EDITORIALS:

Tony Yaksh and David J. Birnbach

Intrathecal Nalbuphine After Cesarean Delivery: Are We Ready?
Anesth Analg 2000 91: 505-508. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Andrew D. Maslow, J. Michael Haering, Stephanie Heindel, John Mashikian, Robert Levine, and Pamela Douglas

An Evaluation of Prosthetic Aortic Valves Using Transesophageal Echocardiography: The Double-Envelope Technique
Anesth Analg 2000 91: 509-516. [Abstract] [Full Text]  

Implications: Quantitative assessment of prosthetic aortic valvearea can be performed on-line by using transesophageal echocardiographyusing the double envelope technique.

Vance G. Nielsen and Brian T. Geary

Thoracic Aorta Occlusion-Reperfusion Decreases Hemostasis as Assessed by Thromboelastography in Rabbits
Anesth Analg 2000 91: 517-521. [Abstract] [Full Text]  

Implications: Thoracic aortic occlusion-reperfusion decreasedhemostatic function in rabbits primarily by decreasing the coagulationfactor-dependent, platelet-independent contribution to clotting.This decrease in hemostatic function may contribute to hemorrhagiccomplications associated with major vascular surgery.

Alexander Loeckinger, Axel Kleinsasser, Karl H. Lindner, Josef Margreiter, Christian Keller, and Christoph Hoermann

Continuous Positive Airway Pressure at 10 cm H₂O During Cardiopulmonary Bypass Improves Postoperative Gas Exchange
Anesth Analg 2000 91: 522-527. [Abstract] [Full Text]  

Implications: Inflation of the lungs at a pressure of 10 cmH2O as compared with leaving the lungs deflated during cardiopulmonarybypass was examined. Lung inflation during bypass resulted insignificantly improved postoperative gas exchange.

Hartmut Kern, Wolfram Johnen, Jan Braun, Bettina Frey, Bernd Rüstow, Wolfgang J. Kox, and Michael Schlame

Heparin Induces Release of Phospholipase A₂ into the Splanchnic Circulation
Anesth Analg 2000 91: 528-532. [Abstract] [Full Text]  

Implications: Heparin, given in the dosage required for cardiopulmonarybypass, caused release of phospholipase A2 into the splanchniccirculation.

Roland Hansen, Andreas Koster, Marian Kukucka, Fritz Mertzlufft, and Herrmann Kuppe

A Quick Anti-Xa-Activity-Based Whole Blood Coagulation Assay for Monitoring Unfractionated Heparin During Cardiopulmonary Bypass: A Pilot Investigation
Anesth Analg 2000 91: 533-538. [Abstract] [Full Text]  

Implications: The ACT II anti-Xa-unfractionated heparin assayallows for reliable monitoring of large concentrations of UFHover a wide range of hematocrit, platelet, and coagulation factorlevels. Further evaluation of this point-of-care device is indicated.

David M. Eckmann, Shelly Bowers, Mark Stecker, and Albert T. Cheung

Hematocrit, Volume Expander, Temperature, and Shear Rate Effects on Blood Viscosity
Anesth Analg 2000 91: 539-545. [Abstract] [Full Text]  

Implications: A theoretical model for blood viscosity predictedindependent effects of temperature, shear rate, and hemodilutionon viscosity over a wide range of physiologic conditions, includingthermal extremes of deep hypothermia in an experimental setting.Moderate hemodilution to a hematocrit of 22% decreased bloodviscosity by 30%-50% at a blood temperature of 15{degrees}C,suggesting the potential to improve microcirculatory perfusionduring deep hypothermia.

Kayo Uryu, Kouichiro Minami, Nobuyuki Yanagihara, Koji Hara, Yumiko Toyohira, Futoshi Izumi, and Akio Shigematsu

Inhibition by Neuromuscular Blocking Drugs of Norepinephrine Transporter in Cultured Bovine Adrenal Medullary Cells
Anesth Analg 2000 91: 546-551. [Abstract] [Full Text]  

Implications: In this study, pancuronium inhibited norepinephrineuptake and was the most potent of the neuromuscular blockingdrugs we tested, including pancuronium, vecuronium, d-tubocurarine,and succinylcholine. Pancuronium may affect the sympatheticnervous system by inhibiting the activity of the presynapticnorepinephrine transporter at clinically relevant concentrations.

