[Analysis of difficult tracheal intubation in patients with first and second brachial arch syndrome].

We experienced 87 anesthetic managements of 26 patients with first and second brachial arch syndrome in the past 20 years. We analyzed retrospectively the occurrence of difficulty in tracheal intubation with these patients. The incidence of difficult intubation was as high as 39.5% of the cases. Furthermore it was quite difficult to place endotracheal tube, especially in younger children undergoing oral procedure. We examined the correlation among classification of mandibular hypoplasia (Pruzansky classification), the fusion of cervical spines and the degrees of difficulty in intubation for 16 patients who had had radiographs of skull, but we found no correlation among them. But in all the 3 patients with the fusion of cervical spines, intubation was difficult. Therefore, we must perform radiographic assessment of the fusion of the cervical spine.

[Evaluation of cross circulation in conjoined twins].

This report describes the evaluation of cross circulation in conjoined twins. Female thoracoomphalopagus conjoined twins were delivered by cesarean section after 37 week's gestation. CT, MRI and echography were performed. A partial communication of pericardium and sternum, and a union of the liver were found. For the preoperative evaluation of cross circulation, a bolus of indigo carmine was injected, and the pigment appeared in the urine of the other twin. RI angiography showed that radionuclides in one twin were similar to those in the other after 5-10 minutes. During the operation, an injected bolus of SCC to one twin was not effective for the other twin. Inhaled isoflurane in one twin did not appear in the expired gas of the other twin. After the intentional hemorrhage for 3 minutes from one twin, the hemoglobin concentration of one of the twin was the same as that of the other. This demonstrates that acute hemorrhage from one twin seems to result in a significant and rapid decrease of hemoglobin in both babies equally. However, intravenous infusion of drugs to one of the twins requires a relatively long time to take effect in the other baby. We must be careful in anesthetic management of the surgical separation of conjoined twins.

[Effect of induction methods of pediatric anesthesia on serum myoglobin].

Two hundred and twenty nine children from infancy to middle teens divided into six groups were studied to determine the effect of induction methods of pediatric general anesthesia on serum myoglobin. After the slow induction with nitrous oxide-oxygen-halothane (GOF), the serum myoglobin increased significantly to 1774.7 +/- 4285.8 ng.ml-1 (mean +/- SD) by iv administration of succinylcholine 1 mg.kg-1. This significant increase of serum myoglobin was reduced by pretreatment with d-tubocurarine (dTc) 0.05 mg.kg-1 before administration of succinylcholine. However, it was not reduced by pretreatment with thiopental 3 mg.kg-1. After the rapid induction with thiopental 5 mg.kg-1 and succinylcholine 1 mg.kg-1, the serum myoglobin increased slightly to 387.6 +/- 596.5 ng.ml-1. But this increase in serum myoglobin was stopped by pretreatment with dTc 0.05 mg.kg-1 before the rapid induction. Serum myoglobin was not changed without succinylcholine after the slow induction with GOF. In each group, there was no relation with serum myoglobin and ages or fasciculation. Serum myoglobin was more influenced by the induction methods of pediatric general anesthesia than by ages.