EDITORIALS:

J. G. Reves

Lessons on Learning About Learning Curves
Anesth Analg 2000 91: 1047-1048. [Full Text] [PDF] [Request Permissions]  

AMBULATORY ANESTHESIA:

Girish P. Joshi, Brenda D. Jamerson, Michael F. Roizen, Lee Fleisher, Rebecca S. Twersky, David S. Warner, and Michael Colopy

Is There a Learning Curve Associated with the Use of Remifentanil?
Anesth Analg 2000 91: 1049-1055. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: This study demonstrated that anesthesiologists rapidly acquire the ability to use remifentanil with limited experience. However, there is a learning curve that aids reduction of minor adverse effects associated with the use of analgesic medications administered at the end of surgery in outpatients, which might have reduced the incidence of postoperative vomiting and the duration of postanesthesia care unit stay.

Annemiek de Roode, Joop M. A. van Gerven, Rik C. Schoemaker, Frank H. M. Engbers, Wim Olieman, J. Ria Kroon, Adam F. Cohen, and James G. Bovill

A Comparison of the Effects of Propofol and Midazolam on Memory During Two Levels of Sedation by Using Target-Controlled Infusion
Anesth Analg 2000 91: 1056-1061. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Implicit memory can occur during different states of consciousness and might lead to psychological damage. In 10 volunteers, implicit memory was investigated during sedation with propofol and midazolam in a double-blinded, placebo-controlled study. To compare the effects of both drugs, they were titrated using a computer-controlled infusion system to produce similar high and low levels of sedation.

Ritva M. Jokela, Tuula A. Kangas-Saarela, Jukka V. I. Valanne, Merja K. Koivuranta, Pirjo O. Ranta, and Seppo M. Alahuhta

Postoperative Nausea and Vomiting After Sevoflurane With or Without Ondansetron Compared with Propofol in Female Patients Undergoing Breast Surgery (Brief Report)
Anesth Analg 2000 91: 1062-1065. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: We studied 180 female patients undergoing breast surgery. The patients were randomly allocated to receive one of three anesthetic techniques. Compared with either propofol or sevoflurane alone, sevoflurane with ondansetron resulted in a decreased incidence of postoperative nausea and vomiting. Sevoflurane with ondansetron prophylaxis is a good alternative to propofol with respect to avoiding postoperative nausea and vomiting.

CARDIOVASCULAR ANESTHESIA:

Dmitry N. Derkach, Hirotsugu Okamoto, and Shosuke Takahashi

Neuronal and Astroglial Injuries in Patients Undergoing Coronary Artery Bypass Grafting and Aortic Arch Replacement During Hypothermic Cardiopulmonary Bypass
Anesth Analg 2000 91: 1066-1072. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Neuronal and astroglial cell injuries are likely to occur during coronary artery bypass grafting with mild hypothermic cardiopulmonary bypass (CPB) or aortic arch replacement with deep hypothermic CPB. Conversely, patients undergoing coronary artery bypass grafting without CPB under normothermic conditions may be less likely to suffer brain cell injury.

Neal H. Badner, W. Scott Beattie, David Freeman, and J. David Spence

Nitrous Oxide-Induced Increased Homocysteine Concentrations Are Associated with Increased Postoperative Myocardial Ischemia in Patients Undergoing Carotid Endarterectomy
Anesth Analg 2000 91: 1073-1079. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Use of nitrous oxide during carotid artery surgery induces increases in postoperative plasma homocysteine concentration and is associated with increases in postoperative myocardial ischemia.

Maribel G. Gamoso, Barbara Phillips-Bute, Kevin P. Landolfo, Mark F. Newman, and Mark Stafford-Smith

Off-Pump Versus On-Pump Coronary Artery Bypass Surgery and Postoperative Renal Dysfunction
Anesth Analg 2000 91: 1080-1084. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Retrospective analysis did not identify any significant difference in perioperative change in creatinine clearance after coronary revascularization with cardiopulmonary bypass compared with off-pump coronary surgery.

