We have been studying the long-standing problem of how contractile state affects myocardial oxygen consumption (VO₂), using the new concept that the total mechanical energy generated by contraction can be quantified by the systolic pressure-volume (P-V) area (PVA). PVA is the specific area in a P-V diagram under the end-systolic P-V relation and the systolic P-V trajectory. Experimental data in dog hearts show that PVA correlates linearly and closely with PVA in a given contractile state whereas the VO₂-PVA relation shifts upward in a parallel manner by positive inotropic agents including some new cardiotonic agents. The component of VO₂ for PVA remains proportional to PVA whereas the component of VO₂ for excitation-contraction coupling changes with contractile state in general. The effects of contractile state on various cardiac efficiencies are also discussed using the concept of PVA.

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The use of opium for relief of diarrhea proceded by many centuries its employment for analgesia and the effects of opiates on gastrointestinal (GI) tract have been reported by many investigators. Despite these studies, the mechanisms of action produced on GI tract by opiate remains unclear. Then it was attempted to investigate the effects of opioids on GI tract. Opioid was administered s.c. in male dd-strain mice weighing 18-22g and 15min later, pilocarpine (6mg/kg) or 5-HT (10mg/kg) which produce 100% diarrhea was given s.c. One hour later, the diarrheal effect of animals was evaluated by all or none method in box with 20 separate rooms. 1. In agonists, μ-type receptor ligands inhibited dose-dependently the both diarrhea and the activity was found to be almost the same to that in analgesic effect. k-type receptor ligand, ketocyclazocine, showed the potent anti-diarrheal effect, but the activity varied every each experiments. δ-type and σ-type receptor ligands, leu-enkephalin (1mg/kg, i.v.) and phencyclidine (10mg/kg, s.c.) did not inhibited the both diarrhea. 2. Agonist-antagonists inhibited slightly the diarrhea at some doses, but effect was disappeared with the increase of dose. 3. Antagonist, naloxone, potentiated the both diarrhea, especially 5-HT-induced diarrhea. 4. Dextrorphan did not affect the both diarrhea and the anti-diarrheal effect of levorphanol. 5. Agonistantagonist and antagonist diminished the anti-diarrheal effect of agonist, related with the antagonistic component of the compound. The anti-diarrheal effect of morphine was antagonized completely by naloxone and Mr2266, but that of ketocyclazocine imcompletely by both antagonists. 6. The anti-diarrheal effect of morphine was decreased in morphine-tolerant mice and the administration of naloxone induced significantly the diarrhea in that mice.

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The authors report a patient with Noonan syndrome, who underwent general anesthesia for pelvic osteotomy. Since this syndrome frequently comprises mental retardation, congenital abnormalities including micrognathia (small chin) and cardiac anomalies, care should be required for the anesthetic management. In spite of halothane anesthesia, his body temperature did not increase during perioperative course. Anesthesiologist, however, must be aware of possible relationship between this syndrome and malignant hyperthermia. In this patient, therefore, caudal epidural blockade, in combination with general anesthesia, is very useful in order to reduce requirements of both volatile anesthetics and postoperative analgesics.

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We experienced the anesthesia for bullectomy in 26-year-old woman diagnosed as having diffuse pulmonary hamartoangiomyomatosis with pulmonary hypertension. The anesthesia was maintained with the conbined use of low concentration enflurane with NLA, monitoring of pulmonary arterial pressure and was uneventfully completed.
This case was a rare disease that occurs in middle-aged women. Because of the existence of multiple bulla, spontaneous pneumothorax repeatedly developed causing restrictive and obstructive defects and diffusion disturbance. These are accompanied by pulmonary hypertension due to hyperplasia of pulmonary arterial smooth muscle.
Therefore, it should be taken into account that, at anesthesia, these patients must be at risk be barotrauma and reduced respiratory function requireing special attention to respiratory control and careful management while monitoring pulmonary arterial pressure.

