EDITORIALS:

Michele Curatolo

Is Epinephrine Unfairly Neglected for Postoperative Epidural Mixtures?
Anesth Analg 2002 94: 1381-1383. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Michael K. Cahalan, Martin Abel, Martin Goldman, Alan Pearlman, Pamela Sears-Rogan, Isobel Russell, Jack Shanewise, William Stewart, and Christopher Troianos

American Society of Echocardiography and Society of Cardiovascular Anesthesiologists Task Force Guidelines for Training in Perioperative Echocardiography
Anesth Analg 2002 94: 1384-1388. [Full Text]  

Yukie Sato, Daniel T. Laskowitz, Ellen R. Bennett, Mark F. Newman, David S. Warner, and Hilary P. Grocott

Differential Cerebral Gene Expression During Cardiopulmonary Bypass in the Rat: Evidence for Apoptosis?
Anesth Analg 2002 94: 1389-1394. [Abstract] [Full Text]  

IMPLICATIONS: Cardiopulmonary bypass (CPB) appears to induce transcription of pro- and antiapoptotic genes in the rat brain, but caspase-mediated apoptosis itself does not appear to be activated. Elucidating the molecular biological sequelae of CPB may aid in the understanding of the pathophysiology of cardiac surgery-associated cerebral injury and, in doing so, may be useful in identifying potential therapeutic targets for pharmacologic neuroprotection.

Yuji Kadoi, Shigeru Saito, Fumio Goto, and Nao Fujita

Slow Rewarming Has No Effects on the Decrease in Jugular Venous Oxygen Hemoglobin Saturation and Long-Term Cognitive Outcome in Diabetic Patients
Anesth Analg 2002 94: 1395-1401. [Abstract] [Full Text]  

IMPLICATIONS: We examined the effects of rewarming rate on internal jugular venous oxygen hemoglobin saturation in diabetic and nondiabetic patients during the rewarming period and long-term cognitive outcome. Slow rewarming could not prevent the frequency of the reduction in internal jugular venous oxygen hemoglobin saturation and adverse cognitive outcome in diabetic patients.

Stephen E. Kimmel, Mikkael Sekeres, Jesse A. Berlin, and Norig Ellison

Mortality and Adverse Events After Protamine Administration in Patients Undergoing Cardiopulmonary Bypass
Anesth Analg 2002 94: 1402-1408. [Abstract] [Full Text]  

IMPLICATIONS: A retrospective cohort study demonstrated an association between adverse events after a protamine administration and increased in-hospital mortality.

Michael H. Wall, Drew A. MacGregor, Daniel J. Kennedy, Robert L. James, John Butterworth, Kathryn F. Mallak, and Roger L. Royster

Pulmonary Artery Catheter Placement for Elective Coronary Artery Bypass Grafting: Before or After Anesthetic Induction?
Anesth Analg 2002 94: 1409-1415. [Abstract] [Full Text]  

IMPLICATIONS: Insertion of pulmonary artery catheters (PACs) before the induction of anesthesia requires more needle sticks and takes longer than insertion after the induction of anesthesia; moreover, previous PAC insertion has no significant effect on hemodynamics or use of vasoactive drugs or IV fluid associated with the induction of anesthesia.

Maiko Sawada, Seiji Watanabe, Hideaki Tsuda, and Tatsuhiko Kano

An Increase in Body Temperature During Radiofrequency Ablation of Liver Tumors
Anesth Analg 2002 94: 1416-1420. [Abstract] [Full Text]  

IMPLICATIONS: The increase in body temperature (BT) is predictable during radiofrequency ablation (RFA) of liver tumors under general anesthesia. Close observation of total output energy delivered and BT are required, and preparation of cooling measures is important, in RFA of liver tumors.

Franz Kehl, Tobias T. Kress, Boris Mraovic, Douglas A. Hettrick, Judy R. Kersten, David C. Warltier, and Paul S. Pagel

Propofol Alters Left Atrial Function Evaluated with Pressure-Volume Relations In Vivo
Anesth Analg 2002 94: 1421-1426. [Abstract] [Full Text]  

IMPLICATIONS: Propofol depresses contractile function of left atrial (LA) myocardium, impairs mechanical matching between the LA and the left ventricular (LV), and reduces the active LA contribution to LV filling in vivo. Compensatory decreases in chamber stiffness contribute to relative maintenance of LA reservoir function during the administration of propofol.