Chang Kil Park

The Effect of Patient Positioning on Intraabdominal Pressure and Blood Loss in Spinal Surgery
Anesth Analg 2000 91: 552-557. [Abstract] [Full Text]  

Implications: The relationship of intraabdominal pressure changesto blood loss were examined with a rectal balloon pressure catheterduring spinal surgery. Blood loss tended to increase with anincrease in intraabdominal pressure in the narrow pad supportwidth of the Wilson frame.

Yu-Chen Huang, Ya-Jung Cheng, Yu-Hua Lin, Ming-Jiuh Wang, and Shen-Kou Tsai

Graft Failure Caused by Pulmonary Venous Obstruction Diagnosed by Intraoperative Transesophageal Echocardiography During Lung Transplantation (Case Report)
Anesth Analg 2000 91: 558-560. [Abstract] [Full Text]  

Implications: Intraoperative transesophageal echocardiographycan be useful to diagnose pulmonary venous anastomotic stenosesduring lung transplantation.

Anna Mases, Antonio Montes, Rocio Ramos, Lourdes Trillo, and Margarita M. Puig

Injury to the Abdominal Aorta During Laparoscopic Surgery: An Unusual Presentation (Case Report)
Anesth Analg 2000 91: 561-562. [Abstract] [Full Text] En Espanol  

Implications: Laparoscopic cholecystectomy is a very commonsurgical procedure, and vascular injuries account for one thirdof major complications during this surgery. We describe an unusualpresentation of an abdominal aorta injury.

PEDIATRIC ANESTHESIA:

Shoichi Uezono, Takahisa Goto, Katsuo Terui, Fumito Ichinose, Yoshiki Ishguro, Yoshinori Nakata, and Shigeho Morita

Emergence Agitation After Sevoflurane Versus Propofol in Pediatric Patients
Anesth Analg 2000 91: 563-566. [Abstract] [Full Text]  

Implications: In this cross-over study, we observed the incidenceof emergence agitation with sevoflurane (38%) was significantlygreater than with propofol (0%) in premedicated, preschool-agedchildren undergoing minor noninvasive surgery.

Makoto Tanaka, Tetsu Kimura, Toru Goyagi, Kumiko Ogasawara, Rie Nitta, and Toshiaki Nishikawa

Evaluating Hemodynamic and T Wave Criteria of Simulated Intravascular Test Doses Using Bupivacaine or Isoproterenol in Anesthetized Children
Anesth Analg 2000 91: 567-572. [Abstract] [Full Text]  

Implications: To determine if an epidurally administered localanesthetic has been unintentionally injected into a blood vessel,a small dose of epinephrine or isoproterenol may be added toa local anesthetic. We found that an increase in heart rate>=10 bpm and an increase in T wave amplitude of lead II >=25% areuseful indicators for detecting accidental intravascular injectionof an epinephrine-containing test dose in sevoflurane-anesthetizedchildren, whereas only a heart rate change is a reliable diagnostictool if an isoproterenol-containing test dose is used.

Constance L. Monitto, Robert S. Greenberg, Sabine Kost-Byerly, Randall Wetzel, Carol Billett, Ruth M. Lebet, and Myron Yaster

The Safety and Efficacy of Parent-/Nurse-Controlled Analgesia in Patients Less than Six Years of Age
Anesth Analg 2000 91: 573-579. [Abstract] [Full Text] En Espanol  

Implications: Parent-/nurse-controled analgesia provided effectivepain relief in most children <6 yr of age experiencing nonsurgicalor postoperative pain. The observed incidence of vomiting andpruritis was similar to that seen in older patients treatedwith patient-controlled analgesia. However, significant respiratorydepression, although uncommon, did occur, thus reinforcing theneed for close patient monitoring.

