Vitamin E Reduces Symptoms in a CFA-induced Model of Monoarthritis / 대한마취과학회지

BACKGROUND: Adjuvant arthritic animals show immunologic and inflammatory features which are also observed in patients with rheumatoid arthritis. This study investigated whether high dose vitamin E (alpha-tocopherol) has any additional anti-inflammatory or analgesic effects, or both, in Complete Freund's adjuvant (CFA) induced arthritic rat model. METHODS: Male Sprague-Dawley rats (300-350 g, n = 3) underwent testing up to 26 days after induction of the model. Vitamin E (100 mg/kg) or vehicle was given daily intraperitoneally (IP) for 10 or 20 days following induction. Thus, groups were as follows: group 1, untreated, n = 3; group 2, CFA + vehicle, n = 10; group 3, CFA + vitamin E for 10 days, n = 10; group 4, CFA + vitamin E for 20 days, n = 10. Parameters compared between groups included ankle circumference, range of articulation of the arthritic joint, extravasation of plasma proteins in the tissues around the arthritic joint and sensory withdrawal threshold to von Frey filament mechanical stimulation. RESULTS: Compared to CFA rats administered drug vehicle, those given vitamin E for 20 days exhibited a reduction in all symptoms of monoarthritis, including less ipsilateral ankle swelling, reduced loss of the range of joint articulation, low plasma extravasation and reversal of the decrease in sensory withdrawal threshold. But, vitamin E for 10 days has only analgesic effect until 10 days. CONCLUSIONS: This study showed relatively long duration of high-dose vitamin E treatment have anti-inflammatory and early onset analgesic effects. The findings raise the possibility of high dose vitamin E, or potentially other antioxidants, as adjuvant therapy for alleviation of symptoms of rheumatoid arthritis.

Effect of Hyperglycemia on the Length of Postoperative Hospital Stay / 대한마취과학회지

BACKGROUND: Diabetes mellitus is the most common endocrinopathy encountered in the perioperative period and has long been assumed to increase perioperative risk. However, when diabetes mellitus was segregated from old age and the complications of it, it was questioned that diabetes mellitus itself increased perioperative risk. In this study, we investigated the influence of hyperglycemia on the length of postoperative hospital stay. METHODS: We studied 100 patients undergone intra-abdominal operations with general anesthesia. These patients were divided into the hyperglycemic group (n = 20) with postoperative blood glucose level higher than 10 mM and the non-hyperglycemic group (n = 80) with glucose level lower than 10 mM and we investigated the length of postoperative hospital stay, serum electrolyte, serum chemistry, arterial blood gas values, and base excess by unmeasured anions. We also divided these patients into the diabetic patients group (n = 15) and the non-diabetic patients group (n = 85) and compared the same variables. RESULTS: The length of postoperative hospital stay was significantly prolonged in the hyperglycemic group (20.9 +/- 9.0 days) compared with the non-hyperglycemic group (16.2 +/-8.5 days), and the cumulative postoperative hospital stay curves based on Kaplan-Meier method also showed significant difference between the two groups. When we compared the length of postoperative hospital stay between the diabetic and the non-diabetic patients, there was no significant difference. CONCLUSIONS: This study demonstrated that hyperglycemia prolonged the length of postoperative hospital stay. This finding suggests that the patient's glucose level should be monitored and controlled within an adequate range perioperatively.

The Effects of Music on Maternal Anxiety and the Evaluation of Explicit and Implicit Memory during Cesarean Section / 대한마취과학회지

BACKGROUND: Music is widely used to help a patient relax, and divert their attention from unpleasant and stressful situations. In addition, it eliminates the noise in the operating room. A light level of general anesthesia for a cesarean section is usually applied to the mother to improve the fetal safety. Therefore, there is an increased incidence of maternal explicit and implicit memory with the bispectral index (BIS) monitoring. METHODS: Fifty patients undergoing a cesarean section under general anesthesia were allocated randomly to either a control group (group 1) or a music group (group 2). Patients in group 2 listened to music with a headphone during the procedure. The blood pressure, heart rate, intraoperative awareness, postoperative explicit and implicit memory and the plasma cortisol level were assessed. RESULTS: The systolic blood pressure and heart rate were significantly lower in group 2 than group 1 at 1 minute before intubation and 5 minutes after extubation (P <0.05). The BIS value were significantly lower in group 2 than group 1 at 1 minute after intubation and 10 minutes after delivery (P <0.05). The hit ratios of the implicit of memorial test were significantly higher in the group 2 (2.4 +/- 0.7) than in group 1 (1.6 +/- 0.4) (P <0.05). The hits of the implicit memorial test had no corresponding BIS value (P <0.05). The plasma cortisol level was significantly higher group 1 than in group 2 at 30 minutes after intubation and 10 minutes after arriving at the recovery room (P <0.05). CONCLUSIONS: It was found that the music played to the mother during a cesarean section under general anesthesia decreased the anxiety and stress response, and this technique may help protect patients from unwanted explicit and implicit memory.