Bracken J. De Witt, Ikhlass N. Ibrahim, Erin Bayer, Aaron M. Fields, Todd A. Richards, Ronald E. Banister, and Alan D. Kaye

An Analysis of Responses to Levosimendan in the Pulmonary Vascular Bed of the Cat
Anesth Analg 2002 94: 1427-1433. [Abstract] [Full Text]  

IMPLICATIONS: Calcium-sensitizing drugs, such as levosimendan, are a novel class of drug therapy for heart-failure treatment. The lung circulation affects both right- and left-sided heart failure. Levosimendan decreased lobar arterial pressure via a partial K+ATP (potassium channel sensitive to intracellular adenosine triphosphate levels)-dependent mechanism. These data suggest that, in addition to calcium-sensitizing activity, levosimendan decreases pulmonary resistance, which may also aid in the treatment of heart failure.

Junichirou Hamasaki, Isao Tsuneyoshi, Rumi Katai, Tatewaki Hidaka, Walter A. Boyle, and Yuichi Kanmura

Dual ₂-Adrenergic Agonist and ₁-Adrenergic Antagonist Actions of Dexmedetomidine on Human Isolated Endothelium-Denuded Gastroepiploic Arteries
Anesth Analg 2002 94: 1434-1440. [Abstract] [Full Text]  

IMPLICATIONS: Dexmedetomidine may not directly affect smooth muscle in human peripheral resistance vessels within the usual range of plasma concentrations (<10-7 mol/L) achieved in clinical practice. However, in large doses, it could enhance the response to nonadrenergic vasoconstrictor agonists while antagonizing the vasoconstrictor response to {alpha}1-adrenoceptor agonists.

Klaus Hahnenkamp, Gregor Theilmeier, Hugo K. Van Aken, and Christian W. Hoenemann

The Effects of Local Anesthetics on Perioperative Coagulation, Inflammation, and Microcirculation (Special Article)
Anesth Analg 2002 94: 1441-1447. [Full Text]  

Benedikt H. J. Pannen

New Insights Into the Regulation of Hepatic Blood Flow After Ischemia and Reperfusion (Review Article)
Anesth Analg 2002 94: 1448-1457. [Full Text]  

Alexandre Ouattara, Gilles Boccara, Laurent Chiche, and Pierre Coriat

Intraoperative Diagnosis of an Unsuspected Left Atrial Myxoma by Transesophageal Echocardiography (Case Report)
Anesth Analg 2002 94: 1458-1459. [Abstract] [Full Text] ECHO  

IMPLICATIONS: The authors report the intraoperative diagnosis using transesophageal echocardiography (TEE) of an unsuspected myxoma in a patient admitted for an acute occlusion of the aorta, resulting in emergency excision of the atrial tumor. This observation illustrates the usefulness of intraoperative TEE examination to identify life-threatening pathology.

Prakash K. Dubey and Hemant Kumar

Pain in the Ear Resulting From Misplaced Subclavian Dialysis Catheter Into Ipsilateral Internal Jugular Vein (Case Report)
Anesth Analg 2002 94: 1460-1461. [Abstract] [Full Text]  

IMPLICATIONS: This case describes pain in the ear resulting from inadvertent placement of a subclavian dialysis catheter into the ipsilateral internal jugular vein. The pain subsided when the catheter was withdrawn.

Emad Mossad, Ibrahim Farid, George Youssef, and Makoto Ando

Diverticulum of Kommerell: A Review of a Series and a Report of a Case with Tracheal Deviation Compromising Single Lung Ventilation (Case Report)
Anesth Analg 2002 94: 1462-1464. [Abstract] [Full Text]  

IMPLICATIONS: Birth defects can affect the great vessels of the aorta and its branches, compressing the upper airway and the swallowing track. Surgical repair of these defects requires manipulating the airway to improve surgical exposure. This is a report of a series of cases with compromised airway resulting from such a birth defect and methods of its management.

ERRATA:

Erratum
Anesth Analg 2002 94: 1433. [Full Text]  

PEDIATRIC ANESTHESIA:

Xiao-Ming Deng, Wen-Jing Xiao, Geng-Zhi Tang, Mao-Ping Luo, and Kun-Ling Xu

The Minimum Local Anesthetic Concentration of Ropivacaine for Caudal Analgesia in Children
Anesth Analg 2002 94: 1465-1468. [Abstract] [Full Text]  

IMPLICATIONS: Ropivacaine is a new long-acting amino-amide local anesthetic. The concentrations of ropivacaine used in caudal analgesia ranged from 0.1% to 0.5%. This study determined the minimum local analgesic concentration of ropivacaine to establish effective caudal analgesia under general anesthesia with 0.5 minimum alveolar anesthetic concentration enflurane in children.

