Anesthesia, which once started merely as a technique and procedure to kill pain during operation, has developed into an independent medical speciality including pain management, intensive and critical care as well as cardiopulmonary resuscitation. This fact is to be welcome, but on the other hand it seems worthwhile to reconsider how anesthesiologists should be and what their proper activities are, because their working fields have extended too widely. The author emphasizes that the orthodox tasks of anesthesiologists are analgesia and management of patients in relation to operation and that outstanding knowledges and techniques in anesthesia are the essential background for their participation in pain clinic, intensive care unit and other related fields.
In the practice of anesthesia "safety first" should be kept in mind as a supreme requirement. In pain clinic they should be aware of the indications and limitations of their techniques and make more efforts to alleviate postoperative pain. In intensive care unit it is desirable for them to have more concern about terminal care. Recently brain death has drawn an increasing attention, particularly in connection with human death and organ transplantation. Anesthesiologists should take a prudent attitude when they are confronted with a case of suspected brain death in resuscitation.

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The survival rate of patients with severe respiratory failure and treated with an artificial membrane lung has much improved these past few years, while the progress of mechanical pulmonary ventilation has been in a stalemate. The history of the artificial heart lung as a means of life support system was reviewed at the beginning. Then, fundamental studies in its introductory stage and changing concepts from ECMO to extracorporeal lung assist (ECLA) through extracorporeal carbon dioxide removal were discussed. Innovations in the instrumentations for ECLA, such as the veno-venous bypass system with a double lumen catheter or the to-and-fro system with a singles lumen thin wall catheter, the principles for a safer application of ECLA, and the present status of ECMO in the world, etc. were introduced by showing more than 70 slides. Thoughtprovoking experiences, such as three cases of acute exacerbation of chronic pulmonary diseases treated with ECLA without endotracheal intubation and pulmonary mechanical ventilation were presented and the indications of ECLA in respiratory care were proposed. Though respiratory care with membrane lung is still in its primitive stage, it offers a promising new field. Anesthesiologists, who wish to be specialists in controlling cardiorespiratory functions, should be encouraged to look positively toward a new era of respiratory care with the membrane lung.

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1. Risks of Patients and Environment
The risks to patients from equipment and the environment may be classified as follows:
a) High risk: Equipment in close contact with a break in the skin or mucous membrane, or introduced into a sterile body area. Sterilization is usually required of items ire this category.
b) Intermediate risk: Equipment in close contact with intact skin or mucous membranes. Items in this category usually require disinfection, although cleaning may sometimes be adequate.
c) Low risk: This category includes e.g. floors, walls, ceilings, sinks and drains. Cleaning is usually adequate, although some environmental areas may be classified as high risk and disinfection may be preferred, e.g. operating rooms and ICU.
2. Hygienic Hand Disinfection
The hands are often contaminated with various microbes as a result of patient care or therapeutic work, or from hospital environment. The contaminated hands are also a cause of nosocomial infections. The selection of the hand-washing method and disinfectants to be used, therefore, is important.
3. Disinfection of Medical Equipment
Ventilators, humidifiers and associated tubing and equipment are frequently contaminated with Ps. aeruginosa or other Gram negative bacilli. Ventilators can usually be disinfected with nebulized disinfectants solution or fromaldehyde gas. The smaller ventilators can often be decontaminated by ethylene oxide or possibly with low temperature steam.
Humidifiers should be autoclavable but, if this is not possible, they can be treated with hot water or low temperature steam or a chemical disinfectant.

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Magnesium sulfate was administrated for the treatment of intraoperative hypertension in 2 cases of pheocromocytoma. Hemodynamic measurement were made, and plasma concentration of magnesium, epinephrine and norepinephrine were determined simultaneously. Case 1 showed 10% reduction in mean arterial pressure (MAP), 17% reduction in systemic vascular resistance (SVR) and no change in cardiac output (CO). Plasma concentration of magnesium was 4.72mEq/l immediately after infusion. Case 2 showed 7% reduction in MAP, 31% reduction in SVR and 33% increase in CO. Plasma magnesium concentration was 2.56mEq/l immediately after infusion. The mechanism of decrease in MAP appeared to be vasodilation, as evidenced by a decreased SVR. Magnesium sulfate was not effective to inhibit the release of catecholamines from pheochromocytoma during direct tumor manipulation.

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From our clinical experiences in 18 patients with autism, we have found it is important to administer a sedative (for example, 3-4mg/kg pentobarbital), in addition to analgesics and parasympathicolytics, as preanesthetic medication, in order to eliminate patients' extreme fears. This has also proved to be effective in postoperative sedation and for the removal of mental disturbances.

