EDITORIALS:

E. Joseph Denham and Robert M. Nelson

Self-Determination Is Not an Appropriate Model for Understanding Parental Permission and Child Assent
Anesth Analg 2002 94: 1049-1051. [Full Text] [PDF] [Request Permissions]  

Lee A. Fleisher and Kim A. Eagle

Guidelines on Perioperative Cardiovascular Evaluation: What Have We Learned Over the Past 6 Years to Warrant an Update?
Anesth Analg 2002 94: 1378-1379. [Full Text] [PDF] [Request Permissions]  

CARDIOVASCULAR ANESTHESIA:

Kim A. Eagle, Peter B. Berger, Hugh Calkins, Bernard R. Chaitman, Gordon A. Ewy, Kirsten E. Fleischmann, Lee A. Fleisher, James B. Froehlich, Richard J. Gusberg, Jeffrey A. Leppo, Thomas Ryan, Robert C. Schlant, William L. Winters, Jr, Raymond J. Gibbons, Elliott M. Antman, Joseph S. Alpert, David P. Faxon, Valentin Fuster, Gabriel Gregoratos, Alice K. Jacobs, Loren F. Hiratzka, Richard O. Russell, and Sidney C. Smith, Jr

ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery—Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Anesth Analg 2002 94: 1052-1064. [Full Text] [PDF] [Request Permissions]  

Michael J. Jacka, Marsha M. Cohen, Teresa To, J. Hugh Devitt, and Robert Byrick

The Use of and Preferences for the Transesophageal Echocardiogram and Pulmonary Artery Catheter Among Cardiovascular Anesthesiologists
Anesth Analg 2002 94: 1065-1071. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A survey of anesthesiologists found that pulmonary artery catheter monitoring is currently more frequently used compared with transesophageal echocardiography during cardiac and vascular surgery.

Ian J. Welsby, Elliott Bennett-Guerrero, Darryl Atwell, William D. White, Mark F. Newman, Peter K. Smith, and Michael G. Mythen

The Association of Complication Type with Mortality and Prolonged Stay After Cardiac Surgery with Cardiopulmonary Bypass
Anesth Analg 2002 94: 1072-1078. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Complications, particularly when they involve organs other than just the heart, increase mortality and prolong the length of hospital stay after heart surgery, independent of a patient's preoperative risk factors and the duration of cardiopulmonary bypass. Strategies aimed at preventing damage to other organs during cardiac surgery need to be improved.

Solomon Aronson, Denis Boisvert, and William Lapp

Isolated Systolic Hypertension Is Associated with Adverse Outcomes from Coronary Artery Bypass Grafting Surgery
Anesth Analg 2002 94: 1079-1084. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Isolated systolic hypertension is associated with a 40% increase in the likelihood of perioperative cardiovascular morbidity in coronary artery surgery patients.

Xiangyang Guo, Eiko Kuzumi, Susan C. Charman, and Alain Vuylsteke

Perioperative Melatonin Secretion in Patients Undergoing Coronary Artery Bypass Grafting
Anesth Analg 2002 94: 1085-1091. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Melatonin is a hormone that plays an important role in adjusting the biological clock in humans and that regulates secretion of various other hormones. We studied melatonin secretion in patients undergoing cardiac surgery with cardiopulmonary bypass. Melatonin secretion was disturbed during and immediately after surgery but had recovered a circadian rhythm 24 h later, raising the question of whether melatonin should be supplemented before cardiac surgery.

Robert Lattik, Pierre Couture, André Y. Denault, Michel Carrier, François Harel, Jean Taillefer, and Jean-Claude Tardif

Mitral Doppler Indices Are Superior to Two-Dimensional Echocardiographic and Hemodynamic Variables in Predicting Responsiveness of Cardiac Output to a Rapid Intravenous Infusion of Colloid
Anesth Analg 2002 94: 1092-1099. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In the presence of low cardiac output, the clinician's ability to identify which patients are more likely to benefit from volume administration to improve hemodynamic status while avoiding fluid overload is important. The analysis of Doppler measurement of the mitral flow as an indirect indicator of the individual diastolic pressure/volume relationship may be useful to predict the intravascular volume responsiveness in patients undergoing coronary artery bypass graft surgery.

Nancy J. Delboy, Richard C. Tomichek, and John A. Shields

The Hemodynamic Effects of Rapacuronium in Patients with Coronary Artery Disease: Succinylcholine and Vecuronium Compared
Anesth Analg 2002 94: 1100-1106. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Rapacuronium is associated with a significantly larger decrease in blood pressure than succinylcholine or vecuronium, and this decrease should be considered when using rapacuronium in patients who cannot tolerate this decrease.

