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Anesth Analg 2001;93:906-911
© 2001 International Anesthesia Research Society

AMBULATORY ANESTHESIA

The Effect of Timing of Dolasetron Administration on its Efficacy as a Prophylactic Antiemetic in the Ambulatory Setting

Xiaoguang Chen, MD*, Jun Tang, MD*, Paul F. White, PhD MD, FANZCA*, Ronald H. Wender, MD{dagger}, Raymond Quon{dagger}, Alexander Sloninsky, MD{dagger}, Robert Naruse, MD{dagger}, Robert Kariger, MD{dagger}, Tom Webb, MD{dagger}, and Eve Norel, MD{dagger}

*Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas; and {dagger}Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California

Address correspondence and reprint requests to Dr. P. F. White, Professor and McDermott Chair of Anesthesiology, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., F2.208, Dallas, TX 75390-9068. Address e-mail to paul.white{at}utsouthwestern.edu


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 References
 
Dolasetron (12.5 mg IV) is effective in both preventing and treating postoperative nausea and vomiting (PONV) after ambulatory surgery. However, the optimal timing of dolasetron administration and its effect on the patient’s quality of life after discharge have not been established. One-hundred-five healthy, consenting women undergoing gynecologic laparoscopic procedures with a standardized general anesthetic technique were enrolled in this randomized, double-blinded study. Group 1 received dolasetron 12.5 mg IV 10–15 min before the induction of anesthesia; Group 2 received dolasetron 12.5 mg IV at the end of the laparoscopy (79 ± 48 min later than Group 1); and Group 3 received dolasetron 12.5 mg IV at the end of anesthesia (93 ± 52 min later than Group 1). The incidence of PONV, complete responses (defined as no emetic episodes and no rescue medication within the 24-h period after anesthesia), recovery profiles, and patient satisfaction were recorded. In the postanesthesia care unit and during the 24-h follow-up period, the incidence of nausea and vomiting, as well as the need for rescue antiemetics, did not differ significantly among the three groups. The percentages of patients with complete responses to the study drug within the first postoperative 24 h were also similar in all three groups (55%, 59%, and 52% for Groups 1, 2, and 3, respectively). The early and intermediate recovery profiles, including resumption of a normal diet and patient satisfaction with the control of PONV, were not different among the three study groups. Dolasetron 12.5 mg IV administered before the induction of anesthesia is as effective as dolasetron given at the end of laparoscopy or at the end of anesthesia in preventing PONV after outpatient laparoscopy.

IMPLICATIONS: The timing of dolasetron administration appears to have little effect on its efficacy when administered as a prophylactic antiemetic in the ambulatory setting.


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 References
 
Postoperative nausea and vomiting (PONV) continues to be a significant problem for outpatients undergoing laparoscopic surgical procedures (1,2). Early trials with ondansetron, a 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, demonstrated that it was effective for both the prevention and treatment of PONV (3–5). Dolasetron, a newer 5-HT3 receptor antagonist, is a safe and effective antiemetic for the prevention and treatment of PONV (6–11). In a recent study (12), dolasetron 12.5 mg IV was as effective as ondansetron 4 mg IV in preventing PONV when administered 15 min before the end of anesthesia, as recommended in the Food and Drug Administration-approved package insert (13). Given the lower costs associated with dolasetron, we concluded that it was more cost-effective than ondansetron for prophylaxis of outpatients undergoing otorhinolaryngology surgery (12). Although the timing of ondansetron administration has a direct effect on its efficacy in preventing PONV after ambulatory surgery (14,15), no study has directly evaluated the effect of timing of dolasetron administration on its antiemetic effectiveness in the ambulatory setting. Therefore, we designed a prospective, randomized, double-blinded study to test the hypothesis that timing of dolasetron administration influences its efficacy in preventing PONV and improving patient satisfaction after outpatient gynecologic laparoscopy surgery.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 References
 
