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We investigated the effect of nicardipine and diltiazem on adrenal catecholamine releases, and compared it with the effect of nitroglycerin in dogs. A 35% reduction in mean arterial pressure was achieved and maintained for 45 minutes. The dogs were observed until 60 minutes after the discontinuation of drug infusions. Adrenal catecholamine releases increased during hypotension with continuous administration of nicardipine, diltiazem and nitroglycerin, but they showed no significant differences between each drug. There was no more increase in adrenal catecholamine releases in spite of additional nicardipine administration. These results suggest that Ca2+ antagonist such as nicardipine directly inhibits the catecholamine releases from the adrenal glands.

An accurate and simplified method has been developed for determination of residual ethylene oxide (EO) in the endotracheal tube using gas chromatography with a head space sampler. The endotracheal tube made of polyvinyl chloride was sterilized with EO and aerated. Residual EO after aeration was 6630 +/- 1915 ppm (mean +/- SD). It decreased to 72 +/- 46 ppm on 7th day. The endotracheal tube should be left unused for more than 7 days after sterilization and aeration. The safety level of residual EO in the endotracheal tube by U.S.FDA regulation is less than 250 ppm. The concentration of residual EO should be lower than 250 ppm, if this rule is observed.

A 73-year-old man complained of pain in his right ear with vesicular lesion for three days. He complained of no weakness of facial musculatures, but muscle test revealed slight weakness in orbital and oral muscles on admission. His hearing acuity of the left ear was intact. Vertigo with spontaneous nystagmus to left was complained. The patient was treated with stellate ganglion block four times a day, prednisolone 80 mg a day p.o. and acyclovir i.v. Mannitol solution 300 ml a day for eight days was given i.v. to reduce edema and to protect facial nerve. On his 3rd hospital day, his paralysis progressed and he could not close his eye or whistle with his mouth. Evoked myogram showed 91% impairment of the nerve. During recovery period there was discrepancy between facial palsy score of clinical signs and degree of nerve impairment by evoked myogram. On his 12th hospital day his facial nerve score improved 9 to 12 (0 complete paralysis, 40 no paralysis) but evoked myogram showed further progress of nerve impairment from 86% to 91% (Evoked wave heights were 14% and 9% of normal site respectively). The discrepancy is probably because facial palsy score reflects also neurapraxia of inflammatory nerve, and stellate ganglion block has no effect on changing course of facial nerve injury.

We compared two methods of respiratory managements during bronchoplasty surgery. In one lung ventilation group (OLV-G), 10 patients were ventilated with Broncho-cath tube or Univent tube. On another 10 patients, ventilation was performed with Univent tube following insertion of bronchial blocker into main bronchus of dependent lung. Dependent lung was then ventilated using high frequency jet ventilation (HFJV) through bronchial blocker superimposed with low tidal volume IPPV (selective HFJV, S-HFJV-G). Oxygenation index (O.I.) of S-HFJV-G was significantly higher than that of OLV-G when bronchus was open. These phenomena might have occurred through prevention of pulmonary blood flow shift to the non-dependent lung when S-HFJV was used.

A 56-year-old man (160 cm, 64 kg) having right visual field defect due to obstruction of the central retinal artery for 6 months was treated with stellate ganglion block and electric acupuncture. His visual field improved slightly immediately after preliminary treatment with stellate ganglion block and electric acupuncture judging from perimeter recording and his complaints. Stellate ganglion block on every day and electric acupuncture on every other day were performed for 10 days and there after these treatments were done two times a week. Twenty days after starting the treatment, his visual field improved on his perimeter examination. We discussed that the cause of improvement was activation of slept cone cells which needed more energy for activation than rod cells by increasing retinal blood flow with stellate ganglion block and electric acupuncture. We recommend vasodilating treatments such as stellate ganglion block and electric acupuncture for visual field defect due to obstruction of central retinal artery even in chronic state.

