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SURGERY AND TRANSPLANTATION 
Figure 1. — Instruments necessary for intubation in- 
clude an endotracheal tube, with a syringe attached 
for inflation of the cuff, a plastic pipe for guide of 
the endotracheal tube, a long, thin plastic guide tube, 
a flashlight, and a forceps. 
developed in our laboratory (Figures 1 and 2) 
were used. First a plexiglass pipe (3.8 cm in di- 
ameter, and 35 cm long) was inserted. About 
2/5 of its tip was cut obliquely and its end was 
slightly bent, enabling us to slip it under the 
epiglottis. Since the pipe is transparent, an or- 
dinary flashlight held outside the pipe could il- 
luminate the epiglottic area sufficiently. One 
end of a thin plastic guide line was then slipped 
into the trachea through the pipe. While hold- 
ing it, a French 42 endotracheal tube was 
slipped over the other end of the guide line and 
Figure 2. — Endotracheal tube, plastic pipe, and plastic 
guide line were put together, and the cuff was in- 
flated, simulating the way of intubation. 
inserted into the trachea. While holding the 
tube in place, the guide line was removed and 
the cufF on the tube was inflated. The plexiglass 
pipe was removed, and a short piece of another 
plexiglass pipe was slipped in to protect the en- 
dotracheal tube from being chewed. A thick poly- 
vinyl chloride tube was inserted into the stom- 
ach to prevent air accumulation and also to 
drain out any stomach content which usually 
existed after one day fast. 
The endotracheal tube was connected to a 
bird Mark 8 respirator in dogs and sheep, and 
to a bird Mark 4 anesthesia respirator in calves. 
In order to maintain anesthesia, 1.0% Flu- 
othane and 99% oxygen was first introduced 
into the circuit via a Fluotec vaporizer. Anes- 
thesia was then maintained as light as possible 
using 0.3 to 0.5% concentration of Fluothane 
most of the time. If the sheep or calves moved 
or tried to breathe spontaneously, a muscle re- 
laxant such as succinylcholine chloride was 
given rather than increasing the amount of Flu- 
othane. The blood pressure, being very sensitive 
to Fluothane, is a good indicator of the depth of 
anesthesia. The noninflammability of Fluothane 
allowed us to use electrocautery. 
IMPLANTATION OF B-LHAD 
The chest was entered through the fifth inter- 
costal space. The inlet side conduit, which was 
provided with a Dacron cuff at one end, was 
connected first to the descending aorta by an 
end-tb-side anastomosis. Then one milligram 
per kilogram of body weight of heparin was in- 
travenously administered to prevent subsequent 
blood clotting in the cuff. In the beginning, 
connection of the inlet side conduit, which was 
also provided with a Dacron cuff, was anasto- 
mosed to the left atrium in the same way as the 
outlet side. In some cases, however, air was 
sucked in through the anastomosic line during 
expansion of the pumping chamber. A new 
technique developed later to prevent such leak- 
ing has three steps (Figure 3) : 1) anastomosis 
of a Dacron cuff alone to the left atrium, 2) in- 
sertion of the conduit, which has a stainless 
steel ring covered with Dacron velour, into the 
prefixed Dacron cuff to the level of the anasto- 
mosic line, and 3) connection of the Dacron cuff 