Alexander Loeckinger, Christian Keller, Karl H. Lindner, and Axel Kleinsasser

Pulmonary Gas Exchange in Coronary Artery Surgery Patients During Sevoflurane and Isoflurane Anesthesia
Anesth Analg 2002 94: 1107-1112. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Both sevoflurane and isoflurane modified pulmonary blood flow in patients with coronary artery disease, but only sevoflurane depresses arterial oxygenation in this population.

Athos J. Rassias, Alice L. Givan, Charles A. S. Marrin, Kate Whalen, Janice Pahl, and Mark P. Yeager

Insulin Increases Neutrophil Count and Phagocytic Capacity After Cardiac Surgery
Anesth Analg 2002 94: 1113-1119. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: IV insulin, as used in this study, had effects on blood glucose only after cardiac surgery, when it was associated with an increased neutrophil count and a greater total capacity of peripheral blood neutrophils to ingest foreign particles.

Junpei Nozaki, Hiroshi Kitahata, Katsuya Tanaka, Shinji Kawahito, and Shuzo Oshita

The Effects of Acute Normovolemic Hemodilution on Left Ventricular Systolic and Diastolic Function in the Absence or Presence of ß-Adrenergic Blockade in Dogs
Anesth Analg 2002 94: 1120-1126. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Acute normovolemic hemodilution enhances LV (left ventricular) diastolic function by alterations in the LV loading condition produced by hemodilution, which mainly contributes to a compensatory increase in cardiac output.

Jeroen de Jonge, Theo H. N. Groenland, Herold J. Metselaar, Jan N. M. IJzermans, Huub H. D. M. van Vliet, Loes Visser, and Hugo W. Tilanus

Fibrinolysis During Liver Transplantation Is Enhanced by Using Solvent/Detergent Virus-Inactivated Plasma (ESDEP^®)
Anesth Analg 2002 94: 1127-1131. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The use of solvent/detergent virus-inactivated plasma is of increasing importance in the prevention of human immunodeficiency virus and hepatitis C virus transmission. Since the use of this plasma during orthotopic liver transplantation has increased, the incidence of hyperfibrinolysis was observed. Clotting analysis of the patients revealed small {alpha}2-antiplasmin concentrations because of the solvent/detergent process.

David Amar, Paul M. Heerdt, Robert J. Korst, Hao Zhang, and Hai Nguyen

The Effects of Advanced Age on the Incidence of Supraventricular Arrhythmias After Pneumonectomy in Dogs
Anesth Analg 2002 94: 1132-1136. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this canine pneumonectomy model, advanced age was associated with an increased incidence of supraventricular arrhythmias, perhaps because of increased atrial fibrosis and inflammation.

Shahbaz R. Arain, David J. Williams, Brian J. Robinson, Toni D. Uhrich, and Thomas J. Ebert

Vascular Responsiveness to Brachial Artery Infusions of Phenylephrine During Isoflurane and Desflurane Anesthesia
Anesth Analg 2002 94: 1137-1140. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: {alpha}-receptors on blood vessels regulate constriction and dilation and therefore modulate blood pressure. This research indicates that vasoconstriction via the {alpha}1-receptor vascular response is impaired during isoflurane and desflurane anesthesia.

Alexander Mentel, Friedhelm Bach, Joerg Schüler, Walter Herrmann, Andreas Koster, George J. Crystal, Georgios Gatzounis, and Fritz Mertzlufft

Assessing Errors in the Determination of Base Excess
Anesth Analg 2002 94: 1141-1148. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A clinically useful way to quantify nonrespiratory disturbances of the acid-base balance is calculation of the base excess of extracellular fluid by using blood gas analyzers. In this study, we found significant variability in estimates of base excess of extracellular fluid obtained with five analyzers from different manufacturers. This variability is attributable to multiple factors, including lack of correction for deoxygenated hemoglobin (Haldane effect).

Cynthia Vaughn, George Mychaskiw, II, and Patrick Sewell

Massive Hemorrhage During Radiofrequency Ablation of a Pulmonary Neoplasm (Case Report)
Anesth Analg 2002 94: 1149-1151. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Radiofrequency ablation is a new investigational therapy for primary and secondary neoplasms. In this article, the authors describe the anesthetic management of the radiofrequency ablation of a pulmonary neoplasm complicated by massive hemorrhage.