After obtaining IRB approval and written informed consent, 105 ASA physical status I or II women between the ages of 19 and 56 yr scheduled for outpatient gynecologic laparoscopic procedures were enrolled in this prospective study. Patients were randomly assigned to one of three antiemetic treatment groups by using a computer-generated random number table. Exclusionary criteria included patients who had taken antiemetic or psychoactive medication within 24 h before the operation, were more than 50% above their ideal body weight, were pregnant, had vomiting or retching 24 h before surgery, or had major organ dysfunction. All patients were asked to provide a detailed medical history, including alcohol (or drug) consumption, date of last menstrual period, and any history of PONV or motion sickness. The study medications were prepared by the pharmacy in three numbered syringes (containing either saline or dolasetron 12.5 mg in a total volume of 5 mL), which were identical in appearance. The study medication was administered IV 10–15 min before the induction of anesthesia (Syringe 1), upon removal of the laparoscope (Syringe 2), or at the end of anesthesia (Syringe 3).

In the preoperative holding area, these unpremedicated patients assessed their baseline level of sedation, fatigue, comfort, pain, and nausea by using 100-mm visual analog scales, with 0 = none to 100 = maximum. All patients then received midazolam 2 mg IV for premedication. On arrival in the operating room, routine monitoring devices were placed, and baseline blood pressure, heart rate, and pulse oximetry values were recorded.

The first syringe (containing dolasetron 12.5 mg in Group 1 and saline in Groups 2 and 3) was administered at 10–15 min before the induction of anesthesia. Anesthesia was induced with fentanyl 1.0–1.5 µg/kg IV and propofol 1.5–2.0 mg/kg IV. Tracheal intubation was facilitated with succinylcholine 1 mg/kg IV. Anesthesia was maintained with desflurane 3%–6% in combination with nitrous oxide 60%–70% in oxygen, fentanyl 0.5–1.0 µg/kg IV boluses, and cisatracurium 4–6 mg IV (as needed). When the laparoscope was removed (79 ± 48 min after Syringe 1 was given), the second syringe (containing dolasetron 12.5 mg in Group 2 and saline in Groups 1 and 3) was administered. At the end of anesthesia (93 ± 52 min after Syringe 1 was administered), the third syringe (which contained dolasetron 12.5 mg in Group 3 and saline in Groups 1 and 2) was given. After extubation, all patients were transported directly to the postanesthesia care unit (PACU).

A blinded investigator (XC) recorded all the intraoperative and recovery variables, including anesthesia time (from induction until discontinuation of the maintenance anesthetics) and operating time (from surgical incision to skin closure). The times at which the patient opened her eyes, followed commands (e.g., squeezed the investigator’s hand), and was oriented to her name and date of birth were evaluated at 1-min intervals. The times to the first oral fluid intake, unassisted ambulation, being judged "fit for discharge," and actual discharge were assessed at 15-min intervals. Standardized discharge criteria included stable vital signs, ability to ambulate without assistance, passage of urine, and absence of moderate to severe pain or nausea (3,12,14,15).

Antiemetic efficacy was assessed by monitoring the incidence of PONV and the need for rescue antiemetic medication. An emetic episode was defined as either vomiting or retching, and each episode had to be separated by a minimum interval of 2 min. A complete response was defined as no emetic (or retching) episodes and no rescue medication administered within the initial 24-h period after anesthesia. Rescue antiemetic therapy was administered if the patients experienced emesis episodes or nausea lasting for more than 15 min, or if the patient requested antiemetic medication. Metoclopramide 10 mg IV was given as the initial rescue antiemetic, and if this failed to control the patients’ symptoms, ondansetron 4 mg IV was administered. In all patients, pain was treated with hydromorphone 0.25–0.5 mg IV in the PACU and with oral hydrocodone after discharge home. The visual analog scale scores for sedation, fatigue, comfort, pain, and nausea were evaluated at 30-min intervals after the end of anesthesia until the time of discharge. All adverse events and medication required in the PACU were recorded.