The Effects of Intravenous Anesthetics on Human Cytomegalovirus Infection / 대한마취과학회지

BACKGROUND: Reactivation of human cytomegalovirus (HCMV) from latency is a frequent complication of organ transplantation, and the molecular mechanism by which this occurs is unknown. Previous studies have shown that allogenaic transplantation combined with immunosuppression may be required to achieve complete reactivation in vivo and many anesthetics have wide range immunomodulatory properties. HCMV infection of endothelial cells plays an important role in the establishment of latency and persistence, which appears critical for the maintenance of HCMV within the host. METHODS: We compared the effects of intravenous anaesthetics (propofol, thiopental, and ketamine) on the susceptability of endothelial cells to HCMV infection by indirect immunofluorescent assay at 48 hour postinfection and we also have investigated the time course of luciferase gene expression in human umbilical vein endothelial cell (HUVEC) infected with recombinant HCMV. RESULTS: Treatment with anesthetics after HCMV strain Towne inoculation did not increase HUVEC susceptibility to HCMV infection by indirect immunofluorescent assay. Treatment of HUVEC with propofol, thiopental, and ketamine after the recombinant virus inoculation had no significant effects on the level of the late genes expression. CONCLUSIONS: Intravenous anesthetics (propofol, thiopental, and ketamine) did not increase the susceptability of endothelial cells to HCMV infection at plasma concentrations. Further studies are required to evaluate higher anesthetic concentration which may increases the susceptability of HUVEC to HCMV infection without cell destruction.

Correlation between Pain Scale and Infrared Thermography in Unilateral Pain Patients after Nerve Block / 대한마취과학회지

BACKGROUND: Being a subjective symptom, an objective evaluation of pain and severity is important in the diagnosis and detection of treatment outcome. This study examined the usefulness of infrared thermography for the objective evaluation of pain, irrespective of the original disease. METHODS: Patients with unilateral pain who underwent nerve block were randomly selected. Infrared thermography was performed and subjective pain site and severity were assessed before and after nerve block. RESULTS: The temperature difference between the pain site and the contralateral site was significantly correlated with subjective pain severity before and after block (P < 0.01). Improvements in VAS were correlated with temperature difference decrement between both sides after nerve block (P <0.05). CONCLUSIONS: Infrared thermal imaging can demonstrate subjective pain objectively. Thermal differences between the pain sites and the contralateral sites are an indicator of pain scale in a patient with ipsilateral pain. Moreover the thermal difference may be a useful means of determining outcome.

Subcellular Ca2+ Mobilization in Gastric Smooth Muscle Contraction / 대한마취과학회지

BACKGROUND: The stomach can be generally classified anatomically into three parts; fundus, corpus, and antrum. It has not been well demonstrated how the three regions contribute to specified gastric motility. In the present study, the regional differences on contractile response and intracellular Ca2+ levels ([Ca2+]i) were investigated in a mouse gastric muscle. METHODS: An isometrical contraction was measured with a computerized physiograph, and [Ca2+]i was measured with fura-PE3/AM, a fluorescent Ca2+ indicator in gastric smooth muscle from mice. RESULTS: Carbachol (CCh), a potent muscarinic receptor agonist, generated rhythmic contractions in a dose dependent manner, superimposed on tonic components in the antral muscle. Whereas similar contractile responses to CCh was obtained in the antrum, CCh evoked tonic components predominantly. CCh increased [Ca2+]i in a dose dependent manner in both the antral and fundic smooth muscle. However, the increment of [Ca2+]i in the fundus was greater than that of the antrum. Verapamil (10nM), a l-type Ca2+ channel blocker, inhibited completely the contraction and [Ca2+]i induced by CCh in the antral strips, whereas the responses in the fundus showed a resistance to verapamil. CONCLUSIONS: These results suggest that muscarinic stimulation has a regional difference on muscle contractility and [Ca2+]i, which is mediated by differences of Ca2+ movement in mouse gastric muscle.