Rodrigo R. Gazmuri, Juan A. Muñoz, Juan P. Ilic, Ricardo M. Urtubia, and Roberto R. Glucksmann

Vasospasm After Use of a Tourniquet: Another Cause of Postoperative Limb Ischemia? (Case Report)
Anesth Analg 2002 94: 1152-1154. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:Two previously reported causes of postoperative limb ischemia after use of a tourniquet, compartment syndrome and arterial thromboembolism, require aggressive and invasive management. We report another probable cause that can be managed nonsurgically: vasospasm.

PEDIATRIC ANESTHESIA:

Thomas O. Erb, Scott R. Schulman, and Jeremy Sugarman

Permission and Assent for Clinical Research in Pediatric Anesthesia (Special Article)
Anesth Analg 2002 94: 1155-1160. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This article discusses the process and specific nature of informed consent for clinical research in pediatric anesthesia. For informed consent to be meaningful, permission from the child's proxy must be obtained and the child's assent must be tailored in a manner that is sensitive to the abilities of children.

Susan T. Verghese, Lucille A. Mostello, Ramesh I. Patel, Richard F. Kaplan, and Kantilal M. Patel

Testing Anal Sphincter Tone Predicts the Effectiveness of Caudal Analgesia in Children
Anesth Analg 2002 94: 1161-1164. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A lax anal sphincter in children undergoing inguinal and/or penile surgery can predict the effectiveness of analgesia after pediatric caudal blockade.

Eric Larousse, Karim Asehnoune, Bruno Dartayet, Pierre Albaladejo, Anne-Marie Dubousset, Frédéric Gauthier, and Dan Benhamou

The Hemodynamic Effects of Pediatric Caudal Anesthesia Assessed by Esophageal Doppler
Anesth Analg 2002 94: 1165-1168. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Although pediatric caudal anesthesia does not alter heart rate nor arterial blood pressure, significant changes occur in regional blood flow distribution. Descending aortic blood flow increases significantly after caudal anesthesia, whereas lower body vascular resistances decrease.

Helmut Hager, Peter Marhofer, Christian Sitzwohl, Leo Adler, Stephan Kettner, and Margot Semsroth

Caudal Clonidine Prolongs Analgesia from Caudal S(+)-Ketamine in Children
Anesth Analg 2002 94: 1169-1172. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Caudally administered preservative-free S(+)-ketamine combined with 1 or 2 {micro}g/kg clonidine provides excellent perioperative analgesia in children and has minimal side effects.

Holger K. Eltzschig, Torsten H. Schroeder, B. Jürgen Eissler, Thomas W. Felbinger, Reinhard Vonthein, Raila Ehlers, and Heinz Guggenberger

The Effect of Remifentanil or Fentanyl on Postoperative Vomiting and Pain in Children Undergoing Strabismus Surgery
Anesth Analg 2002 94: 1173-1177. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Opioids increase the incidence of postoperative vomiting (POV). Remifentanil is characterized by the shortest half-life of all opioids used in anesthetic practice. Therefore, we studied the effect of remifentanil on POV compared with the longer-acting opioid fentanyl in children undergoing strabismus surgery.

Ira Todd Cohen, Julia C. Finkel, Raafat S. Hannallah, Kelly A. Hummer, and Kantilal M. Patel

The Effect of Fentanyl on the Emergence Characteristics After Desflurane or Sevoflurane Anesthesia in Children
Anesth Analg 2002 94: 1178-1181. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The concurrent use of fentanyl in a dose of 2.5 {micro}g/kg in children receiving desflurane or sevoflurane results in a low incidence of emergence agitation. Desflurane allows for a more rapid emergence and recovery than sevoflurane.

David S. Beebe, Shoumin Zhu, M. V. Shailesh Kumar, Vijaya Komanduri, John A. Reichert, and Kumar G. Belani

The Effect of Insufflation Pressure on CO₂ Pneumoperitoneum and Embolism in Piglets
Anesth Analg 2002 94: 1182-1187. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The lowest pressure possible should be used when inflating the abdomen with CO2 to perform a laparoscopy in babies. A low pressure allows better ventilation and may prevent mortality if CO2 is accidentally injected into a vein.

AMBULATORY ANESTHESIA:

Tijani Issioui, Kevin W. Klein, Paul F. White, Mehernoor F. Watcha, Margarita Coloma, Gary D. Skrivanek, Stephanie B. Jones, Kevin C. Thornton, and Bradley F. Marple

The Efficacy of Premedication with Celecoxib and Acetaminophen in Preventing Pain After Otolaryngologic Surgery
Anesth Analg 2002 94: 1188-1193. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Oral premedication with a combination of acetaminophen (2000 mg) and celecoxib (200 mg) was effective in decreasing pain and improving patient satisfaction after otolaryngologic surgery. However, acetaminophen (2000 mg) or celecoxib (200 mg) alone was not significantly more effective than placebo in reducing postoperative pain.