Julia C. Finkel, John B. Rose, Michael L. Schmitz, Patrick K. Birmingham, George A. Ulma, Joel B. Gunter, Avital Cnaan, Charles J. Coté, Robert A. Medve, and Mark S. Schreiner

An Evaluation of the Efficacy and Tolerability of Oral Tramadol Hydrochloride Tablets for the Treatment of Postsurgical Pain in Children
Anesth Analg 2002 94: 1469-1473. [Abstract] [Full Text]  

IMPLICATIONS: Oral tramadol 1-2 mg/kg is well tolerated and effective in postoperative children ready to transition from morphine patient-controlled analgesia. The group receiving 2 mg/kg required less rescue analgesic compared with those receiving 1 mg/kg.

Mary Ellen McCann, Robert M. Brustowicz, Julianne Bacsik, Lorna Sullivan, Susan G. Auble, and Peter C. Laussen

The Bispectral Index and Explicit Recall During the Intraoperative Wake-up Test for Scoliosis Surgery
Anesth Analg 2002 94: 1474-1478. [Abstract] [Full Text]  

IMPLICATIONS: The relationship between bispectral index (BIS) and purposeful intraoperative patient movement is consistent with previous BIS utility studies. We conclude that BIS may be a useful clinical monitor for predicting patient movement to command during the intraoperative wake-up test, particularly when controlled hypotension is used and hemodynamic responses to emergence of anesthesia are blunted.

Shinichi Inomata, Shin-ichi Kihara, Masayuki Miyabe, Kenji Sumiya, Yasuyuki Baba, Yukinao Kohda, and Hidenori Toyooka

The Hypnotic and Analgesic Effects of Oral Clonidine During Sevoflurane Anesthesia in Children: A Dose-Response Study
Anesth Analg 2002 94: 1479-1483. [Abstract] [Full Text]  

IMPLICATIONS: Separate dose-response relationships for oral clonidine were found regarding the hypnotic and analgesic effects in children undergoing sevoflurane anesthesia.

Jeffrey L. Galinkin, John B. Rose, Kathleen Harris, and Mehernoor F. Watcha

Lidocaine Iontophoresis Versus Eutectic Mixture of Local Anesthetics (EMLA^®) for IV Placement in Children
Anesth Analg 2002 94: 1484-1488. [Abstract] [Full Text]  

IMPLICATIONS: Iontophoresis is a technique that uses an electrical current to facilitate movement of solute ions (lidocaine) across the stratum corneum barrier to provide dermal analgesia. Lidocaine iontophoresis provides similar pain relief for insertion of IV catheters as eutectic mixture of local anesthetics and is a useful noninvasive alternative to establish dermal analgesia for venous cannulation.

AMBULATORY ANESTHESIA:

Shu-Ming Wang, Lina Kulkarni, Jackqulin Dolev, and Zeev N. Kain

Music and Preoperative Anxiety: A Randomized, Controlled Study
Anesth Analg 2002 94: 1489-1494. [Abstract] [Full Text]  

IMPLICATIONS: Patients who listen to music of their choice during the preoperative period report less anxiety.

ANESTHETIC PHARMACOLOGY:

Shirley M. E. Wong, James M. Sonner, and Joan J. Kendig

Acetylcholine Receptors Do Not Mediate Isoflurane’s Actions on Spinal Cord In Vitro
Anesth Analg 2002 94: 1495-1499. [Abstract] [Full Text]  

IMPLICATIONS: Neither nicotinic nor muscarinic acetylcholine receptor antagonists altered spinal cord actions of isoflurane, suggesting that these receptors have little role in isoflurane actions in spinal cord. Cholinergic receptors thus may be eliminated as molecular targets in determining the anesthetic end-point of immobility in response to a noxious stimulus (minimum alveolar anesthetic concentration).

Edmond I Eger, II, Yi Zhang, Michael Laster, Pamela Flood, Joan J. Kendig, and James M. Sonner

Acetylcholine Receptors Do Not Mediate the Immobilization Produced by Inhaled Anesthetics
Anesth Analg 2002 94: 1500-1504. [Abstract] [Full Text]  

IMPLICATIONS: Inhaled anesthetics produce two crucial effects: amnesia and immobility in the face of noxious stimulation. Block of muscarinic and neuronal nicotinic acetylcholine receptors in rats does not significantly decrease the isoflurane concentration required to suppress movement to stimulation. Thus, acetylcholine receptors do not seem to play a major role as mediators of the immobilization produced by inhaled anesthetics. Their capacity to mediate other effects of inhaled anesthetics (e.g., amnesia) remains to be tested.

Kyung Y. Yoo, Hak S. Kim, Jai-Dong Moon, and JongUn Lee

Sildenafil (Viagra^®) Augments Sodium Nitroprusside-Induced But Not Nitroglycerin-Induced Hypotension in Dogs
Anesth Analg 2002 94: 1505-1509. [Abstract] [Full Text]  

IMPLICATIONS: Sildenafil may reduce the dose of sodium nitroprusside required to induce deliberate hypotension and hence the potential for cyanide toxicity.