Mark Stafford-Smith, Barbara Phillips-Bute, Donal N. Reddan, J. Black, and Mark F. Newman

The Association of -Aminocaproic Acid with Postoperative Decrease in Creatinine Clearance in 1502 Coronary Bypass Patients
Anesth Analg 2000 91: 1085-1090. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In a large population of primary Coronary Artery Bypass Graft including a subset with preoperative renal dysfunction, there were no postoperative reductions in creatinine clearance attributable to {epsilon}-aminocaproic (EACA) administration. This retrospective study suggests that moderate {epsilon}-aminocaproic acid dosing during cardiac surgery is safe for the kidney; however, this inference is based on a single marker of renal dysfunction and requires prospective confirmation using a variety of tests of renal function.

Stephen M. Klein, Thomas F. Slaughter, Parker T. Vail, Brian Ginsberg, Habib E. El-Moalem, Ratan Alexander, Francine D’Ercole, Roy A. Greengrass, Thangam T. M. Perumal, Ian Welsby, and Tong J. Gan

Thromboelastography as a Perioperative Measure of Anticoagulation Resulting from Low Molecular Weight Heparin: A Comparison with Anti-Xa Concentrations
Anesth Analg 2000 91: 1091-1095. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Thromboelastography is a test that could potentially correlate with the degree of anticoagulation produced by low molecular weight heparin. The r time from the thromboelastogram correlates with serum anti-Xa concentration.

Hyun S. Cho, Jeong J. Lee, Ik S. Chung, Byung S. Shin, Ji A. Kim, and Kook H. Lee

Insulin Reverses Bupivacaine-Induced Cardiac Depression in Dogs
Anesth Analg 2000 91: 1096-1102. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: We found that insulin and glucose rapidly reversed hemodynamic abnormality in dogs with bupivacaine-induced cardiac depression. This study implies a possible clinical application of insulin treatment for bupivacaine-induced cardiac depression.

Leanne Groban, Dwight D. Deal, Jason C. Vernon, Robert L. James, and John Butterworth

Ventricular Arrhythmias With or Without Programmed Electrical Stimulation After Incremental Overdosage with Lidocaine, Bupivacaine, Levobupivacaine, and Ropivacaine
Anesth Analg 2000 91: 1103-1111. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Progressive bupivacaine intoxication in anesthetized, ventilated dogs does not produce early arrhythmogenic events. The incidence of programmable electrical stimulation-induced ventricular tachycardia and fibrillation with bupivacaine does not differ from the incidence that occurs with the single S(-) enantiomers levobupivacaine and ropivacaine, providing further evidence against stereoselective arrhythmogenesis as a primary component of local anesthetic-induced cardiotoxicity.

D. W. Blake

Dexmedetomidine and Hemodynamic Responses to Simulated Hemorrhage in Experimental Heart Failure
Anesth Analg 2000 91: 1112-1117. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: As an adjunct to anesthesia, dexmedetomidine may be useful in reducing basal sympathetic nervous activity. This study in experimental animals suggests this may be achieved without compromising protective responses to decreased blood volume.

Michelle A. O. Kinney, Mary E. Warner, Jon A. vanHeerden, Terese T. Horlocker, William F. Young, Jr., Darrell R. Schroeder, Pamela M. Maxson, and Mark A. Warner

Perianesthetic Risks and Outcomes of Pheochromocytoma and Paraganglioma Resection
Anesth Analg 2000 91: 1118-1123. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Few patients who had pheochromocytoma or paraganglioma resection experienced significant perioperative morbidity and none died in the largest retrospective study on this topic to date. This study confirms the very good perioperative outcomes demonstrated in smaller studies on this high-risk population, and identifies several risk factors for adverse outcomes.

Gustav Ekbäck, Kjell Axelsson, Lars Ryttberg, Bror Edlund, Jill Kjellberg, Johan Weckström, Olle Carlsson, and Ulf Schött

Tranexamic Acid Reduces Blood Loss in Total Hip Replacement Surgery
Anesth Analg 2000 91: 1124-1130. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In a prospective, double-blinded study of 40 patients undergoing total hip replacement, the preoperative administration of tranexamic acid reduced bleeding by 35%, probably by decreasing induced fibrinolysis. Whether tranexamic acid therapy can replace predonation of autologous blood or intraoperative autotransfusion requires further study.

Christian H. Bohringer, Jonathan S. Jahr, Susan Rowell, and Kathrin Mayer

Severe Hypotension in a Patient Receiving Pemoline During General Anesthesia (Case Report)
Anesth Analg 2000 91: 1131-1133. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: This case reports hypotension under general anesthesia in a patient taking pemoline. Vigilance for unexpected hypotension is important in patients who are treated with psychostimulants. If hypotension occurs, vasopressors that act directly on adrenergic receptors should be used.