Patients were contacted at 24 h and 7 days after the operation by an investigator (who was unaware of the treatment group) and questioned regarding the number of episodes of vomiting and the need for antiemetic medication after discharge. Patients were also asked to evaluate the severity of their postdischarge nausea using an 11-point verbal scale, with 0 = no nausea to 10 = nausea "as bad as it could be" (3). The quality of life issues (including quality of sleep, time to tolerating regular fluids, resuming normal food intake, and the amount of caretaker time required), as well as satisfaction with the control of PONV symptoms after the operation, were assessed at the same time intervals after surgery.

A sample size of 30 was determined by using a power analysis based on the assumptions that (a) the antiemetic effect of dolasetron 12.5 mg IV administered at the induction of anesthesia was not different from a placebo (11) and the incidence of PONV after gynecologic laparoscopy surgery would be 70% (15,16), (b) a 35% reduction in PONV (from 70% to 35%) in the groups administered dolasetron at the end of surgery or anesthesia would be of clinical relevance, and (c) {alpha} = 0.05 and ß = 0.2. A one-way analysis of variance was performed for continuous variables. If a significant difference appeared, a Newman-Keuls multiple-comparison test was used to determine the intergroup differences. Categorical data were analyzed by {chi}2 test or Fisher’s exact test, as appropriate. All tests were two sided, and a P value < 0.05 was considered statistically significant. Data are presented as mean values ± SD or as numbers and percentages.


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 References
 
A total of 105 patients were enrolled in the study. However, open surgical procedures were performed in three patients after laparoscopy (one patient in each group). Therefore, these three patients were excluded from the final statistical analysis. The three prophylaxis groups were comparable demographically, including time of the menstrual cycle and history of PONV or motion sickness (Table 1). There were no significant differences in the durations of anesthesia and surgery or in the doses of preoperative medication, induction and maintenance anesthetics, muscle relaxant reversal drugs, and postoperative analgesic medication. Furthermore, similar amounts of perioperative fluid were administered in all three groups.


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  		Table 1.  Demographic Data and Total Dosages of Anesthetic and Analgesic Drugs in the Three Dolasetron Prophylaxis Groups
 
With respect to the recovery profiles, there were no significant differences in the times to eye opening, tracheal extubation, following verbal commands, orientation, ambulation, being judged "fit for discharge," or actual discharge home among the three treatment groups (Table 2). Furthermore, the incidence of nausea and vomiting and the need for rescue antiemetics in the PACU, as well as the times to the first emetic episode, were also similar among the three study groups (Table 3).


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  		Table 2.  Early and Intermediate Recovery Profiles for the Three Dolasetron Prophylaxis Groups
 

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  		Table 3.  Incidences of Nausea and Vomiting in the PACU and in the First 24-Hour Period After Surgery in the Three Treatment Groups
 
The investigator was able to contact all of the patients by telephone after surgery except two (one in Group 1 and one in Group 3). These two patients were excluded from the postdischarge analysis. During the first 24-h postoperative follow-up period, the incidence of PONV and the percentages of patients with complete responses to the study drug were similar in all three groups. There were also no differences in the incidence of nonemetic side effects among the three groups (Table 4). After discharge from the ambulatory surgery unit, the times to tolerating fluids and resumption of a normal diet, time taken off work by a caretaker, and patient satisfaction scores with the control of their PONV and quality of sleep were not significantly different among the three groups (Table 5).


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  		Table 4.  The Incidences of Side Effects During the Perioperative Period Among the Three Treatment Groups
 

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  		Table 5.  Postdischarge Assessment of Quality of Life Issues in the Three Dolasetron Prophylaxis Groups
 

   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
References
 
PONV remains a common problem after outpatient surgery, especially in women undergoing laparoscopic surgical procedures. These symptoms not only cause patient discomfort, but also can lead to prolongation of the recovery room stay and unanticipated hospital admissions (2,17,18). Routine use of antiemetic prophylaxis in this patient population could reduce PONV and improve patient satisfaction (14,19,20). Therefore, it has been recommended that routine antiemetic prophylaxis should be considered for these high-risk outpatients (20,21).

