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An 80-year old female underwent subtotal esophagectomy with neck lymphnode dissection for esophageal cancer. The tracheal intubation was done repeatedly. Anesthesia was maintained with O2-N2O-isoflurane. No complications were observed during the operation. About thirty minutes after tracheal extubation, she developed airway obstruction with tracheal tug and stridor. Severe laryngeal edema was found by bronchofiberscopy. Percutaneous minitracheostomy was performed under ventilation support by laryngeal mask airway. Seven days later, bronchoscopy examination revealed that the laryngeal edema had disappeared. It should be kept in mind that severe laryngeal edema could develop immediately after extubation.

A 65-year-old woman with primary breast carcinoma (T 3 N 0 M 0) received neoadjuvant chemotherapy consisting of 4 cycles of 50 mg.m-2 doxorubicin (ADM) and 60 mg.m-2 docetaxel (TXT). The patient received 50 mg.m-2 ADM and 60 mg.m-2 TXT intravenously on day 1 of each cycle every three weeks. The patient underwent transthoracic echocardiography and electrocardiography (ECG) before surgery and these results were normal. ECG showed bigeminy, trigeminy after intubation and incomplete AV block (Mobitz type II) during and after surgery. The patient recovered from these arrhythmias on the first postoperative day. Our data indicate one possibility that the management of anesthetic condition might easily induce the cardiac conduction abnormalities of this patient using ADM as neoadjuvant chemotherapy.

We evaluated the effectiveness of transtracheal heating and humidification system in maintaining body temperature during general anesthesia with low flow gases in 12 gastric cancer patients. Patients were divided into two group; Control group A in which a hot-water circulating system was used and group B in which a transtracheal heating and humidification system by ANAMED HUMITUBE was used, during gastric cancer operation. Compared to the hot-water circulating system, the transtracheal heating and humidification system is more effective for maintaining body temperature and humidification after abdominal lavage by warm saline water. But there was no difference between the two groups about awakening from general anesthesia. We concluded that transtracheal heating and humidification system by ANAMED HUMITUBE is effective in maintaining body temperature under general anesthesia with low flow gases.

We used Panaxylocaine as a suitable lubricant with gargling before insertion of laryngeal mask for twenty preoperative breast cancer patients. Patients were divided into two groups; Control group (N = 10) received water-based lidocaine gel just before insertion of laryngeal mask, and Panaxylocaine group (N = 10) received Panaxylocaine as a premedication for breast cancer operation. Compared to water-based lidocaine gel, Panaxylocaine was more effective for oral discomfort after insertion of laryngeal mask. But there was no difference between two groups about oral paresthesia. We conclude that Panaxylocaine is a good premedication before insertion of laryngeal mask preventing oral and pharyngeal complications.

A once-daily dose of PF-402 60 mg and twice-daily doses of sustained-release morphine sulfate tablets (MSC) 30 mg were repeatedly administered in cancer patients in a cross-over design. Their plasma concentrations were measured, and the pharmacokinetics of PF-402 and MSC were compared. A total of 7 subjects in the study were taking commercially sold MSC 60 mg daily (30 mg twice-daily) prior to the study and had "mild" or "no" pain at the start of the study. Plasma morphine concentrations of PF-402 were longer-lasting and showed smaller fluctuations than those of MSC. Repeated administration of the same daily doses of PF-402 and MSC produced similar plasma concentrations for periods of 24 hr and 12 hr. PF-402 administration produced a Tmax of 7.4 hr, and an MRT of 9.8 hr, all longer than those with MSC. Moreover, no significant difference was observed in AUC between PF-402 and MSC. These results indicate that the sustained-release characteristics of PF-402 are superior to those of MSC, and that the two drugs have a similar absorption pattern. Adverse drug reactions (ADRs) were observed in all 7 subjects and consisted of 6 incidences of constipation, 3 incidences of nausea, 2 incidences of itching, and 1 incidence each of vomiting and somnolence. Study drug administration was not discontinued in any case due to ADRs, and no symptoms indicating physical or psychic drug dependence were observed. No abnormal laboratory values related to study drug administration were observed. The above results indicate that once-daily administration of PF-402 is sufficient to maintain plasma concentrations obtained with twice-daily administration of MSC. As the safety of PF-402 is confirmed, the drug is considered to be a useful sustained release formulation in the treatment of cancer pain.

Recovery from posthyperventilation apnea accompanies a rise in PaCO2, and ventilation starts only when the PaCO2 attains the apneic threshold PCO2 (PATCO2). In the present study, we evaluated the effect of decreasing PaO2 on PATCO2 under light enflurane anesthesia in 17 female patients undergoing elective surgery. The apnea was produced by hyperventilating the lungs under two different conditions [with 1.3% (end-tidal) enflurane in 100% O2 or with 1.3% enflurane in 30% O2]. The initiation of ventilation after apnea was identified by the first expiratory act observed in capnogram, at which time an arterial blood sample was taken to determine PATCO2. The values of PaO2 at the initiation of ventilation with 1.3% enflurane in 100% O2 and 1.3% enflurane in 30% O2 were 394.7 +/- 65.0 mmHg (mean +/- SD), and 51.9 +/- 18.2 mmHg, respectively. There was a significant difference between the two values (P < 0.001). The values of PATCO2 with 1.3% enflurane in 100% O2 and 1.3% enflurane in 30% O2 were 48.3 +/- 4.9 mmHg and 47.2 +/- 3.9 mmHg, respectively, and no significant difference was observed between the two values. Our results indicate that a decrease in PaO2 exerts no effect on PATCO2 at 0.7 MAC of enflurane anesthesia. This suggests that hypoxic stimulation does not play an important role in initiation of ventilation following posthyperventilation apnea at a light level of anesthesia.

Effects of CO2 on circulatory responses to laryngoscopy and endotracheal intubation were investigated in 16 patients under constant depth of enflurane anesthesia (1.2MAC) at different levels of CO2 (normocapnia, PETCO2: 40mmHg or hypercapnia, PETCO2: 60mmHg). Patients were randomly divided into two groups; normocapnia group (n = 8) and hypercapnia group (n = 8). Although there was no significant difference in blood pressure response to laryngoscopy and endotracheal intubation between normocapnic and hypercapnic groups, heart rate response was significantly attenuated in hypercapnic group and the latent period between the start of laryngoscopy and the onset of increase in heart rate was significantly longer in hypercapnic group. Our results suggest that hypercapnia exerts inhibitory influence on heart rate responses to laryngoscopy and endotracheal intubation.

Inhibition of respiration in response to arterial baroreceptor stimulation was studied in 7 patients with no evidence of respiratory or cardiovascular disorders under enflurane-nitrous oxide anesthesia. The arterial baroreceptors were stimulated by a bolus injection of phenylephrine (0.1mg, i.v.). A rise in blood pressure following administration of phenylephrine caused decreases in heart rate and tidal volume, suggesting the presence of cardiovascular and respiratory reflexes from baroreceptors in anesthetized humans. However, despite the statistical significance, the depression of respiration is too small to be clinically important.