We investigated the blood concentrations of intravenously administered buprenorphine 0.05mg, which was of low dose, by the redio-immunoassay method and the analgesic effect of buprenorphine 0.05mg as an assistant drug of enflurane anesthesia with nitrous oxide and pancuronium bromide according to the changes of blood pressure and pulse rate.
The maximum concentration of buprenorphine 0.05mg i. v. was 6.68±4.96 (mean±SD) ng/ml and about two times that of intramuscularly administered buprenorphine 0.3mg.
The changes of blood pressure and pulse rate were not clinically significant.
The result showed that the blood concentration of intravenously administered buprenorphine 0.05mg was efficient to get the analgesic effect and 0.05mg of buprenorphine was optimal dose for this method of anesthesia.

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For the last 10 years, from 1978 to 1987, intraoperative blood loss and preoperative blood preparation for patients undergoing elective oral surgery at Hokkaido University Dental Hospital were analyzed and evaluated. There were 18 types of operation performed on 1003 cases.
With the concept that we developed, the maximum surgical blood order schedule (MSBOS), calculated crossmatched-to-transfused ratio (C/T), we were able to obtaine the amount of adequate preoperative blood preparation.
As a result, the MSBOS was less than 12 units for operations involving oral malignant tumors, and the average C/T was 1.31. The blood usage in our hospital was considered adequate.
But in 382 cases where blood was ordered preoperatively, 183 cases (47.9%) did not received blood transfusion.
From this results, adequate blood preparation will be based on this evaluation for future purposes.

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Somatosensory evoked potential (SEP) was monitored to evaluate causes of neurologic deficits as well as to detect neurologic dysfunction by cross-clamping of the aorta during 101 thoracic aortic aneurysm operations, of which eight patients showed neurologic deficits postoperatively. These deficits were classified as 4 of brain damages and 6 of spinal cord damages. The individual cause of brain damage was as follows, interruption of the left vertebral arterial flow by cross-clamping of the left subclavian artery, cerebral emboli, hypotension, and extreme fluctuations of blood pressure during surgery. The causes of spinal cord damage were attributed to the inadequate distal perfusion in 3 patients, acute retrograde aortic dissection in one, interruption of the critical intercostal artery and retrograde massive bleeding from intercostal arteries in one and postoperative thrombus formation in distal aortic lumen in one. Although the time of the occurrence and the causes of neurologic deficits can be evaluated easily by the monitoring of SEP, the effective methods to prevent or treat neurologic deficits when it is manifested during thoracic aortic aneurysm surgery are not available at the present situation.

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Interface standards between patient monitors and computers do not exist. Since each monitor has specific interfacing requirements, computerized data acquisition systems developed so far have been highly dependent on such a monitor. We designed and made a universal data acquisition interface and simulate standardization at user level. The data acquisition interface has 16 analog and four digital input ports, through which vital sign data in a variety of different formats are collected from patient monitors. Configuration of each input port can be done by a host computer using a set of simple commands. The interface converts collected data to a standardized format and transmits them to the host computer. Users can select an appropriate interval of data transmission for their system. Communication between the interface and the host computer is performed via an RS232C line. Using the interface, a flexible data acquisition system can be developed with less programming effort. The interface provides an excellent environment for collecting vital sign data from monitors. Applications of the interface include data acquisition systems not only for computerized anesthesia record but also for research purposes.

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Epidural buprenorphine by Patient-Controlled Analgesia system was done in patients who underwent laparotomy (14 cases) or mastectomy (2 cases). Averaged period for this treatment was 43 hours and 30min. and averaged doses of buprenorphine was 0.03mg/hr. No other analgesics were required by the patients so that they obtained sufficient analgesia with this procedure. No side effects except reduction of respiratory rate in a patient were seen.
It is concluded that the Patient-Controlled Analgesia used is an useful method for the management of post-operative pain.

