Either epidural or general anesthesia was induced in 67 patients undergoing total hip replacement. Intraoperative blood loss was significantly reduced in patients under epidural anesthesia as compared to general anesthesia. In the post-operative period, the volume of blood obtained from the wound suction drain was similar in both groups. There was no deep venous thrombosis after this operation in either group. Epidural anesthesia is a suitable anesthetic technique for most patients and, in this procedure, has the additional advantage of reduced surgical bleeding as compared to general anesthesia.

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The mortality rate of an emergency surgical procedure for ruptured abdominal aortic aneurysm is still high in contrast to that for elective aneurysmectomy. Ten patients were anesthetized on emergency surgery for ruptured abdominal aortic aneurysm in the last three years (1984-1986).
There were seven males and three females with mean age of 68.1 years (41-83). Severe metabolic acidosis was observed in seven patients and hemorrhagic shock was associated in five. Average time interval from admission to surgery was three hours.
Skin incision was started under local anesthesia supplemented with diazepam (5-10mg) and fentanyl (0.05-0.1mg). Endotracheal intubation was done at the laparotomy without muscle relaxant. Muscle relaxant was given just after aortic control was completed. Severe hemodynamic changes were observed at the aortic cross-clamping and declamping. Systolic blood pressure increased by 41mmHg at aortic cross-clamping and decreased by 16mmHg at declamping. Vasodilators, catecholamines and transfusion were used for corrections.
Six patients died and five of them had renal insufficiency. Increasing age, preoperative hypotension and metabolic acidosis, and postoperative renal insufficiency affected on the mortality rate.
We discussed anesthetic management and risk factors as to postoperative complications and mortality rate in those surgical repair for ruptured abdominal aortic aneurysm.

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We experienced an anesthetic case with stone heart syndrome suspected, one of the complications caused by cardio-pulmonary-bypass. The patient was 1 year-old girl with Cornelia de Lange syndrome and VSD complicated with pulmonary hypertension. At the termination of cardio-pulmonary-bypass, cardiac muscle became contricted and was unable to be weaned from cardio-pulmonary-bypass. Suspecting the stone heart syndrome, we treated her with injections of catecholamine, Ca antagonist, dantrolene sodium and with intra-aortic balloon pumping, but could not obtain any improvement.
The stone heart syndrome is of low incidence, but the mortality has been reported to be very high. Therefore, both the prophylactic use of, β-blocker and an improvement of the cardioplegic method might be essential.

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This report reviews the anesthetic experiences of 411 patients underwent extracorporeal shock wave lithotripsy at the Tranomon Hospital extending from March 1985 to February 1986. The continuous epidural anesthesia was successfully applied to 409 of 411 cases. The general anesthesia was applied to the other 2 cases in those the epidural anesthesia was contraindicated. Instantanious changes of ST-wave or conduction disturbances on electrocardiogram were observed during the procedure in 12 of 411 cases. However, this adverse findings were disappeared with interruption of the procedure. At the present, the mechanism of these phenomena was unclear.
The authors have indicated in this article that continuous epidural anesthesia was most suitable for the management of extracorporeal shock wave lithotripsy, and that further careful clinical observation and evaluations for cardiac emergency must be carried out in this therapy.

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<Introduction>
We previously observed the variation of oxygen consumption (VO₂) and hemodynamics during the awake period of general anesthesia, and found that oxygen delivery (DO₂) increased in response to the marked increase in VO₂, whereas mixed venous oxygen saturation decreased and the oxygen extraction ratio increased. From this, it might be suggested that the tissue oxygenation and metabolism did not operate smoothly. We speculated that the pain induced by surgical stress and the subsequent increase in plasma catecholamine levels might play an important role. In the present study, we wish to evaluate the new halogenated inhalational anesthetic sevoflurane on the changes described above.
<Method and Materials>
Twelve adult patients undergoing elective major surgery were separated into a sevoflurane group (n=6) and an enflurane group (n=6). Swan-Ganz and raidal artery catheters were connected, and hemodynamic, oxygenation and plasma catechoramine data were compared before and after awakeing from general anesthesia.
<Results>
In both groups, the changes above mentioned were remarkable. VO₂ increased from 117.9±39.5ml/min to 200.4±86.5ml/min (mean±SD, p<0.05) and from 120.9±24.9ml/min to 183.2±77.0ml/min (mean±SD, p<0.1) in the sevoflurane and enflurane groups respectively. DO₂ also increased in response to the VO₂. However, the decline of mixed venous oxygen tension and saturation, and increase of the oxygen extraction ratio were all observed in both groups. Also, plasma catecholamine levels in both groups increased higher than normal.
<Conclusion>
We found that neither sevoflurane nor enflurane had a sufficient analgesic eff et and that subsequently neither had a favorable effect on the tissue metabolim during the recovery phase of general anesthesia.

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