the sitting position, respectively. After replacing the patients to the supine Position at the end of operation, CI increased by 14% and SVR decreased by 16%. CPP and CCI were 78±5mmHg and 17±2ml blood/ml O₂ in the sitting position, and 86±6mmHg and 16±1ml blood/ml O₂ in the supine position, respectively. There were no significant changes in either CPP or CCI with positioning. From these results, it was suggested that cerebral oxygen supply was adequate with positioning, if CPP was maintained above 76mmHg.

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The effect of local-anesthetic stellate ganglion block(SGB) on human retinal blood flow was evaluated in 15 cases using a blue field entoptoscope and ophthalmodynamometer. No significant difference in the mean brachial artery pressure and intraocular pressure was noted between before and after SGB. However, the mean central retinal artery pressure rose by 8.0±4.5mm Hg after SGB. Despite no difference in the speed and number of flying corpuscles (FLC) between the left and right eyes before SGB, both the speed and number of FLC increased after SGB on the side of SGB treatment. On ophthalmodynamometric loading of force onto the eye-ball with a fixed gaze at the blue field entoptoscope, FLC showed no change in both speed and number initially but began to slow down in speed and almost simultaneously in number at a certain force level. Defining the value obtained by subtracting the intraocular pressure (converted from the force level) from the mean brachial artery pressure as a perfusion pressure, the post-SGB perfusion pressure at which FLC began to slow down in speed and number decreased by 8.0±4.1mm Hg from the pre-SGB level.
The above results suggest that SGB induces an increase in retinal blood flow and keep autoregulated retinal blood flow until a lower perfusion pressure. Such SGB-induced changes in retinal blood flow is considered to result from the decrease in the vascular resistance from the heart to the eye but mainly from the elevation of the perfusion pressure when viewed in terms of the ophthalmic artery.

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It has been speculated that in acute respiratory failure the main pathophysiological mechanism in the disrurbance of pulmonary oxygenation will be due to the formation of shunt and venilation-perfusion inequality. However there has been a little investigation which clarified such a disorder in distribution of ventilation-perfusion ratio on the cases of acute respiratory failure. In this paper the distribution of ventilationperfusion ratio was observed in the cases of acute respiratory failure using 6 inert gas method by which the distribution of ventilation-perfusion ratio is able to be serially measured dividing ventilation-perfusion ratio into 50 compartments. As the results, spread distribution of blood flow over wide ventilation-perfusion area, twice as wide dispersion as that in normal lung, and the formation of markedly increased shunt were observed in all the cases investigated. Furthermore significant correlation (r=0.97) was obtained between measured PaO₂ and PaO₂ which was calculated by computer simulation on the measured distribution pattern of ventilation-perfusion ratio.

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Under neuroleptic anesthesia maintained by continuous drip infusion of Ketamine, surgical patients with normal pulmonary function were washed in with constant concentrations of nitrogen (20 per cent), nitrous oxide (20 per cent) and halothane (0.5per cent) simultaneously by means of nonrebreathing artificial ventilator. The endtidal concentrations of each gases were measured by breath-by-breath manner. These data were analysed with nonlinear regression method from the simplest 2 compartment model.
Even this simplest model can show good curve-fitting to the measurements. The volume of distribution of nitrous oxide was 1.06-fold alveolar volume and that of halothane was 16.9-fold. The rate constant ratio of halothane to nitrous oxide was 7.22.
This method easily and immediately gives the proper model of each patient at the bed side. Anesthetists will obtain useful information about anesthetic pharmakokinetics of the patient on operating bed by the clinical application of that model.

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The practical problems of continuous axillary block using not intravenous catheter but Tuohy needle and fine polyethylene catheter (1mm O.D.) which are usually used for continuous epidural block are analyzed. In 32 cases (29 for surgical operation and 3 for posttraumatic pain management) continuous axillary block was performed with the result of 78.1% full success and 12.5% partial success.
The advantages of this new technique are as follows: (1) easy preparation (2) easy detection of neurovascular sheath (3) safety for nerves and vessels (4) no disconnection or kinking of catheter (5) easy fixation. However there still exists a problem of reliability which is fundamental and common one to catheter technique either intravenous or epidural catheter of brachial plexus block. Because the complete block of brachial plexus in single needle (catheter) technique depends on the free spread of local anesthetic solution in the neurovascular sheath, so that individual anatomical or pathological peculiarity which prevents free spread of the solution may result in partial incomplete block.

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We examind the bleeding volumes during the operations from our experiences with 120 cases of posterior fusion for scoliosis.
1. Among the cases without hypotensive anesthesia, the bleeding volumes were far less than that with hypotensive anesthesia reported by other institutes in Japan.
2. Under GOE anesthesia, the bleeding volume per vertebra of the cases with hypotensive anesthesia was more than that without hypotensive anesthesia.
3. When we used special flame made of roll cloth in order to decrease the abdominal and intrathoracic pressure, the bleeding volume per vertebra was far less than the reports from other institutes, in which cases they used conventional flames.
4. We found no significant differences of the bleeding volumes between the different anesthetic methods during the operations.
From these considerations, it turned out that the usefullness of hypotensive anesthesia is open to question. To decrease the bleeding volume during operation, we consider that it would be necessary to decrease the central venous pressure, namely, to prevent the increasing of the abdominal and intrathorasic pressure.

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The changes of hemodynamics and the level of plasma epinephrine and norepinephrine were studied on 20 patients who underwent the upper abdominal surgery under N₂O, O₂-epidural anesthesia.
Arterial Pressure was kept slightly lower than control and the rate-pressure product was also stable at the level of below 10000. Both epinephrine and norepinephrine level showed mild reduction and was stable.
Nitrous oxide-oxygen anesthesia associated with epidural analgesia is considered to be very stable and it is satisfactory from view point of hemodynamics and the level of plasma catecholamine.

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The cardiovascular responses and the effect on pulmonary shunt due to aortic cross-clamping and declamping were studied in 5 patients undergoing reconstructive infrarenal aortic surgery.
Prior to aortic cross-clamping enflurane was used for decreasing cardiac afterload. Prior to aortic declamping patients recieved plasmanate solution at a rate which maintained pulmonary artery occlusion pressure (PAOP) 3-5mmHg above pre-clamped values.
No significant changes in cardiovascular responses were seen due to clamping. Declamping produced little changes in cardiovascular responses and which were similar to the pre-declamped state.
No significant changes were seen on the pulmonary shunt during the operation.

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