AMBULATORY ANESTHESIA:

Julius Pawlowski, Radha Sukhani, Ana L. Pappas, Ku-Mie Kim, Jordan Lurie, Helena Gunnerson, Andrea Corsino, Kere Frey, and Pietro Tonino

The Anesthetic and Recovery Profile of Two Doses (60 and 80 mg) of Plain Mepivacaine for Ambulatory Spinal Anesthesia
Anesth Analg 2000 91: 580-584. [Abstract] [Full Text]  

Implications: We evaluated the anesthetic and recovery profilesof 60- and 80-mg doses of plain mepivacaine for ambulatory spinalanesthesia. Both doses produced comparable sensory and motorblock. Sensory and motor regression and ambulatory milestoneswere 20-30 min longer with the 80-mg dose. Side effectswere negligible and transient neurological symptoms were notreported during a 24-h follow-up.

Thomas M. Hemmerling, Wido M. Budde, Wolfgang Koppert, and Jost B. Jonas

Retrobulbar Versus Systemic Application of Morphine During Titratable Regional Anesthesia via Retrobulbar Catheter in Intraocular Surgery (Brief Report)
Anesth Analg 2000 91: 585-588. [Abstract] [Full Text]  

Implications: We investigated the effects of morphine on postoperativepain in patients undergoing intraocular surgery using a newindwelling catheter. Although morphine produced central analgesiceffects, there was no evidence for the involvement of peripheralopioid receptors in the modulation of ocular pain.

Eberhard Sumpf, Thomas Allen Crozier, Dirk Ahrens, Amselm Bräuer, Thomas Neufang, and Ulrich Braun

Carbon Dioxide Absorption During Extraperitoneal and Transperitoneal Endoscopic Hernioplasty (Brief Report)
Anesth Analg 2000 91: 589-595. [Abstract] [Full Text]  

Implications: The greater magnitude of carbon dioxide absorptionduring total extraperitoneal hernioplasty puts an additionalload on the lungs and could pose a risk for patients with chroniclung disease who might be unable to eliminate excess carbondixoide.

Tian J. Zhou, Margarita Coloma, Paul F. White, Jun Tang, Tom Webb, John E. Forestner, Nancy B. Greilich, and Larry L. Duffy

Spontaneous Recovery Profile of Rapacuronium During Desflurane, Sevoflurane, or Propofol Anesthesia for Outpatient Laparoscopy (Brief Report)
Anesth Analg 2000 91: 596-600. [Abstract] [Full Text]  

Implications: When administered for laparoscopic surgery, theduration of action of an intubating dose of rapacuronium wasprolonged 40%-50% by desflurane and sevoflurane, respectively,(versus propofol). Monitoring recovery of neuromuscular blockadeproduced by rapacuronium is particularly important when desfluraneor sevoflurane is administered to ensure that an adequate recovery(train-of-four >= 0.8) is achieved by the end of anesthesia.

OBSTETRIC ANESTHESIA:

Xavier Culebras, Giovanni Gaggero, Jiri Zatloukal, Christian Kern, and René-Andréas Marti

Advantages of Intrathecal Nalbuphine, Compared with Intrathecal Morphine, After Cesarean Delivery: An Evaluation of Postoperative Analgesia and Adverse Effects
Anesth Analg 2000 91: 601-605. [Abstract] [Full Text]  

Implications: Small doses of intrathecal nalbuphine producefewer adverse effects, such as pruritus and postoperative nauseaand vomiting, compared with intrathecal morphine. This may allowearlier discharge of patients from the recovery room.

Adeyemi J. Olufolabi, John V. Booth, Howard G. Wakeling, Peter S. Glass, Donald H. Penning, and James D. Reynolds

A Preliminary Investigation of Remifentanil as a Labor Analgesic (Brief Report)
Anesth Analg 2000 91: 606-608. [Abstract] [Full Text]  

Implications: In this preliminary investigation, we evaluatedthe safety and analgesic efficacy of IV remifentanil for laborpain. Four women were studied, and then the trial was terminatedbecause administration of this novel synthetic opioid producedsignificant maternal side effects in the absence of effectivepain control.