Involvement of Protein Kinase C Isoforms and Rho GTPase in Contractile Response of Swine Pulmonary Artery / 대한마취과학회지

BACKGROUND: It is well established that vascular contraction is caused by not only an increase in cytosolic Ca2+ level but also activations of Ca2+-sensitizing mechanisms including protein kinase C (PKC) and low molecular GTP binding protein. However, the roles of PKC and RhoA, a low molecular GTP-binding protein, on the receptor agonist-mediated contraction in swine pulmonary artery has not been clarified. In the present study, we examined the contribution of PKC isoform and RhoA to the arterial stimulants-induced contraction in swine pulmonary artery. METHOD: The large (> 5 mm), medium (1-3 mm) and small (< 1 mm in outer diameter) sized pulmonary arteries were excised and the contractions were recorded isometrically. The contents and subcellular distribution of PKC isoforms and RhoA were detected using immunoblotting. RESULTS: In medium pulmonary artery, norepinephrine (NE, 10 nM-30micrometer) led contraction in a dose-dependent manner. In large and small pulmonary arteries, however, NE failed to induce a contraction. Adding of 12-deoxyphorbol 13-isobutyrate (DPB, 1micrometer), a PKC activator, developed muscle force in 1 mM EGTA-contained Ca2+-free physiological salt solution. The expressions of PKC alpha, elsilon were significantly increased in medium pulmonary artery. NE (10micrometer) evoked the translocation of RhoA from cytosol to the membrane but not those of PKC isoforms. In Ca2+-free physiological salt solution, DPB (1micrometer) caused a translocation of PKC isoforms. CONCLUSIONS: These results support that NE induces contraction via RhoA pathway but not PKC pathway in swine pulmonary artery.

Comparing the Effects between a Continuous Epidural Infusion of an Opioid or an Opioid-Local Anesthetic Mixture and a Continuous IV Infusion of an Opioid after a Spinal Laminectomy / 대한마취과학회지

BACKGROUND: Postoperative pain after a spinal laminectomy has very harmful effects on human physiology, and many people are trying to control it more easily and safely. There are controversies in methods used for controlling postoperative pain after a spinal laminectomy. The purpose of this study was to examine an effective way to control postoperative pain after a spinal laminectomy. METHODS: Ninety patients (ASA I-II, aged 40 to 70) scheduled for a spinal laminectomy were divided into three groups. In group A, we administered fentanyl 1,000 microgram and morphine 5 mg (mixed in 0.9% normal saline) using the continuous epidural infuser; in group B, we administered fentanyl 500 microgram and morphine 5 mg and 0.25% bupivacaine (mixed in 0.9% normal saline) using the continuous epidural infuser; in group C, we administered fentanyl 1,500 microgram and morphine 10 mg (mixed in 0.9% normal saline) using the continuous IV infuser. We compared effects between the continuous epidural infusion and the continuous intravenous infusion by using the visual analogue scale and side effects. RESULTS: There was no significant difference between continuous epidural infusion groups. When the continuous epidural infusion groups and the continuous IV infusion group were compared, there were significant differences in 3 hr, 6 hr, and 12 hr VAS scores (P < 0.01). The incidence of side effects was very low, and there was no significant difference in side effects between the continuous epidural infusion and the continuous IV infusion groups. CONCLUSIONS: It was found that continuous epidural infusion methods were more effective than the continuous IV infusion method, but none of them showed satisfactory postoperative pain control in the early periods.

The Effects of Succinylcholine on the Neuromuscular Block of Mivacurium / 대한마취과학회지

