EDITORIALS:

Robert M. Savage and Delos M. Cosgrove

Systematic Transesophageal Echocardiographic Examination in Mitral Valve Repair: The Evolution of a Discipline into the Twenty-First Century
Anesth Analg 1999 88: 1197. [Full Text] [PDF] [Request Permissions]  

Paul F. White and Mehernoor F. Watcha

Has the Use of Meta-Analysis Enhanced Our Understanding of Therapies for Postoperative Nausea and Vomiting?
Anesth Analg 1999 88: 1200. [Full Text] [PDF] [Request Permissions]  

Pamela Pierce Palmer

Implantable Pain Therapies—What Training is Required?
Anesth Analg 1999 88: 1203. [Full Text] [PDF] [Request Permissions]  

CARDIOVASCULAR ANESTHESIA:

A.-Stephane Lambert, Joseph P. Miller, Scot H. Merrick, Nelson B. Schiller, Elyse Foster, Isobel Muhiudeen-Russell, and Michael K. Cahalan

Improved Evaluation of the Location and Mechanism of Mitral Valve Regurgitation with a Systematic Transesophageal Echocardiography Examination
Anesth Analg 1999 88: 1205. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In this article, we describe how a systematic examination of the mitral valve by using transesophageal echocardiography allows identification of the different segments of the mitral valve, precise localization of pathology, and helps to diagnose the mechanism of mitral regurgitation. This is important in determining an approach to mitral valve repair and its feasibility.

André Gries, Christoph Bode, Stefanie Gross, Karlheinz Peter, Hubert Böhrer, and Eike Martin

The Effect of Intravenously Administered Magnesium on Platelet Function in Patients After Cardiac Surgery
Anesth Analg 1999 88: 1213. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In a randomized, blinded, placebo-controlled study of patients 24 h after coronary artery bypass grafting, IV administered magnesium inhibited platelet function in vitro and in vivo.

Angela Rajek, Rainer Lenhardt, Daniel I. Sessler, Martin Grabenwöger, Johannes Kastner, Peter Mares, Ursula Jantsch, and Eva Gruber

Tissue Heat Content and Distribution During and After Cardiopulmonary Bypass at 17°C
Anesth Analg 1999 88: 1220. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Temperature afterdrop after bypass at 17°C was 2.2 ± 0.4°C, with approximately 73% of the decrease in core temperature resulting from core-to-peripheral redistribution of body heat. Cooling and rewarming were associated with large radial tissue temperature gradients in the thigh.

Charles W. Whitten, Philip E. Greilich, Roy Ivy, Dan Burkhardt, and Paul M. Allison

D-Dimer Formation During Cardiac and Noncardiac Thoracic Surgery
Anesth Analg 1999 88: 1226. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: We assessed the ability of a readily available D-dimer assay to detect excessive fibrinolysis in patients undergoing thoracic surgery with and without extracorporeal circulation. The findings demonstrate that the assay used in this investigation reflected variable amounts of fibrinolysis in patients undergoing both types of thoracic surgery.

Michiaki Yamakage, Takashi Matsuzaki, Naoki Tsujiguchi, Tomohisa Mori, and Akiyoshi Namiki

The Direct Effects of Heparin and Protamine on Canine Tracheal Smooth Muscle Tone
Anesth Analg 1999 88: 1232. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Protamine and heparin-protamine complex inhibited carbachol-induced canine tracheal smooth muscle contraction by inhibiting the increase in intracellular concentration of free Ca²⁺. These drugs can decrease the agonist-induced increase in intracellular Ca²⁺ by the inhibition of voltage-dependent Ca²⁺ channels in both the activated and inactivated states.

Joel L. Parlow, Pierre Sagnard, Gérard Begou, Jean-Paul Viale, and Luc Quintin

The Effects of Clonidine on Sensitivity to Phenylephrine and Nitroprusside in Patients with Essential Hypertension Recovering from Surgery
Anesth Analg 1999 88: 1239. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Clonidine increases the sensitivity to bolus injections of the vasoconstrictor phenylephrine, but not the vasodilator sodium nitroprusside, before and after surgery in patients with preexisting hypertension. The doses of vasopressors should be reduced accordingly in hypertensive patients receiving perioperative clonidine.

B. Vollmar, A. Olinger, U. Hildebrandt, and M. D. Menger

Cardiopulmonary Dysfunction During Minimally Invasive Thoraco-Lumboendoscopic Spine Surgery
Anesth Analg 1999 88: 1244. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: For endoscopic thoraco-lumbar spine fusion, CO₂ thoraco-retroperitoneum–induced cardiopulmonary dysfunction must be of concern, especially in patients with cardiopulmonary compromise. Appropriate monitoring and immediate CO₂ desufflation may be beneficial in cases of therapy-resistant hemodynamic, oxygenation, and ventilation difficulties.