Alexander Ng, David G. Raitt, and Graham Smith

Induction of Anesthesia and Insertion of a Laryngeal Mask Airway in the Prone Position for Minor Surgery
Anesth Analg 2002 94: 1194-1198. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: With experience and appropriate patient selection, it is possible to induce and maintain anesthesia using a laryngeal mask airway in patients in the prone position for ambulatory surgery.

Tong J. Gan, Randall Franiak, and Jolin Reeves

Ondansetron Orally Disintegrating Tablet Versus Placebo for the Prevention of Postdischarge Nausea and Vomiting After Ambulatory Surgery (Brief Report)
Anesth Analg 2002 94: 1199-1200. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Ondansetron orally disintegrating tablet reduces postdischarge nausea and vomiting and improves patient satisfaction with postoperative nausea and vomiting management.

ANESTHETIC PHARMACOLOGY:

Tetsuya Kushikata, Kazuyoshi Hirota, Hitoshi Yoshida, Takeshi Kubota, Hironori Ishihara, and Akitomo Matsuki

Alpha-2 Adrenoceptor Activity Affects Propofol-Induced Sleep Time
Anesth Analg 2002 94: 1201-1206. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Central {alpha}2 adrenoceptor is thought to be involved in several IV anesthetics-induced sleep. In this study, activation of the receptor increased the propofol-induced sleep time, whereas its inhibition decreased the sleep time. The results provide further evidence that the {alpha}2 receptor is a good tool to elucidate the mechanism of anesthetics-induced sleep.

Noriaki Kanaya, Hitoshi Satoh, Sumihiko Seki, Masayasu Nakayama, and Akiyoshi Namiki

Propofol Anesthesia Enhances the Pressor Response to Intravenous Ephedrine
Anesth Analg 2002 94: 1207-1211. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The effect of anesthetics on vasopressor-mediated cardiovascular effects is poorly understood. We evaluated the pressor response to ephedrine during propofol or sevoflurane anesthesia. Our study suggests that anesthesia-induced hypotension may be easier to reverse with ephedrine during propofol anesthesia than during sevoflurane anesthesia.

Sylvie Passot, Frédérique Servin, René Allary, Jean Pascal, Jean-Michel Prades, Christian Auboyer, and Serge Molliex

Target-Controlled Versus Manually-Controlled Infusion of Propofol for Direct Laryngoscopy and Bronchoscopy
Anesth Analg 2002 94: 1212-1216. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study compares the clinical profile of propofol anesthesia for direct laryngoscopy with spontaneous ventilation when the drug is administered either as a manually controlled infusion or by targeting the effect-site concentration through a target-controlled infusion (TCI) device. TCI improves the time course of propofol effects.

Emilio Matute, Estíbaliz Alsina, Rosario Roses, Guadalupe Blanc, Concepción Pérez-Hernández, and Fernando Gilsanz

An Inhalation Bolus of Sevoflurane Versus an Intravenous Bolus of Remifentanil for Controlling Hemodynamic Responses to Surgical Stress During Major Surgery: A Prospective Randomized Trial
Anesth Analg 2002 94: 1217-1222. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We compared an inhalation bolus of sevoflurane with remifentanil for managing hemodynamic responses to major abdominal or thoracic surgery. This prospective, randomized trial demonstrated better results with sevoflurane.

Burkhard Gustorff, Gabriele Nahlik, Klaus H. Hoerauf, and Hans G. Kress

The Absence of Acute Tolerance During Remifentanil Infusion in Volunteers
Anesth Analg 2002 94: 1223-1228. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The opioid remifentanil was applied to 20 volunteers at a constant concentration for 3 h while pain thresholds to temperature and current were repeatedly assessed. Our aim was to study whether thresholds decrease over time because of the rapid development of opioid tolerance. No development of rapid opioid tolerance was observed.

W. Andrew Kofke, Ahmed F. Attaallah, Hiroto Kuwabara, Robert H. Garman, Elizabeth H. Sinz, John Barbaccia, Naresh Gupta, and Jeffery P. Hogg

The Neuropathologic Effects in Rats and Neurometabolic Effects in Humans of Large-Dose Remifentanil
Anesth Analg 2002 94: 1229-1236. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study demonstrates dose-related remifentanil neurotoxicity in physiologically controlled rats with congruent brain metabolic effects in four humans undergoing positron emission tomography evaluation during brief large-dose remifentanil anesthesia. These data suggest that some adverse effects reported in rats may be clinically relevant.

