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P Pu ur rp po os se e: : An epidural block is frequently combined with general anesthesia. Both systemic and pulmonary hemodynamics may be affected by high epidural anesthesia and the combined general anesthetic. These effects were investigated in a canine model.

All general anesthetics markedly impair thermoregulatory responses; nonetheless, sufficient hyperthermia or hypothermia will trigger most protective reflexes. Shivering, however, remains an exception among thermo-regulatory responses: it is common during postanesthetic recovery, but is rare at typical anesthetic concentrations. This observation suggests that general anesthesia impairs shivering far more than other thermoregulatory defenses. Accordingly, we tested the hypothesis that low concentrations of isoflurane and sevoflurane would virtually obliterate shivering. Japanese white rabbits were anesthetized with isoflurane or sevoflurane at end-tidal concentrations of 0.2, 0.3, and 0.4 minimum alveolar anesthetic concentration (MAC) (n = 6 in each group); the normal core temperature for these rabbits is approximately 39 degrees C. Core temperatures were subsequently reduced by a water-perfused thermode positioned in the colon. The core temperature triggering shivering identified the threshold for this response. Five of the six rabbits given 0.2 MAC isoflurane shivered at a mean core temperature of 36.3 +/- 0.3 degrees C (mean +/- SD), and one rabbit failed to shiver at a minimum core temperature of 35.0 degrees C. Four of the six rabbits given 0.3 MAC isoflurane shivered at a mean core temperature of 36.2 +/- 0.6 degrees C, and two of these rabbits failed to shiver at a minimum core temperature of 35.0 degrees C. However, no rabbit given 0.4 MAC isoflurane shivered, even at minimum core temperatures of 35.0 degrees C. All of the rabbits given 0.2 MAC sevoflurane shivered at a mean core temperature of 36.6 +/- 0.7 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraoperative care of the patients with pheochromocytorna presents many difficult problems in anesthetic mariagement-. There are some patients who show no definite clinical symptoms, so-called "asymptomatic pheochromocytoma"~~H. Recent advances in techniques of computed tomography (CT) and magnetic resonance imaging (MRI) have increased an opportunity of the incidental discovery of retroperitoneal tumors, in the absence of clinical symptoms. We experienced a case of asymptomatic pheochromocytoma associated with sudden hypertension and tachycardia following surgical manipulation. Case ReportA 68-year-old man, weighing 37 kg and 150 ern tall, presented with appetite loss. Routine laboratory tests revealed hypercalcemia (13.1 mg·dl-\ normal range 9.1~10.6 mg·dl-1 ) and slight anemia (Hb 9.2 g-dl-1 , normal range 13.3-17.0 g.dl-1 ) . He was admitted to our hospital for further investigation of hypercalcemia. He had a medical history of acute subdural hematoma 4 years ago resulting in left hemiparesis. CT finding of the abdomen demonstrated a mass with necrosis at a left supraadrenal lesion. An aortic angiogram showed that the tumor was originated from the left adrenal gland artery. This suggested a possible case of pheochromocytoma but he presented no complaints of hypertension, palpitations, headache or sweating. Blood pressrue (BP) and heart rate (HR) were within the normal range. The functions of the thyroid, pancreatic islet cells, adrenal cortex and pituitary gland were also within the normal range. Electrocardiogram showed slight depressions of the ST-segment on V1-V G leads. Subsequent to admission, the patient was febrile to 38.5°C for several days. White cell counts were within the normal range, but monocytes increased. Blood and urine cultures were obtained, and intravenous broadspectrum antibiotics were started. In view of the rapid deterioration of this patient, an emergency operation was planned to remove the mass, which was thought to include an infectious lesion. Serum and urinary catecholamines were examined, but the results had not been returned yet.He was premedicated with scopo-

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