EDITORIALS:

B. Scott Segal and David J. Birnbach

Epidurals and Cesarean Deliveries: A New Look at an Old Problem
Anesth Analg 2000 90: 775-777. [Full Text] En Espanol  

CARDIOVASCULAR ANESTHESIA:

Kyung W. Park, Kaori Sato, Hai B. Dai, Mark E. Comunale, and Frank W. Sellke

Epithelium-Dependent Bronchodilatory Activity Is Preserved in Pig Bronchioles After Normothermic Cardiopulmonary Bypass
Anesth Analg 2000 90: 778-783. [Abstract] [Full Text]  

Implications: Normothermic cardiopulmonary bypass does not result in epithelial dysfunction in pigs. Epithelium-dependent and epithelium-independent bronchodilators may be equally effective before and after cardiopulmonary bypass.

Klaus Laczika, Florian Thalhammer, Gottfried Locker, Robert Apsner, Heidrun Losert, Julia Kofler, Werner Rabitsch, Peter Mares, Michael Frass, Gere Sunder-Plassmann, and Manfred Muhm

Safe and Efficient Emergency Transvenous Ventricular Pacing via the Right Supraclavicular Route
Anesth Analg 2000 90: 784-789. [Abstract] [Full Text]  

Implications: Temporary transvenous cardiac pacing can yield high complication rates especially under emergency conditions. We investigated emergency pacing via the right supraclavicular access in 17 consecutive hemodynamically compromised patients and found good safety, efficacy, and a low complication rate.

Eiji Hashiba, Kazuyoshi Hirota, Hideki Yoshioka, Yoshio Hashimoto, Tsuyoshi Kudo, Tetsumi Sato, and Akitomo Matsuki

Milrinone Attenuates Serotonin-Induced Pulmonary Hypertension and Bronchoconstriction in Dogs
Anesth Analg 2000 90: 790-794. [Abstract] [Full Text]  

Implications: We studied the effects of milrinone on serotonin-induced pulmonary hypertension and bronchoconstriction in dogs. Milrinone produces pulmonary vasodilation and bronchodilation, whose effects may not be caused by {beta}-adrenoceptor activation. In addition, this drug may be more sensitive to phosphodiesterase III in the airway smooth muscle than that in pulmonary vascular smooth muscle.

Georg A. Petroianu, Jie Liu, Wolfgang H. Maleck, Cathrine Mattinger, and Wolfgang F. Bergler

The Effect of In Vitro Hemodilution with Gelatin, Dextran, Hydroxyethyl Starch, or Ringer’s Solution on Thrombelastograph®
Anesth Analg 2000 90: 795-800. [Abstract] [Full Text]  

Implications: Blood coagulation may be compromised when the dilution ratio of blood volume to colloid solution volume is >10:4. Whereas gelatin solutions have less intrinsic effect on blood coagulation than hydroxyethyl starch or dextran, 10% dextran 40 has the strongest effect on coagulation.

Jill E. Knutson, Jane A. Deering, Frank W. Hall, Gregory A. Nuttall, Darrell R. Schroeder, Roger D. White, and Charles J. Mullany

Does Intraoperative Hetastarch Administration Increase Blood Loss and Transfusion Requirements After Cardiac Surgery?
Anesth Analg 2000 90: 801-807. [Abstract] [Full Text]  

Implications: Our large retrospective study suggests that intraoperative use of hetastarch in primary cardiac surgery with cardiopulmonary bypass may increase bleeding and transfusion requirements. A large prospective study is needed to determine if intraoperative administration of hetastarch should be avoided during cardiovascular surgery.

Sibylle A. Kozek-Langenecker, S. Fazal Mohammad, Takahisa Masaki, Craig Kamerath, and Alfred K. Cheung

The Effects of Heparin, Protamine, and Heparinase 1 on Platelets in vitro Using Whole Blood Flow Cytometry
Anesth Analg 2000 90: 808-812. [Abstract] [Full Text]  

Implications: This experimental in vitro study demonstrates that heparin and its reversal agents affect platelet secretion and aggregation.

