Our host computer system (HP PDMS) was linked by four subsystems using personal computers, designed by ourselves. In these systems, a multi-patients respiratory, anesthetic and metabolic scanned monitoring system (RAMSCAN named by us) was used most frequentry in our operating rooms.
All functions of RAMSCAN start at the timing of "power on". For example, users don't need to touch the key board for feeding patient ID to the computer. Host computer can accept the monitoring data from RAMSCAN, using the message including room No. s and measuring times.
We concluded that successful acceptance of RAMSCAN in clinical anesthesia came from its human interface, leaving out keybord input and many conections, between bedside terminal of RAMSCAN and vital sign monitors.
Now (1987.), this system in renewing because of its longterm (9 years) use. The futures of the new system are following; 3 long sampling line per a patient; a gas wave sharpner using a technique of analogue computation; a local area network (omni-net). Almost of these futures come from our developments during 9 years.

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This is a case report of a 58-year-old male with Huntington'chorea who received subdural dranage under local anesthesia and subduralo-peritoneal shunt under general anesthesia for chronic subdural hematome. He had been given haloperidol in controlling chorioform movements. The premedications of diazepam were very effective for disappearance of involuntary movements and for sedation. General anesthesia was induced with NLA and minimal dose of thiopental, intubated with pancronium and maintained with GO-NLA. There wan no trouble during and after operation. No choreoform was seen in the recovery room, which was thought to be due to droperidol. NLA is preferable choice for the patient with Huntington'chorea.
We did not use succinylcholine for prevention of hyperkalemia owing to denervation supersensitivity of neurogenic atrophic muscle in Huntington's chorea.
The cosideration for reduction of acetylcholine and excess of dopamine in the striatum is important in anesthesia for this disease.

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A 27-year-old man, 168cm, 73kg, was reffered for emergency clipping operation of cerebral aneurysm. On preoperative examination the patient had no problem without the history of broncheal asthma. After atropine, 0.5mg, iv, anesthesia was induced with diazepam, 10mg, and ketamine, 100mg, followed by succinylcholine, iv. Endotracheal intubation was difficult and needed 4 times trial to be accomplished. Soon after intubation, the patient developed severe wheezing. There are no effect on bronchodilation by administration of aminophylline, methyl-predonizorone, sulbutamol, halothane, enflurane and DB-cAP. The operation was performed inspite of the enormous risk, and succeeded.
With the onset of spontaneous breathing, wheezing were improved gradually. The postoperative course was unevenful.
We raise three problems. 1) Why did the bronchospasms improve with the onset of spontaneous breathing? 2) Was it right to operate on severe asthmatic state? 3) How much influence are there in hypercapnea on craniotomy?

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Postoperative erythroderma is a very rare but fatal syndrome following major surgeries. This syndrome is characterized by systemic erythromatous skin eruptions and multi-organ failures. We described three cases of this syndrome, and all patients received fresh whole blood perioperatively. With various signs and symptoms, all died in 2 to 4weeks postoperatively. The types of human leukocyte antigen (HLA) were studied in one case. The results revealed an alteration between the 16th and the 17th postoperative day. The types on the 17th day were identical to those of one blood donor. This alteration confirmed that the immunopathologic etiology of this syndrome was graft versus host reaction (GVHR) due to blood tranfusion. Two factors appeared to be essential for this syndrome: (1) identical HLA haplotype in the host and the graft, (2) depression of the immunological defence mechanisms of the host due to operation, use of the extracorporeal circulation, or drugs administered periperatively.

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Twenty patients with nephrolithiasis in the upper urinary tract scheduled for ESWL under general anesthesia were studied. Following endotracheal intubation with rapid induction using intravenous thiopental and succinylcholine, anesthesia was maintained with 70% nitrous oxide and 1.5-2.5% enflurane in oxygen. Following the intermittent positive pressure ventilation (IPPV) for 15 minutes, HFPPV was performed during ESWL. During ESWL the patients were ventilated mechanically with the ventilation frequency of 85/min, the IE ratio of 1/2 and the tidal volume of 2.5ml/kg (group I) or 3.0ml/kg (group II). HFPPV was performed with a Penlon Nuffield 200 Ventilator attached to a conventional semiclosed rebreathing system. A significantly increase of PaCO₂ and decrease of PaO₂ in HFPPV than IPPV were noticed in group I. The group II showed no significant changes in PaCO₂ and PaO₂. Movements of the stones were approximately 1mm during HFPPV in both groups.

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The celiac plexus block by transaortic approach using transseptal needle (19G.) was applied to five patients who had been suffering from intracutable pain.
A 7.2 French catheter was introduced percutaneously into the femoral artery by Seldinger technique passed through the aorta to the first lumbar vertebral level, puncture-needle (transseptal needle) was introduced by this catheter, piercing the aorta wall and needle-tip entered to peri-aortic region.
Before neurolysis with absolute ethanol solution, we should be confirming the optimum spreading of radiopaque and lidocaine mixture as a test-block under fluoroscopy.
No severe adverse reaction were encountered except for transient hopotension coincidence with the aorta wall puncture. We have obtained the 100% pain remission in five patients with 10-15ml of neurolytics.
This novel procedure of celiac plexus block was considered to be useful for intracutable pain due to advanced hepatoma or post-transarterial embolization.