Barbara A. Marak, Denise J. Wedel, and Naser M. Ammash

An Unusual Presentation of Atrial Septal Defect in a Patient Undergoing Total Hip Arthroplasty (Case Report)
Anesth Analg 2000 91: 1134-1136. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Atrial septal defect is usually diagnosed and surgically repaired in childhood. We present a case of previously asymptomatic atrial septal defect that presented during total hip arthroplasty during general anesthesia in a 72-yr-old woman. Intraoperative transesophageal echocardiography assisted in the diagnosis and in determining the appropriate treatment.

Kenji Takeda, Shigehito Sawamura, Hisayoshi Tamai, Reiko Hagihara, and Kazuo Hanaoka

Reversible Tricuspid Valve Obstruction During Removal of Renal Cell Carcinoma with Intracardiac Tumor Extension (Case Report)
Anesth Analg 2000 91: 1137-1138. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Transesophageal echocardiography was used to identify and guide management of reversible tricuspid valve obstruction by a tumor mass during surgical removal of a renal cell carcinoma.

Carl J. Borromeo, Michael S. Stix, Anne Lally, and Elizabeth A. Pomfret

Epidural Catheter and Increased Prothrombin Time After Right Lobe Hepatectomy for Living Donor Transplantation (Case Report)
Anesth Analg 2000 91: 1139-1141. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Donor right hepatic lobectomy for the purpose of living liver transplantation may be associated with postoperative abnormalities in tests of clotting function. This study explores the possible causes and anesthetic implications of this phenomenon.

PEDIATRIC ANESTHESIA:

Abdelazeem Ali El-Dawlatly, Waleed Rida Murshid, Adel Elshimy, Magboul Ali Magboul, Abdulhameed Samarkandi, and Mohamed Said Takrouri

The Incidence of Bradycardia During Endoscopic Third Ventriculostomy
Anesth Analg 2000 91: 1142-1144. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The use of endoscopy for treating pediatric patients with increased intracranial pressure is a new surgical procedure. These patients require general anesthesia with continuous heart rate monitoring. We have observed a high incidence of decrease in heart rate. If a decrease in heart rate occurs, alerting the surgeon to speed the procedure would be an effective treatment.

Stephen A. Stayer, Sabrina T. Bent, Barbara S. Skjonsby, Anna Frolov, and Dean B. Andropoulos

Pressure Control Ventilation: Three Anesthesia Ventilators Compared Using an Infant Lung Model
Anesth Analg 2000 91: 1145-1150. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: There are differences in performance of ventilators when set to deliver pressure control ventilation to an infant test lung model.

Akira Kudoh and Akitomo Matsuki

Halothane and Sevoflurane Decrease Norepinephrine-Stimulated Glucose Transport in Neonatal Cardiomyocyte
Anesth Analg 2000 91: 1151-1159. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The effect of inhaled anesthetics on myocardial glucose uptake during administration of catecholamine is unclear. The myocardial glucose uptake is stimulated not only by catecholamine, but also by insulin, protein kinase C, and increase of intracellular calcium. We examined the effects of halothane and sevoflurane on glucose uptake.

H. Eugene Harker and Thomas A. Majcher

Hypermagnesemia in a Pediatric Patient (Case Report)
Anesth Analg 2000 91: 1160-1162. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: A high blood magnesium level is a rare but life-threatening event. This case report describes an accidental overdose of magnesium that occurred in an18-month-old girl during a routine operation. The effects of high magnesium levels and its treatment are explained in detail.

INTRAVENOUS ANESTHESIA:

Paul S. Myles, Jennifer O. Hunt, Helen Fletcher, Jamie Smart, and Terri Jackson

Part I: Propofol, Thiopental, Sevoflurane, and Isoflurane—A Randomized, Controlled Trial of Effectiveness
Anesth Analg 2000 91: 1163-1169. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Propofol and sevoflurane do not offer any significant advantages over thiopental and isoflurane in adults undergoing elective inpatient surgery.