In a recent quantitative systemic review of 32 studies comparing the prophylactic effects of 5-HT3 receptor antagonists with the traditional antiemetic drugs, the authors concluded that the 5-HT3 receptor antagonists were superior for preventing PONV (22). Although dolasetron is a well tolerated and effective antiemetic in both the prevention and treatment of PONV after highly emetogenic surgical procedures (6–12), the effect of the timing of its administration on patient outcome has not been carefully studied. Irrespective of the timing of dolasetron’s administration, 15%–24% of the women participating in this study still expressed dissatisfaction with the management of their PONV symptoms. Although no arrhythmias were observed during the perioperative period, dolasetron has been alleged to produce changes in the electrocardiogram tracing (data on file, Abbott Laboratories, Chicago, IL).

In most of the studies evaluating the prophylactic antiemetic efficacy of dolasetron in surgical patients, the drug was administered 15 to 30 minutes before the end of anesthesia (6,7,10,12). When administered before surgery, it has been assumed that larger doses of dolasetron would be required to achieve prophylactic benefits. For example, Korttila et al. (11) reported that dolasetron 50 mg IV, but not 25 mg IV, was effective in preventing PONV compared with a placebo (saline) when administered before the induction of anesthesia. In addition, Diemunsch et al. (23) reported that a single 50-mg oral dose of dolasetron administered one to two hours before the induction of anesthesia significantly reduced the incidence of PONV in patients undergoing gynecologic surgery. Dolasetron 0.3 mg/kg IV was also effective in reducing radiotherapy-induced emesis when given 30 minutes before the procedure (24).

In this study, we evaluated the effect of the timing of dolasetron administration by giving the same dose before induction, at the time the laparoscope was removed, or at the end of anesthesia. These data suggest that dolasetron 12.5 mg IV given 10–15 minutes before the induction of anesthesia had the same antiemetic efficacy as 12.5 mg IV given at the end of laparoscopy or at the end of anesthesia. The percentage of patients with complete responses were 55%, 59%, and 52%, respectively, remarkably similar to the incidences reported in earlier placebo-controlled studies (6,7). Graczyk et al. (6), for example, reported that the incidence of complete responses was 50% in the dolasetron (12.5 mg IV) group, compared with only 31% in the placebo group, when the study medications were given 15 minutes before the end of anesthesia. In another similar study, the complete response rate after dolasetron 12.5 mg IV was 54% when it was administered at the end of anesthesia (7).

In this study, the early and intermediate recovery profiles, as well as the assessment of quality of life after anesthesia and patient satisfaction with the control of their PONV, were similar to those reported earlier in a study involving the prophylactic administration of ondansetron (4 mg IV) to a similar outpatient population undergoing gynecologic laparoscopy procedures (14). However, in that study, ondansetron 4 mg IV administered immediately before the end of surgery was more effective in preventing PONV than the same dose of ondansetron given before the induction of anesthesia. It would appear that the effect of timing of drug administration on its antiemetic efficacy depends on the drug. For example, a recent study found that prophylactic administration of dexamethasone 10 mg IV immediately before the induction of anesthesia was more effective in preventing PONV than the same dose given at the end of anesthesia (25). Kraus et al. (26) also reported that droperidol (0.075 mg/kg IV) was more effective for prophylaxis against postoperative emesis when given before the start of surgery.