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The first attempt of surgical removal of a tumor of the urinary bladder on 69 years old male patient was discontinued, because of a sudden circulatory collapse with an elevation of ST segment in II, III, aVF leads on ECG monitoring, being suspected the right coronary angiospasm.
The second attempt of the surgery was then carefully performed under epidural and general anesthesia with intraoperative monitoring of circuratory system consisting of AP, CVP, and ECG with fiberoptic devices.
Hypotension and bradycardia with ST elevation in II, III, aVF occured again 5 hours later at the time of skin incision when surgical maneuver was extending to perineal region which might have caused vagal stimulation.
Early clinical sign of this right coronary angiospasm was initially detected by prolongation of R-R interval followed fall in blood pressure, ST elevation in lead II, widening of QRS complex and flatten T wave.
Recovery from these events observed along with getting back to normal ranges of R-R interval, QRS complex, ST and then T segments.

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Relationship between the latency of visual evoked potential (VEP) and the depth of anesthesia was studied in order to evaluate its applicability for monitoring the depth of anesthesia. The VEP was recorded with a standard EEG electrode from the midline parietal region with reference to both earlobes linked to the ground. LED array in opaque goggles was used to stimulate both eyes simultaneously and photic stimulus was delivered at random interstimulus intervals with uniform distribution ranged from 2 to 5 seconds. Averaging method was used to estimate the Pmax latency, i. e., the latent period from the photic stimulus to the maximum positive peak.
It was observed that the Pmax latency increased shortly after the administration of anesthesia and returned to the preanesthetic value with the recovery of anesthesia. Significant correlation was found between the Pmax latency and the concentration of enflurane gas. The Pmax latency was also prolonged with addition of the NLA and with decrease in blood pressure during enflurane anesthesia. In a case with hypoglycemia, the Pmax latency increased predominantly, suggesting its extreme sensitivity to anesthesia during hypoglycemia. In conclusion, the observation of the latency of VEP is very useful for monitoring the depth of anesthesia and the vital conditions of the patients during anesthesia.

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A system is described by which a mixture of nitrous oxide-oxygen, instead of pure nitrous oxide, is supplied via a nitrous oxide conduit system throughout the hospital. Nitrous oxide and oxygen are mixed by an apparatus located inside a manifold chamber. With this system, hypoxia due to errors in tube connection or manipulation of the needle valves can be avoided. This low-cost system is highly reliable, and recommended for hospitals anticipating the continued use of nitrous oxide.

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Antibody titers to varicella-zoster virus (VZV) were serially measured by complement-fixation test in 54 non-immunocompromised patients with acute zosterrelated pain who were treated with nerve block. The relationships of the antibody titer to the seventies of zoster lesions and to the duration of treatment with nerve block were analysed. Skin lesions of zoster remained mild in 20 patients (mild group), became moderately severe in 18 (moderate group), and extremely severe in 16 (severe group). There were no significant differences in age among three groups. The antibody titers to VZV paralleled well with the seventies of zoster lesions. High antibody titers of 1:256 or greater, which did not differ from those in the young with extremely severe skin lesions, were produced in the elderly having almost the same severity of zoster. There was a highly significant (r=0.51, p<0.001) positive correlation between the antibody titers and the durations of the treatment for herpetic pain. The durations of treatment in those below 60 years of age tended to be shorter than those of 60 years or older having the same antibody titers. Trigeminal zoster did not apparently need a more prolonged treatment than zoster of the same severity affecting other regions, when the severity of zoster zoster is expressed by the antibody titer.
Our findings suggest that the maximum antibody titer to VZV, at least, in an otherwise healthy patient with zoster may be used as an objective index of the severity of zoster and allows to infer the duration of the treatment for zoster-related pain with nerve block.

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After a bolus administration of vecuronium bromide 0.04mg/kg, tetanic (50Hz, 1 second) and single twitch contractions of the adductor pollicis muscle were recorded simultaneously and continuously every 12 seconds in 13 patients under lumbar epidural anesthesia supplemented with nitrous oxide and pentazocine. Vecuronium decreased the tetanic contraction earlier and deeper, and the recovery of tetanus was slower compared with the single twitch. Tetanic force was maintained during the onset of the blockade, and the tetanic fade appeared first during the recovery phase. After the initial peak of the tetanus became equal with the latter part of the tetanus (equalizing point), the latter part of the one second tetanic contraction produced more force. The results indicate that the fade of tetanus after the bolus injection of vecuronium bromide is a time dependent phenomenon and in order to asess the nature of the tetanic force development fully, it is necessary to use the tetanic contraction of considerable duration.

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