Carl J. Borromeo, George T. Blike, Christopher W. Wiley, and Joshua A. Hirsch

Cortical Blindness in a Preeclamptic Patient After a Cesarean Delivery Complicated by Hypotension (Case Report)
Anesth Analg 2000 91: 609-611. [Abstract] [Full Text]  

Implications: Visual strokes can occur after prolonged hypotensionor as a complication of preeclampsia-eclampsia. This case describesthe diagnostic dilemma posed by a patient who developed transientblindness after a hypotensive episode during cesarean deliveryfor severe preeclampsia-eclampsia.

ECONOMICS AND HEALTH SYSTEMS RESEARCH:

David L. Reich, Richard K. Wood, Jr, Raafat Mattar, Marina Krol, David C. Adams, Sabera Hossain, and Carol A. Bodian

Arterial Blood Pressure and Heart Rate Discrepancies Between Handwritten and Computerized Anesthesia Records
Anesth Analg 2000 91: 612-616. [Abstract] [Full Text]  

Implications: The discrepancies between handwritten and computerizedanesthesia records suggest that some of the data in handwrittenrecords are inaccurate. The potential for inaccuracy shouldbe considered when handwritten records are used as source materialfor research, quality assurance, and medicolegal purposes.

Franklin Dexter, Alex Macario, and Rodney D. Traub

Enterprise-Wide Patient Scheduling Information Systems to Coordinate Surgical Clinic and Operating Room Scheduling Can Impair Operating Room Efficiency (Special Article)
Anesth Analg 2000 91: 617-626. [Full Text]  

CRITICAL CARE AND TRAUMA:

Wolfgang G. Voelckel, Keith G. Lurie, Karl H. Lindner, Todd Zielinski, Scott McKnite, Anette C. Krismer, and Volker Wenzel

Vasopressin Improves Survival After Cardiac Arrest in Hypovolemic Shock
Anesth Analg 2000 91: 627-634. [Abstract] [Full Text]  

Implications: The chances of surviving cardiac arrest in hemorrhagicshock are considered dismal without adequate fluid replacement.However, treatment of hypovolemic cardiac arrest with vasopressin,but not with large-dose epinephrine or saline placebo, resultedin sustained vital organ perfusion and prolonged survival inan animal model of suspended infusion therapy.

J. Brimacombe, S. Newell, A. Bergin, J. McCarthy, and J. Barry

The Laryngeal Mask for Percutaneous Endoscopic Gastrostomy (Case Report)
Anesth Analg 2000 91: 635-636. [Abstract] [Full Text]  

Implications: We report the successful use of the laryngealmask airway for percutaneous endoscopic gastrostomy in an adultpatient with a known difficult airway and severe cerebral palsy.

NEUROSURGICAL ANESTHESIA:

William E. Hoffman and Guy Edelman

Isoflurane Increases Brain Oxygen Reactivity in Dogs
Anesth Analg 2000 91: 637-641. [Abstract] [Full Text]  

Implications: We evaluated the ability of oxygen ventilationto increase brain tissue oxygen pressure in dogs anesthetizedwith 1.5% and 3% isoflurane and propofol. Increases in tissueoxygen were significantly greater during 3% isoflurane comparedwith 1.5% isoflurane and propofol.

Hiroshi Endoh, Tadayuki Honda, Noboru Komura, Chieko Shibue, Ippei Watanabe, and Koki Shimoji

The Effects of Nicardipine on Dynamic Cerebral Autoregulation in Patients Anesthetized with Propofol and Fentanyl
Anesth Analg 2000 91: 642-646. [Abstract] [Full Text]  

Implications: During deliberate hypotension induced by nicardipine,the cerebral dynamic autoregulatory response is impaired innormal adult patients.

