EDITORIALS:

Mark S. Schreiner and William J. Greeley

Pediatric Clinical Trials: Shall We Take a Lead?
Anesth Analg 2002 94: 1-3. [Full Text] [PDF] [Request Permissions]  

CARDIOVASCULAR ANESTHESIA:

Alina M. Grigore, Hilary P. Grocott, Joseph P. Mathew, Barbara Phillips-Bute, Timothy O. Stanley, Aimee Butler, Kevin P. Landolfo, Joseph G. Reves, James A. Blumenthal, and Mark F. Newman

The Rewarming Rate and Increased Peak Temperature Alter Neurocognitive Outcome After Cardiac Surgery
Anesth Analg 2002 94: 4-10. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Slower rewarming during cardiopulmonary bypass (CPB) was associated with better cognitive performance at 6 wk. These results suggest that a slower rewarming rate with lower peak temperatures during CPB may be an important factor in the prevention of neurocognitive decline after hypothermic CPB.

Mert Sentürk, Perihan Ergin Özcan, Gül Köknel Talu, Esen Kiyan, Emre Çamci, Süleyman Özyalçin, Sükrü Dilege, and Kamil Pembeci

The Effects of Three Different Analgesia Techniques on Long-Term Postthoracotomy Pain
Anesth Analg 2002 94: 11-15. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Preoperatively initiated thoracic epidural analgesia has the most satisfying results in controlling postthoracotomy pain in the acute and long-term period, and it is associated with a decreased incidence (and intensity) of chronic pain compared with postoperative (epidural or IV) analgesia. Chronic pain has an incidence of 62%.

Masaki Kawase, Toru Komatsu, Kimitoshi Nishiwaki, Makoto Kobayashi, Tomomasa Kimura, and Yasuhiro Shimada

Heart Rate Variability and Arterial Blood Pressure Variability Show Different Characteristic Changes During Hemorrhage in Isoflurane-Anesthetized, Mechanically Ventilated Dogs
Anesth Analg 2002 94: 16-21. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Power spectra of heart rate variability (HRV) and blood pressure variability (BPV) were computed using the fast Fourier transformation. The HRV and BPV showed their differential characteristics during hemorrhage, isoflurane anesthesia, and retransfusion, and would help to assess changes in autonomic nervous system and preload under mechanical ventilation.

Mutsuhito Kikura and Shigehito Sato

The Efficacy of Preemptive Milrinone or Amrinone Therapy in Patients Undergoing Coronary Artery Bypass Grafting
Anesth Analg 2002 94: 22-30. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Preemptive milrinone or amrinone administration before separation from cardiopulmonary bypass in cardiac surgical patients not only ameliorates postoperative deterioration in cardiac function and oxygen transport, but also reduces dopamine requirement and increases serum lactate, glucose, and cellular enzyme levels, although milrinone may increase heart rate.

PEDIATRIC ANESTHESIA:

Keith K. Brosius and Carolyn F. Bannister

Oral Midazolam Premedication in Preadolescents and Adolescents
Anesth Analg 2002 94: 31-36. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We demonstrated a measurable sedative effect of oral midazolam in adolescents which correlated with simultaneous bispectral index (BIS) measurement. Considering the overall group, midazolam premedication did not affect intraoperative BIS, emergence times, or recovery times compared with placebo controls. Detectable preoperative sedation, and not merely midazolam administration, was predictive of prolonged emergence.

Charles J. Coté, Ira T. Cohen, Santhanam Suresh, Mary Rabb, John B. Rose, B. Craig Weldon, Peter J. Davis, George B. Bikhazi, Helen W. Karl, Kelly A. Hummer, Raafat S. Hannallah, Ko Chin Khoo, and Patrice Collins

A Comparison of Three Doses of a Commercially Prepared Oral Midazolam Syrup in Children
Anesth Analg 2002 94: 37-43. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Commercially prepared oral midazolam syrup is effective in producing sedation and anxiolysis in doses as small as 0.25 mg/kg; there is a slightly faster onset with increasing the dose to 1.0 mg/kg. At all doses, 97% of patients demonstrated satisfactory sedation, whereas 86% demonstrated satisfactory anxiolysis when the face mask was applied.