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We tried to evaluate 2 patients both in deep coma and on ventilator, using the Criteria for Brain Death by the Japanese Ministry of Public Welfare. One was a 17 year-old boy with head injury from a traffic accident and the other was a 31 year-old female resuscitated from 20min of cardiac arrest. In the first patient brain death was diagnosed without any problems. In the 2nd patient, during apneic test the PO₂ decreased from 330mmHg (FIO₂ 1.0) to 90mmHg in 2min, so the test had to be discontinued. The rapidity in the decrease of PO₂ was, we assume, due to instability of the patinet's respiratory system. This means that everything possible, a prerequisite for the testing of brain death, may not have been carried out. In this paper we discussed the importance of testing for apnea in the diagnosis of brain death in detail.

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Repeated exposure to halothane has now been confirmed to be a risk factor for hepatotoxicity in humans. Enflurane has not been proven to hepatotoxic. We investigated the effect of prolonged general anesthesia on liver function.
Thirty-three patients following anesthesia for over twenty hours were divided into three groups according to type of anesthesia; group GOF (N₂O-O₂-halothane), n=8; group GOE (N₂O-O₂-enflurane), n=17; group NLA (N₂O-O₂-fentanyl), n=8.
Liver enzymes-serum transaminases, lactate dehydrogenase were studied during peri operative periods. There was a tendency towards a greater frequency of enzymatic changes following halothane anesthesia than following enflurane or neuroleptanesthesia.
These laboratory tests do not allow us to be certain that an anesthetic is the cause for postoperative hepatic dysfunction. However, the effects of prolonged enflurane exposures on hepatic function wer cosidered to be slighter than that of halothane from our results.

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In patients with myocardial infarction, risk factors concerning anesthesia on non-cardiac surgeries were retrospectively evaluated. During the years 1981 to 1987, a total of 19, 868 cases underwent anesthesia and non-cardiac surgery. Among them, there were 102 cases (0.51%) with a evidence of myocardial infarction. Three (2.9%) had a reinfarction postoperatively and all of them died during their hospital stay. The number of the patients with a previous myocardial infarction is increasing close to those reported in the United States, however, the reinfarction rate in our cases is lower than those of previous studies. We could not find any risk factors significantly correlated with reinfarction rates in our study.

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In order to estimate the effects of suppository type bromazepam for premedication, we employed plasma and urine catecholamine (CA) measurement which are known to reflect sympatho-adrenal activity directly. Fifty three patients scheduled for elective surgery (ASA I, II) were randomly divided into three groups, C group (no premedication), D group (diazepam 10mg i.m. early in the morning about one hour prior to induction of anesthesia) and B group (bromazepam 3mg suppository were administered at preoperative night).
Blood sumple were first collected in time on medical examination by anesthegiologist in preoperative day and secondly collected immediately before induction of anesthesia. Urine sumple were also collected after induction of anesthesia. Plasma CA concentration change (%) and urine CA concentration (ng/mg creat.) is significantly decreased in D group and B group compared to C group, and significant difference of CA concentration by premedication is more easily appeared in urine than in plasma.
So we concluded that bromazepam 3mg suppository administered at preoperative night is not at all inferior to diazepam 10mg i.m. for the preoperative deppressant of sympatho-adrenal activity, and that urine CA concentration is more favourable than plasma CA concentration as the objective assessment of premedication.

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Between October 1981 and March 1987, 308 patients, in age of 13 to 70 years old, underwent microsurgery of anterior cervical interbody fusion at Ohtsu Municipal Hospital. The perioperative anesthetic problems have been reviewed. Preoperative neurologic evaluations in relation to the movement of the neck were essential to prevent further exaggeration of the symptoms which might likely occur especially during tracheal intubation. Anesthetic inductions were followed by droperidol, diazepam and N₂O-O₂, and pancuronium was used to facilitate tracheal intubation. In eight patients in whom conventional orotracheal intubation with less extension of the neck was considered to be difficult, awake nasotracheal intubation was performed under topical anesthesia to the nasopharynx and concomitantly use with droperidol and diazepam. Anesthesia was maintained with N₂O-O₂ and intermittent doses of diazepam, and halothane or enflurane at low concentration was given if necessary. Full muscle relaxants were given during microsurgery. The most drastic complication encountered during operation was massive bleeding; more than 10, 000ml of bleeding from epidural venous plexus was noted in one patient in the ossification of the posterior longitudinal ligament. CVP measurement and the use of a large-bore intravenous catheter were helpful in such massive bleeding. Postoperatively, no serious complications such as upper airway obstruction or spinal cord injury was encountered although these are possible complications. Monitoring of the patient's respiratory state, however, are advisable postoperatively.

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Shiverings during epidural anesthesia are sometimes recognized. To investigate this mechanism, we injected normal saline solutions into epidural space, which were cooled to 4°C (15 cases), Kept in the room temperature (15 cases) or warmed to 37°C (15 cases). We recognized shiverings after injections of these normal saline solutions in about 38% and observed a tendency that a solution of lower temperature produced shiverings more frequently than higher ones. The occurence of these shiverings was strikingly depressed by hydroxyzine as a premedication.

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Magnetic data recorder, covering from DC level, is a versatile data logging device for recording physiological signals such as ECG, pressure waves and etc. However such device is expensive to use as a recording unit of ECG monitoring in central operating unit. Hence, easy frequency modulation circuit using LM566 (voltage to frequency converter) and LM2917 (frequency to voltage converter) integrated circuit was devised to utilize ordinal audio cassette tape recorder as the recording unit. Through the measured cut off frequency of demodulation was 20Hz, the quality of regeneration signals was almost similar to that of data recorders commercially available.

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