BACKGROUND: We studied the interaction between Succinylcholine (SCh) and mivacurium when mivacurium was administered during early and late recovery from SCh block was investigated. METHODS: Eighty patients undergoing elective surgery under general anesthesia were studied. General anesthesia was induced and maintained with propofol under TCI control. Neuromuscular function was measured in response to TOF stimulation of the ulnar nerve using an electromyographic method. The patients were allocated randomly to the following four groups; group 1 (n = 20): a bolus intravenous injection of 0.08 mg/kg mivacurium; group 2 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 2 minutes of 1 mg/kg SCh injection; group 3 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 25% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh; group 4 (n = 20): intravenous injection of 0.08 mg/kg mivacurium after 75% recovery of initial twitch height from twitch height depression induced by 1 mg/kg SCh. The onset and duration of neuromuscular blockade, recovery rate and TOF ratio at T75% were measured. RESULTS: The onset of block in groups 3 and 4 were slower than in group 1 (5.2 +/- 0.7 and 2.3 +/- 0.6 vs 2.5 +/- 0.4 min P < 0.05). The clinical duration in groups 2 and 3 were longer than in groups 1 and 4 (12.5 +/- 2.1 min and 11.3 +/- 1.7 min vs 17.0 +/- 3.0 min and 18.5 +/- 2.6 min, p < 0.05). There was no difference in recovery index all groups. The TOF ratio of groups 2, 3 and 4 were smaller than for group 1 (38.2 +/- 5.3, 32.3 +/- 5.6 and 31.5 +/- 4.2 vs 56.0 +/- 7.3, P < 0.05). CONCLUSIONS: The Previous 1 mg/kg SCh injection was affected the time course of action of mivacurium 0.08 mg/kg-induced neuromuscular block.

Postoperative Epidural Fibrosis: An Erroneous Diagnosis as Epidural Abscess after Epidural Block: A case report / 대한마취과학회지

The epidural abscess, while rare, should be taken seriously, as it can result in permanent neurological complications. Fever, back pain, leukocytosis and elevation of Erythrocyte Sedimentation Rate (ESR) are major signs and symptoms of epidural abscesses. But clinical recognition of such abscesses may be very difficult because of nonspecific symptoms or signs as well as previous or underlying painful disorders. Few cases has been reported of epidural abscess and epidural fibrosis associated with back surgery or temporary epidural blocks. In these cases, however, fever, low back pain, sciatica and elevation of ESR were the major findings. Magnetic Resonance Imaging findings after Gadolinium- diethylenetriaminopenta-acetic acid (Gd-DTPA) enhancement show central low signal intensity and surrounding high signal intensity at the anterior epidural space between the 5th lumbar and 1st sacral vertebrae. We suspected an epidural abscess caused by epidural block, and so operated. But our operative finding was epidural fibrosis without abscess. Our final pathological diagnosis was epidural fibrosis.

Effect of Water Ingestion before Elective Surgery on Gastric Volume and pH in Adults / 대한마취과학회지

BACKGROUND: To decrease the risk of pulmonary aspiration of gastric contents, patients are routinely asked not to eat or drink anything for at least 6 to 8 hours before surgery. We studied to evaluate whether the volume and pH of gastric fluid immediately after induction of anesthesia is correlated with water ingestion. METHODS: Fifty patients, scheduled for elective surgery, were randomly divided into two groups. Control group(n=25) were fasted overnight and received no water. Experimental group(n=25) were fasted overnight and received 150 ml water approximately 2 hours before the induction of anesthesia. Gastric fluid was obtained via multiorifice gastric tube with the patient in three different positions. The volume of gastric fluid was recorded and its pH was measured. RESULTS: The gastric volumes were no differences between the two groups. The gastric pH values were significant differences. The incidence of patients with the high risk factors of gastric volume greater than 25 ml and pH less than 2.5 was decreased in experimental group. CONCLUSIONS: We concluded that surgical patients could be permitted to ingest 150 ml water approximately 2 hours before the induction of anesthesia.

Effect of Epidural Autologous Blood Patch on the Prevention of Post-dural Puncture Headche after Spinal Anesthesia / 대한마취과학회지

Background: Post-dural puncture headache (PDPH) is one of the well-known complication of spinal anesthesia. Epidural blood patch is the treatment of choice for PDPH but is rarely used for the prevention of PDPH after spinal anesthesia. The purpose of this study is to observe the effectiveness of epidural blood patch for prevention of PDPH and to evaluate the complications after epidural blood injection. Methods: Three hundred patients (ASA I or II) receiving spinal anesthesia were studied. They were randomly devided into two groups. Patients in Group I, the control group, were maintained in a supine position for 24 hour after spinal anesthesia. Patients in Group II, the study group, received 3 ml of autologous blood in the epidural space after spinal anesthesia. PDPH was evaluated for 5 days. The incidence, location, onset, and duration of headache in the patients presenting with PDPH were measured for 5 days, and the complications following epidural blood patch in Group II were observed for 2 weeks. Results: The incidence of PDPH in group I was 11%, but 0% in group II. There were no specific complications following epidural blood patch in Group II. Conclusions: This study suggest that the 3 ml epidural autologous blood patch is an useful method for the prevention of PDPH in patients with spinal anesthesia.