Antje Pittner, Marek Nalos, Marc Theisen, Franz Ploner, Uwe B. Brückner, Michael Georgieff, Peter Radermacher, and Gebhard Fröba

Inhaling Nitrous Oxide or Xenon Does Not Influence Bowel Wall Energy Balance During Porcine Bowel Obstruction
Anesth Analg 2002 94: 1510-1516. [Abstract] [Full Text]  

IMPLICATIONS: In anesthetized pigs, short-term inhalation of xenon or nitrous oxide over 4 h when compared with total IV anesthesia had no additional deleterious effects on the metabolic balance of the gut wall during intestinal obstruction, no matter whether the arterial blood flow was reduced or not.

Dilek Memis, Alparslan Turan, Beyhan Karamanlioglu, Necdet Süt, and Zafer Pamukçu

The Prevention of Pain from Injection of Rocuronium by Ondansetron, Lidocaine, Tramadol, and Fentanyl
Anesth Analg 2002 94: 1517-1520. [Abstract] [Full Text]  

IMPLICATIONS: We compared the efficacy of ondansetron, lidocaine, tramadol, and fentanyl in minimizing the pain on injection of rocuronium in 250 patients. Ondansetron, lidocaine, tramadol, and fentanyl were effective in preventing and decreasing the level of rocuronium injection pain. Among these drugs, lidocaine was the most effective, and fentanyl was the least effective.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Bernd Hartmann, Axel Junger, Joachim Klasen, Matthias Benson, Andreas Jost, Anne Banzhaf, and Gunter Hempelmann

The Incidence and Risk Factors for Hypotension After Spinal Anesthesia Induction: An Analysis with Automated Data Collection
Anesth Analg 2002 94: 1521-1529. [Abstract] [Full Text]  

IMPLICATIONS: By using automated data collection, 5 (chronic alcohol consumption, history of hypertension, body mass index, sensory block height, and urgency of surgery) of 29 variables could be detected as having an association with hypotension after spinal anesthesia induction. The knowledge of these risk factors should be useful in increasing vigilance in those patients most at risk for hypotension, in allowing a more timely therapeutic intervention, or even in suggesting the use of alternative methods of spinal anesthesia, such as titrated continuous or small-dose spinal anesthesia.

Toshiya Koitabashi, Jay W. Johansen, and Peter S. Sebel

Remifentanil Dose/Electroencephalogram Bispectral Response During Combined Propofol/Regional Anesthesia
Anesth Analg 2002 94: 1530-1533. [Abstract] [Full Text]  

IMPLICATIONS: This experiment identified a significant, dose-dependent decrease in bispectral index (BIS), 95% spectral edge frequency, heart rate, and mean arterial blood pressure with increasing remifentanil dose. The change in baseline BIS was relatively modest but significant, suggesting that remifentanil has some sedative/hypnotic properties, or that it potentiates the hypnotic effect of propofol.

Paul B. Bigeleisen

An Unusual Presentation of End-Tidal Carbon Dioxide After Esophageal Intubation (Case Report)
Anesth Analg 2002 94: 1534-1536. [Abstract] [Full Text]  

IMPLICATIONS: This article discusses the inherent danger of general anesthesia and the need for a variety of tools to safely manage the airway.

Katsuhiko Nakai, Yoshifumi Takenobu, Kazuhide Eguchi, Hideyuki Takimizu, Kaneyoshi Honjo, Shinji Akimaru, Hitoshi Maegawa, Martin Marsala, and Nobuo Katsube

The Effects of OP-1206 -CD on Walking Dysfunction in the Rat Neuropathic Intermittent Claudication Model
Anesth Analg 2002 94: 1537-1541. [Abstract] [Full Text]  

IMPLICATIONS:Intermittent motor dysfunction is a clinical symptom associated with partial spinal compression. The present study provides evidence that oral treatment with the prostaglandin E1 analog (OP-1206 {alpha}-CD) is effective in improving motor dysfunction and spinal cord blood flow in rats with spinal compression.

Gopi A. Tejwani and Anil K. Rattan

The Role of Spinal Opioid Receptors in Antinociceptive Effects Produced by Intrathecal Administration of Hydromorphone and Buprenorphine in the Rat
Anesth Analg 2002 94: 1542-1546. [Abstract] [Full Text]  

IMPLICATIONS:Hydromorphone and buprenorphine are two important drugs used for pain relief. We observed that intrathecal buprenorphine is 17 times more potent than hydromorphone to inhibit pain in rats. Both drugs exert their effects through specific spinal opioid receptors.