Douglas G. Ririe, Robert L. James, James J. O’Brien, Yonggu A. Lin, Judy Bennett, David Barclay, Michael H. Hines, and John F. Butterworth

The Pharmacokinetics of -Aminocaproic Acid in Children Undergoing Surgical Repair of Congenital Heart Defects
Anesth Analg 2002 94: 44-49. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Pharmacokinetic modeling of {epsilon}-aminocaproic acid in children undergoing cardiac surgery suggests that there are developmental differences in pharmacokinetic variables. Based on these data, a dosing modification in children is suggested which may better maintain serum concentrations in children when compared with adults.

Scott D. Cook-Sather, Kathleen A. Harris, and Mark S. Schreiner

Cisapride Does Not Prevent Postoperative Vomiting in Children
Anesth Analg 2002 94: 50-54. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Cisapride does not prevent postoperative vomiting in children and may increase its severity.

AMBULATORY ANESTHESIA:

Scott S. Reuben, Shailesh Bhopatkar, Holly Maciolek, Wanda Joshi, and Joseph Sklar

The Preemptive Analgesic Effect of Rofecoxib After Ambulatory Arthroscopic Knee Surgery
Anesth Analg 2002 94: 55-59. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The administration of rofecoxib 50 mg before arthroscopic knee surgery provides a longer duration of analgesia, less 24-h opioid use, and lower pain scores than administering the drug after the completion of surgery.

Dajun Song, Frances Chung, Jean Wong, and Suntheralingam Yogendran

The Assessment of Postural Stability After Ambulatory Anesthesia: A Comparison of Desflurane with Propofol
Anesth Analg 2002 94: 60-64. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The residual effects of the short-acting general anesthetics desflurane and propofol on patient's balance function during recovery after surgery were assessed with a computerized force platform. The results showed that desflurane seemed to be associated with better postural control than propofol in the early recovery period.

Stephen M. Klein, Karen C. Nielsen, Roy A. Greengrass, David S. Warner, Aliki Martin, and Susan M. Steele

Ambulatory Discharge After Long-Acting Peripheral Nerve Blockade: 2382 Blocks with Ropivacaine
Anesth Analg 2002 94: 65-70. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study demonstrates that long-acting peripheral nerve blockade may be safely used in the ambulatory setting with a high degree of efficacy and satisfaction. This technique is associated with an infrequent incidence of neurologic complications and injuries despite discharge with an insensate extremity. The frequent incidence of pain at 7 days suggests that longer-acting local anesthetics are still needed.

Stephen M. Klein, Ricardo Pietrobon, Karen C. Nielsen, David S. Warner, Roy A. Greengrass, and Susan M. Steele

Peripheral Nerve Blockade with Long-Acting Local Anesthetics: A Survey of The Society for Ambulatory Anesthesia
Anesth Analg 2002 94: 71-76. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This survey demonstrates that use of regional anesthesia in outpatients is common but restricted to a few techniques. Discharge with an insensate upper extremity is common but discharge with an insensate lower extremity is not prevalent and remains controversial.

Andre Gilbert, Brian D. Owens, and Michael F. Mulroy

Epidural Hematoma After Outpatient Epidural Anesthesia (Case Report)
Anesth Analg 2002 94: 77-78. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Epidural hematoma is a rare complication of epidural anesthesia in healthy patients. Expedient diagnosis and treatment are essential to avoid permanent neurologic deficits. In an outpatient setting, patients should be instructed to communicate symptoms of severe back pain or weakness early.

ANESTHETIC PHARMACOLOGY:

Kouichiro Minami, Munehiro Shiraishi, Yasuhito Uezono, Susumu Ueno, and Akio Shigematsu

The Inhibitory Effects of Anesthetics and Ethanol on Substance P Receptors Expressed in Xenopus Oocytes
Anesth Analg 2002 94: 79-83. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We examined the effects of halothane, isoflurane, enflurane, diethyl ether, and ethanol on substance P receptor (SPR) expressed in Xenopus oocytes, by using a whole-cell voltage clamp. All the anesthetics and ethanol inhibited SPR function, and the protein kinase C (PKC) inhibitor abolished these inhibitions. These results suggest that anesthetics and ethanol inhibit SPR function via PKC.

Michiaki Yamakage, Xiangdong Chen, Akira Kimura, Sohshi Iwasaki, and Akiyoshi Namiki

The Repolarizing Effects of Volatile Anesthetics on Porcine Tracheal and Bronchial Smooth Muscle Cells
Anesth Analg 2002 94: 84-88. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: By use of a current-clamp technique, the volatile anesthetics isoflurane and sevoflurane repolarized porcine airway smooth muscle cell membranes depolarized by a muscarinic agonist. This effect might be caused mainly by change in Ca2+-activated Cl- channel activity, not in K+ channel activity.