We would speculate that dolasetron is less influenced by the timing of its administration than ondansetron because it is a prodrug. Therefore, dolasetron has to be converted to its active metabolite, hydrodolasetron, to produce its antiemetic effect (27). Given that hydrodolasetron has a longer elimination half-life (eight hours) and is approximately 100 times more potent as a serotonin antagonist than the parent compound (27), it is not surprising to find that dolasetron 12.5 mg IV was equally effective in this outpatient population whether it was administered before the induction of anesthesia, at the end of the laparoscopic procedure, or at the end of anesthesia.

The etiology of PONV is multifactorial and is influenced by the type of anesthetic, preanesthetic medication, surgical manipulations, postoperative pain medication, and demographic characteristics, including sex, menstrual cycle, smoking, and a history of PONV and motion sickness (1). Our study design carefully standardized the patient population, as well as the type of anesthesia and surgery. Therefore, any differences in outcomes among the three groups would have been attributable to the effect of the timing of dolasetron administration rather than these potentially confounding variables.

The two major concerns regarding the study design relate to (1) failure to include a placebo (control) group and (2) selection of a 12.5-mg dose of dolasetron. The primary reason that we chose not to include a placebo group was because a large, placebo-controlled study had previously demonstrated that dolasetron 12.5 mg IV, given 15–30 minutes before the end of anesthesia, was more effective than saline in the prevention of PONV after outpatient gynecologic laparoscopic surgery (6). Given the frequent incidence of emesis in this female population (more than 70% in a similar "untreated" patient population) (14), we also believed that it was not ethical to deny these patients the benefits of prophylactic (antiemetic) therapy. Furthermore, the standard practice at the institution where the study was conducted was to administer prophylactic antiemetics to all women undergoing gynecologic laparoscopic surgery. The choice of a 12.5-mg dose of dolasetron in this study was based on a previous study demonstrating that this was the most cost-effective dose of the 5-HT3 antagonist for preventing PONV (12).

In summary, dolasetron (12.5 mg IV) administered before the induction of anesthesia is as effective as when it is administered at the end of the procedure in preventing PONV in this outpatient population. The recovery profiles, quality of life after surgery, and patient satisfaction are also similar whether dolasetron was administered at the start or the end of surgery. Thus, timing of dolasetron administration seems to have no significant influence on its efficacy in preventing PONV after outpatient gynecologic laparoscopic surgery.


   Acknowledgments
 
An educational grant was received from Abbott Laboratories (Chicago, IL) and support from the White Mountain Institute, a private foundation in Los Altos, CA (Dr. P. F. White, President).