Belinda M. Schramm and Beverley A. Orser

Dystonic Reaction to Propofol Attenuated by Benztropine (Cogentin) (Case Report)
Anesth Analg 2002 94: 1237-1240. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Neuroexcitatory movements associated with propofol anesthesia are well recognized. Here we report on the successful use of benztropine (2 mg) to abolish abnormal dystonic movements after propofol anesthesia. Forty-five case reports are reviewed, and a treatment strategy for abnormal movements during propofol anesthesia is provided.

Ken B. Johnson, Jeffrey D. Swenson, Talmage D. Egan, Robert Jarrett, and Mathew Johnson

Midazolam and Remifentanil by Bolus Injection for Intensely Stimulating Procedures of Brief Duration: Experience with Awake Laryngoscopy (Case Report)
Anesth Analg 2002 94: 1241-1243. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The pharmacokinetic characteristics of midazolam and remifentanil administered by bolus injection may make them advantageous for providing brief, intense analgesia without prolonged respiratory depression. This application is particularly useful for awake, direct laryngoscopy.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Burkhard Gustorff, Norbert Lorenzl, Laleh Aram, Claus G. Krenn, Brigitte P. Jobst, and Klaus H. Hoerauf

Environmental Monitoring of Sevoflurane and Nitrous Oxide Using the Cuffed Oropharyngeal Airway
Anesth Analg 2002 94: 1244-1248. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this study, we have shown that the occupational exposure to waste anesthetic gases is comparable when using the cuffed oropharyngeal airway (COPA) and the laryngeal mask airway and is increased when using the face mask. Therefore, the COPA may be a valuable alternative to the conventional face mask during short surgical procedures.

Fumio Nishihara and Shigeru Saito

Pre-Ictal Bispectral Index Has a Positive Correlation with Seizure Duration During Electroconvulsive Therapy
Anesth Analg 2002 94: 1249-1252. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Pre-ictal bispectral index had a positive correlation with seizure duration and could be useful to prevent an unacceptably short seizure in electroconvulsive therapy under propofol anesthesia.

PAIN MEDICINE:

Igor Kissin, Cheryl A. Bright, and Edwin L. Bradley, Jr.

Selective and Long-Lasting Neural Blockade with Resiniferatoxin Prevents Inflammatory Pain Hypersensitivity
Anesth Analg 2002 94: 1253-1258. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report that an ultrapotent vanilloid agonist resiniferatoxin can provide a selective and long-lasting neural blockade. Applied to the sciatic and saphenous nerves, it completely prevented pain hypersensitivity caused by prolonged inflammatory process (injection of carrageenan into the paw).

Julia C. Finkel, Charles I. Yang, Jessica L. Yarvitz, and Kantilal M. Patel

Neuroselective Sensory Electrodiagnostic Evaluation of 4% Liposomal Topical Lidocaine
Anesth Analg 2002 94: 1259-1262. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: An average onset time of approximately 7 min for topical 4% liposomal lidocaine was determined using neuroselective neurostimulation. This suggests that procedural pain such as venipuncture may be attenuated in this time frame. This technique requires correlation with conventional sensory measurements.

Jean-Paul Laulin, Pierre Maurette, Jean-Benoît Corcuff, Cyril Rivat, Marcel Chauvin, and Guy Simonnet

The Role of Ketamine in Preventing Fentanyl-Induced Hyperalgesia and Subsequent Acute Morphine Tolerance
Anesth Analg 2002 94: 1263-1269. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Fentanyl-induced analgesia is followed by early hyperalgesia (hours), acute tolerance to the analgesic effects of morphine, and long-lasting hyperalgesia (days). All these phenomena are totally prevented by repeated administrations of the NMDA-receptor antagonist, ketamine, simultaneously with fentanyl and morphine administration.

Mattias Casutt, Georgios Ekatodramis, Konrad Maurer, and Alain Borgeat

Projected Complex Sensations After Interscalene Brachial Plexus Block (Case Report)
Anesth Analg 2002 94: 1270-1271. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The development of projected complex sensations mimicking phantom pain after interscalene block is reported. The recognition of this entity is important because it may be confused with some other cardiac, esophageal, or visceral pathologies.