Degree of Agreement between the Result of the Korean Medical Licensing Examination and Two Different Types of Scholastic Achievement at Konkuk University College of Medicine / 한국의학교육

In order to identify students who needs more intensive guide, we analysed the association between the results of Korean medical licensing examination(KMLE) and two different types of scholastic achievement; 4th grade score and graduation examination score. The scholastic achievement between passed and failed the KMLE at Konkuk University College of Medicine from 1995 to 1998 was investigated. First, we grouped the students into four groups according to the year they graduated. Second, we regrouped the group into two subgroups according to whether passed or failed in the KMLE. In the 4th grade score, the passed KMLE is higher than the failed from 0.49 to 0.71 and which is statistically significant. In the graduation examination score, the passed KMLE is higher than the failed from 4.9 to 9.9 and which is also statistically significant. We analyzed the degree of agreements between the results of the KMLE and the two different types of scholastic achievement. In 4th grade score, the highest degree of agreement shows 2.2 and its kappa index is 0.49. In graduation examination score, the highest degree of agreement shows 71 and its kappa index is 0.64. In conclusion, students who have lower than 2.2 in 4th grade score or lower than 71 in graduation examination score are tend to be failed the KMLE. So they need more intensive guide for the KMLE.

Orotracheal Intubation with Magnet / 대한마취과학회지

BACKGROUND: Every practitioner, however skilled, will encounter patients who are unexpectedly difficult to intubation. The incidence of difficult laryngoscopy appears to be approximately 0.5% to 2%. So many methods are used to intubate the trachea, but endotraheal intubation by them is not always possible. The purpose of the this study is to evaluate the effectiveness of magnet on the endotracheal intubation. METHODS: Twenty patients(aged 30 to 59yr, ASA physical status 1) required general anesthesia with an endotracheal tube. Anesthesia was induced with thiopental sodium and succinylcholine, ventilation was controlled with 100% O2. The tip of the epiglottis was exposed wtih a No.3 MacIntosh laryngoscope. A catheter with ferrous stylet was placed behind epiglottis close to tracheal lumen and a magnet was placed over the cricoid cartilage allowing the stylet to be pulled. Endotraheal tube was guided into the trachea over the stylet. The time to intubation, the blood pressure and heart rate of pre- and postintubation, and the difficulty of intubation were recorded and the complications of the endotracheal intubation such as bronchial spasm, oral and tracheal mucosal trauma, and sore throat, were observed. RESULTS: The mean time to intubation was 31.2+/- 8(18 to 50)sec. There were statistically signigicant increase in blood pressure and heart rates following intubation. The incidence of excellent and good intubating condition were 14 and 6 respectively. Seventeen and three intubations were successful on the 1st and 2nd attempts respectively. There were no differences in incidence of complications of endotracheal intubation compared to other reports. CONCLUSIONS: Though magnet guided technique has some limitations to use in case of difficult laryngoscopy, it can be used with merits such as simplicity and cheapness when other methods are not available.

Effect of General Anesthesia with Isoflurane and Epidural Anesthesia Bupivacaine and Surgery on Interleukin-2 Receptor Levels / 대한마취과학회지

Inability to synthetize adequate amounts of IL-2 has been suggested to be the basis of defective T-cell function following anesthesia with the operation. The present study was designed to examine the effect of anesthesia and operation on host defence mechenism. serum soluble IL-2R(sIL-2R) levels and hemo-dynamic parameters were measured in 30 patients. Patients were divided into two groups (G: general anesthesia with isoflurane, E:epidural anesthesia with bupivacaine) according to the method of anesthesia. Venous blood samples were taken before anesthesia(T1), 10 mins after induction of anesthesia(T2), 10 mins after injection of bupivacaine in epidural anesthesia(T2), 1 hour after skin incision(T3), 30 mins after completion of operation(T4), and 24 hours after completion of operation(T5). Simultaneously arterial blood pressure and heart rate were measured. Six mililiter of perip-heral blood was obtained for sIL-2R studies in plain tubes. Serum concentration of sIL-2R was measured by human IL-2 receptor ELISA kit(Boehringer Mannheim Biochemica, Mannheim, Germany). Any significant change in IL-2R level was not seen in patients under general anesthesia with isoflurane and operation. Also any significant change in IL-2R level was not seen in patients who had an epidural anesthesia with bupivacaine and operation. The results suggest that suppression of T-lymphocyte function and decrease in lymphocyte counts induced by anesthesia and operation is not due to alteration of intracellular metabolism, but due to extracellular immune depressor. And general anesthesia operation with isoflurane as well as epidural anesthesia with bupivgcaine is safe and can be selected for immunosuppressive patients.

