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Isolated left ventricular noncompaction (LVNC) is a rare primary genetic cardiomyopathy characterized by prominent trabeculation of the left ventricular wall and intertrabecular recesses. Perioperative management of the patient with LVNC might be challenging due to the clinical symptoms of heart failure, systemic thromboembolic events, and fatal left ventricular arrhythmias. We conducted real time intraoperative transesophageal echocardiography in a patient with LVNC undergoing general anesthesia for ovarian cystectomy.

Aortic dissection during pregnancy is a devastating event for both the pregnant woman and the baby. We report a case of acute aortic dissection (Stanford type A) in a pregnant woman with Marfan syndrome at the 29(th) week of gestation. She underwent a cesarean section followed by an ascending aorta and total arch replacement with cardiopulmonary bypass, without a prior sternotomy. The hemodynamic parameters were kept stable during the cesarean section by using inotropes and vasopressors under transesophageal echocardiography monitoring. The newborn survived after endotracheal intubation and management in a neonatal intensive care unit.

Right aortic arch, a congenital malformation of the great vessels, can cause compression of trachea and/or esophagus. We experienced a case of ventilatory compromise in an infant with tetralogy of Fallot and right aortic arch immediately after insertion of transesophageal echocardiography probe during cardiac surgery. Although intraoperative transesophageal echocardiography can be safely performed in infants with congenital heart disease, it should be done with caution in patient with similar vascular malformation.

Background: Ethanol injection during a sclerotherapy for the treatment of arteriovenous malformation, which performed under general anesthesia, can cause significant hemodynamic changes, even cardiovascular collapse. However, guideline for adequate management of hemodynamic change or preventing detrimental complication has still not been proposed. Methods: Twenty-two piglets were randomly allocated to one of two groups: a 2.5 ml and a 4.0 ml ethanol. After baseline hemodynamic measurements, 2.5 ml or 4.0 ml of absolute ethanol was repeatedly administered in distal portion of renal vein with 10 minute intervals, and hemodynamic parameters were measured immediately before and after bolus injection of absolute ethanol until 10 minutes after final injection. Results: Compared with 2.5 ml group, systolic, mean and diastolic pulmonary arterial pressures (PAP) and pulmonary vascular resistance (PVR) of 4.0 ml group showed significant differences from the first bolus injection of absolute ethanol. Hemodynamic parameters of 2.5 ml group did not show the increasing or decreasing tendency during a session, whereas, in 4.0 ml group, systolic, mean and diastolic PAP and PVR showed significantly increasing tendency. However, systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, and systemic vascular resistance did not show increasing or decreasing tendency in both groups. Conclusions: Based on the hemodynamic alterations observed from piglet model, the bolus injection of absolute ethanol during sclerotherapy in congenital arteriovenous malformation requires careful hemodynamic monitoring. We strongly recommend that anesthesiologist should carefully monitor the hemodynamic parameters after injection of relatively large amount of absolute ethanol.

Background: This study evaluated the position and relationship between the right internal jugular vein (IJV) and the surrounding external landmarks using ultrasonography. Methods: Fifty-four patients undergoing central vein access for cardiac surgery were enrolled in this study. The IJV, carotid artery (CA) and sternocleidomastoid muscle (SCM) at the cricoid cartilage level in trendelenburg position with head rotation were examined using a two dimensional ultrasound transducer of a TEE machine. Images of the vessels and the demographic data of the patients were recorded and analysed. Results: At the level of the cricoid cartilage, the position of the right IJV was medial to middle of the clavicular head of the SCM muscle in 26 cases (48.2%), lateral in 11 cases (20.4%) and just above the middle of clavicular head of the SCM muscle in 17 cases (31.5%). In 43 patients (79.6%), the IJV overlapped the CA anterolaterlly ＜ 5 mm, and these cases were regarded as normal. Ten patients (18.5%) had a medially positioned IJV overlapping the CA more than 5 mm and the IJV was positioned lateral to CA in 1 (2%) patient. The mean ratio of the overlapped diameter and the diameter of the CA was 33.6% and the overlapping ratios were greater than 50% in 10 patients (31.4%). The mean skin-to-vein distance at the angle of was 1.82 cm. Conclusions: In 18.5% of patients positioned in the Trendelenburg position, with their head turned to the left 30o, the IJV overlapped the CA medially more than 5 mm, which increased the risk of a carotid puncture using the blind technique.