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This is a report of a case of periodic leg movements (PLM) observed in an 86 year old male during either mid-thoracic epidural anesthesia using 1.5%-lidocaine for cholecystectomy or lumbar spinal anesthesia using 2%-lidocaine. The PLM observed were stereotyped (extension of the big toe in combination with partial flexion of the ankle, knee, and hip lasting 3-5 seconds) and repetitive (inter-event intervals between jerks were 20-40 seconds) for about 120 minutes and 30 minutes respectively. The patient was awake but unaware of the PLM unless reminded.
Periodic episodes of repetitive and highly stereotyped leg muscle jerks during sleep are well known as sleep-related (nocturnal) myoclonus (SRM). The present case was quite similar to SRM in every respect except for its occurrence during wakefulness. SRM is more prevalent in aged males but its mechanism remains to be elucidated. In our two cases PLM were seen only while the local anesthetic was acting on the spinal cord. Since there were no specific findings in this patient relevant to SRM, these anesthesia-related PLM may suggest that the spinal cord was involved in the development of the leg jerks. In particular we consider that physiologic changes commonly seen during NREM sleep and a certain phase of anesthesia such as suppression of the descending inhibitory pathway, and pyramidal tract dysfunction are relevant to anesthesia-related PLM. In addition, the concomitant alteration of the blood flow in the leg, and changes due to aging of the spinal cord may also be involved.

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We had a case which coronary artery spasm (CAS) occurred 7 times during one anesthesia. A 60-year-old man suffering from rectal cancer was scheduled for elective surgery. Anesthesia was maintained with a combination of epidural anesthesia and light general anesthesia. After one and a half hours from the start of surgery, hypotension suddenly occurred. The ECG showed ST elevation and a wide QRS complex. Repeat episodes of hypotension and ECG changes occurred another 6 times during the operation. All of these attacks were successfully treated with intravenous injections of 2mg Verapamil, a Ca antagonist. After completion of the operation, serial ECG and serum enzymatic examinations were within normal. These clinical findings suggest that the hypotension and ST elevations were caused by CAS.
Myocardial ischemia caused by CAS is often accompanied by severe arrhythmias and hypotension. In these situations, the use of Nitroglycerine is not indicated, because of its higher possibility of severe hypotesion. In this case, a Ca antagonist was effective. The cause of repeated episodes of CAS was discussed.

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Two cases of postoperative cerebrovascular accident were reported. Both patients were on the age of forties and clinical cerebral abnormal sign could not be found in the preoperative examinations.
Case 1. A 47-year-old man underwent a removal of rectal cartinoid under spinal anesthesia. The patient complained of a severe headache on the following day, being drowsy thereafter. CT-scanning revealed on the right hemisphere cerebral infarction. A lobectomy was performed urgently and the level of consciousness was improved gradually. He had a right internal carotid artery occlusion in postoperative examinations. Three monthes later he discharged with left hemiplegia.
Case 2. A 49-year-old woman underwent a resection of liver cyst uneventfully under enflurane-N₂O-O₂ anesthesia. The next day she had a headache and became drowsy with eye movement disturbance. Cereberal hemorrhage was recognized by CT-scanning. A partial resection of hemicerebellum was performed immediately and her consciousness was improved clearly on the next day. A histological diagnosis revealed cavernous angioma. She discharged without neurological deficits three monthes later.
Early diagnosis and treatment are important in the prognosis of postoperative cerebrovascular accident. Continuous observation of conscious level is necessary to all postoperative patients.

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Twenty-four hours after oral ingestion of paraquat, a 67-year-old female was admitted to have hemodialysis, direct hemoperfusion and steroid pulse therapy. During the intensive care, a gastric cancer which required an early radical operation was diagnosed.
The minimum requirement for anesthesia was regarded as 1) negative qualitative paraquat urinalysis, 2) normalization of the serum peroxide lipid level, and 3) restoration and stabilization of the arterial blood gas level. On the 53rd day of hospitalization, the patient satisfied above mentioned requirements for anesthesia and subtotal gastrectomy was performed. Some attempts at anesthetic management were 1) normoxic ventilation keeping FIO₂ in 0.21-0.22 to prevent lung fibrillation, 2) no use of N₂O to prevent enlargement of pulmonary bulla which the patient already had right after ingestion of paraquat and 3) epidural anesthesia supplement by droperidol and fentanyl. No complications occurred in intra- or post-operative course of management.