Tim D. Runzer, David M. Ansley, David V. Godin, and Gordon K. Chambers

Tissue Antioxidant Capacity During Anesthesia: Propofol Enhances In Vivo Red Cell and Tissue Antioxidant Capacity in a Rat Model
Anesth Analg 2002 94: 89-93. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We designed this study to investigate the antioxidant effects of propofol in various tissues in a rat model. Pretreatment of animals with propofol led to a reduction in the susceptibility to an in vitro oxidative stress of five different tissues investigated, demonstrating the drug's ability to limit oxidative injury. This may have future application in limiting organ dysfunction after periods of tissue ischemia (which results in oxidative damage).

Mark P. Yeager, Marcia A. Procopio, Joyce A. DeLeo, Janice L. Arruda, Laurie Hildebrandt, and Alexandra L. Howell

Intravenous Fentanyl Increases Natural Killer Cell Cytotoxicity and Circulating CD16⁺ Lymphocytes in Humans
Anesth Analg 2002 94: 94-99. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Many previous studies have suggested that opioid drugs can impair immune resistance in patients who may be at risk for infection. This study suggests that the opioid fentanyl, when given to healthy humans without coexisting diseases, does not suppress immune resistance. On the basis of these results, the use of fentanyl should not be restricted because of concerns that it may suppress immune function.

Thierry Labaille, Jean Xavier Mazoit, Xavier Paqueron, Dominique Franco, and Dan Benhamou

The Clinical Efficacy and Pharmacokinetics of Intraperitoneal Ropivacaine for Laparoscopic Cholecystectomy
Anesth Analg 2002 94: 100-105. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Intraperitoneal ropivacaine 100 mg injected during laparoscopic cholecystectomy significantly decreased postoperative pain when compared with injection of intraperitoneal placebo. At this dose, plasma concentrations remained in the nontoxic range,

Swen N. Piper, Kerstin D. Röhm, Wolfgang H. Maleck, Moritz T. Fent, Stefan W. Suttner, and Joachim Boldt

Dolasetron for Preventing Postanesthetic Shivering
Anesth Analg 2002 94: 106-111. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Shivering, an irregular muscular fasciculation lasting longer than 15 s, is a common complication secondary to general anesthesia. We compared dolasetron with clonidine (an established antishivering drug) in the prevention of postanesthetic shivering. Dolasetron 12.5 mg was not effective.

Ruari Orme, Kate Leslie, Abhay Umranikar, and Antony Ugoni

Esmolol and Anesthetic Requirement for Loss of Responsiveness During Propofol Anesthesia
Anesth Analg 2002 94: 112-116. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: There is no evidence to suggest that esmolol, an ultra-short-acting cardioselective {beta}-blocker, affects anesthetic requirement for loss of responsiveness during propofol anesthesia.

Ayuko Igarashi, Sumio Amagasa, Hideo Horikawa, and Machiko Shirahata

Vecuronium Directly Inhibits Hypoxic Neurotransmission of the Rat Carotid Body
Anesth Analg 2002 94: 117-122. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We investigated the effect of vecuronium on the chemoreceptor response to hypoxia with perfused rat carotid bodies. The results indicate that vecuronium significantly reduces carotid body neural responses to hypoxia, acetylcholine, and nicotine by inhibiting neuronal nicotinic receptors in the carotid body.

Paul A. Sloan and Mazhar Rasul

Prolongation of Rapacuronium Neuromuscular Blockade by Clindamycin and Magnesium (Case Report)
Anesth Analg 2002 94: 123-124. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report a prolonged neuromuscular block with the nondepolarizing muscle relaxant rapacuronium in the presence of clindamycin. Even when using "short-acting" muscle relaxants, the anesthesiologist must routinely monitor the neuromuscular function.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Diederik Nieuwenhuijs, Emma L. Coleman, Neil J. Douglas, Gordon B. Drummond, and Albert Dahan

Bispectral Index Values and Spectral Edge Frequency at Different Stages of Physiologic Sleep
Anesth Analg 2002 94: 125-129. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Although computer processing of the electroencephalogram can provide an adequate index of depth of anesthesia, the same processing cannot reliably convey depth of natural sleep. At each sleep stage, the output signal has a wide range of possible values.