Background: A new transfusion guideline was developed to reduce the number of unnecessary blood preparations and transfusions as well as the complications associated with transfusions in an off-pump coronary artery bypass (OPCAB) procedure. The results were compared with those using existing guidelines. Methods: The patients who had undergone an elective OPCAB were divided into 2 groups. In group A (n = 70, with existing transfusion guideline), the anesthesiologists transfused to a Hemoglobin (Hb) level of 8.0-10.0 g/dl based on the decisions of the anesthesiologists or surgeons. In group B (n = 102, using new transfusion guideline), the transfusion was performed to a Hb of 8.0 g/dl. The number of preoperative blood preparations, transfusions, and wastage were evaluated, and the Hb concentrations were examined preoperatively, postoperatively, at discharge, and 2 weeks after surgery. The incidence of postoperative complications in the two groups was compared. Results: There was no significant difference in the preoperative, intraoperative, and postoperative minimal Hb concentrations between the two groups. However, the Hb concentrations in group B on the day after surgery, at discharge, and 2 weeks after surgery were significantly lower than those in the control group (P ＜ 0.001); the Hb was ＞ 10.0 g/dl in group B (minimum Hb 10.4 g/dl). The rate of bloodless OPCAB increased from 2% to 57%. There was a similar number of blood restorations and wastage, incidence of wound infections, bleeding, arrhythmias, myocardial infarctions, sudden death, length of the ICU stay and postoperative admissions in the two groups. Conclusions: With the new transfusion guideline, number of P-RBC preparations and transfusions was decreased significantly without an increase in the incidence of complications.

Background: Because of the difficulty of resuscitation caused by bupivacaine-induced cardiotoxicity, the choice of resuscitation medication is still unclear. We investigated whether insulin can improve outcomes of resuscitation by epinephrine from bupivacaine-induced cardiovascular collapse. Methods: Twenty-four mongrel dogs were randomly allocated to one of the two groups: an EPI group (n = 12), and an EPI + RI group (n = 12). Sixty minutes after induction of general anesthesia, baseline measurement of hemodynamic parameters and arterial blood gas tension was performed. Bupivacaine infusion was started at a rate of 0.5 mg/kg/min and kept until mean arterial blood pressure fell below 40 mmHg and heart rate 40 beats per minute. At this point, bupivacaine infusion was stopped and resuscitation was started, with epinephrine in EPI group and epinephrine combined with regular insulin in EPI + RI group. Results: Bupivacaine infusion caused significant decreases in mean arterial blood pressure, heart rate, cardiac output, and systemic vascular resistance and increases in mean pulmonary blood pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, and central venous pressure. The recovery rate of EPI + RI group (8/12) was higher than that of EPI group (2/12). Conclusions: Combined administration of epinephrine and regular insulin improves outcomes of resuscitation of bupivacaine- induced cardiovascular collapse. Therefore, we believe that prompt administration of insulin should be strongly considered in case of bupivacaine-induced cardiotoxicity.

Background: The prevention of hypotension continues to be one of major challenges in spinal anesthesia (SA) for cesarean delivery. And prehydration is widely performed to prevent hypotension. However, some controversy exists over the types of fluid used for prehydration. Therefore, we investigated the effects of crystalloid versus colloid preload on the incidences of hypotension, and the notion that minimal local anesthetic used in combined spinal-epidural anesthesia (CSEA) could further decrease the incidence of hypotension after colloid preloading. Methods: One hundred and fifty parturients were randomly allocated into three groups: CR (crystalloid)-SA, CO (colloid)-SA, and CO-CSEA according to the types of preload and anesthesia. In the CR-SA group, 1,000-1,500 ml of crystalloid was administered under spinal anesthesia. In the CO-SA and CO-CSEA groups, 500 ml of colloid followed by 500-1,000 ml of crystalloid under SA and CSEA was administered, respectively. Bupivacaine 9 mg with opioids was used for SA, and bupivacaine 6 mg with opioids and epidural top-up with 0.25% bupivacaine 10 ml for CSEA. Incidences of hypotension, nausea and vomiting were recorded until delivery. Results: Colloid preload reduced the incidence of hypotension (18% vs 44%, P = 0.005), and side effects (2% vs 20%, P = 0.005) compared to crystalloid in SA. However, lowering local anesthetic using CSEA (hypotension 20%, side effects 4%) did not further decrease the incidences of hypotension and side effects when using colloid. Conclusions: Colloid is a better fluid for prehydration in cesarean section under spinal anesthesia. 18-20% is considered a minimum incidence of hypotension.