REGIONAL ANESTHESIA AND PAIN MEDICINE:

Salvatore Sia, Maurizio Bartoli, Antonella Lepri, Osea Marchini, and Paolo Ponsecchi

Multiple-Injection Axillary Brachial Plexus Block: A Comparison of Two Methods of Nerve Localization–Nerve Stimulation Versus Paresthesia
Anesth Analg 2000 91: 647-651. [Abstract] [Full Text]  

Implications: Two methods of nerve localization were comparedwhen performing an axillary brachial plexus block by the multiple-injectiontechnique. Nerve stimulation provided a faster onset and a greaterincidence of complete block, related to a better success ratefor anesthetizing the radial and the musculocutaneous nerves,than paresthesia elicitation.

Tomoki Nishiyama and Kazuo Hanaoka

The Effects of Epidural Bupivacaine, Morphine, and Their Combination on Thermal Nociception with Different Stimulus Intensity in Rats
Anesth Analg 2000 91: 652-656. [Abstract] [Full Text]  

Implications: When patients have severe pain even when receivingepidural morphine, adding bupivacaine might be more effectivethan increasing the dose of epidural morphine.

Makoto Tanaka and Toshiaki Nishikawa

Aging Reduces the Efficacy of the Simulated Epidural Test Dose in Anesthetized Adults
Anesth Analg 2000 91: 657-661. [Abstract] [Full Text]  

Implications: To determine whether an epidurally administeredlocal anesthetic has been unintentionally injected into a bloodvessel, a small dose of epinephrine is often added to a localanesthetic. We found that an increase in systolic blood pressure>= 15 mm Hg is a more useful indicator than an increase in heartrate >= 10 bpm in the patients >= 60 yr old during stable sevofluraneanesthesia administration.

Cem F. Arkiliç, Ozan Akça, Akiko Taguchi, Daniel I. Sessler, and Andrea Kurz

Temperature Monitoring and Management During Neuraxial Anesthesia: An Observational Study
Anesth Analg 2000 91: 662-666. [Abstract] [Full Text]  

Implications: In this observational study, we evaluated coretemperatures and intraoperative thermal management in patientsundergoing spinal or epidural anesthesia. Hypothermia was common,however, rarely detected either by temperature monitoring orestimates by anesthesiologists. In addition, it was not treatedwith active warming. Consequently, temperature monitoring andmanagement have to be done during neuraxial anesthesia.

Sallyann T. Colbert, Kirean Moran, Deirdre M. O’Hanlon, Frank Chambers, D. C. Moriarty, and William P. Blunnie

An Assessment of the Value of Intraperitoneal Meperidine for Analgesia Postlaparoscopic Tubal Ligation
Anesth Analg 2000 91: 667-670. [Abstract] [Full Text]  

Implications: The combination of bupivacaine and meperidinedelivered to the intraperitoneal cavity proved superior to equivalentdoses of intraperitoneal bupivacaine and IM meperidine for postoperativepain relief in patients undergoing laparoscopic tubal ligation.Intraperitoneal delivery of analgesia proved effective in thisstudy and merits further study and more widespread use.

Dennis H-T Chang, Leigh A. Ladd, Kylie A. Wilson, Linda Gelgor, and Laurence E. Mather

Tolerability of Large-Dose Intravenous Levobupivacaine in Sheep
Anesth Analg 2000 91: 671-679. [Abstract] [Full Text]  

Implications: Levobupivacaine produced fatal cardiac toxicityat doses significantly greater than those found in previousstudies with bupivacaine. As the two drugs have similar potencyfor producing clinical nerve blocks, the data imply that levobupivacaineshould provide a safer alternative to bupivacaine in practice.

Jianren Mao and Lucy L. Chen

Gabapentin in Pain Management (Medical Intelligence)
Anesth Analg 2000 91: 680-687. [Full Text]  

Terese T. Horlocker, Shawn W. O’Driscoll, and Robert P. Dinapoli

Recurring Brachial Plexus Neuropathy in a Diabetic Patient After Shoulder Surgery and Continuous Interscalene Block (Case Report)
Anesth Analg 2000 91: 688-690. [Abstract] [Full Text]  

Implications: The performance of regional blockade on a patientwith a preexisting neurologic condition or a history of neurologiccomplications after regional anesthesia is controversial. Wepresent a case of recurring brachial plexus neuropathy in adiabetic patient after two shoulder procedures performed 4 moapart. In both cases, the patient underwent intensive physicaltherapy with continuous postoperative interscalene analgesia.