Avi A. Weinbroum

Dextromethorphan Reduces Immediate and Late Postoperative Analgesic Requirements and Improves Patients’ Subjective Scorings After Epidural Lidocaine and General Anesthesia
Anesth Analg 2002 94: 1547-1552. [Abstract] [Full Text]  

Roberto Arcioni, Marco della Rocca, Sarah Romanò, Rocco Romano, Paolo Pietropaoli, and Alessandro Gasparetto

Ondansetron Inhibits the Analgesic Effects of Tramadol: A Possible 5-HT₃ Spinal Receptor Involvement in Acute Pain in Humans
Anesth Analg 2002 94: 1553-1557. [Abstract] [Full Text]  

IMPLICATIONS: Serotonin is an important neurotransmitter of the descending pathways that down-modulate spinal nociception. In postoperative pain, ondansetron, a selective 5-HT3 receptor antagonist, increased the analgesic dose of tramadol. We suggest that, when antagonized for antiemetic purpose, 5-HT3 receptors foster nociception, because of their site-dependent action.

Neeraj Kapur and Robert Friedman

Oral Ketamine: A Promising Treatment for Restless Legs Syndrome (Case Report)
Anesth Analg 2002 94: 1558-1559. [Abstract] [Full Text]  

IMPLICATIONS: Oral Ketamine, an NMDA receptor antagonist, can be used to treat restless legs syndrome. A mechanism for the efficacy of this treatment is discussed.

ECONOMICS AND HEALTH SYSTEMS RESEARCH:

Anne-Sophie Nyssen, Robert Larbuisson, Marc Janssens, Philippe Pendeville, and Alain Mayné

A Comparison of the Training Value of Two Types of Anesthesia Simulators: Computer Screen-Based and Mannequin-Based Simulators
Anesth Analg 2002 94: 1560-1565. [Abstract] [Full Text]  

IMPLICATIONS: We compared two different training simulators (computer screen-based versus full-scale) for training anesthesia residents to better document the effectiveness of such devices as training tools. This is an important issue, given the extensive use and the high cost of mannequin-based simulators in anesthesiology.

Michael J. Tessler, Stamatina T. Trihas, Olga Overbury, and Thierry Ducruet

Acute Vision Impairment: Does It Affect an Anesthesiologist’s Ability to Intubate the Trachea?
Anesth Analg 2002 94: 1566-1569. [Abstract] [Full Text]  

IMPLICATIONS: We found that acute severe vision impairment adversely affects the anesthesiologist's ability to intubate the trachea. This implies that anesthesiologists with acute onset of severe visual handicaps might have more difficulty intubating the trachea, which could initiate more critical incidents.

CRITICAL CARE AND TRAUMA:

Rolf Dembinski, Martin Max, Ralf Bensberg, Rolf Rossaint, and Ralf Kuhlen

Pressure Support Compared with Controlled Mechanical Ventilation in Experimental Lung Injury
Anesth Analg 2002 94: 1570-1576. [Abstract] [Full Text]  

IMPLICATIONS: Assisted spontaneous breathing may have beneficial effects on gas exchange in acute lung injury. We tested this hypothesis for pressure support ventilation in an animal model of acute lung injury. Our results demonstrate that pressure support does not necessarily provide better gas exchange than controlled mechanical ventilation.

Kuo-Chen Cheng, Haibo Zhang, Chang-Yi Lin, and Arthur S. Slutsky

Ventilation with Negative Airway Pressure Induces a Cytokine Response in Isolated Mouse Lung
Anesth Analg 2002 94: 1577-1582. [Abstract] [Full Text]  

IMPLICATIONS:Repeated closing and reopening of lung units induced by negative end-expiratory pressure resulted in lung inflammation and cell injury even under mechanical ventilation using a normal tidal volume. This finding may have clinical relevance in certain patients who are prone to atelectasis during mechanical ventilation.

Ali H. Al-Khafaji, William E. Dewhirst, and Harold L. Manning

Propylene Glycol Toxicity Associated with Lorazepam Infusion in a Patient Receiving Continuous Veno-Venous Hemofiltration with Dialysis (Case Report)
Anesth Analg 2002 94: 1583-1585. [Abstract] [Full Text]  

IMPLICATIONS: We report a case of toxicity from the drug solvent propylene glycol resulting from prolonged, large-dose lorazepam infusion. The case is unusual in that toxicity developed during continuous veno-venous hemofiltration with dialysis, a renal replacement therapy that should been have been effective at eliminating the chemical and its metabolites.

