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A 2-year-old boy with Russell-Silver syndrome (RSS) was scheduled for corrective surgery for hypospadia. He had characteristic features of RSS, such as intrauterine growth retardation with subsequent marked postnatal growth impairment, body asymmetry and small triangular face. Anesthesia was induced with sevoflurane in oxygen-enriched air. The lungs were easily ventilated with a bag and mask. Tracheal intubation was extremely difficult because of the micrognathia and high arched palate, but finally successful with the use of a stylet in the endotracheal tube. Caudal epidural block was not performed because of a possible spina bifida. There were no complications related to anesthesia and surgery.

Background: The authors evaluated the efficacy of anesthetic management by total intravenous anesthesia with propofol, pentazocine and ketamine., Methods: Thirty-five patients for mastectomy were anesthetized by propofol, pentazocine and ketamine. Patients were divided into two groups by age; one is patients under 61 years of age and the others are patients above 61 years. Analysis was made retrospectively. Anesthesia was induced with propofol and ketamine and was maintained with propofol infusion and intermittent administration of vecuronium with 40% oxygen in air. Pentazocine was administrated as a bolus dose before incision., Results: There were no differences in the patient background except age and height between the two groups. After induction of anesthesia, systolic and diastolic blood pressures decreased compared with those before induction in both groups. Systolic and diastolic blood pressures and heart rate increased after tracheal intubation, but the hemodynamics remained stable after the start of surgery. The induction and maintenance doses of propofol were not different between the two groups. Patients above 61 years had smaller dosage of pentazocine compared with those in patients under 61 years. The dosage of ketamine was not different between two groups. Awakening time in about 80% of patients was within 15 minutes and is not different between the two groups. Postoperative pain relief was good in both groups. Incidence of nausea and vomiting was 25% and was not the different between the two groups., Conclusions: Total intravenous anesthesia with propofol, pentazocine and ketamine would be useful to stabilize hemodynamic state, to obtain rapid recovery and to provide effective postoperative pain relief.

Drug dependence is a social problem of over the world and resistant to medical intervention by psychiatrist as well as general clinicians. In Japan, methamphetamine dependence is one of the most critical social problems, but opioid dependence is relatively rare. Pentazocine was called the non-addictive opioid at the time of development and release and there are few reports of its dependence. We experienced a medical worker with pentazocine dependence. He started to use pentazocine to reduce serious migraine and felled into dependence by changing the purpose to relaxation of stammering fear and strain towards other people. He was successfully treated by cognitive therapy.

We evaluated the combination of pentazocine and thiamylal as induction agents for laryngeal mask airway (LMA) insertion and compared this with propofol. Ninety-four patients, ASA grade 1 or 2, were randomly assigned to one of four induction groups as follows; group P: propofol 2.5 mg.kg-1, group p 0.3: pentazocine 0.3 mg.kg-1 followed by thiamylal 5 mg.kg-1, group p 0.6: pentazocine 0.6 mg.kg-1 followed by thiamylal 5 mg.kg-1, and group T: thiamylal 5 mg.kg-1. In group T (n = 5), insertion of LMA was impossible due to inadequate anesthesia. In contrast, good and acceptable conditions for LMA insertion were obtained in 85.2%, 86.7%, and 96.9% of group P, p 0.3, and p 0.6, respectively. Apneic interval, endtidal CO2 and arterial CO2 were significantly greater in pentazocine groups than in propofol group (group P < p 0.3 < p 0.6). Systolic pressure decreased after induction in all groups. Decreases in systolic and diastolic pressure were significantly greater in group P. Heart rate did not show any significant change. We conclude that the induction with the combination of pentazocine and thiamylal provides suitable conditions for LMA insertion with more stable hemodynamics compared with propofol. Doses of 0.3 mg.kg-1 seem to be desirable for LMA insertion.

Non-Fukuyama type congenital muscular dystrophy (n-FCMD), a subtype of progressive muscular dystrophy (PMD), is a very rare autosomal recessive disorder. N-FCMD is characterized by severe and progressive motor weakness and atrophies of proximal muscles during the infant period. A 9-year-old boy with n-FCMD underwent elective surgery for muscle release around the hip joints bilaterally. As many perioperative complications related with volatile anesthetics and muscle relaxants had been reported in the anesthetic management of PMD, these drugs were thought to be contraindicated in patients with n-FCMD. Because n-FCMD seemed to have very similar pathogenesis with PMD, caudal epidural block was chosen, supplemented with the administration of diazepam, pentazocine and nitrous oxide. The operation and anesthesia were conducted uneventfully. No complications occurred postoperatively.

We examined the ventilation of patients whose faces were draped during facial surgery under local anesthesia. Ten patients who underwent eye surgery received hydroxyzine 25 mg and pentazocine 15 mg i.m. before local anesthesia. Arterial blood samples and end-tidal respiratory gases from nasal cannulae were collected at the following selected times: before draping their faces, 10 min, 30 min, 60 min after draping, and after the drapes were removed. Both arterial carbon dioxide tension (42 +/- 1 mmHg before draping and 46 +/- 1 mmHg at 10 min) and end-tidal carbon dioxide tension (33 +/- 2 mmHg before draping and 36 +/- 1 mmHg at 10 min) were elevated significantly after their faces were draped. Hypercapnea was completely eliminated by suctioning the expired gases. It is concluded that hypercapnea is inevitable during face or neck surgery under local anesthesia, and that the expired gases should be monitored and removed.

Fifty patients underwent various surgical procedures including abdominal, orthopedic, plastic and gynecological operations under total intravenous anesthesia with ketamine, pentazocine and droperidol. Neither nitrous oxide, inhaled anesthetics nor narcotics such as fentanyl were administered to the patients. Intraoperative muscle relaxation was achieved with vecuronium and the patients were ventilated manually throughout the surgical procedures. Thirty percent of the patients developed hypertension and tachycardia, but they were easily overcome with administration of calcium ion channel blocker. Their peripheral circulation as well as urine output was well maintained. No adverse effects on the liver and kidney were observed post-operatively. Their post-operative sedation and analgesia were evaluated excellent. A few patients had strange dream as if they might have missed their way into the "pink" tunnel. The data above described suggest that this anesthetic method would deserve further detailed clinical study.

The present study examined comparative self-administration of some typical CNS-affecting drugs with a new sleep-inducer, 450191-S, in rats, Most animals self-administered both methamphetamine and cocaine in an extremely stable and invariable fashion with cycles of alternating responding and non-responding periods during the day and at night. Response frequency increased in proportion to a fixed-ratio value. An initial increase in response rate followed by cessation of the responding was observed during extinction. Sixty-five percent of the rats tested self-administered morphine in a relatively variable and less stable fashion. Total daily morphine intake was directly related to the unit dose. Eighty-three percent of the rats self-administered pentazocine. Fifty and sixty-four percent of the rats maintained self-administration of phenobarbital and diazepam, respectively, with higher intake at night than during the day. Responding persisted at a low rate for several days during extinction. Abrupt withdrawal of 450191-S caused the same slight weight loss and moderate decrease in food intake as those seen with diazepam and nitrazepam, and cross-physical dependence between 450191-S and diazepam was found. Self-administration of 450191-S at 0.5-2.5 mg/kg/infusion was observed with 2 out of 11 rats, which was much less than that found with diazepam. These results suggest that 450191-S possesses little, if any, drug dependence liability of the tranquilizer type.