Background: Even though the effect of prehydration on the spinal anesthesia-induced hypotension has not yet been concluded, prehydration prior to spinal anesthesia is recommended in order to reduce the incidence and severity of hypotension. We investigated the effects of prehydration on hemodynamic change during spinal anesthesia with isobaric 0.5% tetracaine. Methods: We prospectively performed this study on 96 patients who underwent elective transurethral surgery from October 2002 to January 2004. Patients were randomly allocated to receive either no prehydration or 10 ml/kg crystalloids administered over 10-15 min prior to spinal anesthesia. We compared dermatomal spreads of spinal anesthesia, hemodynamic parameters (blood pressure, heart rate), incidences of hypotension and bradycardia between two groups. Results: Hemodynamic parameters, incidences of hypotension and bradycardia showed no statistically significant differences during spinal anesthesia between two groups. There were statistically significant differences in the dermatomal spread of sensory levels between two groups from 5 to 90 min after spinal anesthesia. Sensory block levels in prehydration group were statistically lower than no prehydration group. Conclusion: We hypothesized that prehydration can be one of factors that influence on dermatomal spread of local anesthetics in isobaric spinal anesthesia. The difference of dermatomal spread between two groups may be caused by brain blood barrier (BBB)-freely passing crystalloids, which may influence on the volume and density of cerebrospinal fluids. To verify this phenomenon found in our study, further investigation is still warranted.

Background: We frequently experience the elevation of pulmonary arterial pressure (PAP) during ethanol sclerotherapy of arteriovenous malformations. But, the study on the degree of PAP elevation during ethanol sclerotherapy has not yet been made. Therefore, we evaluated the PAP elevation during ethanol sclerotherapy. Methods: We retrospectively reviewed PAP changes in 124 procedures conducted on 41 arteriovenous malformation patients during ethanol sclerotherapy. We investigated the degree of elevation of PAP and the incidences of pulmonary arterial hypertension during ethanol sclerotherapy. Results: High incidences of pulmonary arterial hypertension were observed during ethanol sclerotherapy (53/124 procedures, 42.7%). The mean highest PAP values were 33.8 10.9 mmHg (systolic), 25.2 7.9 mmHg (mean), and 18.3 7.4 mmHg(diastolic). Incidence of nitroglycerine administration was 47.5% (59/124 procedures). Mean PAP values at the end of procedure was 29.1 9.1 mmHg (systolic), 22.0 7.0 mmHg (mean), and 16.1 6.4 mmHg (diastolic). Conclusion: The incidences of pulmonary hypertension during ethanol sclerotherapy were high. Therefore, cautious management and close cooperation between anesthesiologist and interventional radiologist are essential to prevent dreadful outcome.

Background: In this study, we performed one-lung ventilation (OLV) in rabbits to assess the effects of OLV on the / ratio and the respiratory physiological changes using MIGET. Methods: Ten male New Zealand white rabbits, weighing 3-4 kg were selected. To perform MIGET, six inactive gases (SF, krypton, desflurane, enflurane, diethyl ether, acetone) in 500 ml normal saline were injected intravenously. During two-lung ventilation (TLV), and after OLV for 30 minutes, blood was sampled for blood gas analysis and MIGET, hemodynamic variables were measured. For MIGET, the concentrations of the injected inert gases were measured and converted to retention/excretion data; the / distribution curve was obtained using a computer. Results: Systolic, mean, and diastolic pulmonary pressures were elevated significantly and pulmonary resistance was doubled (P ＜ 0.05) in OLV compared to TLV. Blood pH decreased in OLV. The calculated intrapulmonary shunt was 19% and 52%, TLV and OLV, respectively. The analysis of / using MIGET showed that the / distribution curve was wider and that the / area was larger in normal rabbits. And, that intrapulmonary shunt approximated to 11%. In the case of OLV, a significant increase in shunt was observed but no change in the amount of dead space at distribution area, (log SD, log SD) remained the same, whereas the / distribution curve shifted toward the right. Conclusions: OLV in rabbits showed severe hypercapnia and hypoxemia leading to a considerable increase in shunt. Because of the wide range of / distribution in TLV, no significant changes in respiratory variables were observed during OLV.