Terri Jackson and Paul S. Myles

Part II: Total Episode Costs in a Randomized, Controlled Trial of the Effectiveness of Four Anesthetics
Anesth Analg 2000 91: 1170-1175. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Propofol and sevoflurane do not offer any significant economic advantages over thiopental and isoflurane in adults undergoing elective inpatient surgery.

ECONOMICS AND HEALTH SYSTEMS RESEARCH:

Soichiro Yamashita, Hiroshi Yamaguchi, Misa Sakaguchi, Tsuyoshi Satsumae, Sumii Yamamoto, and Fumiaki Shinya

Longer-Term Diabetic Patients Have a More Frequent Incidence of Nosocomial Infections After Elective Gastrectomy
Anesth Analg 2000 91: 1176-1181. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Postoperative nosocomial infection is one of the major problems in diabetic patients. This study demonstrated that postoperative nosocomial infections were more common in patients undergoing elective gastrectomy if they had diabetes mellitus longer than 10 yr.

CRITICAL CARE AND TRAUMA:

Gisbert Knichwitz, Thomas Brüssel, Paul Reinhold, Frank Schaumann, Klaus Dieter Richter, and Hugo Van Aken

Early Onset of Regional Intestinal Ischemia Can Be Detected with Carbon Dioxide Tension Measurement Inside the Peritoneal Cavity
Anesth Analg 2000 91: 1182-1187. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Unless systemic changes are induced, regional intestinal perfusion deficits cannot be detected with a PCO2 measurement in the gastric lumen. In pigs, an occlusion of blood flow to an isolated gut segment resulted in a significant increase in intraperitoneal CO2 tension. Thus, the measurement of intraperitoneal PCO2 could allow the early detection of regional intestinal ischemia.

Cornelius Keyl, Annette Schneider, Martin Dambacher, Ulrike Wegenhorst, Matthias Ingenlath, Michael Gruber, and Luciano Bernardi

Dynamic Cardiocirculatory Control During Propofol Anesthesia in Mechanically Ventilated Patients
Anesth Analg 2000 91: 1188-1195. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: An irregular dynamic behavior of the cardiovascular control system, associated with an impaired baroreflex control of heart rate and blood pressure, can be observed during propofol anesthesia in mechanically ventilated subjects.

REGIONAL ANESTHESIA AND PAIN MEDICINE:

Makoto Tanaka, Toru Goyagi, Tetsu Kimura, and Toshiaki Nishikawa

The Efficacy of Hemodynamic and T wave Criteria for Detecting Intravascular Injection of Epinephrine Test Doses in Anesthetized Adults: A Dose-Response Study
Anesth Analg 2000 91: 1196-1202. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: To determine whether an epidural catheter is in a blood vessel, an epidural test dose containing 15 {micro}g of epinephrine is used. We found that a decrease in T wave amplitude appears to be more sensitive than heart rate and systolic blood pressure change for detecting accidental intravascular injection of a small dose of epinephrine-containing test dose in sevoflurane-anesthetized patients.

Hwee H. Lim, Kwok M. Ho, Wing Y. Choi, Guek S. Teoh, and Kai Y. Chiu

The Use of Intravenous Atropine After a Saline Infusion in the Prevention of Spinal Anesthesia-Induced Hypotension in Elderly Patients
Anesth Analg 2000 91: 1203-1206. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: IV atropine increases heart rate in a dose-dependent manner in elderly patients undergoing spinal anesthesia. It reduces the incidence of hypotension and the dose of ephedrine required. Small-dose atropine may be a useful supplement in preventing spinal anesthesia-induced hypotension in elderly patients.

Mika J. Jokinen, Jouni Ahonen, Pertti J. Neuvonen, and Klaus T. Olkkola

The Effect of Erythromycin, Fluvoxamine, and Their Combination on the Pharmacokinetics of Ropivacaine
Anesth Analg 2000 91: 1207-1212. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Clinicians should be aware of the possibility of increased toxicity of ropivacaine when used together with inhibitors of CYP1A2. Concomitant use of CYP1A2 and CYP3A4 inhibitors further increases ropivacaine concentration.

Akiyoshi Oda, Hidenori Ohashi, Seiichi Komori, Hiroki Iida, and Shuji Dohi

Characteristics of Ropivacaine Block of Na+ Channels in Rat Dorsal Root Ganglion Neurons
Anesth Analg 2000 91: 1213-1220. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Whole-cell patch-clamp recordings of tetrodotoxin-sensitive and tetrodotoxin-resistant Na+ currents in rat dorsal root ganglion neurons showed ropivacaine preferentially blocked tetrodotoxin-resistant Na+ channels over tetrodotoxin-sensitive Na+ channels. This could provide a desirable differential sensory blockade during epidural anesthesia using ropivacaine.