ECONOMICS AND HEALTH SYSTEMS RESEARCH:

Scott A. Strassels, Connie Chen, and Daniel B. Carr

Postoperative Analgesia: Economics, Resource Use, and Patient Satisfaction in an Urban Teaching Hospital
Anesth Analg 2002 94: 130-137. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Despite impressive relief with analgesics, postoperative pain interferes with patients' ability to sleep, walk, and participate in other activities. Medications used postoperatively account for a small portion of total costs. Satisfaction ratings alone are a poor indicator of pain control. These data can be used to help improve pain relief.

Franklin Dexter, John T. Blake, Donald H. Penning, and David A. Lubarsky

Calculating a Potential Increase in Hospital Margin for Elective Surgery by Changing Operating Room Time Allocations or Increasing Nursing Staffing to Permit Completion of More Cases: A Case Study
Anesth Analg 2002 94: 138-142. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: For hospitals where elective surgery caseload is limited by nursing recruitment, to increase one surgeon's operating room time either another surgeon's time must be decreased, nurses need to be paid a premium for working longer hours, or higher-priced "traveling" nurses can be contracted. Linear programming was performed using Microsoft Excel to estimate the effect of each of these interventions on hospital contribution margin.

John T. Blake, Franklin Dexter, and Joan Donald

Operating Room Managers’ Use of Integer Programming for Assigning Block Time to Surgical Groups: A Case Study
Anesth Analg 2002 94: 143-148. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: At hospitals with a fixed budget of operating room (OR) time, integer programming can be used by OR managers to decide which surgical group is to be allocated which OR on which day(s) of the week. In this case study, we describe the successful application of integer programming to this task, and discuss the applicability of the results to other hospitals.

Meg A. Rosenblatt and Kenneth J. Abrams

The Use of a Human Patient Simulator in the Evaluation of and Development of a Remedial Prescription for an Anesthesiologist with Lapsed Medical Skills (Special Article)
Anesth Analg 2002 94: 149-153. [Abstract] [Full Text] [PDF] [Request Permissions]  

Jens Krombach, Sandra Kampe, Birgit S. Gathof, Christoph Diefenbach, and Stefan-Mario Kasper

Human Error: The Persisting Risk of Blood Transfusion: A Report of Five Cases (Case Report)
Anesth Analg 2002 94: 154-156. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Human error leading to the transfusion of blood to an unintended recipient is a major source of transfusion-related fatalities. We report five cases that highlight some specific areas in which transfusion error is likely to occur.

CRITICAL CARE AND TRAUMA:

Sang-Bum Hong, Younsuck Koh, Tae-Sun Shim, Sang D. Lee, Woo S. Kim, Dong S. Kim, Won D. Kim, and Chae-Man Lim

Physiologic Characteristics of Cold Perfluorocarbon-Induced Hypothermia During Partial Liquid Ventilation in Normal Rabbits
Anesth Analg 2002 94: 157-162. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The induction of moderate hypothermia was feasible in rabbits by administrating cold perfluorocarbon liquid into the lung. Physiologic changes induced by this pulmonary cooling were comparable to those induced by systemic cooling. Our method may be regarded as a methodological advance in the field of therapeutic hypothermia.

NEUROSURGICAL ANESTHESIA:

Marco Gemma, Concezione Tommasino, Silvano Cozzi, Simona Narcisi, Pietro Mortini, Marco Losa, and Armando Soldarini

Remifentanil Provides Hemodynamic Stability and Faster Awakening Time in Transsphenoidal Surgery
Anesth Analg 2002 94: 163-168. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In patients undergoing transsphenoidal surgery, balanced anesthesia with remifentanil (0.22 {+/-} 0.17 {micro}g {middle dot} kg-1 {middle dot} min-1) provides faster awakening time, as compared with large-dose volatile-based anesthesia, without the risk of postoperative opioid respiratory depression.

Hiroshi Endoh, Tadayuki Honda, Satomi Ohashi, Seiji Hida, Chieko Shibue, and Noboru Komura

The Influence of Nicardipine-, Nitroglycerin-, and Prostaglandin E₁-Induced Hypotension on Cerebral Pressure Autoregulation in Adult Patients During Propofol-Fentanyl Anesthesia
Anesth Analg 2002 94: 169-173. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Vasodilators may influence cerebral autoregulation by changing cerebral vascular tone. Nicardipine, but not nitroglycerin or prostaglandin E1, attenuated cerebral pressure autoregulation in normal adult patients during propofol-fentanyl anesthesia.