Background: The incidence of intraoperative awareness is known to be high in cardiac surgery using cardiopulmaonary bypass, and there is a tendency to use more anesthetics to maintain anesthesia without recall. We investigated the usefulness of the bispectral index monitor in reducing the amount of anesthetics without intraoperative awareness. Methods: Forty patients scheduled for elective coronary artery bypass graft surgery under cardiopulmonary bypass were randomly allocated into two groups. In the control group, systemic blood pressure was a main indicator to contol the infusion rate of propofol and fentanyl. Infusion rate of propofol and fentanyl were controlled by the bispectral index in the BIS group. A postanesthetic interview relating to intraoperative awareness was performed on the second postoperative day by a research assistant. Results: The average flow rate of propofol (control group;0.137 0.012 mg/kg/min, BIS group;0.110 0.003 mg/kg/min, P ＜ 0.01) and fentanyl (control group;6.485 0.413/kg/h, BIS group;4.321 0.5/kg/h, P ＜ 0.01) were significantly different between groups. The postoperative extubation time was 6.8 1.9 h in the control group and 5.3 2.3 h in the BIS group (P ＜ 0.05). The average BIS was 43.1 5.6. No subjects showed positive results in the intraoperative awareness test. Conclusions: Intraoperative monitoring of the bispectral index in patients undergoing cardiopulmonary bypass for coronary bypass surgery reduced requirement of anesthetics without intraoperative awareness.

Background: Venovenous bypass (VVB) in liver transplantation has been used to decrease the acute hemodynamic and metabolic changes during anhepatic periods. But, the use of VVB in patients undergoing liver transplantation is still under debate concerning its relative risks and benefits. Therefore, the aim of this study was to examine the influences of VVB on the coagulation status and the amount of transfusion in living-related liver transplantation. Methods: We conducted this retrospective study on 39 patients who underwent orthotopic living-related liver transplantation using the piggyback technique from March 2001 to April 2002. While 19 patients did not receive venovenous bypass, 20 patients received. We compared the two groups in terms of coagulation-related parameters (prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen and thromboelastograph), the amount of transfusion during intraoperative and post-operative 1day. We also compared the incidences of post-reperfusion syndrome in the two groups. Results: The group that underwent living-related liver transplantation with VVB required more packed red blood cell (p-RBC) transfusion than the other group without VVB from post-reperfusion untill the end of operation (P ＜ 0.05). This difference in the amount of p-RBC transfusion may be due to the blood remained in the VVB circuit at the termination of VVB. However, the two groups were similar in terms of coagulation-related parameters, the amount of other blood components, such as fresh frozen plasma, platelet concentrates, cryoprecipitate, total amount of transfusion during the 24 hours postoperatively, and the incidence of post-reperfusion syndrome. Conclusions: We conclude that the using of venovenous bypass in living-related liver transplantation did not influence coagulation status and the amount of transfusion perioperatively.

A 31-year-old female patient suffering from hemoptysis was scheduled for a lobectomy. Her preoperative electrocardiogram was normal sinus rhythm and electrolytes were within normal range. During mask ventilaton a short run of ventricular tachycardia appeared, but she returned to normal sinus rhythm after lidocaine 60 mg was injected. However, after intubation, sustained ventricular tachycardia developed and did not respond to additional lidocaine immediately. Blood gases and electrolytes were in acceptable range and severe hypotension did not occur during the attack. Several minutes later, the rhythm changed spontaneously to sinus rhythm with intermittent premature ventricular contractions. However, stimuli such as position change and endotracheal suctioning caused another paroxysmal ventricular tachycardia. Idiopathic ventricular tachycardia was suspected and esmolol 30 mg was injected. Ventricular tachycardia terminated abruptly and changed to sinus rhythm so that the lobectomy was done successfully with a continuous infusion of esmolol. Weare going to report this clinical experience with review of its mechanism, treatment, and long term prognosis.