Scott S. Reuben and Neil Roy Connelly

Postoperative Analgesic Effects of Celecoxib or Rofecoxib After Spinal Fusion Surgery
Anesth Analg 2000 91: 1221-1225. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The cyclooxygenase-2-specific nonsteroidal antiinflammatory drugs, celecoxib and rofecoxib, both demonstrate an opioid-sparing effect after spinal fusion surgery. Celecoxib resulted in decreased morphine use for the first 8 h after surgery, whereas rofecoxib demonstrated less morphine use throughout the 24-h study period.

Wei-wu Pang, Shyuan Huang, Chien-Chiung Tung, and Min-Ho Huang

Patient-Controlled Analgesia with Tramadol Versus Tramadol Plus Lysine Acetyl Salicylate
Anesth Analg 2000 91: 1226-1229. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Injectable aspirin can be used as an effective and safe adjuvant to tramadol for patient-controlled analgesia (PCA) in orthopedic patients. The tramadol requirement is therefore reduced. This combination supports the concept that drugs other than opioids can be used for PCA.

Ralf E. Gebhard, James Berry, William W. Maggio, Adrian Gollas, and Jacques E. Chelly

The Successful Use of Regional Anesthesia to Prevent Involuntary Movements in a Patient Undergoing Awake Craniotomy (Case Report)
Anesth Analg 2000 91: 1230-1231. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The authors demonstrate that the combination of single and continuous peripheral nerve blocks allows the control of involuntary movements in patients undergoing awake craniotomy.

Christopher L. Wu and Lee A. Fleisher

Outcomes Research in Regional Anesthesia and Analgesia (Review Article)
Anesth Analg 2000 91: 1232-1242. [Full Text] [PDF] [Request Permissions]  

GENERAL ARTICLES:

Chikwendu Ibebunjo and J. A. Jeevendra Martyn

Thermal Injury Induces Greater Resistance to d-Tubocurarine in Local Rather than in Distant Muscles in the Rat
Anesth Analg 2000 91: 1243-1249. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The resistance to d-tubocurarine after a burn differs between muscles near and distant from the burn and seems to depend on quantitative and qualitative changes in acetylcholine receptors and muscle atrophy associated with the insult.

W. Scott Jellish, Michael Brody, Kristina Sawicki, and Stephen Slogoff

Recovery from Neuromuscular Blockade After Either Bolus and Prolonged Infusions of Cisatracurium or Rocuronium Using Either Isoflurane or Propofol-Based Anesthetics
Anesth Analg 2000 91: 1250-1255. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: This study describes the effect of different anesthetic techniques on the recovery of two different muscle relaxants, cisatracurium and rocuronium, when administered as either a single bolus or prolonged infusion during neurosurgery. This study demonstrates the feasibility of using these relaxants for these prolonged procedures.

Nevin S. Kreisler, Burkhard F. Spiekermann, Clavio M. Ascari, Heather A. Rhyne, Robin L. Kloth, Lisa M. Sullivan, and Marcel E. Durieux

Small-Dose Droperidol Effectively Reduces Nausea in a General Surgical Adult Patient Population
Anesth Analg 2000 91: 1256-1261. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Droperidol 0.625 mg IV before emergence from general anesthesia effectively reduces postoperative nausea and vomiting (PONV) in the general surgical population. Our randomized, double-blinded, placebo-controlled study demonstrated a reduction in PONV from 41% to 7%. Droperidol is a safe and inexpensive alternative to ondansetron. Droperidol, ondansetron, and promethazine are also equally effective in treating PONV in the postanesthesia care unit.

Ryoji Obata, Hiromichi Bito, Morihiro Ohmura, Goroku Moriwaki, Yukako Ikeuchi, Takasumi Katoh, and Shigehito Sato

The Effects of Prolonged Low-Flow Sevoflurane Anesthesia on Renal and Hepatic Function
Anesth Analg 2000 91: 1262-1268. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: During low-flow sevoflurane anesthesia, intake of Compound A reached 277 {+/-} 120 ppm-h, but the effect on the kidney and the liver was the same in high-flow sevoflurane and low-flow isoflurane anesthesia.