NEUROSURGICAL ANESTHESIA:

Manabu Kakinohana, Tatsuya Fuchigami, Seiya Nakamura, Tetsuya Kawabata, and Kazuhiro Sugahara

Propofol Reduces Spinal Motor Neuron Excitability in Humans (Brief Report)
Anesth Analg 2002 94: 1586-1588. [Abstract] [Full Text]  

IMPLICATIONS: We investigated in humans whether changes in spinal motor neuron excitability correlate with the predicted propofol concentration (Cpt) achieved by a target-controlled infusion system. Propofol suppressed F-wave persistence in a Cpt-dependent manner, indicating that propofol depresses spinal motor neuron excitability at clinically relevant concentrations.

OBSTETRIC ANESTHESIA:

Gerald Cherayil, Bruce Feinberg, Julian Robinson, and Lawrence C. Tsen

Central Neuraxial Blockade Promotes External Cephalic Version Success After a Failed Attempt
Anesth Analg 2002 94: 1589-1592. [Abstract] [Full Text]  

IMPLICATIONS: Our retrospective analysis of central neuraxial techniques, both epidural and spinal anesthesia, noted a significant success rate in the setting of previously failed external cephalic version attempts.

Arnaud de La Chapelle, Stephane Benoit, Mohamed Bouregba, Marc Durand-Reville, and Marc Raucoules-Aimé

The Treatment of Severe Pulmonary Edema Induced by Beta Adrenergic Agonist Tocolytic Therapy with Continuous Positive Airway Pressure Delivered by Face Mask (Case Report)
Anesth Analg 2002 94: 1593-1594. [Abstract] [Full Text]  

IMPLICATIONS: We report the case of a pregnant patient who developed severe pulmonary edema secondary to beta-adrenergic agonist tocolytic therapy (salbutamol) and was successfully treated with mask-delivered continuous positive airway pressure ventilation.

Steven Y. Wang, Suresh Kannan, Dennis Shay, Scott Segal, Sanjay Datta, and Lawrence Tsen

Anesthetic Considerations for a Patient with Compound Heterozygous Medium-Chain Acyl-CoA Dehydrogenase Deficiency (Case Report)
Anesth Analg 2002 94: 1595-1597. [Abstract] [Full Text]  

IMPLICATIONS: We describe the anesthetic management of a parturient with compound heterozygous medium chain acyl-CoA dehydrogenase deficiency, the most common disorder of fatty acid metabolism.

REGIONAL ANESTHESIA:

Geir Niemi and Harald Breivik

Epinephrine Markedly Improves Thoracic Epidural Analgesia Produced by a Small-Dose Infusion of Ropivacaine, Fentanyl, and Epinephrine After Major Thoracic or Abdominal Surgery: A Randomized, Double-Blinded Crossover Study With and Without Epinephrine
Anesth Analg 2002 94: 1598-1605. [Abstract] [Full Text]  

IMPLICATIONS: Epidural epinephrine markedly improves the pain relief and sensory blockade of a small-dose thoracic epidural infusion of ropivacaine and fentanyl. Nausea was reduced, and mobilization of the patients was facilitated.

Xavier Capdevila, Philippe Macaire, Christophe Dadure, Olivier Choquet, Philippe Biboulet, Yves Ryckwaert, and Françoise d’Athis

Continuous Psoas Compartment Block for Postoperative Analgesia After Total Hip Arthroplasty: New Landmarks, Technical Guidelines, and Clinical Evaluation
Anesth Analg 2002 94: 1606-1613. [Abstract] [Full Text]  

IMPLICATIONS: Lumbar plexus depth is correlated with the patient's body mass index and differs between men and women, but this is not true of the lumbar plexus-transverse process distance. Considering new landmarks, a continuous psoas compartment block promotes optimal analgesia after hip arthroplasty, with few side effects.

Chen-Hwan Cherng, Chih-Shung Wong, Fang-Lin Chang, Shung-Tai Ho, and Chian-Her Lee

Epidural Morphine Delays the Onset of Tourniquet Pain During Epidural Lidocaine Anesthesia
Anesth Analg 2002 94: 1614-1616. [Abstract] [Full Text]  

IMPLICATIONS: We examined the effect of epidural morphine on the onset of tourniquet pain during epidural lidocaine anesthesia. We found that the addition of 2 mg of morphine to epidural 2% lidocaine significantly delayed the onset of tourniquet pain without increasing morphine-related side effects.

Ya-Jung Cheng, Yong-Ping Wang, Chiang-Ting Chien, and Chau-Fong Chen

Small-Dose Propofol Sedation Attenuates the Formation of Reactive Oxygen Species in Tourniquet-Induced Ischemia-Reperfusion Injury Under Spinal Anesthesia
Anesth Analg 2002 94: 1617-1620. [Abstract] [Full Text]  

IMPLICATIONS: Small-dose propofol sedation, compared with IV midazolam, attenuates free radical production after release of the tourniquet during total knee replacement under spinal anesthesia.