Robert D. Henderson and Eelco F. M. Wijdicks

Downbeat Nystagmus Associated with Intravenous Patient-Controlled Administration of Morphine (Case Report)
Anesth Analg 2000 91: 691-692. [Abstract] [Full Text]  

Implications: This case documents a patient who developed dizzinesswith downbeating nystagmus while receiving a relatively largedose of IV patient-controlled analgesia morphine. Although therehave been case reports of epidural morphine with these symptomsand signs, this has not been previously documented with IV orpatient-controlled analgesia morphine.

GENERAL ARTICLES:

Markus D. W. Lipp, Gunnar Jaehnichen, Nikolaus Golecki, Gerda Fecht, Rudolf Reichl, and Peter Heeg

Microbiological, Microstructure, and Material Science Examinations of Reprocessed Combitubes^® After Multiple Reuse
Anesth Analg 2000 91: 693-697. [Abstract] [Full Text]  

Implications: Reprocessing of single-use medical devices offersthe opportunity of significant savings and is already performedwith some devices. Microbiological, microstructure, and materialscience examinations proved that reprocessing of multiple reusedCombitubesTM (Kendall-Sheridan, Argyll, NY), mainly used foremergency airway management, is possible and safe.

Yong Chul Kim, Seung Hwan Lee, Gyu Jeong Noh, Sang Yoon Cho, Jong Hoon Yeom, Woo Jong Shin, Dong Ho Lee, Je Seon Ryu, Young Sun Park, Kyung Joon Cha, and Sang Chul Lee

Thermosoftening Treatment of the Nasotracheal Tube Before Intubation Can Reduce Epistaxis and Nasal Damage
Anesth Analg 2000 91: 698-701. [Abstract] [Full Text]  

Implications: Thermosoftening treatment of a nasotracheal tubewith warm saline before intubation can effectively reduce epistaxisand nasal damage. This technique is safe, easy, and suitablefor all types of tubes and does not require additional implements.

Lennart Magnusson, Arne Tenling, Robert Lemoine, Marieann Högman, Hans Tydén, and Göran Hedenstierna

The Safety of One, or Repeated, Vital Capacity Maneuvers During General Anesthesia
Anesth Analg 2000 91: 702-707. [Abstract] [Full Text]  

Implications: This study demonstrates in an animal model thatinflating the lung once or repeatedly to the vital capacityis a safe procedure. This maneuver, also called the vital capacitymaneuver, can be used to relieve lung collapse which occursin all patients during general anesthesia.

Fujio Karasawa, Takashi Ohshima, Isao Takamatsu, Takafumi Ehata, Isao Fukuda, Yoshitaka Uchihashi, and Tetsuo Satoh

The Effect on Intracuff Pressure of Various Nitrous Oxide Concentrations Used for Inflating an Endotracheal Tube Cuff
Anesth Analg 2000 91: 708-713. [Abstract] [Full Text]  

Implications: Nitrous oxide (N2O) diffuses into the cuff, equilibratingat a smaller concentration than the gas mixture with which patientsare ventilated. Our data indicate that inflation of the cuffwith 40% N2O is recommended to prevent both excessive endotrachealcuff pressure and air leaks during anesthesia with 67% N2O,reducing postoperative sore throats.

Philippe Juvin, Christophe Vadam, Leslie Malek, Hervé Dupont, Jean-Pierre Marmuse, and Jean-Marie Desmonts

Postoperative Recovery After Desflurane, Propofol, or Isoflurane Anesthesia Among Morbidly Obese Patients: A Prospective, Randomized Study
Anesth Analg 2000 91: 714-719. [Abstract] [Full Text]  

Implications: In morbidly obese patients, postoperative immediateand intermediate recoveries are more rapid and consistent afterdesflurane than after propofol or isoflurane anesthesia.