Andrea Casati, Andrea Albertin, Guido Fanelli, Francesco Deni, Marco Berti, Giorgio Danelli, Federica Grifoni, and Giorgio Torri

A Comparison of Remifentanil and Sufentanil as Adjuvants During Sevoflurane Anesthesia with Epidural Analgesia for Upper Abdominal Surgery: Effects on Postoperative Recovery and Respiratory Function
Anesth Analg 2000 91: 1269-1273. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In this double-blinded study, we evaluated the effects of adding small infusions of either remifentanil or sufentanil to sevoflurane in combination with postoperative epidural analgesia for upper abdominal surgery. We demonstrated that remifentanil is as effective as sufentanil during the intraoperative period, but that it provides shorter time to extubation and fewer effects on postoperative SpO2 in the first 7 h after surgery.

Joseph Brimacombe, Christian Keller, Karl H. Künzel, Othmar Gaber, Michael Boehler, and Fredrich Pühringer

Cervical Spine Motion During Airway Management: A Cinefluoroscopic Study of the Posteriorly Destabilized Third Cervical Vertebrae in Human Cadavers
Anesth Analg 2000 91: 1274-1278. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: In the cadaver model of a destabilized third cervical vertebrae, significant displacement of the injured segment occurs during airway management with the face mask, laryngoscope-guided oral intubation, the esophageal tracheal Combitube(R) (Kendall-Sheridan, Neustadt, Germany), the intubating and standard laryngeal mask airway; but not with fiberscope-guided nasal intubation. For cervical motion and the techniques tested, the safest airway technique with this injury is fiberscope-guided nasotracheal intubation. Laryngeal mask devices are preferable to the esophageal tracheal Combitube(R).

Heather J. Gorton, Elisa R. Warren, Nigel A. B. Simpson, Gordon R. Lyons, and Malachy O. Columb

Thromboelastography Identifies Sex-Related Differences in Coagulation
Anesth Analg 2000 91: 1279-1281. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The thromboelastograph, used as a diagnostic tool, shows that women have more whole blood coagulability than men.

Joseph F. Antognini, E. Carstens, Makoto Sudo, and Satoko Sudo

Isoflurane Depresses Electroencephalographic and Medial Thalamic Responses to Noxious Stimulation via an Indirect Spinal Action
Anesth Analg 2000 91: 1282-1288. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: Isoflurane action in the spinal cord diminished the transmission of noxious input to the brain. Because memory and consciousness are likely dependent on the "arousal" state of the brain, this indirect action of isoflurane could contribute to anesthetic-induced amnesia and unconsciousness.

Maria Paola Mascia, Diane H. Gong, Edmond I Eger, II, and R. Adron Harris

The Anesthetic Potency of Propanol and Butanol Versus Propanethiol and Butanethiol in 1 Wild Type and 1(S267Q) Glycine Receptors
Anesth Analg 2000 91: 1289-1293. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The in vivo potencies of propanethiol, butanethiol, propanol, and butanol correlate with their capacities to enhance the effect of glycine on {alpha}1 glycine receptors expressed in Xenopus laevis oocytes. These results support the notion that a protein mediates anesthetic action.

Yi Zhang, James R. Trudell, Maria Paola Mascia, Michael J. Laster, Diane H. Gong, R. Adron Harris, and Edmond I Eger, II

The Anesthetic Potencies of Alkanethiols for Rats: Relevance to Theories of Narcosis
Anesth Analg 2000 91: 1294-1299. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: The in vivo anesthetic potency of alkanols and alkanethiols correlates with their lipophilicity and hydrophilicity.

CASE REPORTS:

Samuel A. Irefin, Ibrahim S. Farid, and Anthony J. Senagore

Urgent Colectomy in a Patient with Membranous Tracheal Disruption After Severe Vomiting
Anesth Analg 2000 91: 1300-1302. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: We report a case of a patient who developed membranous tracheal disruption after severe vomiting. He subsequently required urgent colectomy for toxic megacolon under general anesthesia. With this challenging situation, we were able to successfully conduct general anesthesia in the presence of tracheal laceration, pneumothorax, and pneumomediastinum.