A 58 year old man had been suffering from intractable left ophthalmic post herpetic neuralgia (PHN) for 7 years. He has also been treated for polyarteritis nodosa for 10 years. For pain relief, he was treated initially with frequent (4 times a day) stellate ganglion block (SGB) and peripheral ophthalmic nerve block for a month without relief. Then supraorbital nerve block with neurolytics, TENS and acupuncture were done with a slight relief of his pain. Recently his pain became worse even with imipramine 75 mg and carbamazepine 100 mg a day which relieved effectively the patient from the pain for the last 3 years. The pain was so severe to disturb his usual daily activity. Gasserian ganglion block with methyl prednisolone acetate 10 mg was done. After the block, his ADL improved markedly. Three months after the block, he had no spontaneous pain and slight pain with light touch on the injured skin did not annoy him. Several days before the block, electric stimulation to control his pain was tested. Stimulation with the electricity (4.5 mA, 10 cycle and 400 microseconds) brought him complete relief from the pain during the stimulation. Trigeminal SEP showed no response to the stimulation of injured skin.

From 40 patients under surgical operation, gastric or bile juice was obtained to determine the possible excretion of free and conjugated catecholamine (CA) into the two kinds of juice. The patients were divided into normal renal function group and chronic renal failure group and former group was further divided into the dopamine (DA)-administered group and the non-DA-administered group. In the non-DA group with normal renal function, the gastric juice contained 0.30 +/- 0.11ng.ml-1 of free and 0.12 +/- 0.06ng.ml-1 of conjugated norepinephrine (NE) and also 0.09 +/- 0.07ng.ml-1 of free and 0.40 +/- 0.10ng.ml-1 of conjugated DA. In DA group, the gastric juice contained 2.01 +/- 0.41ng.ml-1 of free and 3.66 +/- 0.84ng.ml-1 of conjugated DA respectively. Significant differences in DA were observed between two groups. In the bile juice, the conjugated NE increased significantly from 0.15 +/- 0.05 ng.ml-1 to 1.24 +/- 0.34ng.ml-1 and also the conjugated DA increased significantly from 2.17 +/- 0.77ng.ml-1 to 21.33 +/- 5.23ng.ml-1 by infusion of DA at the rate of 2 micrograms.kg-1.min-1 for 197 +/- 48min. In chronic renal failure group, the conjugated NE and DA increased significantly to 1.04 +/- 0.27ng.ml-1 and 1.64 +/- 0.61ng.ml-1 respectively compared to that of normal renal group. It was confirmed that gastric juice and bile juice contain the free and conjugated CA during surgical operation and by the infusion of DA, free and conjugated DA are excreted into gastric juice and bile juice and also conjugated CA in the gastric juice from chronic renal failure group is increased.

Difficulty to determine level of spinal or epidural anesthesia troubles us in the patients who can not communicate well, for example in patients with hearing loss, depressed CNS with or without depressants and in slowly replying patients with various reasons. We know that one can determine spinal or epidural anesthetic level with stroking the skin with finger with which we can detect different touch sensation, feeling as anesthetized smooth and unanesthetized rough. We thought that different touch sensation is due to perspiration at unblocked skin area. If cause of difference of touch sensation was due to perspiration at unanesthetized area as we thought, perspiration may be visible on unblocked area. We found no perspiration but texture change on the anesthetized skin. We photographed the texture of the blocked skin, before and after spinal anesthesia. The skin texture after the block became shallow and widened. These texture changes give us different touch sensation, rough and scratched before and smooth after the block. We can easily differentiate the blocked from the unblocked skin area with finger or by magnifying glass by which the skin texture change is visible.

A rare anesthetic experience of a 30-year-old woman with acromegaly complicated with Basedow's disease is reported. After the thyroid function was successfully controlled by drug therapy, resection of pituitary adenoma was performed under general anesthesia. Anesthesia was induced and maintained with NLA. No problem was observed during the operation and postoperative period. Careful attention should be paid to the management of circulation, respiration, metabolism and endocrinium through the perioperative period.