Timothy B. Gilbert, Craig W. Goodsell, and Mark J. Krasna

Bronchial Rupture by a Double-Lumen Endobronchial Tube During Staging Thoracoscopy (Case Report)
Anesth Analg 1999 88: 1252. [Full Text] [PDF] [Request Permissions]  

David J. Cook

Changing Temperature Management for Cardiopulmonary Bypass (Review Article)
Anesth Analg 1999 88: 1254. [Full Text] [PDF] [Request Permissions]  

Charles Weissman

Pulmonary Function After Cardiac and Thoracic Surgery (Review Article)
Anesth Analg 1999 88: 1272. [Full Text] [PDF] [Request Permissions]  

AMBULATORY ANESTHESIA:

Harold P. Lehmann, Lee A. Fleisher, Janet Lam, Barbara A. Frink, and Eric B. Bass

Patient Preferences for Early Discharge After Laparoscopic Cholecystectomy
Anesth Analg 1999 88: 1280. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Patients preferred to be at home for mild postoperative symptoms but in the hospital for worse postoperative symptoms. Preferences did not change with different methods of asking and were the same pre- and postoperatively. If patients made choices for their care before their procedure, they would still be happy with those decisions postoperatively.

Scott S. Reuben, Neil Roy Connelly, and Holly Maciolek

Postoperative Analgesia with Controlled-Release Oxycodone for Outpatient Anterior Cruciate Ligament Surgery
Anesth Analg 1999 88: 1286. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: A controlled-release formulation of oxycodone in patients undergoing anterior cruciate ligament repair on an ambulatory basis provides significant analgesic benefit and a lowering of side effects compared with either fixed-dose or as-needed oxycodone regimens.

PEDIATRIC ANESTHESIA:

Napoleon Burt, Gary R. Haynes, and Melinda K. Bailey

Patients with Malignant Osteopetrosis Are at High Risk of Anesthetic Morbidity and Mortality
Anesth Analg 1999 88: 1292. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Osteopetrosis is a rare disease that increases perioperative morbidity and mortality. By performing a retrospective chart review, we found that this increased perioperative morbidity and mortality is primarily related to airway and respiratory factors. Anesthetic management strategies should consider the factors that cause the high frequency of adverse airway events in this patient population.

Yoshitaka Fujii, Yuhji Saitoh, Hiroyoshi Tanaka, and Hidenori Toyooka

Preoperative Oral Antiemetics for Reducing Postoperative Vomiting After Tonsillectomy in Children: Granisetron Versus Perphenazine
Anesth Analg 1999 88: 1298. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: We compared the efficacy of granisetron and perphenazine given orally for preventing postoperative vomiting after tonsillectomy with or without adenoidectomy in children. Preoperative oral granisetron was more effective than perphenazine.

Hervé Bouaziz, Naomitsu Okubo, Jean-Marc Malinovsky, Dan Benhamou, Kamran Samii, and Jean Xavier Mazoit

The Age-Related Effects of Epidural Lidocaine, With and Without Epinephrine, on Spinal Cord Blood Flow in Anesthetized Rabbits
Anesth Analg 1999 88: 1302. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In young rabbits, any decrease in blood pressure was followed by a decrease in spinal cord blood flow, a decrease that did not correlate to the use of epinephrine and was not observed in adult animals. These data suggest that blood pressure should be monitored closely to promptly treat any decrease in blood pressure when combined epidural-general anesthesia is used in children.

Lynda T. Wells and Deborah K. Rasch

Emergence "Delirium" After Sevoflurane Anesthesia: A Paranoid Delusion? (Case Report)
Anesth Analg 1999 88: 1308. [Full Text] [PDF] [Request Permissions]  

REGIONAL ANESTHESIA AND PAIN MANAGEMENT:

Gilbert J. Fanciullo, Robert J. Rose, Peter G. Lunt, Patricia K. Whalen, and Edgar Ross

The State of Implantable Pain Therapies in the United States: A Nationwide Survey of Academic Teaching Programs
Anesth Analg 1999 88: 1311. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Of the pain teaching programs in the United States, 80% responded to a questionnaire eliciting information about the implantation of spinal cord-stimulating and opioid infusion devices. The range and diversity of responses imply a lack of agreement about implantation techniques, drugs, and protocols.

