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We successfully anesthetized a 19-year-old female with type I glycogen storage disease for hepatectomy. She had hypoglycemia and severe metabolic acidosis before surgery. General anesthesia was performed with epidural anesthesia. We used acetated Ringer solution mainly as intraoperative fluids instead of lactated Ringer solution and controlled administration of glucose determining blood glucose. The patient's plasma lactate levels, pyruvate and base excess during and after operation, were unchanged compared with those before operation. Administration of sodium bicarbonate was not necessary. In the case of metabolic acidosis due to accumulation of lactate as in glycogen storage diseases, it was useful to use acetated Ringer solution for fluid therapy.

Carboplatin is one of most commonly used chemotherapeutic agents in clinical oncology practice. We presented a case of subacute cardiotoxicity supposedly due to carboplatin. A patient with ovarian cancer had been treated with carboplatin based chemotherapeutic agent for about a month before surgery. Although she had not shown symptoms of cardiac failure, severe pulmonary edema developed immediately after general anesthesia. It disappeared within a week. For three days following the administration of carboplatin alone for two weeks after surgery, arrhythmias (SVT, SVPB and VPB) and hypotension appeared. Symptoms of congestive heart failure, resembling dilated cardiomyopathy, lasted for one month. It required about two months to restore the normal cardiac functions. Carboplatin seems to have infrequent but possible cardiotoxicity as many other chemotherapeutic agents.

We developed a new method to measure the total circulating blood volume using fluorescein isothiocyanate (FITC) labeled autologous red blood cell as an indicator. Red blood cells were labeled by incubation with 0.1 mg.ml-1 FITC in PBS (pH 7.2) for 30 min at 37 degrees C. Eighteen dogs were given an intravenous injection of FITC labeled red blood cells, which were approximately 0.1% of the total circulating red blood cells estimated from the body weight. The ratio of labeled cells to the normal circulating red blood cells was determined by a flow cytometry. The total blood volume was calculated from its dilution rate. The average circulating blood volume determined by this method was 76.8 +/- 9.2 ml.kg-1 (mean +/- SD). This result coincides well with the values reported previously. This method using non radioactive tracers enables a reproducible measurement of circulating blood volume and its change with time.

In 18 patients for abdominal operations, the skin blood flow of the sole was measured with a laser Doppler flowmeter under general anesthesia. The deep body temperature was also measured. During the induction of anesthesia with thiopental, an elevation of the skin blood flow was observed. The elevation was due to administration of thiopental. After the induction, the elevation appeared to be more prolonged under nitrous-oxide and enflurane anesthesia than under diazepam or droperidol, with nitrous-oxide and fentanyl anesthesia. The persistent elevation was observed for 104 +/- 10 minutes under enflurane anesthesia in 10 patients, but the elevation was 71 +/- 7 minutes under modified neuroleptanesthesia in 8 patients. This difference might be associated with the peripheral vasodilatation by enflurane and the short peripheral vasodilatation by droperidol or diazepam. Increases of the skin blood flow correlated well with the changes of the deep temperature of the sole. These results indicate that the peripheral skin blood flow is different during long operation between enflurane anesthesia and modified neuroleptanesthesia and the laser Doppler flowmetry is a useful tool as a monitor of peripheral circulation and body temperature.

The plasma concentrations of buprenorphine were measured and blood gas analysis was done after administration of buprenorphine suppositories (0.2 and 0.4 mg) or its intramuscular injection (0.2mg) in postoperative patients. The C max for 0.4mg suppositories was comparable to that for 0.2mg injection, whereas the T max for suppositories was as large as about 2 hrs in contrast to 1.5 hrs for 0.2mg injection. The size of AUC was in the following order: 0.4mg suppositories greater than 0.2mg injection greater than 0.2mg suppositories. Neither notable increase in PaCO2 nor decrease in respiration rate was observed after administration of the suppositories, indicating that the formulation will not cause clinically significant respiratory depression. No significant changes were observed in blood pressure or pulse rate. Buprenorphine suppositories are considered to be safe for use in postoperative patients. Percent pain relief in the suppository group was smaller than that in the injection group. This appears to be due to a slower rate of increase in the plasma levels of buprenorphine after administration of suppositories than that after intramuscular injection. Therefore, it seems practical to give this drug to postoperative patients before the start of pain.