Linda Shore-Lesserson, Heather E. Manspeizer, Maria Bolastig, Donna Harrington, Frances Vela-Cantos, and Marietta DePerio

Anticoagulation for Cardiac Surgery in Patients Receiving Preoperative Heparin: Use of the High-Dose Thrombin Time
Anesth Analg 2000 90: 813-818. [Abstract] [Full Text]  

Implications: The diminished activated clotting time response to heparin, in patients receiving preoperative heparin therapy, poses difficulties when attempting to provide adequate anticoagulation for cardiopulmonary bypass. Current data suggest that heparin resistance is not observed when high-dose thrombin time is used to monitor anticoagulation and that a lower activated clotting time value in these patients may be safe.

Elliott Bennett-Guerrero, G. Robin Barclay, Michael E. Youssef, Sabera Hossain, Frances Vela-Cantos, Lewis A. Andres, and Ian R. Poxton

Exposure to Bacteroides fragilis Endotoxin During Cardiac Surgery
Anesth Analg 2000 90: 819-823. [Abstract] [Full Text]  

Implications: We prospectively measured hemodilution-corrected antiendotoxin antibody levels in 55 cardiac surgical patients. We observed significant decreases in hemodilution-corrected levels of antibody to both Bacteroides fragilis and the core of endotoxin.

Anna Stadnicka, Zeljko J. Bosnjak, John P. Kampine, and Wai-Meng Kwok

Modulation of Cardiac Inward Rectifier K⁺Current by Halothane and Isoflurane
Anesth Analg 2000 90: 824-833. [Abstract] [Full Text]  

Implications: Differential modulation of myocardial inward rectifier potassium current by volatile anesthetics under normal and altered rectification may contribute to the mechanism of dysrhythmic actions by these anesthetics.

Pekka Talke, Richard Chen, Brian Thomas, Anil Aggarwall, Alexandru Gottlieb, Per Thorborg, Stephen Heard, Albert Cheung, Stanley Lee Son, and Antero Kallio

The Hemodynamic and Adrenergic Effects of Perioperative Dexmedetomidine Infusion after Vascular Surgery
Anesth Analg 2000 90: 834-839. [Abstract] [Full Text]  

Implications: The {alpha}2 agonist, dexmedetomidine, attenuates increases in heart rate and plasma norepinephrine concentrations during emergence from anesthesia in vascular surgery patients.

Arthur W. Wallace and Wynnis L. Tom

Interaction of L-Arginine and Phosphodiesterase Inhibitors in Vasodilation of the Porcine Internal Mammary Artery
Anesth Analg 2000 90: 840-846. [Abstract] [Full Text]  

Implications: Amrinone and milrinone, Type III cAMP-dependent phosphodiesterase inhibitors, are additive to L-arginine-dependent vasodilation. Zaprinast and sildenafil, Type V cGMP-dependent phosphodiesterase inhibitors, are synergistic with L-arginine.

Yoshihiro Hamaya, Shuji Dohi, and Chika Takenaka-Hamaya

Localized Airway Anesthesia With Lidocaine Partially Suppresses Cardiovascular Responses To Lung Inflation
Anesth Analg 2000 90: 847-851. [Abstract] [Full Text]  

Implications: Localized airway anesthesia with lidocaine is unlikely to suppress the cardiovascular responses to lung inflation. This suggests that a limited number of neurogenic mechanisms are involved in the cardiovascular responses to lung inflation in anesthetized humans.

Markus Rehm, Victoria Orth, Uwe Kreimeier, Manfred Thiel, Mathias Haller, Heinz Brechtelsbauer, and Udilo Finsterer

Four Cases of Radical Hysterectomy with Acute Normovolemic Hemodilution Despite Low Preoperative Hematocrit Values (Brief Report)
Anesth Analg 2000 90: 852-855. [Full Text]  

Hirokatsu Toyoyama, Nobutaka Kariya, and Yoshiro Toyoda

Electrocardiographic Artifacts During Shoulder Arthroscopy Using a Pressure-Controlled Irrigation Pump (Case Report)
Anesth Analg 2000 90: 856-857. [Full Text]  

AMBULATORY ANESTHESIA:

Shyamala Badrinath, Michail N. Avramov, Melissa Shadrick, Thomas R. Witt, and Anthony D. Ivankovich

The Use of a Ketamine-Propofol Combination During Monitored Anesthesia Care
Anesth Analg 2000 90: 858-862. [Abstract] [Full Text] En Espanol  

Implications: Ketamine, when used in subhypnotic dosages, may be an useful adjuvant to propofol sedation.