ECONOMICS AND HEALTH SYSTEMS RESEARCH:

Franklin Dexter and Alex Macario

Changing Allocations of Operating Room Time From a System Based on Historical Utilization to One Where the Aim is to Schedule as Many Surgical Cases as Possible
Anesth Analg 2002 94: 1272-1279. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We investigated the complex relationships among the number of surgical services, number of staffed operating rooms (ORs), length of the regularly scheduled OR workday, efficiency of use of OR time, OR staffing cost, and changes in each services' allocated OR time.

CRITICAL CARE AND TRAUMA:

Dietmar Fries, Petra Innerhofer, Anton Klingler, Ulrike Berresheim, Markus Mittermayr, Andreas Calatzis, and Wolfgang Schobersberger

The Effect of the Combined Administration of Colloids and Lactated Ringer’s Solution on the Coagulation System: An In Vitro Study Using Thrombelastograph^® Coagulation Analysis (ROTEG^®)
Anesth Analg 2002 94: 1280-1287. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The effect of the combined administration of different colloids and/or crystalloids on coagulation is not known. We show that hemostasis is less impaired using a combination of gelatin and median-weight starches than using median-weight starches alone. Furthermore, the combination of lactated Ringer's solution and gelatin decreases the coagulation system to the same extent as the combination of lactated Ringer's solution and 6% hydroxyethyl starch 130/0.4.

Kenneth C. Petroni and Neal H. Cohen

Continuous Renal Replacement Therapy: Anesthetic Implications (Review Article)
Anesth Analg 2002 94: 1288-1297. [Full Text] [PDF] [Request Permissions]  

NEUROSURGICAL ANESTHESIA:

Kate Leslie, Andrew R. Bjorksten, Antony Ugoni, and Peter Mitchell

Mild Core Hypothermia and Anesthetic Requirement for Loss of Responsiveness During Propofol Anesthesia for Craniotomy
Anesth Analg 2002 94: 1298-1303. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Neurosurgical patients may be allowed to become mildly hypothermic during anesthesia in an effort to provide brain protection. Propofol maintenance infusion doses may not require adjustment in these patients.

OBSTETRIC ANESTHESIA:

Steven Y. Wang, Sanjay Datta, and Scott Segal

Pregnancy Alters Adrenergic Mechanisms in Uterine Arterioles of Rats
Anesth Analg 2002 94: 1304-1309. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Both {alpha}- and ß-adrenergic responses are important mechanisms for the regulation of uteroplacental perfusion. By use of an in vitromicrovascular technique, we have shown pregnancy-associated alteration in adrenergic responses in the uterine microcirculation of the rat.

Raymond S. Sinatra, Steven Eige, James H. Chung, K. Sam Chung, Ferne B. Sevarino, Ana Lobo, Lee Fermo, and Carlos A. Ocampo

Continuous Epidural Infusion of 0.05% Bupivacaine Plus Hydromorphone for Labor Analgesia: An Observational Assessment in 1830 Parturients (Brief Report)
Anesth Analg 2002 94: 1310-1311. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We evaluated a continuous epidural infusion containing bupivacaine 0.05% plus the opioid hydromorphone in 1830 women requesting pain relief during labor and delivery. The infusion provided effective analgesia with minimal adverse events for patients differing in parity and at varying stages of labor. Pain relief was maintained in most patients without the need for epidural reinforcement with more concentrated doses of local anesthetic.

Yan-Ling He, Hiroshi Seno, Ken Sasaki, and Chikara Tashiro

The Influences of Maternal Albumin Concentrations on the Placental Transfer of Propofol in Human Dually Perfused Cotyledon In Vitro (Brief Report)
Anesth Analg 2002 94: 1312-1314. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: These results indicate that fetal exposure to propofol can vary considerably depending on maternal plasma albumin concentration. A fractional change in the maternal protein binding of propofol can result in a relatively large difference in fetal exposure.

Tracey M. Vogel, Emily F. Ratner, Robert C. Thomas, Jr., and Usha Chitkara

Pregnancy Complicated By Severe Osteogenesis Imperfecta: A Report Of Two Cases (Case Report)
Anesth Analg 2002 94: 1315-1317. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This case report discusses the anesthetic management of two parturients with severe osteogenesis imperfecta who presented for cesarean delivery. Although the anesthetic management for milder forms of the disease has been previously reported, anesthetic options for cases of this severity have not.