Background : Although a personal interview with the patient during the preoperative visit decreases anesthesia-related anxiety, few efforts have been directed at identifying the patients` greatest concerns. The present study was undertaken to assess patients` anxiety regarding anesthetic management and their specific concerns about anesthesia. Methods : Before any premedication or explanstion of proposed an esthetic technique was given, two hundred and ninety five people (family members and patients) scheduled to undergo elective surgical procedures under general or regional anesthesia, were asked the question of what worried them about the anesthesia and what patients really want to know about their anesthesia. Results : The vast majority of patients and their families want to know comprehensive information concerning their general or regional anesthesia including information about all possible complications related to anesthesia. The most common preoperative anxiety and concern regarding the anesthetic procedure relates to complications. In addition, frequent anxiety and curiosity were about recovery time after anesthesia, anesthetic method and pain. Parents and families of children undergoing general anesthesia most worried about brain damage including decline of memory and learning ability. Conclusions : Reassurance and satisfactory explanations about preanesthetic anxiety and curiosity are required for the patient and their family preoperatively in an attempt to reduce the patient`s anxiety. The information from this study could help anesthetists communicate more effectively with the patient and their family during preoperative visits. (Korean J Anesthesiol 200: 42: 11~16)

Background: Respiratory complications have been the main cause of death after a resection of esophageal cancer. This retrospective study was conducted to investigate the effect of thoracic epidural analgesia on respiratory complications after a resection of esophageal cancer. Methods: This study enrolled two groups of patients undergoing an esophageal resection during a 7-year period. The first group (control group) was comprised of 105 patients in whom thoracic epidural analgesia was not used. The second group (epidural group) was comprised of 121 patients in whom thoracic epidural analgesia was done routinely. The latter group received an initial bolus of 0.1% bupivacaine 10 ml with 2 mg of morphine at the end of surgery and an infusion of 2 ml/hr of the solution comprised of 0.1% bupivacaine with 0.2 mg/ml morphine for 3 days. The incidence of respiratory complications and the duration of ventilator care and ICU stay were investigated by reviewing of charts. Results: There were no significant differences in the incidence of respiratory complications and the duration of ventilator care and ICU stay in both groups. Conclusions: The results of this study suggest that the routine use of thoracic epidural analgesia did not reduce the incidence of respiratory complications after resection of esophageal cancer.

Background : One of the most important physical properties affecting the level of analgesia after intrathecal administration of a local anesthetic is baricity. This study was done to compare the distribution of 0.5% tetracaine in 5% glucose solution and in 10% glucose solution. Methods : Tetracaine 2.6 ml (0.5% with 5% glucose or 10% glucose) added with 0.1% epinephrine 0.2 ml was administered to each of 20 patients. All patients'' heights were within 160-170 cm. The cephalad spread of analgesia, the degree of motor block in the legs and hemodynamic values were assessed at 2-min intervals for the first 10 min and then at 5-min intervals until 30 min. Results: In the 5% glucose and 10% glucose solutions. the maximum sensory level was T5.4 and 74,3, the maximum sensory block time was 128.1 min and 118.2 min and the time to complete motor block was 5.4 mill and 5.2 min respectively. It was not statistically significant between groups. But T 8.1 (vs T 9.6 in the 5% glucose solution) of initial sensory level measured at 4 min after injection of drug was significantly higher (P < 0.05) in the 10% glucose solution. Maximum hemodynamic changes from the baseline were not different in two groups. Conclusions: Tetracaine 0.5% with 5% glucose or 10% glucose solutions showed similar distribution in the cerebrospinal fluid. (Korean J Anesthesiol 2000; 38: 58∼62)

Background: Prolonged extracorporeal circulation entails tremendous threats of red cell lysis, severe bleeding problems due to platelet injury and activation, and endothelial damages by sequestered leukocytes. In consideration of these problems, a new centrifugal pump was developed and tested clinically to evaluate its effectiveness. Methods : We compared the effects of a centrifugal pump with those of a roller pump on hematological responses during cardiopulmonary bypass(CPB) in 20 coronary artery bypass surgery patients. The patients were divided into two groups of 10 each. The studied parameters included WBC counts, platelet counts, plasma Hb and D-dimer. Blood samples were taken after sternotomy, at 60 min, 120 min and 180 min after CPB start, and at 2 hr after CPB stop. Results : No differences between the groups were found in bypass time, aortic cross clamp time, extracorporeal circulation flow and hematocrit. The centrifugal pump group demonstrated less platelet depletion(p＜0.05), hemolysis(plasma Hb, p＜0.05) and fibrinolysis(D-dimer, p＜0.05). These differences were CPB time dependent and became statistically significant after 120 min bypass. Conclusions: We conclude that roller pump still can be safely used for standard cardiac procedures with bypass time less than 120 minutes and the centrifugal pump has significant potential to be safely applied to CPB for long ypass time in order to avoid postperfusion syndrome. (Korean J Anesthesiol 1998; 34: 1208∼1215)