OBSTETRIC ANESTHESIA:

Haluk Kafali, Tijen Kaya, Sinan Gürsoy, Ihsan Bagcivan, Baris Karadas, and Yusuf Sarioglu

The Role of K⁺ Channels on the Inhibitor Effect of Sevoflurane in Pregnant Rat Myometrium
Anesth Analg 2002 94: 174-178. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this study, we found that sevoflurane causes significantly decreased myometrial contractile activity in pregnant rats. The inhibition of myometrial smooth muscle induced by sevoflurane seems to be mediated, at least in part, via activation of Ca2+-activated K+ channels, because inhibition was reduced by tetraethylammonium.

Medge D. Owen, John A. Thomas, Trevor Smith, Lynn C. Harris, and Robert D’Angelo

Ropivacaine 0.075% and Bupivacaine 0.075% with Fentanyl 2 µg/mL are Equivalent for Labor Epidural Analgesia
Anesth Analg 2002 94: 179-183. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: At small concentrations, ropivacaine and bupivacaine when combined with fentanyl are equally effective for labor analgesia. Patients self-administered similar volumes of 0.075% ropivacaine or bupivacaine solutions containing fentanyl (2 {micro}g/mL) suggesting that at this concentration, and with the addition of fentanyl, ropivacaine and bupivacaine can be used interchangeably.

Nour-Eddine Baka, Françoise Bayoumeu, Marie-Jeanne Boutroy, and Marie-Claire Laxenaire

Colostrum Morphine Concentrations During Postcesarean Intravenous Patient-Controlled Analgesia
Anesth Analg 2002 94: 184-187. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Colostrum concentrations of morphine and its active metabolite morphine-6 glucuronide were measured in mothers receiving patient-controlled analgesia with morphine after cesarean delivery. The concentrations were found to be very small, thus supporting the safety of breast-feeding in mothers receiving IV patient-controlled analgesia with morphine.

REGIONAL ANESTHESIA:

Elizabeth A. Alley, Dan J. Kopacz, Susan B. McDonald, and Spencer S. Liu

Hyperbaric Spinal Levobupivacaine: A Comparison to Racemic Bupivacaine in Volunteers
Anesth Analg 2002 94: 188-193. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Hyperbaric spinal levobupivacaine has equivalent clinical efficacy to hyperbaric spinal bupivacaine over the 4-12-mg ranges.

Christian Glaser, Peter Marhofer, Gabriela Zimpfer, Marie T. Heinz, Christian Sitzwohl, Stephan Kapral, and Ingrid Schindler

Levobupivacaine Versus Racemic Bupivacaine for Spinal Anesthesia
Anesth Analg 2002 94: 194-198. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Levobupivacaine, the pure S(-)-enantiomer of racemic bupivacaine is an equally effective local anesthetic for spinal anesthesia compared with racemic bupivacaine.

Ngukhoon Tan, Neil M. Agnew, Nigel D. Scawn, Stephen H. Pennefather, Michael Chester, and Glenn N. Russell

Suprascapular Nerve Block for Ipsilateral Shoulder Pain After Thoracotomy with Thoracic Epidural Analgesia: A Double-Blind Comparison of 0.5% Bupivacaine and 0.9% Saline
Anesth Analg 2002 94: 199-202. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This randomized, double-blinded, placebo-controlled trial showed that suprascapular nerve block does not treat the severe ipsilateral shoulder pain that patients experience after thoracotomy. This has implications for established theories of referred pain and indicates that this pain is unlikely to originate in the shoulder.

Lionel Simon, Nobutaka Kariya, Emilie Pelle-Lancien, and Jean-Xavier Mazoit

Bupivacaine-Induced QRS Prolongation is Enhanced by Lidocaine and by Phenytoin in Rabbit Hearts
Anesth Analg 2002 94: 203-207. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The effects of lidocaine and phenytoin on bupivacaine-related increases in cardiac conduction time have been studied in an isolated heart preparation. Both drugs increased the QRS widening induced by bupivacaine. We conclude that none of these drugs should be used for treating bupivacaine intoxication.

Kamatham A. Naidu, Eugene S. Fu, and Leon D. Prockop

Acute Experimental Allergic Encephalomyelitis Increases Lumbar Spinal Cord Incorporation of Epidurally Administered [³H]-D-Mannitol and [¹⁴C]-Carboxyl-Inulin in Rabbits
Anesth Analg 2002 94: 208-212. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Acute experimental allergic encephalomyelitis, a disease model for multiple sclerosis, increased spinal cord incorporation of radioactive drugs administered in the epidural space. We conclude that demyelinating disease processes may expose the spinal cord to larger amounts of substances administered neuraxially.