REGIONAL ANESTHESIA:

Süreyya Gültekin and Saziye Özcan

Does Hearing Loss After Spinal Anesthesia Differ Between Young and Elderly Patients?
Anesth Analg 2002 94: 1318-1320. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Spinal anesthesia is one of the most frequently used regional anesthesia techniques in surgical interventions; however, rarely it may cause some transient or permanent neurological problems. One of these problems is headache, which is more frequent and severe in the young, and hearing loss, especially at low frequencies. Both the pain and the hearing loss are caused by leak of cerebrospinal fluid caused by the puncture in the membrane of the spinal cord during the procedure. We hypothesized that hearing loss might also be more frequent and severe in the young, and to test this hypothesis, we compared the hearing loss developing after spinal anesthesia between the young and the elderly. The implications of this study are as follows: First, spinal anesthesia must be performed carefully, especially in the young. Second, measures must be taken to avoid the leak of cerebrospinal fluid. This study reveals possible problems caused by spinal anesthesia in the young which can be easily overlooked.

Admir Hadzic, Jerry D. Vloka, R. Singson, Alan C. Santos, and Daniel M. Thys

A Comparison of Intertendinous and Classical Approaches to Popliteal Nerve Block Using Magnetic Resonance Imaging Simulation
Anesth Analg 2002 94: 1321-1324. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A simulation of popliteal block using magnetic resonance imaging in volunteers suggests that using tendons of the hamstring muscles as the anatomical landmarks yields a more consistent localization of the sciatic nerve.

Mischa J. G. Simon, Bernadette T. Veering, Rudolf Stienstra, Jack W. van Kleef, and Anton G. L. Burm

The Effects of Age on Neural Blockade and Hemodynamic Changes After Epidural Anesthesia with Ropivacaine
Anesth Analg 2002 94: 1325-1330. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Analgesia levels after the epidural administration of 15 mL of ropivacaine 1.0% increase with increasing age. This is associated with an increased incidence of hypotension in the elderly, although an effect of age on the hemodynamic homeostasis may have contributed. It appears that epidural doses should be adjusted for elderly patients.

Luis Casati, Susana Fernández-Galinski, Enriqueta Barrera, Olga Pol, and Margarita M. Puig

Isoflurane Requirements During Combined General/Epidural Anesthesia for Major Abdominal Surgery
Anesth Analg 2002 94: 1331-1337. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In patients undergoing colon resection under combined anesthesia, isoflurane requirements were assessed by changes in blood pressure or bispectral index. Epidural bupivacaine at concentrations of 0.125% or 0.0625% (each with 2 mg/mL of fentanyl) induced the same sparing of isoflurane (35%). The smaller dose produced less hypotension and should be favored.

Majid Aramideh, Huub L. A. van den Oever, Gerard J. Walstra, and Misa Dzoljic

Spinal Anesthesia as a Complication of Brachial Plexus Block Using the Posterior Approach (Case Report)
Anesth Analg 2002 94: 1338-1339. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this case report we describe a technique used to provide local analgesia for surgical procedures. Although this technique has a reduced risk of complications, we present a patient who experienced a life-threatening paralysis without loss of consciousness during an attempted brachial plexus block with a posterior approach.

GENERAL ARTICLES:

Selma Türkan, Yesim Ates, Handan Cuhruk, and Ibrahim Tekdemir

Should We Reevaluate the Variables for Predicting the Difficult Airway in Anesthesiology?
Anesth Analg 2002 94: 1340-1344. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study was performed to establish data on the average values of airway morphology in the adult population of different age groups and sex. Hyomental, thyromental, sternomental distances and neck extension values were measured on 12 cadavers and 334 patients.

Juraj Sprung, David G. Whalley, Tommaso Falcone, David O. Warner, Rolf D. Hubmayr, and Jeffrey Hammel

The Impact of Morbid Obesity, Pneumoperitoneum, and Posture on Respiratory System Mechanics and Oxygenation During Laparoscopy
Anesth Analg 2002 94: 1345-1350. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Morbid obesity significantly decreases respiratory system compliance and increases inspiratory resistance. Increased body weight, and not altered mechanics of breathing, was associated with worse PaO2 during laparoscopy.