PEDIATRIC ANESTHESIA:

Peter J. Davis, Julia C. Finkel, Rosemary J. Orr, Lisa Fazi, John J. Mulroy, Susan K. Woelfel, Raafat S. Hannallah, Anne M. Lynn, C. Dean Kurth, Michele Moro, Lynn G. Henson, David K. Goodman, and Meredith D. Decker

A Randomized, Double-Blinded Study of Remifentanil Versus Fentanyl for Tonsillectomy and Adenoidectomy Surgery in Pediatric Ambulatory Surgical Patients
Anesth Analg 2000 90: 863-871. [Abstract] [Full Text] En Espanol  

Implications: This is a study designed to examine the efficacy and safety of a short-acting opioid, remifentanil, when used in pediatric patients. The frequent incidence of postoperative pain observed in the postoperative recovery room suggests that better intraoperative prophylactic analgesic regimens for postoperative pain control are necessary to optimize remifentanil's use as an anesthetic for children.

William T. Denman, Emily L. Swanson, David Rosow, Kristen Ezbicki, Patricia D. Connors, and Carl E. Rosow

Pediatric Evaluation of the Bispectral Index (BIS) Monitor and Correlation of BIS with End-tidal Sevoflurane Concentration in Infants and Children
Anesth Analg 2000 90: 872-877. [Abstract] [Full Text] En Espanol  

Implications: The use of bispectral index (BIS) during general anesthesia improves the titration of anesthetics in adults. The data from this study suggest that the same equipment and method of electroencephalogram analysis may be applied to infants and children.

Steve M. Auden

Additional Techniques for Managing the Difficult Pediatric Airway (Case Report)
Anesth Analg 2000 90: 878-880. [Full Text]  

OBSTETRIC ANESTHESIA:

Philip E. Hess, Stephen D. Pratt, Anil K. Soni, Mukesh C. Sarna, and Nancy E. Oriol

An Association Between Severe Labor Pain and Cesarean Delivery
Anesth Analg 2000 90: 881-886. [Abstract] [Full Text] En Espanol  

Implications: This is a retrospective observational study demonstrating an association between labor pain and cesarean delivery. Our results provide an alternative explanation of why epidural analgesia is associated with cesarean delivery.

Craig M. Palmer, Wallace M. Nogami, Gretchen Van Maren, and Diane M. Alves

Postcesarean Epidural Morphine: A Dose-Response Study
Anesth Analg 2000 90: 887-891. [Abstract] [Full Text]  

Implications: Quality of analgesia increases as the dose of epidural morphine increases to at least 3.75 mg; increasing the dose further to 5 mg did not improve analgesia. Side effects were not dose related. For optimal analgesia, augmentation of epidural morphine with systemic analgesics or other epidural medications may be necessary.

Jeffrey S. Jacobs, Ricardo Vallejo, Gerard J. DeSouza, and Menno F. TerRiet

Severe Hypoglycemia After Labor Epidural Analgesia (Case Report)
Anesth Analg 2000 90: 892-893. [Full Text]  

REGIONAL ANESTHESIA AND PAIN MEDICINE:

Roberto García-Aguado, Francisco Gil, Juan A. Barcia, José Aznar, Francisco Hostalet, José Barberá, and Francisco Grau

Prophylactic Percutaneous Sealing of Lumbar Postdural Puncture Hole with Fibrin Glue to Prevent Cerebrospinal Fluid Leakage in Swine
Anesth Analg 2000 90: 894-898. [Abstract] [Full Text]  

Implications: In this swine study, we repaired a cerebrospinal fluid leak after a dural puncture by percutaneously injecting tissue adhesive. The technique of percutaneous injection of fibrin glue seems promising for the prophylaxis of headache associated with cerebrospinal fluid leakage, and may be an alternative to an epidural blood patch.