Wilfred R. Lewis and Albert C. Perrino, Jr.

Transient Neurological Symptoms After Subarachnoid Meperidine (Case Report)
Anesth Analg 2002 94: 213-214. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The syndrome of transient neurological symptoms (TNS) after subarachnoid use of local anesthetics, particularly lidocaine, has been well described. This syndrome has not been reported with the subarachnoid use of opioids. This case report describes TNS that occurred after administration of subarachnoid meperidine, an opioid with local anesthetic properties.

GENERAL ARTICLES:

Alex Macario and Franklin Dexter

What are the Most Important Risk Factors for a Patient’s Developing Intraoperative Hypothermia?
Anesth Analg 2002 94: 215-220. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Surveys of clinicians and physician researchers identified what they consider to be the most important risk factors for perioperative hypothermia (e.g., neonates, a low ambient operating room temperature, burn patients, and general anesthesia with neuraxial anesthesia).

Yasufumi Nakajima, Toshiki Mizobe, Takashi Matsukawa, Daniel I. Sessler, Yoshihiro Kitamura, and Yoshifumi Tanaka

Thermoregulatory Response to Intraoperative Head-Down Tilt
Anesth Analg 2002 94: 221-226. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Intraoperative hypothermia is exaggerated when patients are maintained in the leg-up position because the vasoconstriction threshold is reduced. However, head-down tilt (Trendelenburg position) does not reduce the vasoconstriction threshold or aggravate hypothermia. The head-down tilt position thus does not require special perioperative thermal precautions or management unless the leg-up position is used simultaneously.

Jean-Pierre Estebe, Gilles Dollo, Pascal Le Corre, Alain Le Naoures, François Chevanne, Roger Le Verge, and Claude Ecoffey

Alkalinization of Intracuff Lidocaine Improves Endotracheal Tube-Induced Emergence Phenomena
Anesth Analg 2002 94: 227-230. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Use of 40 mg of alkalinized lidocaine, rather than lidocaine or air, to fill the endotracheal tube cuff reduces the incidence of sore throat in the postoperative period. This approach also decreases hemodynamic effects, restlessness, dysphonia, and hoarseness.

Luc-Marie Joly, A. M. Oswald, M. Disdet, and J. L. Raggueneau

Difficult Endotracheal Intubation as a Result of Penetrating Cranio-Facial Injury by an Arrow (Case Report)
Anesth Analg 2002 94: 231-232. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:We report a case of a 42-yr-old patient who underwent surgery for a penetrating craniofacial injury caused by an arrow. Because of the median vertical trajectory of the arrow (from the chin to the frontal skull), only the right nasal approach was accessible for endotracheal intubation. Fiberoptic nasal intubation and securing the airway under local anesthesia are described.

LETTERS TO THE EDITOR:

Munehiro Shiraishi, Kouichiro Minami, and Tatsuo Kadaya

A Safe Anesthetic Method Using Caudal Block and Ketamine for the Child with Congenital Myotonic Dystrophy
Anesth Analg 2002 94: 233. [Full Text] [PDF] [Request Permissions]  

Wolfram Schummer and Claudia Schummer

Another Cause of Epidural Catheter Breakage?
Anesth Analg 2002 94: 233. [Full Text] [PDF] [Request Permissions]  

Christopher MB Heard, James E. Fletcher, Manuel C. Vallejo, Gordon L. Mandell, and Sivam Ramanathan

Is it Ethically Correct to Study the Quincke Spinal Needle in Obstetric Patients? • Response
Anesth Analg 2002 94: 233-234. [Full Text] [PDF] [Request Permissions]  

Hiroki Yamamoto, Keiichi Omote, Eiji Homma, Yurie Kawamata, and Akiyoshi Namiki

Hazard with a Triple-Lumen Catheter
Anesth Analg 2002 94: 234-235. [Full Text] [PDF] [Request Permissions]  

Serge M. Broka and Sihem Boujlel

Capnography and Severe COPD
Anesth Analg 2002 94: 235. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Anesthesia, 5th Edition, on CD-ROM • Textbook of Cardiothoracic Anesthesiology • Anesthesia for Minimally Invasive Surgery: Laparoscopy, Thoracoscopy, Hysteroscopy; Volume 18 Number 1 (March 2001) of Anesthesiology Clinics of North America • Books and Multimedia Received
Anesth Analg 2002 94: 236-238. [Full Text] [PDF] [Request Permissions]  

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