Massimo Runza, Riccardo Pietrabissa, Sara Mantero, Alessandro Albani, Virginio Quaglini, and Roberto Contro

Lumbar Dura Mater Biomechanics: Experimental Characterization and Scanning Electron Microscopy Observations
Anesth Analg 1999 88: 1317. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In this experimental work, we studied the structural and functional relationship of human lumbar dura mater. We performed mechanical tests and microscopic observations on dura mater samples. The results show that the dura mater is mainly composed of longitudinally oriented collagen fibers, which account for higher tissue resistance in this direction.

Jen-Kun Cheng, Mu-Hsi Pan, Kuo-Hwa Wu, Martin Saiwong Mok, and Tze-Taur Wei

Epidural Phenylephrine Attenuates Hypotension Induced by Alkalinized Lidocaine Epidural Anesthesia
Anesth Analg 1999 88: 1322. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Hypotension after epidural anesthesia is common in general clinical practice. Phenylephrine administered epidurally in combination with alkalinized lidocaine may reduce the incidence of hypotension.

Marc Gentili, Jean-Marc Bernard, and Francis Bonnet

Adding Clonidine to Lidocaine for Intravenous Regional Anesthesia Prevents Tourniquet Pain
Anesth Analg 1999 88: 1327. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: A 150-µg dose of clonidine added to lidocaine improved tourniquet tolerance during IV regional anesthesia.

Ching-Tang Wu, Jyh-Cherng Yu, Chun-Chang Yeh, Sy-Tzu Liu, Chi-Yuan Li, Shung-Tai Ho, and Chih-Shung Wong

Preincisional Dextromethorphan Treatment Decreases Postoperative Pain and Opioid Requirement After Laparoscopic Cholecystectomy
Anesth Analg 1999 88: 1331. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Preincisional dextromethorphan (40 mg IM) treatment offers a preemptive analgesic effect, thus improving the postoperative pain management.

ECONOMICS AND HEALTH SYSTEMS RESEARCH:

Arto I. E. Puura, Michael G. F. Rorarius, Pia Manninen, Sanna Hopput, and Gerhard A. Baer

The Costs of Intense Neuromuscular Block for Anesthesia During Endolaryngeal Procedures Due to Waiting Time
Anesth Analg 1999 88: 1335. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In this randomized, double-blinded, prospective study, we evaluated the costs of intense neuromuscular block due to waiting time. Succinylcholine and mivacurium are the most economical muscle relaxants to use when intense neuromuscular block is mandatory. Using intermediate-acting muscle relaxants results in unduly prolonged recovery time and extra costs.

OBSTETRIC ANESTHESIA:

Yaakov Beilin, Mihai Galea, Jeffrey Zahn, and Carol A. Bodian

Epidural Ropivacaine for the Initiation of Labor Epidural Analgesia: A Dose Finding Study
Anesth Analg 1999 88: 1340. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The lowest effective concentration of ropivacaine for the initiation of labor epidural analgesia has not been determined. We found that ropivacaine 0.20% offers adequate analgesia significantly more often than either ropivacaine 0.15% or ropivacaine 0.10%. If one selects ropivacaine as the sole local anesthetic for the initiation of labor epidural analgesia, the minimal concentration should be 0.20%.

Yoshitaka Fujii, Yuhji Saitoh, Hiroyoshi Tanaka, and Hidenori Toyooka

Granisetron/Dexamethasone Combination for Reducing Nausea and Vomiting During and After Spinal Anesthesia for Cesarean Section
Anesth Analg 1999 88: 1346. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Intraoperative, postdelivery, and postoperative nausea and vomiting are distressing to patients undergoing cesarean section under spinal anesthesia. The combination of granisetron plus dexamethasone was evaluated and found to be effective for preventing these emetic symptoms.

Francine J. D'Ercole, Dianne Scott, Elizabeth Bell, Stephen M. Klein, and Roy A. Greengrass

Paravertebral Blockade for Modified Radical Mastectomy in a Pregnant Patient (Case Report)
Anesth Analg 1999 88: 1351. [Full Text] [PDF] [Request Permissions]  

GENERAL ARTICLES:

Martin R. Tramèr and Bernhard Walder

Efficacy and Adverse Effects of Prophylactic Antiemetics During Patient-Controlled Analgesia Therapy: A Quantitative Systematic Review
Anesth Analg 1999 88: 1354. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Of 100 patients treated with droperidol added in a patient-controlled analgesia pump with morphine, 30 who would have vomited or been nauseated had they not received droperidol will not suffer these effects. There is no evidence of dose-responsiveness for efficacy with droperidol, but the risk of adverse effects is dose-dependent. There is a lack of evidence for other antiemetics.