Steen Møiniche, Henrik Jørgensen, Jørn Wetterslev, and Jørgen Berg Dahl

Local Anesthetic Infiltration for Postoperative Pain Relief After Laparoscopy: A Qualitative and Quantitative Systematic Review of Intraperitoneal, Port-Site Infiltration and Mesosalpinx Block
Anesth Analg 2000 90: 899-912. [Abstract] [Full Text]  

Implications: A systematic review summarizes, through transparent methodology, available information from randomized, controlled trials to produce the best available evidence-based estimate of a "true" clinical effect of an intervention. This systematic review confirms intraperitoneal and mesosalpinx local anesthetic block, not port-site infiltration, to have some impact on postoperative pain after laparoscopy.

Jeffrey S. Kroin, Robert J. McCarthy, Natasha Von Roenn, Brady Schwab, Kenneth J. Tuman, and Anthony D. Ivankovich

Magnesium Sulfate Potentiates Morphine Antinociception at the Spinal Level
Anesth Analg 2000 90: 913-917. [Abstract] [Full Text]  

Implications: Magnesium sulfate potentiates morphine analgesia when coadministered intrathecally in normal rats, and in an animal model of mechanical allodynia after a surgical incision. These results suggest that intrathecal administration of magnesium sulfate may be a useful adjunct to spinal morphine analgesia.

Roxane Fournier, Elizabeth Van Gessel, Anne Weber, and Zdravko Gamulin

A Comparison of Intrathecal Analgesia with Fentanyl or Sufentanil After Total Hip Replacement
Anesth Analg 2000 90: 918-922. [Abstract] [Full Text]  

Implications: We compared the postoperative analgesic properties of 40 {micro}g intrathecal fentanyl and 7.5 {micro}g sufentanil after total hip replacement. Both opioids provided satisfactory analgesia, with comparable onset (11 {+/-} 8 vs 9 {+/-} 9 min) and duration of action (214 {+/-} 120 vs 241 {+/-} 102 min), as well as low incidence of minor side effects.

Peter D. Drummond

The Effect of Peripheral Opioid Block and Body Cooling on Sensitivity to Heat in Capsaicin-Treated Skin
Anesth Analg 2000 90: 923-927. [Abstract] [Full Text]  

Implications: This study shows that opiate receptor block paradoxically inhibits sensitivity to heat-pain in inflamed skin during body cooling. The findings suggest that endogenous opioids release substances from nerves or other cells during inflammation, which heighten pain. Thus, opioids may fine-tune pain and the inflammatory response while healing takes place.

Tomohiro Yamakura, Kenji Sakimura, and Koki Shimoji

N-Methyl-D-Aspartate Receptor Channel Block by Meperidine Is Dependent on Extracellular pH
Anesth Analg 2000 90: 928-932. [Abstract] [Full Text]  

Implications: At acidic pH the potency of meperidine for N-methyl-D-aspartate-receptor channels was increased. Any antinociceptive and neuroprotective benefit from the N-methyl-D-aspartate-receptor antagonist property of meperidine may be pH dependent.

Nathalie Do Quang-Cantagrel, Mark S. Wallace, and Scott K. Magnuson

Opioid Substitution to Improve the Effectiveness of Chronic Noncancer Pain Control: A Chart Review
Anesth Analg 2000 90: 933-937. [Abstract] [Full Text] En Espanol  

Implications: This study showed that if a patient receiving chronic opioid therapy experiences an intolerable side effect or if the drug is ineffective, changing to a different opioid may result in a lessening or elimination of the side effect and/or improved analgesia.

Christine G. Cattaneo, Steven M. Frank, Todd W. Hesel, Hossam K. El-Rahmany, Lauren J. Kim, and Kha M. Tran

The Accuracy and Precision of Body Temperature Monitoring Methods During Regional and General Anesthesia
Anesth Analg 2000 90: 938-945. [Abstract] [Full Text]  

Implications: Body temperature should be monitored during spinal anesthesia because patients are at significant risk for hypothermia. Rectal temperature is a valid method of measuring core temperature, whereas other methods tend to underestimate true core temperature.

GENERAL ARTICLES:

Stefan Scheingraber, Lars Heitmann, Werner Weber, and Udilo Finsterer

Are There Acid Base Changes During Transurethral Resection of the Prostate (TURP)?
Anesth Analg 2000 90: 946-950. [Abstract] [Full Text]  

Implications: We measured acid base status in 20 patients undergoing transurethral resection of the prostate comparing a larger fluid absorption group with a minor or no fluid absorption group. We postulate the development of a typical metabolic transurethral resection of the prostate-acidosis caused by irrigant absorption.