Stephen P. Hallworth, Roshan Fernando, and Gary M. Stocks

Predicting the Density of Bupivacaine and Bupivacaine-Opioid Combinations (Technical Communication)
Anesth Analg 2002 94: 1621-1624. [Abstract] [Full Text]  

IMPLICATIONS: Manipulating the density of local anesthetic solutions by using a simple formula may be clinically useful in producing optimal density solutions for spinal anesthesia under a variety of clinical conditions.

J. S. P. van den Berg, S. E. Sijbrandy, A. H. Meijer, and A. H. J. Oostdijk

Subdural Hygroma: A Rare Complication of Spinal Anesthesia (Case Report)
Anesth Analg 2002 94: 1625-1627. [Abstract] [Full Text]  

IMPLICATIONS: We describe a patient with frontal hygroma after spinal anesthesia—a rare complication. This condition should be considered in patients after spinal anesthesia with persisting orthostatic headache. Risk factors include ventriculo-peritoneal shunt or brain atrophy caused by old age.

GENERAL ARTICLES:

Khwaja J. Zakriya, Colleen Christmas, James F. Wenz, Sr, Shawn Franckowiak, Ross Anderson, and Frederick E. Sieber

Preoperative Factors Associated with Postoperative Change in Confusion Assessment Method Score in Hip Fracture Patients
Anesth Analg 2002 94: 1628-1632. [Abstract] [Full Text]  

IMPLICATIONS: This prospective study investigated preoperative variables that are predictive of postoperative delirium in geriatric patients undergoing surgical repair of hip fracture. The results suggest that the patient's preoperative medical condition and inability to mount a stress response influence postoperative delirium.

Kazuyoshi Hirota, Hiroshi Hashimoto, Toshihito Tsubo, Hironori Ishihara, and Akitomo Matsuki

Quantification and Comparison of Pulmonary Emboli Formation After Pneumatic Tourniquet Release in Patients Undergoing Reconstruction of Anterior Cruciate Ligament and Total Knee Arthroplasty
Anesth Analg 2002 94: 1633-1638. [Abstract] [Full Text]  

IMPLICATIONS: We compared emboli formation after tourniquet release in patients undergoing arthroscopic reconstruction of the anterior cruciate ligament (ACL, n = 20) and total knee arthroplasty (TKA, n = 20) using transesophageal echocardiography. The present data suggest that the risk of acute pulmonary embolism after tourniquet release could be more frequent during TKA than ACL.

Guy H. Montgomery, Daniel David, Gary Winkel, Jeffrey H. Silverstein, and Dana H. Bovbjerg

The Effectiveness of Adjunctive Hypnosis with Surgical Patients: A Meta-Analysis
Anesth Analg 2002 94: 1639-1645. [Abstract] [Full Text]  

IMPLICATIONS: A meta-analytical review of studies using hypnosis with surgical patients was performed to determine the effectiveness of the procedure. The results indicated that patients in hypnosis treatment groups had better clinical outcomes than 89% of patients in control groups. These data strongly support the use of hypnosis with surgical patients.

Yasufumi Nakajima, Akira Takamata, Tomoyuki Ito, Daniel I. Sessler, Yoshihiro Kitamura, Goshun Shimosato, Satoshi Taniguchi, Hiroki Matsuyama, Yoshifumi Tanaka, and Toshiki Mizobe

Upright Posture Reduces Thermogenesis and Augments Core Hypothermia
Anesth Analg 2002 94: 1646-1651. [Abstract] [Full Text]  

IMPLICATIONS: Upright posture attenuates the thermogenic response to core hypothermia but augments peripheral vasoconstriction. This divergent result suggests that input from the baroreceptor modifies the individual thermoregulatory efferent pathway at a site distal to the common thermoregulatory center or neural pathway.

Franz Pusch, Alexander Berger, Eckart Wildling, Werner Tiefenthaler, and Peter Krafft

The Effects of Systolic Arterial Blood Pressure Variations on Postoperative Nausea and Vomiting
Anesth Analg 2002 94: 1652-1655. [Abstract] [Full Text]  

IMPLICATIONS: A prospective clinical investigation revealed that a marked systolic blood pressure decrease >35% ({Delta}SBP >35%) during the induction of general anesthesia is associated with an increased incidence of postoperative nausea and vomiting (PONV). The association between a {Delta}SBP >35% during maintenance of general anesthesia and PONV is less pronounced.

