EDITORIALS:

L. Wiley Nifong and W. Randolph Chitwood, Jr.

Challenges for the Anesthesiologist: Robotics?
Anesth Analg 2003 96: 1-2. [Full Text]  

John B. Rose

Spinal Cord Injury in a Child After Single-Shot Epidural Anesthesia
Anesth Analg 2003 96: 3-6. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Nutan Mehta, Sumeet Goswami, Michael Argenziano, Craig R. Smith, and Berend Mets

Anesthesia for Robotic Repair of the Mitral Valve: A Report of Two Cases (Case Report)
Anesth Analg 2003 96: 7-10. [Abstract] [Full Text]  

IMPLICATIONS: We describe the anesthetic management of two patients who underwent successful mitral valve repair with use of a robot-assisted cardiac surgical technique. We describe the robot used, as well as the surgical procedure, and highlight aspects of the anesthetic management, in particular the need for one-lung ventilation and the utility of transesophageal echocardiography.

Kazuo Irita, Yoichiro Kai, Kozaburo Akiyoshi, Yukako Tanaka, and Shosuke Takahashi

Performance Evaluation of a New Pulse Oximeter During Mild Hypothermic Cardiopulmonary Bypass
Anesth Analg 2003 96: 11-14. [Abstract] [Full Text]  

IMPLICATIONS: We compared the performance of a new pulse oximeter with that of a conventional pulse oximeter during hypothermic cardiopulmonary bypass with nonpulsatile flow. The newly developed device displayed accurate SpO2 significantly more frequently and longer than a conventional oximeter. Newly developed pulse oximeters seem to be more useful for monitoring SpO2 during hypoperfusion.

Anthony M.-H. Ho, Anna Lee, Elizabeth Ling, Alan Daly, Kevin Teoh, and Theodore E. Warkentin

Agreements Between the Prothrombin Times of Blood Treated In Vitro with Heparinase During Cardiopulmonary Bypass (CPB) and Blood Sampled After CPB and Systemic Protamine
Anesth Analg 2003 96: 15-20. [Abstract] [Full Text]  

IMPLICATIONS: Coagulation dysfunction after cardiopulmonary bypass may contribute to bleeding. Obtaining coagulation tests and fresh frozen plasma requires time and delays treatment in patients who need fresh frozen plasma. We have devised a technique to provide early estimation of postbypass coagulation status.

Peter Zimmermann, Clemens Greim, Herbert Trautner, Ulrich Sagmeister, Katharina Kraemer, and Norbert Roewer

Echocardiographic Monitoring During Induction of General Anesthesia with a Miniaturized Esophageal Probe
Anesth Analg 2003 96: 21-27. [Abstract] [Full Text]  

IMPLICATIONS: This study demonstrates that it is feasible and generally safe to introduce a miniaturized transesophageal echocardiography probe transnasally in awake cardiac risk patients to monitor cardiac performance during the induction of general anesthesia.

Makoto Tanaka and Toshiaki Nishikawa

Hemodilution Does Not Alter Arterial Baroreflex Control of Heart Rate in Anesthetized Dogs
Anesth Analg 2003 96: 28-32. [Abstract] [Full Text]  

IMPLICATIONS: Acute normovolemic hemodilution may be preoperatively used to minimize the requirement of allogeneic blood products during major surgery. We found that baroreflex function is preserved during mild (hemoglobin concentration, 7-8 g/dL) and profound hemodilution (hemoglobin concentration, 4-5 g/dL) in pentobarbital-anesthetized dogs.

Victor De Castro, Gilles Godet, Gonzalo Mencia, Mathieu Raux, and Pierre Coriat

Target-Controlled Infusion for Remifentanil in Vascular Patients Improves Hemodynamics and Decreases Remifentanil Requirement
Anesth Analg 2003 96: 33-38. [Abstract] [Full Text]  

IMPLICATIONS: Remifentanil for intraoperative analgesia in carotid artery surgery is associated with a better stability in perioperative hemodynamics when administered in target-controlled infusion compared with continuous weight-adjusted infusion. This may be related to a smaller requirement of this drug when using target-controlled infusion, as well as a smooth mode of administration.

Zeev Friedman, Haim Berkenstadt, Sergei Preisman, and Azriel Perel

A Comparison of Lactated Ringer’s Solution to Hydroxyethyl Starch 6% in a Model of Severe Hemorrhagic Shock and Continuous Bleeding in Dogs
Anesth Analg 2003 96: 39-45. [Abstract] [Full Text]  

IMPLICATIONS: Fluid resuscitation to a target mean arterial blood pressure of 60 mm Hg during uncontrolled bleeding resulted in larger oxygen delivery and smaller systemic lactate concentrations when hydroxyethyl starch 6% was used, in comparison to lactated Ringer's solution resuscitation to a target mean arterial blood pressure of 60 or 80 mm Hg.

Fedor Lurie, Bernd Driessen, Jonathan S. Jahr, Rashell Reynoso, and Robert A. Gunther

Validity of Arterial and Mixed Venous Oxygen Saturation Measurements in a Canine Hemorrhage Model After Resuscitation with Varying Concentrations of Hemoglobin-Based Oxygen Carrier
Anesth Analg 2003 96: 46-50. [Abstract] [Full Text]  

IMPLICATIONS: This study evaluated oxygen saturation monitors in a canine model of acute blood loss and resuscitation with a blood substitute and found that these may interfere with the monitors' results in a dose-dependent way.