James M. Sonner, Diane Gong, and Edmond I Eger, II

Naturally Occurring Variability in Anesthetic Potency Among Inbred Mouse Strains
Anesth Analg 2000 91: 720-726. [Abstract] [Full Text]  

Implications: Laboratory mouse strains differ significantlyin susceptibility to anesthetics. These phenotypic differencesmay be exploited to help determine the genetic basis of anesthetic-inducedimmobility.

Massimo Girardis, Stefania Milesi, Stefano Donato, Michela Raffaelli, Alessandra Spasiano, Guglielmo Antonutto, Alberto Pasqualucci, and Alberto Pasetto

The Hemodynamic and Metabolic Effects of Tourniquet Application During Knee Surgery
Anesth Analg 2000 91: 727-731. [Abstract] [Full Text]  

Implications: The clinical effects of tourniquet applicationwere evaluated in 10 young men undergoing knee surgery. Ourdata indicate that tourniquet application causes hemodynamicand metabolic changes which may become clinically relevant aftera long period of tourniquet inflation, particularly in patientswith concomitant cardiovascular diseases.

Cyrus Motamed, Krassen Kirov, Thomas Lieutaud, and Philippe Duvaldestin

The Mechanism of Pancuronium Potentiation of Mivacurium Block: Use of the Isolated-Arm Technique
Anesth Analg 2000 91: 732-735. [Abstract] [Full Text]  

Implications: Using the isolated-arm technique, we suggest thatpancuronium potentiation of the neuromuscular blocking effectsof mivacurium is more likely attributable to an increase inthe effective plasma concentration of mivacurium than to occupancyof postsynaptic acetylcholine receptors.

Masanori Sueyasu, Kimihito Fujito, Hideki Shuto, Takako Mizokoshi, Yasufumi Kataoka, and Ryozo Oishi

Protein Binding and the Metabolism of Thiamylal Enantiomers In Vitro
Anesth Analg 2000 91: 736-740. [Abstract] [Full Text]  

Implications: Because clinically marketed thiamylal is a racemiccompound, a pharmacokinetic study of each enantiomer may bebeneficial. We found that the enantioselectivity of thiamylalexisted in protein binding and metabolism. This may be causedby the differences in the affinities of enantiomers for albuminand cytochrome P-450 isoform.

Toshio Sasaki, Tomio Andoh, Itaru Watanabe, Yoshinori Kamiya, Hideki Itoh, Tomoko Higashi, and Takayuki Matsuura

Nonstereoselective Inhibition of Neuronal Nicotinic Acetylcholine Receptors by Ketamine Isomers
Anesth Analg 2000 91: 741-748. [Abstract] [Full Text]  

Implications: We found that inhibition of neuronal nicotinicacetylcholine receptors by ketamine is not stereoselective inPC12 cells. The result suggests that this effect does not directlycorrelate with the anesthetic action of ketamine.

Hiroaki Morooka, Yoshitaka Wakasugi, Hiroko Shimamoto, Osamu Shibata, and Koji Sumikawa

Hyperbaric Nitrogen Prolongs Breath-Holding Time in Humans
Anesth Analg 2000 91: 749-751. [Abstract] [Full Text]  

Implications: Breath-holding time is significantly prolongedin hyperbaric air than it is in hyperbaric oxygen. The mechanisminvolves the anesthetic effect of nitrogen suppressing the suffocatingfeeling during breath-holding.

CASE REPORTS:

Noriaki Kanaya, Shin Kawana, Hiroaki Watanabe, Yukitoshi Niiyama, Tomohisa Niiya, Masayasu Nakayama, and Akiyoshi Namiki

The Utility of Three-Dimensional Computed Tomography in Unanticipated Difficult Endotracheal Intubation
Anesth Analg 2000 91: 752-754. [Abstract] [Full Text]  

Implications: We experienced a case of unanticipated difficultintubation with direct laryngoscopy because of narrowing ofthe retropharyngeal air apace and laryngeal vestibulum. It issuggested that three-dimensional computed tomography is usefulfor evaluating both the abnormality of an airway and its relationshipto surrounding tissue.