Zhengnian Ding and Paul F. White

Anesthesia for Electroconvulsive Therapy (Review Article)
Anesth Analg 2002 94: 1351-1364. [Full Text] [PDF] [Request Permissions]  

LETTERS TO THE EDITOR:

B. J. Riedel and A. D. Shaw

Thoracic Epidural Anesthesia & Analgesia in Patients Undergoing Coronary Artery Bypass Surgery
Anesth Analg 2002 94: 1365. [Full Text] [PDF] [Request Permissions]  

R. Peter Alston and N. B. Scott

Thoracic Epidurals and Coronary Artery Bypass Grafting Surgery • Response
Anesth Analg 2002 94: 1365-1366. [Full Text] [PDF] [Request Permissions]  

J. Kurian, V. Raghavan, R. Raobaikady, Thomas Simopoulos, and Christine Peeters-Asdourian

Minimizing the Risk of Dural Puncture During Cervical Epidural Injection • Response
Anesth Analg 2002 94: 1366. [Full Text] [PDF] [Request Permissions]  

N. R. Evans, S. V. Gardner, M. F. M. James, Joseph Brimacombe, Sarah Kennaugh, Alison Berry, and Christian Keller

Malposition of the ProSeal Laryngeal Mask • Response
Anesth Analg 2002 94: 1366-1367. [Full Text] [PDF] [Request Permissions]  

I. Quintus Molenaar, Robert J. Porte, Michael G. Fitzsimons, and Robert A. Peterfreund

Aprotinin and Thromboembolism in Liver Transplantation: Is There Really a Causal Effect? • Response
Anesth Analg 2002 94: 1367-1368. [Full Text] [PDF] [Request Permissions]  

Adrian Matioc, George A. Arndt, J. Brimacombe, M. Howes, C. Keller, and A. Berry

Use of the Portex Laryngeal Mask Introducer with the ProSeal LMA • Response
Anesth Analg 2002 94: 1368-1369. [Full Text] [PDF] [Request Permissions]  

Luz Cánovas, Carmen Barros, Ana Gómez, Marcos Castro, and Andrés Castro

Use of Intravenous Tetracosactin in the Treatment of Postdural Puncture Headache: Our Experience in Forty Cases
Anesth Analg 2002 94: 1369. [Full Text] [PDF] [Request Permissions]  

Wulf Dietrich, Michael Spannagl, Herman G. D. Hendriks, Joost M. A. A. van der Maaten, Joost Th. M. de Wolf, and Jan van der Meer

Caveat Against the Use of Activated Recombinant Factor VII for Intractable Bleeding in Cardiac Surgery • Response
Anesth Analg 2002 94: 1369-1371. [Full Text] [PDF] [Request Permissions]  

Xiaoyuan Xie, Xuan Au-Truong, Arthur J. Klowden, Ninos J. Joseph, and M. Ramez Salem

Mallampati Class "Zero"
Anesth Analg 2002 94: 1371. [Full Text] [PDF] [Request Permissions]  

K. Toker, Y. Gürkan, and M. Keser

A Faulty Epidural Catheter
Anesth Analg 2002 94: 1371-1372. [Full Text] [PDF] [Request Permissions]  

Steven M. Neustein, Daniel Krellenstein, Edmond Cohen, and Tatsuhiro Oka

Arrhythmias After Video Assist Thoracoscopy • Response
Anesth Analg 2002 94: 1372. [Full Text] [PDF] [Request Permissions]  

Jae-Hyon Bahk, Dean B. Andropoulos, and Stephen A. Stayer

The Optimal Location of Central Venous Catheters • Response
Anesth Analg 2002 94: 1372-1373. [Full Text] [PDF] [Request Permissions]  

Michael A. Cooper, Andrew D. M. McLeod, Terese T. Horlocker, and Gregory A. Nuttall

The Accuracy of Coagulation Testing • Response
Anesth Analg 2002 94: 1373-1374. [Full Text] [PDF] [Request Permissions]  

Gregory F. Paine, Joseph J. Kochan, III, Christine J.C. Cheng, and Davinder S. Garewal

Failure of the Chain-Link Mechanism of the Ohmeda Excel 210 Anesthesia Machine • Response
Anesth Analg 2002 94: 1374. [Full Text] [PDF] [Request Permissions]  

Cornelius J. O’Connor, Jr, Carl J. Borromeo, Michael S. Stix, Joseph Brimacombe, Christian Keller, Alison Berry, and Steve Mitchell

Assessing ProSeal Laryngeal Mask Positioning: The Suprasternal Notch Test • Response
Anesth Analg 2002 94: 1374-1375. [Full Text] [PDF] [Request Permissions]  

Evan G. Pivalizza, Mir Sohel, Karin Persely, and Tara Wegryn

An Evoked Arrhythmia
Anesth Analg 2002 94: 1375-1376. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 10^th Edition • Books and Multimedia Received
Anesth Analg 2002 94: 1377. [Full Text] [PDF] [Request Permissions]  

ERRATA:

Erratum
Anesth Analg 2002 94: 1172. [Full Text] [PDF] [Request Permissions]  

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