CASE REPORTS:

Cornelius J. O’Connor, Jr., Sara R. Davies, Michael S. Stix, and Robert W. Dolan

Gastric Distention in a Spontaneously Ventilating Patient with a ProSeal Laryngeal Mask Airway
Anesth Analg 2002 94: 1656-1658. [Abstract] [Full Text]  

IMPLICATIONS: Partial upper airway obstruction during spontaneous respiration with a ProSealTM laryngeal mask airway can result in gastric distention.

Anil Agarwal, Atul Gaur, Dinesh Sahu, Prabhat K. Singh, and Chandra K. Pandey

Nasogastric Tube Knotting Over the Epiglottis: A Cause of Respiratory Distress
Anesth Analg 2002 94: 1659-1660. [Abstract] [Full Text]  

IMPLICATIONS: Nasogastric tube placement can cause ulceration and bleeding from the nose, pharynx, esophagus, and stomach. Its accidental placement into the tracheopulmonary system may lead to pneumothorax, hemothorax, or even death. We report a case of its knotting over the epiglottis, leading to life-threatening respiratory distress.

MEETING REPORT:

Frank H. Kern

The Society of Pediatric Anesthesia: Fifteenth Annual Meeting, New Orleans, Louisiana, October 12, 2001
Anesth Analg 2002 94: 1661-1668. [Full Text]  

LETTERS TO THE EDITOR:

Elif Basgul, Seda B. Akinci, and Paul F. White

Cognitive Failures After General Anesthesia Are Probably Not Related to the Type of Anesthetic Used • Response
Anesth Analg 2002 94: 1669. [Full Text]  

Archie Brain

Esophageal Breathing and Upper Airway Obstruction with the ProSeal^TM Laryngeal Mask
Anesth Analg 2002 94: 1669-1670. [Full Text]  

Gordon Lyons

Unreported Deaths Underplay Importance of Thromboembolism
Anesth Analg 2002 94: 1670. [Full Text]  

J. Brimacombe, D. Vosoba Judd, K. Tortely, E. Barron, and H. Branagan

Gastric Tube-Guided Reinsertion of the ProSeal^TM Laryngeal Mask Airway
Anesth Analg 2002 94: 1670. [Full Text]  

Ban C.H. Tsui, Brendan Finucane, and Keiko Hayatsu

Verifying Accurate Placement of an Epidural Catheter Tip Using Electrical Stimulation • Response
Anesth Analg 2002 94: 1670-1671. [Full Text]  

Cornelius J. O’Connor, Jr. and Michael S. Stix

Bubble Solution Diagnoses ProSeal^TM Insertion into the Glottis
Anesth Analg 2002 94: 1671-1672. [Full Text]  

Seiji Ishikawa, Koichi Nakazawa, and Koshi Makita

Hypoxic Gas Flow Caused by Malfunction of the Proportioning System of Anesthesia Machines
Anesth Analg 2002 94: 1672. [Full Text]  

Shu-Lin Guo and Aggeliki Bairaktari

Respiratory Failure After Pneumonectomy in a Patient with Unknown Hyperlipidemia • Response
Anesth Analg 2002 94: 1672-1673. [Full Text]  

Laurence Landow

Another Example of Regression to the Mean
Anesth Analg 2002 94: 1673. [Full Text]  

John C. Lundell, John Butterworth, and Robert James

Evidence-Based EACA Dosing? • Response
Anesth Analg 2002 94: 1673. [Full Text]  

Ashraf A. Dahaba

Remifentanil Pharmacokinetics
Anesth Analg 2002 94: 1674. [Full Text]  

Byron Tsusaki, Alina Grigore, Denton A. Cooley, and Charles D. Collard

Reversal of Delayed Paraplegia with Cerebrospinal Fluid Drainage after Thoracoabdominal Aneurysm Repair
Anesth Analg 2002 94: 1674. [Full Text]  

Stephen Stayer, Jill Gouvion, Lee Evey, and Dean Andropoulos

Subambient Gas Delivery
Anesth Analg 2002 94: 1674-1675. [Full Text]  

Katsuya Mikawa, Kahoru Nishina, and Makoto Shiga

Prevention of Sevoflurane-Induced Agitation with Oral Clonidine Premedication
Anesth Analg 2002 94: 1675-1676. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

The Massachusetts General Hospital Handbook of Pain Management, 2nd Edition • Near Misses in Neuroanesthesia • Preoperative Cardiac Evaluation; Volume 39, Number 4 (Fall 2001) of International Anesthesiology Clinics • Pediatric Anesthesia, 4th Edition • Books and Multimedia Received
Anesth Analg 2002 94: 1677-1679. [Full Text]  

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