Clinical Evaluation of Atracurium for Endotracheal Intubation / 대한마취과학회지

The usefulness of nondepolarizing muscle relaxants for intubation is limited by a relatively slow onset of neuromuscular block compared to that achived with succinylcholine. But, authors have reported that larger doses of nondepolarizing muscle relaxants produce a more rapid onset of maximal neuromuscular block and conditions conductive to endotracheal intubation and recent reports support the use of the "priming principle in the clinical practice of anesthesiology. This phenomenon may apply to all nondepolarizing relaxants: it is reported to facilitated neuromuscular blockade and tracheal intubation when used with atracurium, vecurouium, alcuronium or pancuronium. In this study, administering a small subclinical dose of atracurium (75ug/kg) Smin. prior to the remainder of an intubating doae of atracurium (250ug/kg) had no different on grade of block for intubation compared to single IV bolus of atracurium (500ug/kg).

Clinical Evaluation of Atracurium for Endotracheal Intubation / 대한마취과학회지

The usefulness of nondepolarizing muscle relaxants for intubation is limited by a relatively slow onset of neuromuscular block compared to that achived with succinylcholine. But, authors have reported that larger doses of nondepolarizing muscle relaxants produce a more rapid onset of maximal neuromuscular block and conditions conductive to endotracheal intubation and recent reports support the use of the "priming principle in the clinical practice of anesthesiology. This phenomenon may apply to all nondepolarizing relaxants: it is reported to facilitated neuromuscular blockade and tracheal intubation when used with atracurium, vecurouium, alcuronium or pancuronium. In this study, administering a small subclinical dose of atracurium (75ug/kg) Smin. prior to the remainder of an intubating doae of atracurium (250ug/kg) had no different on grade of block for intubation compared to single IV bolus of atracurium (500ug/kg).

Malignant Hyperthermia Syndrome - A case report / 대한마취과학회지

The popular term malignant hyperthermia syndrome (MHS) refers to a clinical syndrome classically observed during general anesthesia. It is characterized by a rapidly increasing .temperature and a high mortality rate. A case of MHS was experienced which developed 60 minutes after induction of general anesthesia with thiopental sodium, succinylcholine, halothane, N2O and 02. High fever, muscle rigidity and cyanosis developed and were followed by arrythmia and unstable blood pressure. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient died about 6 hours after induction of anesthesia.

Epidural Narcotics and Multiple Fractured Ribs / 대한마취과학회지

Pain relief becomes a major concern when treating patients with rib fractures so adequate ventilation must be maintained. Many techniques have been described for the management of frectured ribs, including systemic analgesics, intercostal nerve blockade, intrathecal morphine, epidural bupivacaine and epidural morphine. This case report illustrates the successful use of epidural narcotics in a patient with multiple fractured ribs.

Thalamonal for Laryngomicrosurgery / 대한마취과학회지

Microsurgery of the larynx using direct laryngoscopy is becoming an increasingly popular technique for the otorhinolaryngologist. Many techniques of anesthesia have been developed for these procedures but they all have the same drawbacks. General anesthesia with endotracheal intubation decreases the field of vision for the surgeon or it requires unusual surgeon anesthetist co-operatives. Therefore neuroleptic analgesia has been adapted to the suspension laryngoscope. Because of the greater stability of the circulatery and respiratory systems associated with their use. Thalamonal(droperidol 2.5mg/ml with fentanyl 0.05mg/ml) was found to be preferable to other anesthstic for the production of neuroleptic analgesia. Thus in 28 patients requiring laryngomicrosurgery in Severance hospital duriag the past 4 years(May, 1975-March, 1979), a butyrophenon derivative, droperidol and fentanyl has been used for the production of neuroleptic analgesia. Consequently. we concluded that, in most cases of suspension laryngoscopy, we could gain a good analgesic and anesthetic condition with 3.02ml(mean value) Thalamonal adveres action for a 55 minute(mean value) operation without remarkable undesirable adveres effects. In addition to this. this technique was of great benefit to the operator, because not only the patient awake during operation and cooperative to the operation but also vocal cord mobility can be observed during the operation.