We experienced 2 cases of trigeminal neuralgia due to cerebellopontine angle tumor. Seventy-one-year-old male had been suffering from the pain in the third division of right trigeminal nerve since 6 years ago. The trigeminal nerve block was performed, but the effect was not completed and the pain did not disappear. X-p and CT scan was performed. X-p revealed a decalcification of the right cerebellopontine angle cistern. A right suboccipital craniectomy was performed. Three quarters of the mass was removed and the histological diagnosis was epidermoid cyst. The trigeminal neuralgia disappeared after this surgical procedure.
Fourty-five-year-old female had been suffering from left mandibular neuralgia since fifteen years ago. CT scan revealed a low density area in the left cerebellopontine angle cistern. She was not operated because of her will and the pain was controlled by carbamazepine.
It has been established that tumors causing trigeminal neuralgia do so by pushing the trigeminal nerve against the blood vessel rather than the usual arterial cross-compression or the usual venous compression. It is necessary to distinguish symptomatic trigeminal neuralgia due to brain tumor from idiopathic neuralgia.

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Recently, the number of the cases with ruptured intracranial aneurysms transported to major hospitals in the acute stage has increased, so that early operations also have done year by year.
Generally, a number of the cases with ruptured intracranial aneurysms of the acute stage are severe and lose consciousness, so that they often need respiratory therapy.
In the ICU of Hakodate Municipal Hospital, the preoperative and postoperative management, especially respiratory intensive care of such patients has done by anesthesiologists, and contributed to the success of the operations.

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Patients with Amyotrophic Lateral Sclerosis have many anesthetic problems; muscle atrophy, bulbar palsy, respiratory infections, hypersensitivity to non-depolarizing muscle relaxants, Succinylcholine-induced hyperkalemia.
Though neurological deficits following spinal and epidural anesthesia have been reported in various disease state, we used epidural anesthcsia to the patients with ALS and found no problems during and after the operation.
We discuss the anesthetic management for the patients with ALS and state the benefits of epidural anesthesia.

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This is a case report that unonsciousness was found postopratively but her consciousness retured completly after three weeks. Patient was 54 years old woman who was diagnosed chronic rheumatoid arthritis and had history of administration of steroid for long times. The patient was scheduled for total hip replacement. Opration was performed under general anesthesia with mixture of nitrous oxide and epidural anesthesia with lidocaine. When low visosity bone cement was injected into bone marrow of femur. Arterial blood pressure was dropped from 130mmHg to 90mmHg and puls rate increased to 100 bears/min.. After this time, hypotension and tachcardia continued and PaO₂ was 57.6mmHg. PaCO₂ 40.6mmHg and pH7.416.
In recovery of anesthesia, the patient did not respond to verval contact and her level of consciousness was 300 by 3-3-9 method. Therefore, patient was placed on a mechanical ventilation with PEEP and infusion of dopamine. After 10 days, her respiratory and circulatory condition were improved without unconsciousness. But this patient recovered slowly from unconsciousness during three weeks after operation. This cause of unconsciousness was considered pulmonary fat embolism by injection of bone cement. Because, in post operative course, serum lipase rose markedly and in chest Xray pulmonary vessel disappeared and this lung field was hyperlucency. Our experience has shown that caution should be exercised in orthopedic surgery using low viscosity bone cement.

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A first-degree burn on the forehead caused by Coretemp probe PD-1 (Termo) in 1 year-4 month-old female who had her VSD closed under extracorporeal circulation was reported.
This is one of minor complications caused by so-called "non-invasive monitors".
Coretemp probe should not be placed on the forehead of the infants having cardiac surgery under deep hypothermia, or with poor peripheral circulation.

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Tow cases with hepatic cell damage are reported. 1st case was 54-year-old man, who was prepared spreno-renal (S. R) shunt because of portal hypertension and repeated gastro-intestinal bleeding after right lobe hepatectomy.
2nd case was 51-year-old man, whose S•R shunt was closed because of repeated hepatic encephalitis and hepatic coma recently.
Thracic epidural anesthesia was induced with small dose of morhpine hydrochloride and local anesthetics mixture and supplemented with 67% nitrous oxide in oxygen and incremental dose of thiopenton and/or diazepam in both cases.
Recovery from anesthesia was rapidly and no anesthetic complications wer found after operation, although in 1st case, the portal venous pressure decreased and serum ammonium increased after S•R shunt preparation and on the contrary in 2nd case the portal venous pressure increased and serum ammonium decreased after closed S•R shunt.
In conclusion, it is important that the anesthesia for these patients does not influence the hepatic cell so much and fur ther more takes care of recovery prolonged caused by direct influx of the portal venous blood in to the systemic circulation.

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A53years-old woman received the open heart surgery for the myxoma in left atrium under the cardiopulmonarybypass. After digoxin was administrated intravenouslly postoperativey in ICU, she suffered from chromopsia, nausea and vomiting which were suggestive of the digitalis intoxication. Plasma concentrations of digoxin were determined pharmacokineticaly with one compartment open model. The result of the anlysis calculated the high concentration of digoxin at the time when she started to complain the above symptoms and the digitalis intoxication was suspected. The usefulness of the therapeutic drug monitoring and the pharmacokinetic analysis of the drug were discussed in such a case.