Virendra K. Arya, Amitabh Dutta, and Pramila Chari

Reinforcement of Laryngeal Mask Airway Cuff Position with Endotracheal Tube Cuff for Airway Control in a Patient with Altered Upper Airway Anatomy
Anesth Analg 2000 91: 1303-1305. [Abstract] [Full Text] [PDF] [Request Permissions]  

Implications: This case report suggests that the laryngeal mask airway (LMA) cuff position may not be optimal in some difficult airway situations in which the anatomical position of the larynx is altered. Reinforcement of the LMA cuff position by an additional cuff on the dorsal side of the LMA cuff may prove helpful. In this case, in which a difficult airway was anticipated, a nasopharyngeal tube cuff placed behind the standard LMA cuff helped relieve upper airway obstruction.

LETTERS TO THE EDITOR:

Prakash K. Dubey, Kumar H. Raghwendra, and Titisha S. Mitra

Sister Maria’s Test to Differentiate Between Cerebrospinal Fluid and a Local Anesthetic
Anesth Analg 2000 91: 1306. [Full Text] [PDF] [Request Permissions]  

Admir Hadzic

Peripheral Nerve Stimulators for Regional Anesthesia Can Generate Excessive Voltage Output with Poor Ground Connection
Anesth Analg 2000 91: 1306. [Full Text] [PDF] [Request Permissions]  

Clair S. Weenig, Pierre A. Diemunsch, Sidiki Doumbia, and Joël Leroy

N₂O Usage in Laparoscopic Cases • Response
Anesth Analg 2000 91: 1306-1307. [Full Text] [PDF] [Request Permissions]  

Eric L. Chernin and Barry Smiler

Any Propofol Compatibility Study Must Include an Emulsion Stability Analysis
Anesth Analg 2000 91: 1307-1308. [Full Text] [PDF] [Request Permissions]  

Mitchel B. Sosis, Sujit K. Pandit, Katherine W. Loberg, and Uma A. Pandit

Coffee Is Not a Clear Liquid • Response
Anesth Analg 2000 91: 1308-1309. [Full Text] [PDF] [Request Permissions]  

Maria J. Tzoufi, Spyros D. Mentzelopoulos, and Si-Tun Fung

Foreign Body Removal: Tracheal Backflow Air or Rigid Bronchoscopy? • Response
Anesth Analg 2000 91: 1309. [Full Text] [PDF] [Request Permissions]  

Kazuyoshi Aoyama, Etsuko Nagaoka, Ichiro Takenaka, and Tatsuo Kadoya

New Jaw Support Device and Awake Fiberoptic Intubation
Anesth Analg 2000 91: 1309-1310. [Full Text] [PDF] [Request Permissions]  

Amanda J. Pinder, Martin Dresner, Robert D’Angelo, Medge Owen, and Kenneth Nelson

Ropivacaine and Bupivacaine with Fentanyl for Labor Epidural Anesthesia • Response
Anesth Analg 2000 91: 1310-1311. [Full Text] [PDF] [Request Permissions]  

Marc E. Gentili

Are Postdural Puncture Symptoms Immediate in Elderly Patients?
Anesth Analg 2000 91: 1311. [Full Text] [PDF] [Request Permissions]  

Amr E. Abouleish and Donald S. Prough

Are Medicare Patients Sicker, More Complex, and at a Higher Risk for Perioperative Complications?
Anesth Analg 2000 91: 1311-1312. [Full Text] [PDF] [Request Permissions]  

Denise Martin-Sheridan

The Cost Effectiveness of Anesthesia Workforce Models: A Critique
Anesth Analg 2000 91: 1312. [Full Text] [PDF] [Request Permissions]  

Chuck Biddle and Laurent Glance

The Cost Effectiveness of Anesthesia Workforce Models: The Creation of a Procrustean Bed • Response
Anesth Analg 2000 91: 1313. [Full Text] [PDF] [Request Permissions]  

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Constantine D. Sarantopoulos, John C. Rowlingson, Christopher J. O’Connor, and Samuel Tirer

Foundations of Anesthesia Basic and Clinical Sciences • Textbook of Pain • Cardiovascular Drugs in the Perioperative Period • The Evolution of the Anesthesia Machine • Books and Multimedia Received
Anesth Analg 2000 91: 1314-1316. [Full Text] [PDF] [Request Permissions]  

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