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A 15 year-old woman with MCTD had left side trigeminal sensory disturbance as an early stage of the disease. She had Raynaud's phenomenon, muscle weakness, arthritis, difficulty in swallowing and myalgia. Serological studies revealed positive anti-nuclear antibody of speckled pattern and solitary anti-RNP antibody. These clinical findings and serological studies were compatible with MCTD. Left trigeminal sensory neuropathy was severe in maxillary nerve and mandibulary nerve especially. And Glucocorticoids therapy was not effective for trigeminal sensory neuropathy. Ticlopidin was effective shortly but neural disturbance increased gradually again. Stellate ganglion block therapy (SGB) was effective. SGB and hyperbaric oxygen therapy (OHP) were more effective than SGB only. The patient was almost completely recovered without the sensory disturbance of left upper gingiva. We concluded that SGB and OHP are effective for trigeminal sensory neuropathy in MCTD.

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Despite advances in neonatal surgical techniques and intensive care treatments, the mortality rate of infants displaying CDH (Congenital Diaphragmatic Hernia) within the 24 hours of birth remains frustratingly high.
The cornerstone of current managements techniques rests on the immediate surgical repair. However, many infants die after 'honeymoon period' of about 18 hours on account of PPHN (Persistent Pulmonary Hypertension of the Neonate), which is a consequence of hypoxia, acidosis, and the innately abnormal pulmonary arterioles.
Recent reports have suggested that preoperative stabilization and delaying radical surgery decrease the severity of PPHN. We adopted this new management approach to infants displaying CDH within 24 hours of life.
Our experience of two cases suggests that delaying surgery is recommandable as a new management of CDH.

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Anesthetic management of a 9-year-old boy with upper extremity amelia undergoing posterior spinal fusion (Harrington's operation) offered the following problems.
The most careful management was blood pressure monitoring because of abnormality of vascular system through the defective or rudimentary limbs. It is advisable to cut down a superficial temporal artery in complete amelic patients. ECG should be recorded through chest lead. The catheter for central venous pressure monitoring and infusion should be inserted via the internal or external jugular veins. And the needle inserted into an artery for only blood gas analysis should be as small as possible.

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Three children with anterior mediastinal tumors developed airway obstruction during induction of anesthesia for emergency operations.
Computed tomography of a 13 year-old female with right chest pain, revealed an anterior mediastinal tumor, which compressed the right mainstem bronchus and lower bronchus backwards. Just after endotracheal intubation, inspiratory resistance increased becoming life-threatening. Turning her from the supine position to the right lateral position decreased airway obstruction.
CT scan of a 15 year-old male in the right lateral position due to dyspnea, revealed an anterior mediastinal tumor compressing trachea backwards. Just after endotracheal intubation under awake induction in the sitting position, the airway was obstructed completely. However right bronchial intubation by a fiberoptic bronchoscope decreased airway obstruction.
CT scan of a 13 year-old female with right axillary pain, demonstrated an anterior mediastinal tumor compressing trachea backwards. Immediately after endotracheal intubation, airway obstruction occurred, but later improved by reappearance of spontaneous breathing. Under bronchial intubation on the right side beyond the stenosed portion, and stand-by partial cardiopulmonary bypass, general anesthesia was begun again. Soon after airway obstruction occurred, median sternal incision and bilateral thoracotomies decreased airway obstruction.
Therefore, the followings are our anesthetic management for children with anterior mediastinal tumors in general anesthesia.
(1) Pre-operative evaluation (CT scan, echocardiogram).
(2) Arrangement of the patient's position, the use of fiberoptic bronchoscope and the use of partial cardiopulmonary bypass.
(3) Avoidance of anesthetics with a negative inotropic effect.
(4) Avoidance of muscle relaxants and support of spontenous breathing.
(5) Monitoring: Pulse-oxymeter and end-tidal CO₂ are of great use.

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