Keiichi Nitahara, Motoko Matsuyama, Tadakazu Sakuragi, and Kazuo Higa

Depression of Evoked Electromyographic (EEMG) Responses by Propofol in a Patient with Human T-Cell Lymphotropic Virus Type I-Associated Myelopathy (HAM)
Anesth Analg 2000 91: 755-757. [Abstract] [Full Text]  

Implications: We report a patient with human T-cell lymphotropicvirus type I-associated myelopathy. Although muscle strengthin both of the upper extremities was normal in this patient,evoked electromyogram of the adductor pollicis was depressedby propofol at the induction of anesthesia.

Stephen P. Fischer, James M. Healzer, Michael W. Brook, and John G. Brock-Utne

General Anesthesia in a Patient on Long-Term Amphetamine Therapy: Is There Cause for Concern?
Anesth Analg 2000 91: 758-759. [Abstract] [Full Text]  

Implications: Amphetamines are powerful, sympathomimetic aminesthat, when used chronically, can profoundly effect a patient'scardiovascular stability during anesthesia and surgery. Amphetaminesare the third most widely abused class of drugs in the UnitedStates. They also have legitimate medical use for attentiondeficit disorder with hyperactivity, exogenous obesity, andnarcolepsy. We report a case of a patient with a 40-yr historyof chronic amphetamine use having undergone two general anesthesiaswithout complication.

SPECIAL ARTICLES:

Nicholas M. Greene

Laureates of the History of Anesthesia, 2000
Anesth Analg 2000 91: 760-761. [Full Text]  

LETTERS TO THE EDITOR:

Michael A. E. Ramsay, Javier H. Campos, and Kemp H. Kernstine

Right-Sided Double-Lumen Endobronchial Tubes for Left-Sided Thoracic Surgery • Response
Anesth Analg 2000 91: 762. [Full Text]  

Mark S. Shulman, Javier H. Campos, and Kemp H. Kernstine

Right Versus Left Double-Lumens for Left-Sided Thoracic Surgery • Response
Anesth Analg 2000 91: 762-763. [Full Text]  

V. Hari Prasad Krovvidi, V. K. Grover, and P. Chari

Digital Pulp Space Infiltration of Local Anesthetic Enhances Pulse Oximeter Signal
Anesth Analg 2000 91: 763. [Full Text]  

Frédéric Pastureau, Alain C. Van Elstraete, and Thierry Lebrun

The Prophylactic Antiemetic Efficacy of Naloxone During Patient-Controlled Opioid Analgesia
Anesth Analg 2000 91: 763. [Full Text]  

Jonathan Whiteside

Meningitis After Spinal Anaesthesia
Anesth Analg 2000 91: 763-764. [Full Text]  

Scott Segal and Paul Langevin

Nitroglycerin and Uterine Relaxation • Response
Anesth Analg 2000 91: 764-765. [Full Text]  

Linda S. Polley, Malachy O. Columb, Robert D’Angelo, and Medge D. Owen

Potency, Impotency, and Importance! • Response
Anesth Analg 2000 91: 765-766. [Full Text]  

Thomas F. Slaughter, Jonathan B. Mark, Michael J. Jacka, and Andrew Clark

Heparin-Mediated Hypotension Associated with Cardiac Surgery • Response
Anesth Analg 2000 91: 766-767. [Full Text]  

Benoît Cots and Jean P. Racle

On the Effect of Propofol on Human Colonic Muscle
Anesth Analg 2000 91: 767. [Full Text]  

Brigitte Ulrich, Georg Kreienbühl, Kent Rehfeldt, and Malcolm Sanders

Complication After Artery Catheterization: Digital Gangrene in a Patient with Myeloproliferative Disease with Thrombocytosis • Response
Anesth Analg 2000 91: 767-768. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Maria E. Fagan Shier

Procedures and Techniques in Intensive Care Medicine. 2nd ed • Books and Multimedia Received
Anesth Analg 2000 91: 769. [Full Text]  

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