Pierre A. Diemunsch, Klaus D. Torp, Thomas Van Dorsselaer, Didier Mutter, Anne M. Diemunsch, Roland Schaeffer, Gérard Teller, and Alain Van Dorsselaer

Nitrous Oxide Fraction in the Carbon Dioxide Pneumoperitoneum During Laparoscopy Under General Inhaled Anesthesia in Pigs
Anesth Analg 2000 90: 951-953. [Abstract] [Full Text]  

Implications: Pig models were used to evaluate the time course of nitrous oxide (N2O) diffusion in the pneumoperitoneum during nitrous oxide/oxygen anesthesia. Although peritoneal N2O concentration approaches the end-expiratory value after 8-10 h, it reaches 29% within 2 h. At this level, N2O is known to support combustion. This N2O pollution should be prevented.

Swen N. Piper, Wolfgang H. Maleck, Joachim Boldt, Stefan W. Suttner, Christian C. Schmidt, and Daniel G. P. Reich

A Comparison of Urapidil, Clonidine, Meperidine and Placebo in Preventing Postanesthetic Shivering
Anesth Analg 2000 90: 954-957. [Abstract] [Full Text]  

Implications: Shivering (irregular muscle activity) is common after surgery and anesthesia. This study compared urapidil (an antihypertensive drug) as a prophylaxis with two established antishivering drugs (meperidine and clonidine) and placebo. In the dosage used, we were unable to show a significant benefit of urapidil.

Ricardo M. Urtubia, Carmen M. Aguila, and Miguel A. Cumsille

Combitube^®: A Study for Proper Use
Anesth Analg 2000 90: 958-962. [Abstract] [Full Text]  

Implications: The esophageal-tracheal Combitube(R) Model 37F SA (Kendall-Sheridan Catheter Corp., Argyle, NY) may be used in patients from 122 to 185 cm in height. The trachea could be directly intubated with the Combitube(R) in esophageal position in patients with normal airways. The airway protection appears to be adequate.

Pascale Picard and Martin R. Tramèr

Prevention of Pain on Injection with Propofol: A Quantitative Systematic Review
Anesth Analg 2000 90: 963-969. [Abstract] [Full Text]  

Implications: IV lidocaine (0.5 mg/kg) should be given with a rubber tourniquet on the forearm, 30 to 120 s before the injection of propofol; lidocaine will prevent pain in approximately 60% of the patients treated in this manner.

Krampfl Klaus, Schlesinger Friedrich, Dengler Reinhardt, and Johannes Bufler

Pentobarbital Has Curare-Like Effects on Adult-Type Nicotinic Acetylcholine Receptor Channel Currents
Anesth Analg 2000 90: 970-974. [Abstract] [Full Text]  

Implications: The interaction between adult-type nicotinic acetylcholine receptors, acetylcholine, and pentobarbital was biophysically investigated by using the patch-clamp technique in combination with tools for ultrafast solution exchange. PB elicited open-channel block and competitive block of nicotinic acetylcholine receptor channel currents, whereas the latter seems to be effective in clinically relevant concentrations.

ECONOMICS AND HEALTH SYSTEMS RESEARCH:

Franklin Dexter and Rodney D. Traub

Sequencing Cases in the Operating Room: Predicting Whether One Surgical Case will Last Longer than Another
Anesth Analg 2000 90: 975-979. [Abstract] [Full Text]  

Implications: Our statistical method uses historical case duration data from an operating room information system to estimate the actual probability to within 1.5% that the second case of a pair will last longer than the first case of a pair.

Franklin Dexter, Alex Macario, and Liam O’Neill

Scheduling Surgical Cases into Overflow Block Time— Computer Simulation of the Effects of Scheduling Strategies on Operating Room Labor Costs
Anesth Analg 2000 90: 980-988. [Abstract] [Full Text]  

Implications: The strategy we developed provides surgeons and patients with some flexibility in scheduling, while increasing OR staffing costs only slightly over the minimum achieved when the OR manager controls scheduling. Staffing costs were lowest when the operating room (OR) manager did not incorporate surgeon and patient preferences when scheduling cases into overflow block time.