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We experienced a case of atypical Malignant Hyperthermia, being clinically diagnased. The symptoms were following; muscle rigidity after succinylcholine infusion, myoglobinuria and increase of serum emzymes-CPK, LDH, GOT and GPT. While on postoperative muscle biopsy, Ca-induced Ca release (CICR) test was negative. There would be false positive and false negative on this test. Because there were the programs of the place and the time of muscle biopsy and the examination beginning time in this case. And reported there are another mechanisms in Ca release, because this test is only sarcoplasmic reticulum mechanism.
This case must managed as Malignant Hyperthermia in anesthetic case, because this case showed uncommon response for the drugs in general anesthesic practice.

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Atrial fibrillation(Af) is a very common ectopic arrhythmia especially in a patient with underlying heart disease. If the ventricular response in Af is great, not only the blood pressure falls but also the patients may be precipitated into heart failure. Moreover, paroxysmal Af tends to occure, and even if it is chronic, the ventricular response may be accelelated in the perioperative period. Thus, how to prevent and manage Af is mandatory for anesthesiologists.
We experienced three cases precipitated into Af with a rapid ventricular response in the perioperative period. But we could reduce ventricular response effectively and finally convert them to sinus rhythm in all cases by the combined use of drugs such as propranolol and digoxin, verapamil and digoxin or verapamil and disopyramide, respectively.

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The authors investigated the effect of methylprednisolone (MP) administered after coming-off from cardiopulmonary bypass (CPB) on intrapulmonary shunt. For this purpose We selected the patients to avoid the effect of artery-to-pulmonary collateral circulation, catecholamines or vasodilators. Collateral flow to pulmonary circulation may have uncertain effects on intrapulmonary shunt calculation. Catecholamines and vasodilators have various effects on shunt. Fifty-four patients, who were not cyanotic and need not use catecholamines and/or vasodilators, were subjected to measurement of arterial and mixed-venous-blood gas conditions to calculate shunt effect. These patients were divided into 2 groups. To one group (MP group) 30mg/kg of MP was administered 20min after the comming-off and the other group (control group) had no MP. Blood samples were analyzed on both groups 10 and 70 minutes after the coming-off. In MP group significant decrease in shunt was observed at 70 minutes measurement compared with 10 minutes measurement, however in control group no significant changes were observed between 2 measurements. Furthermore there was a significant difference in shunt between 2 groups at 70 minutes measurement. There were no significant difference in the background factors between 2 groups. These findings indicate that MP has the potency to improve intrapulmonary shunt.

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The serum CK value was measured during peri-operative periods to evaluate the effect of anesthesia on the stability of the skeletal muscle membrane.
Thirty-nine patients were divided into 3 groups according to type of anesthesia and age; group A, general anesthesia (N₂O-O₂-enflurane), under 10ys (6.9±2.1), n=15; group B, general anesthesia (N₂O-O₂-enflurane), over 10ys (27.7±16.5), n=15; group C, local anesthesia (10-15ml of 0.5% lidocaine with 1:100, 000 epinephrine), adult (40.2±15.6), n=9. Groups A and B were for tonsillectomy and C for para-natal procedure. No succinylcholine was used during general anesthesia.
The CK values in group A before, during, and after the operation were 59.20±4.34, 163. 80±41.70, and 254.73±60.20, respectively; in group B, 63.80±7.83, 72.00±22.05, and 111. 67±30.46, respectively; in group C, 43.11±2.53, 45.00±9.08, and 50.22±9.75, respectively; and in group A+B (general anesthesia group) 61.5±4.42, 123.00±28.73, and 183.20±35.71, respectively. The differences between the values before and after in group A, between the values before, during, and after in group A+B, and between the values of all groups after (operation) were significant. In this CK, subtype-MM, occupied more than 95%. The elevated CK levels returned to normal within 5 days.
We concluded that general anesthesia may impair the membrane stability of the skeletal muscle and that muscle of the young is more vulnerable to general anesthesia than that of the adult.

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