Anna Lee and Mary L. Done

The Use of Nonpharmacologic Techniques to Prevent Postoperative Nausea and Vomiting: A Meta-Analysis
Anesth Analg 1999 88: 1362. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: This systematic review showed that nonpharmacologic techniques were equivalent to commonly used antiemetic drugs in preventing vomiting after surgery. Nonpharmacologic techniques were more effective than placebo in preventing nausea and vomiting within 6 h of surgery in adults, but there was no benefit in children.

Karen B. Domino, Emily A. Anderson, Nayak L. Polissar, and Karen L. Posner

Comparative Efficacy and Safety of Ondansetron, Droperidol, and Metoclopramide for Preventing Postoperative Nausea and Vomiting: A Meta-Analysis
Anesth Analg 1999 88: 1370. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: We performed a systematic review of published, randomized, controlled trials to determine the relative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting. Ondansetron and droperidol were more effective than metoclopramide in reducing postoperative vomiting. The overall risk of adverse effects did not differ.

Kazuna Sugiyama, Kozo Yokoyama, Ken-ichi Satoh, Masahiro Nishihara, and Tatsushi Yoshitomi

Does the Murphy Eye Reduce the Reliability of Chest Auscultation in Detecting Endobronchial Intubation?
Anesth Analg 1999 88: 1380. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The Murphy eye was designed to allow ventilation of the lung when the bevel of the endotracheal tube is occluded. We demonstrated that the eye of the Murphy tube reduces the reliability of chest auscultation in detecting endobronchial intubation.

Anne P. Vakkuri, Leena Lindgren, Kari T. Korttila, and Arvi M. Yli-Hankala

Transient Hyperdynamic Response Associated with Controlled Hypocapneic Hyperventilation During Sevoflurane-Nitrous Oxide Mask Induction in Adults
Anesth Analg 1999 88: 1384. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In this randomized, prospective study, we found that controlled hypocapneic hyperventilation delivered manually during sevoflurane/N₂O/O₂ mask induction was associated with a significant transient hyperdynamic response. This kind of hemodynamic arousal can be detrimental to many patients and can be avoided by conducting sevoflurane mask induction with unassisted spontaneous breathing.

Wolfgang Oczenski, Herbert Krenn, Ashraf A. Dahaba, Maria Binder, Irene El-Schahawi-Kienzl, Helmuth Jellinek, Sylvia Schwarz, and Robert D. Fitzgerald

Hemodynamic and Catecholamine Stress Responses to Insertion of the Combitube®, Laryngeal Mask Airway or Tracheal Intubation
Anesth Analg 1999 88: 1389. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In this study, we showed that the hemodynamic and catecholamine stress responses after insertion of the Combitube® (Kendall-Sheridan Catheter Corp., Argyle, NY) were significantly higher compared with laryngeal mask airway or endotracheal intubation. We conclude that the increased stress response to insertion of a Combitube® may represent a serious hazard to patients with cardiovascular disease.

E. I Eger, II, M. J. Halsey, R. A. Harris, D. D. Koblin, A. Pohorille, J. C. Sewell, J. M. Sonner, and J. R. Trudell

Hypothesis: Volatile Anesthetics Produce Immobility by Acting on Two Sites Approximately Five Carbon Atoms Apart
Anesth Analg 1999 88: 1395. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Volatile anesthetics may produce immobility by a concurrent action on two sites five carbon atom lengths apart.

Tetsutaro Shinomura, Shin-ichi Nakao, Takehiko Adachi, and Koh Shingu

Clonidine Inhibits and Phorbol Acetate Activates Glutamate Release from Rat Spinal Synaptoneurosomes
Anesth Analg 1999 88: 1401. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: We demonstrated that synaptoneurosomes from rat spinal cord could release glutamate in response to depolarization. We showed that an activator of protein kinase C increased glutamate released from spinal cord synaptoneurosomes but that clonidine decreased it. Glutamate release may be one of the mechanisms of antinociception at the spinal cord level.

Itaru Watanabe, Tomio Andoh, Ryosuke Furuya, Toshio Sasaki, Yoshinori Kamiya, and Hideki Itoh

Depressant and Convulsant Barbiturates Both Inhibit Neuronal Nicotinic Acetylcholine Receptors
Anesth Analg 1999 88: 1406. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: We found that both convulsant and depressant barbiturates inhibit the current mediated through ganglionic nicotinic acetylcholine receptors in PC12 cells. This finding suggests that the inhibition of neuronal nicotinic acetylcholine receptors does not contribute to the anesthetic action of barbiturates.