TECHNICAL COMMUNICATIONS:

Yoko Masaki, Makoto Tanaka, and Toshiaki Nishikawa

Changes in Propofol Concentration in a Propofol-Lidocaine 9:1 Volume Mixture
Anesth Analg 2000 90: 989-992. [Full Text]  

CASE REPORTS:

Si-Tun Fung, Yan-Yuen Poon, Zu-Kong Chong, Bruno Jawan, and Ju-Hao Lee

Removal of an Aspirated Prosthetic Tooth by Tracheal Backflow Air
Anesth Analg 2000 90: 993-994. [Full Text]  

MEETING REPORT:

Tom Elwood and Lynn D. Martin

Thirteenth Annual Meeting of the Society for Pediatric Anesthesia, Dallas, Texas, October 8, 1999
Anesth Analg 2000 90: 995-999. [Full Text]  

LETTERS TO THE EDITOR:

Hirokatsu Toyoyama, Koh Mizutani, Yoshiro Toyoda, R. Slappendel, B. Benraad, R. Dirksen, E. W. G. Weber, M. J. M. Gielen, and J. van Limbeek

One Drop of Morphine Added to Local Anesthetics by Means of a 23-Gauge Injection Needle Can Relieve Postoperative Pain Under Spinal Anesthesia • Response
Anesth Analg 2000 90: 1000. [Full Text]  

Takashi Asai and Koh Shingu

One-Lung Ventilation in the Patient with Laryngeal or Tracheal Stenosis
Anesth Analg 2000 90: 1000-1001. [Full Text]  

S. B. Backman and G. Kostopanagiotou

Anticholinesterases and the Transplanted Heart • Response
Anesth Analg 2000 90: 1001. [Full Text]  

Steven V. Sherman, Michael H. Wall, and Jack S. Shanewise

Assessment of LV Diastolic Function • Response
Anesth Analg 2000 90: 1001-1002. [Full Text]  

Torsten Meier, Thorsten Leibecke, Jan Schumacher, Klaus Berger, and Karl F. Klotz

Detection of a Tracheal Obstruction Caused by a Retrosternal Goiter by the Use of a Cuff Leak Test
Anesth Analg 2000 90: 1002. [Full Text]  

Serge M. Broka, Philippe E. Dubois, and Kurt L. Joucken

A Structural Deficiency of TCI Syringes
Anesth Analg 2000 90: 1002-1003. [Full Text]  

Ayman Elfar and Steve D. Barnes

A Real Eye-Opener!
Anesth Analg 2000 90: 1003-1004. [Full Text]  

Andrea G. Schellenberg, Bonnie L. Milas, and Linda Chen

Atrioventricular Dissociation
Anesth Analg 2000 90: 1004. [Full Text]  

Peter Kranke, Christian C. Apfel, Norbert Roewer, and Yoshitaka Fujii

Reported Data on Granisetron and Postoperative Nausea and Vomiting by Fujii et al. Are Incredibly Nice! • Response
Anesth Analg 2000 90: 1004-1007. [Full Text]  

D. Gozal and Y. Gozal

Nonpharmacologic Sedation in a Deaf Child
Anesth Analg 2000 90: 1007. [Full Text]  

Paolo Biban, Simone Rugolotto, and Giuseppe Zoppi

Fiberoptic Endotracheal Intubation Through an Ultra-Thin Bronchoscope with Suction Channel in a Newborn with Difficult Airway
Anesth Analg 2000 90: 1007. [Full Text]  

Emma Chojnowska and Gary McCleane

Which Intravenous Sodium Channel Blocker for Neuropathic Pain? • Response
Anesth Analg 2000 90: 1007-1008. [Full Text]  

Michael S. Stix and Eduardo Mancini

How a Rigid Stylet Can Make an Endotracheal Tube Move
Anesth Analg 2000 90: 1008. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Lauren Berkow, Norig Ellison, and Thomas J. Gal

Handbook of Neuroanesthesia. • Careers in Anesthesiology: Autobiographical Memoirs. Vol 3 in the Wood Library-Museum of Anesthesiology Series. • Nunn’s Applied Respiratory Physiology. 5th ed. • Books and Multimedia Received
Anesth Analg 2000 90: 1009-1010. [Full Text]  

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