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To make the administration of intravenous anesthetics more rational on the base of pha rmacokinetics, we applied microcomputer to controle the infusion pump by which not only the anesthetics but various drugs could be adminstered. We have chosen ketamine as an intravenous anesthetics.
Before the infusion begins, the user enters the patient weight, the ketamine concentration of the injectate, and the desired plasma concentration into the computer. And thereafter all he has to do is to press one key to start and another key to stop the infusion pump.
Thirty three patients undergoing elective surgery were studied. The desired plasma concentration of ketamine was 2.0μg/ml. All patients became unconscious before the predicted concentration reached the desired level without using any adjuvant. Intubation was performed about 4min after the infusion system started. Blood pressure and heart rate did not change significantly during the surgical procedure including skin incision. The depth of the anesthsia was considered adequate. Blood samples were obtained several times during the anesthesia and measured for plasma ketamine concentration. Measurements of the plasma levels indicate that from the very begining of the anesthesia they remained considerably constant at the adequate level, though 0.3-0.8μg/ml higher than the target level.
We conclude that the infusion system could controle the intravenous anesthesia to the considerable extent and it demonstrates great potentialities.

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Low flow, closed technique for nitrous oxide anesthesia was reported. This technique is distinguished by the idea to supply only nitrous oxide into the anesthesia circuit for a certain minutes ("N₂O minutes") to get expected inspiratory oxygen concentration.
Authors invented a theoretical formula to calculate above mentioned "N₂O minutes", and compared the actual oxygen concentration at the end of "N₂O minutes" with expected value in 138 patients. Oxygen concentration was measured by Gas-Liquid Chromatography.
The actual oxygen concentration was 31.67±8.07%, which agreed with expected value (30.0%) fairly well. Our low flow, closed technique is thought to be practical without specially prepared monitoring equipment.

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The purpose of this study was to achieve a formula to predict the most appropriate endotracheal tube size for infants and children by using statistic analysis of a thousand cases.
Endotracheal tube size was most correlated with age where the correlation coefficient was 0.8859. The correlation coefficient between endotracheal tube size and combined three factors age, height, and weight was highest in combination of triplicates, then higher in the combination of duplicates of the age and height.
The values were 0.935 and 0.9299 respectively. The predicted tube sizes which were given by the regression formula between tube sizes and age were larger than the actually used tube sizes under the twentieth french number. The predicted tube sizes which were given by the regression formula between tube sizes and combined three factors age, height, and weight were larger than the actually used tube sizes over the thirtieth french number.

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In order to estimate the optimal dose and adverse reactions when used simultaneously with laughing gas, pentazocine and muscle relaxant for induction and maintenance of anesthesia, midazolam was administered into 251 patients subject to surgical operation under general anesthesia. The patients were divided into 3 groups, one with the induction dose of 0.1mg, another with that of 0.2mg/kg and the other with that of 0.3mg/kg. The dose was increased for the maintenance of anesthesia by 0.1mg/kg 1.2 and 3 hours after the administration with the induction dose. As a result, it was proved that with the induction dose of 0.2mg/kg, anesthetic effects were satisfactory. Hypnotic effects were also good and no vascular pain or phlebitis were caused. Midazolam was considered to be very useful as a modified NLA.

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Injection time of epidural morphine was investigated. Morphine [3mg or 5mg] diluted with 5ml of physiological saline was injected epidurally between Th₁₂-L₂ intravertebral spaces through epidural catheter before anesthesia induction or at the end of operations for the breast, upper and lower abdominal operations. Patients were anesthetized with halothene or ethrane and nitroxide.
As compared with the previous epidural morphine procedure [injection at the end of operations], the new epidural morphine procedure [injection before anesthesia induction] did not have any changes of respiratory rate, the depression of intestinal movement and the other side effects. And the new procedure had almost same pain-relief effect as the previous procedure.

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A well-controlled comparative study was carried out with midazolam vs. diazepam in 234 patients subject to surgical operation on the usefulness for induction and maintenance of anesthesia in a modified NLA. One hour after injection i. m. with atropine sulfate and hydroxydine hydrochloride, 0.2mg/kg of midazolam or 0.2mg/kg of diazepam was administered i. v. to induce anesthesia, followed by the administration with 1mg/kg of pentazocine.
Midazolam was significantly superior to diazepam in the smoothness of induction of anesthesia, the depth of maintenance of anesthesia and in the grade of causation of vascular pain. There was no significant difference between the two drugs in the fluctuation of vital signs and the process after the operation in terms of arousal, start of spontaneous respiration and amnestic effects. No problematic adverse reactions were observed clinically or in clinical laboratory test results. Judging from the efficacy and safety, midazolam was considered to be more useful than diazepam in a modified NLA.

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The cerebrovascular effects of arterial carbon dioxide tension were studied in 12 children (4-11 years old) with moyamoya disease confirmed by cerebral angiography. The cerebral blood flow (CBF) mesurements with argon washout technique were undertaken in cerebral cortex and in whole brain respectively under normocapnia during fentanyl-diazepam anesthesia. Cortical CBF and whole brain CBF were 38.0±8.5ml/100g•min and 39.2±7.9ml/100g•min respectively. Cerebral metabolic rate was also determined by oxygen content difference between arterial blood and transverse and/or superficial sagittal sinus blood. The electroencephalography frequency and ampli-tude analysis were achieved by a zero-crossing methed (Datex-100). CBF equivalent was determined by changing the alveolar ventilation. Hypercapnia (PaCO₂ 53.0±4.2mmHg) increased insignificantly CBF equivalent by 12% in the cerebral cortex and by 32% in whole brain respectively. Hypocapnia (PaCO₂ 33.1±2.9mmHg) decreased CBF equivalent significantly (P<0.01) by 20% in cerebral cortex and by 28% in whole brain respectively. An awake EEG demonstrated the minimal background slowing and five minutes of hyperventilation produced the build up and the re-build up of theta and/or delta slowing. However, the distinctive EEG change were not found under hypercapnia and hypocapnia during anesthesia. These results suggested that the cerebrovascular CO₂ response in moyamoya disease was deteriorated during hypercapnia but not during hypocapnia. Therefore, normocapnic ventilation is preferable for the anesthetic management of moyamoya disease.

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