Eberhard Kochs, Cor J. Kalkman, Christine Thornton, Douglas Newton, Petra Bischoff, Hermann Kuppe, Jochen Abke, Ewald Konecny, Werner Nahm, and Gudrun Stockmanns

Middle Latency Auditory Evoked Responses and Electroencephalographic Derived Variables Do Not Predict Movement to Noxious Stimulation During 1 Minimum Alveolar Anesthetic Concentration Isoflurane/Nitrous Oxide Anesthesia
Anesth Analg 1999 88: 1412. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Reliable estimation of anesthetic adequacy remains a challenge. Changes in spontaneous or auditory evoked brain activity after a brief electrical stimulus at the wrist could not be used to predict whether anesthetized patients would subsequently move at the time of surgical incision.

BRIEF COMMUNICATION:

C. Keller and J. Brimacombe

Mucosal Pressure, Mechanism of Seal, Airway Sealing Pressure, and Anatomic Position for the Disposable Versus Reusable Laryngeal Mask Airways
Anesth Analg 1999 88: 1418. [Full Text] [PDF] [Request Permissions]  

LETTERS TO THE EDITOR:

William Camann and Franklin Dexter

Visual Analog Scale Scores for Labor Pain • Response
Anesth Analg 1999 88: 1421. [Full Text] [PDF] [Request Permissions]  

Robert S. Greenberg and Cheryl B. Prichard Keith J. Jacquin

Repeated Use of the Cuffed Oropharyngeal Airway in an Infant for Radiation Therapy
Anesth Analg 1999 88: 1421. [Full Text] [PDF] [Request Permissions]  

Roberto de Menezes Lyra

Glottis Simulator
Anesth Analg 1999 88: 1422. [Full Text] [PDF] [Request Permissions]  

Daniel Talmor, Leonid Roytblat, Yoram Shapira, and Alan A. Artru

Are Vasopressors Beneficial After Cranial Trauma?
Anesth Analg 1999 88: 1423. [Full Text] [PDF] [Request Permissions]  

Meral Kanbak

Massive Intraoperative Pulmonary Embolism: With Succinylcholine or Not?
Anesth Analg 1999 88: 1423. [Full Text] [PDF] [Request Permissions]  

Dennis B. Hall

Takes a Lickin' and Keeps on Tickin'
Anesth Analg 1999 88: 1424. [Full Text] [PDF] [Request Permissions]  

Arnold J. Berry and Daniel I. Sessler

Recommended Exposure Limits for Desflurane and Isoflurane • Response
Anesth Analg 1999 88: 1424. [Full Text] [PDF] [Request Permissions]  

Spyros D. Mentzelopoulos, Marina V. Tsitsika, and Evangelia A. Karamichali

Difficult Airway Management with Balloon Inflation
Anesth Analg 1999 88: 1425. [Full Text] [PDF] [Request Permissions]  

Rajiv Lakhotia, Chandra Kant Pandey, and Prabhat Tewari

Arterialization of the Dorsum Vein on the Hand
Anesth Analg 1999 88: 1425. [Full Text] [PDF] [Request Permissions]  

C. Pham Dang

Midfemoral Block: A New Lateral Approach to the Sciatic Nerve
Anesth Analg 1999 88: 1426. [Full Text] [PDF] [Request Permissions]  

Kokichi Hase, Kazuko Meguro, and Takako Nakamura

Assessment of Renal Effects of Sevoflurane in Elderly Patients Using Urinary Markers
Anesth Analg 1999 88: 1426. [Full Text] [PDF] [Request Permissions]  

Anthony Schapera and Brendan Garry

Rediscovering the Obvious • Response
Anesth Analg 1999 88: 1427. [Full Text] [PDF] [Request Permissions]  

Robert J. Byrick and Michael A. E. Ramsay

Fat Embolism and Neurological Dysfunction • Response
Anesth Analg 1999 88: 1427. [Full Text] [PDF] [Request Permissions]  

David R. Lindsay

False Comfort from a Pulse Oximeter
Anesth Analg 1999 88: 1428. [Full Text] [PDF] [Request Permissions]  

Takashi Asai, PhD Sachiko Johmura, and Koh Shingu

Use of the Laryngeal Mask Before Tracheal Intubation in a Patient with a Cancerous Nose
Anesth Analg 1999 88: 1429. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Michel Y. Dubois

Pain Management. Vol 6 in Atlas of Anesthesia • Books and Multimedia Received
Anesth Analg 1999 88: 1430. [Full Text] [PDF] [Request Permissions]  

ERRATA:

Correction for vol. 88, p. 141
Anesth Analg 1999 88: 1231. [Full Text] [Request Permissions]  

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