Background: In using the Double-lumen tube(DLT), knowing the minimum bronchial cuff volume (MCV) for an effective air-tight seal will be useful; to provide a collapse of the lung; and to avoid pressure damage. The aims of the present study are thus three-fold: to measure the MCV; to measure the diameter of left main bronchus(LMBD); and to prove any relationships between two parameters. Methods: One hundred men and forty women who needed intubation of left-sided DLT were enrolled in this study. 37 Fr DLTs were used in male patients, and 35 Fr DLTs were used in female patients. We evaluated the MCV by air bubble method and measured the LMBD in chest PA. We also evaluated the pressure/volume characteristics of the bronchial cuffs by control inflator. Results: 29 patients of 100 patients(29%) exhibited persistent air leakage in 2.5 ml cuff volume in male patients(group of MCV ＞2.5). On the contrary, 18 patients of 40 patients(45%) did not require any cuff volume in female patients(group of MCV 0). The mean LMBD were 13.23 1.45 mm in male and 11.09 0.96 mm in female. There were significant positive correlations between MCV and LMBD in both sex and their respective correlation coefficients were 0.264(P=0.008) in male and 0.484(P=0.002) in female. The equations of linear regression were: LMBD = 12.394 0.429×MCV in male, LMBD = 10.725 0.438×MCV in female. Conclusions: The MCV of the brochial cuffs in left-sided DLTs has significant relationships with the LMBD measured in chest PA. (Korean J Anesthesiol 1997; 33: 849∼857)

Background : Nitric Oxide(NO) has been discovered to be an important endothelium-derived relaxing factor. The exogenous inhaled NO may diffuse from the alveoli to pulmonary vascular smooth muscle and produce pulmonary vasodilation, but any NO that diffuses into blood will be inactivated before it can produce systemic effects. To examine the effects of NO on pulmonary and systemic hemodynamics, NO was inhaled by experimental dogs in an attempt to reduce the increase in pulmonary artery pressure(PAP) and pulmonary vascular resistance(PVR) induced by hypoxia in dogs. Methods : Eight mongrel dogs were studied while inhaling 1)50% O2(baseline), 2)12% O2 in N2(hypoxia), 3)followed by the same hypoxic gas mixture of O2 and N2 containing 20, 40 and 80 ppm of NO, respectively. Results : Breathing at FIO2 0.12 nearly doubled the pulmonary vascular resistance from 173 56dyn sec cm-5 to 407 139dyn sec cm-5 and significantly increased the mean pulmonary artery pressure from 16 3mmHg to 22 4mmHg. After adding 20∼80 ppm NO to the inspired gas while maintaining the FIO2 at 0.12, the mean pulmonary artery pressure decreased(p＜0.05) to the level when breathing oxygen at FIO2 0.5 while the PaO2 and PaCO2 were unchanged. The pulmonary vascular resistance decreased significantly and the right ventricular stroke work index returned to a level similar to breathing at FIO2 0.5 by addition of NO into the breathing circuit. Pulmonary hypertension resumed within 3∼5 minutes of ceasing NO inhalation. In none of our studies did inhaling NO produce systemic hypotension and elevate methemoglobin levels. Conclusions : Inhalation of 20∼80 ppm NO selectively induced pulmonary vasodilation and reversed hypoxic pulmonary vasoconstriction without causing systemic vasodilation and bronchodilation. Methemoglobin and NO2 were within normal limit during the study.(Korean J Anesthesiol 1997; 33: 811∼821)

Autonomic hyperreflexia is a syndrome of massive reflex sympathetic discharge that occurs in patients with chronic spinal cord lesions above the major sympathetic splanchnic outflow (T 4 -T6). We experienced autonomic hyperreflexia that occured in a patient with spinal cord trans-section at T5 level during general anesthesia with O₂-N2O-halothane. Hypertension was controlled with intravenous infusion of sodium nitroprusside (1-2 ug/kg/min) and ventricular arrhythmia was treated with intra- venous lidocaine. We recommend that direct acting vasodilators are useful drugs to control hypertension in autonomic hyperreflexia during anesthesia in patients with chronic spinal cord injury.