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 

  1. Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162–84.[ISI][Medline]
  2. Song D, Whitten CW, White PF, et al. Antiemetic activity of propofol after sevoflurane and desflurane anesthesia for outpatient laparoscopic cholecystectomy. Anesthesiology 1998; 89: 838–43.[ISI][Medline]
  3. Bodner M, White PF. Antiemetic efficacy of ondansetron after outpatient laparoscopy. Anesth Analg 1991; 73: 250–4.[Abstract/Free Full Text]
  4. McKenzie R, Kovac A, O’Conner T, et al. Comparison of ondansetron versus placebo to prevent postoperative nausea and vomiting in women undergoing ambulatory gynecologic surgery. Anesthesiology 1993; 78: 21–8.[ISI][Medline]
  5. Scuderi P, Wetchler B, Sung Y-F, et al. Treatment of postoperative nausea and vomiting after outpatient surgery with 5-HT3 antagonist ondansetron. Anesthesiology 1993; 78: 15–20.[ISI][Medline]
  6. Graczyk SG, McKenzie R, Kallar S, et al. Intravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery. Anesth Analg 1997; 84: 325–30.[Abstract]
  7. Diemunsch P, D’Hollander A, Paxton L, et al. Intravenous dolasetron mesilate in the prevention of postoperative nausea and vomiting in females undergoing gynecological surgery. J Clin Anesth 1997; 9: 365–73.[ISI][Medline]
  8. Kovac AL, Scuderi PE, Boerner TF, et al. Treatment of postoperative nausea and vomiting with single intravenous doses of dolasetron mesylate: a multicenter trial. Dolasetron Mesylate PONV Treatment Study Group. Anesth Analg 1997; 85: 546–52.[Abstract]
  9. Diemunsch P, Leeser J, Feiss P, et al. Intravenous dolasetron mesilate ameliorates postoperative nausea and vomiting. Can J Anaesth 1997; 44: 173–81.[Abstract/Free Full Text]
  10. Philip BK, Mcleskey CH, Chelly JE, et al. Pooled analysis of three large clinical trials to determine the optimal dose of dolasetron mesylate needed to prevent postoperative nausea and vomiting. The Dolasetron Prophylactic Study Group. J Clin Anesth 2000; 12: 1–8.[ISI][Medline]
  11. Korttila K, Clergue F, Leeser J, et al. Intravenous dolasetron and ondansetron in prevention of postoperative nausea and vomiting: a multicenter, double-blind, placebo-controlled study. Acta Anaesthesiol Scand 1997; 41: 914–22.[ISI][Medline]
  12. Zárate E, Watcha MF, White PF, et al. A comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis. Anesth Analg 2000; 90: 1352–8.[Abstract/Free Full Text]
  13. Physicians’ desk reference. Montvale, NJ: Medical Economics Co Inc, 1999: 1299–1302.
  14. Tang J, Wang B, White PF, et al. The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg 1997; 86: 274–82.[Abstract]
  15. Sun R, Klein KW, White PF. The effect of timing of ondansetron administration in outpatients undergoing otolaryngologic surgery. Anesth Analg 1997; 84: 331–6.[Abstract]
  16. Pearman MH. Single dose intravenous ondansetron in the prevention of postoperative nausea and vomiting. Anaesthesia 1994; 49: 11–5.
  17. Isenberg SJ, Apt L, Yamada S. Overnight admission of outpatient strabismus patients. Ophthalmic Surg 1990; 21: 540–3.[ISI][Medline]
  18. Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262: 3008–10.[Abstract]
  19. Sadhasivam S, Saxena A, Subramniam K, et al. The safety and efficacy of prophylactic ondansetron in patients undergoing modified radical mastectomy. Anesth Analg 1999; 89: 1340–5.[Abstract/Free Full Text]
  20. White PF, Watcha MF. Postoperative nausea and vomiting: prophylaxis versus treatment. Anesth Analg 1999; 89: 1337–9.[Free Full Text]
  21. Watcha MF. The cost-effective management of postoperative nausea and vomiting. Anesthesiology 2000; 92: 931–3.[ISI][Medline]
  22. Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists vs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth 2000; 47: 1008–18.[Abstract/Free Full Text]
  23. Diemunsch P, Korttila K, Leeser J, et al. Oral dolasetron mesylate for prevention of postoperative nausea and vomiting: a multicenter, double-blind, placebo-controlled study. The Oral Dolasetron PONV Prevention Study Group. J Clin Anesth 1998; 10: 145–52.[ISI][Medline]
  24. Bey P, Wilkinson PM, Resbeut M, et al. A double-blind, placebo-controlled trial of i.v. dolasetron mesylate in the prevention of radiotherapy-induced nausea and vomiting in cancer patients. Support Care Cancer 1996; 4: 378–83.[ISI][Medline]
  25. Wang J, Ho S, Tzeng J, Tang C. The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg 2000; 91: 136–9.[Abstract/Free Full Text]
  26. Kraus GB, Giebner M, Palackal R. The prevention of postoperative vomiting following strabismus surgery in children. Anaesthesist 1991; 40: 92–5.[ISI][Medline]
  27. Shah A, Lanman R, Bhargava V, et al. Pharmacokinetics of dolasetron following single- and multiple-dose administration to normal male subjects. Biopharm Drug Dispos 1995; 16: 177–89.[ISI][Medline]
Accepted for publication June 7, 2001.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press