Ursula Cammerer, Wulf Dietrich, Tobias Rampf, Siegmund L. Braun, and Josef A. Richter

The Predictive Value of Modified Computerized Thromboelastography and Platelet Function Analysis for Postoperative Blood Loss in Routine Cardiac Surgery
Anesth Analg 2003 96: 51-57. [Abstract] [Full Text]  

IMPLICATIONS: Thrombelastography and platelet function analysis in routine cardiac surgery demonstrate high negative predictive values for postoperative bleeding, which supports early identification and targeted treatment of surgical bleeding by distinguishing it from a significant coagulopathy. The positive predictive values are small. The best predictors are thrombelastography values obtained after cardiopulmonary bypass.

A. M. Roche, M. F. M. James, M. P. W. Grocott, and M. G. Mythen

Citrated Blood Does Not Reliably Reflect Fresh Whole Blood Coagulability in Trials of In Vitro Hemodilution (Technical Communication)
Anesth Analg 2003 96: 58-61. [Abstract] [Full Text]  

IMPLICATIONS: Citration and storage of whole blood markedly alter the Thrombelastograph(R) effects of hemodilution on coagulation. The results of hemodilution studies in which citrated blood has been used to study coagulation may not be reliable.

Christopher J. O’Connor, Robert March, and Kenneth J. Tuman

Severe Myxedema After Cardiopulmonary Bypass (Case Report)
Anesth Analg 2003 96: 62-64. [Abstract] [Full Text]  

IMPLICATIONS: We report a case illustrating the serious perioperative consequences that can potentially result from failure to provide adequate thyroid hormone therapy for severe hypothyroidism before cardiac surgery.

PEDIATRIC ANESTHESIA:

T. Kasai, K. Yaegashi, M. Hirose, and Y. Tanaka

Spinal Cord Injury in a Child Caused by an Accidental Dural Puncture with a Single-Shot Thoracic Epidural Needle (Case Report)
Anesth Analg 2003 96: 65-67. [Abstract] [Full Text]  

IMPLICATIONS: A child experienced a spinal cord injury by an accidental dural puncture during thoracic epidural anesthesia. A magnetic resonance image was used for diagnosis and treatment.

Steen Møiniche, Janne Rømsing, Jørgen B. Dahl, and Martin R. Tramèr

Nonsteroidal Antiinflammatory Drugs and the Risk of Operative Site Bleeding After Tonsillectomy: A Quantitative Systematic Review
Anesth Analg 2003 96: 68-77. [Abstract] [Full Text]  

IMPLICATIONS: The evidence for nonsteroidal antiinflammatory drugs to increase the risk of bleeding after tonsillectomy is equivocal, and the risk-benefit ratio is not straightforward. There is some evidence for an increased likelihood of reoperation because of bleeding. The agenda must be one of further research rather than of clinical recommendations.

John B. Rose, Julia C. Finkel, Adriano Arquedas-Mohs, Bruce P. Himelstein, Mark Schreiner, and Robert A. Medve

Oral Tramadol for the Treatment of Pain of 7–30 Days’ Duration in Children (Brief Report)
Anesth Analg 2003 96: 78-81. [Abstract] [Full Text]  

IMPLICATIONS: This open-label, multicenter trial was designed to determine the safety profile and analgesic efficacy of tramadol for the treatment of painful conditions lasting 7-30 days in 7-16-yr-old children. We found that tramadol 1-2 mg/kg per os every 4-6 h (maximal dose = 8 mg {middle dot} kg-1 {middle dot} d-1, not to exceed 400 mg/d) is a safe and effective analgesic in this patient population.

Andres Tschupp and Sergio Fanconi

A Combined Ear Sensor for Pulse Oximetry and Carbon Dioxide Tension Monitoring: Accuracy in Critically Ill Children (Technical Communication)
Anesth Analg 2003 96: 82-84. [Abstract] [Full Text]  

IMPLICATIONS: A new combined ear sensor was tested for accuracy in 20 critically ill children. It provides noninvasive and continuous monitoring of arterial oxygen saturation, arterial carbon dioxide tension, and pulse rate. The sensor proved to be clinically accurate in the tested range.

Sergey Preisman, Yakov Yusim, David Mishali, and Azriel Perel

Compression of the Pulmonary Artery During Transesophageal Echocardiography in a Pediatric Cardiac Patient (Case Report)
Anesth Analg 2003 96: 85-87. [Abstract] [Full Text]  

IMPLICATIONS: Hemodynamic compromise caused by the insertion of the probe for transesophageal echocardiography in a patient with severe stenosis of the main pulmonary artery is reported for the first time. The first symptom of the impending problem was a rapid decrease of end-tidal CO2.

Laura K. Diaz and Fernando Cantu

Hemodynamic Response to Caudal Epidural Clonidine in a Pediatric Cardiac Patient (Case Report)
Anesth Analg 2003 96: 88-90. [Abstract] [Full Text]  

IMPLICATIONS: Postoperative management of sedation and analgesia in pediatric cardiac patients presents many challenges. This case report describes a child who experienced dramatic clinical improvement with the postoperative use of caudal morphine and clonidine after conventional therapy had failed.

AMBULATORY ANESTHESIA:

Sinikka Purhonen, Matti Turunen, Ulla-Maija Ruohoaho, Minna Niskanen, and Markku Hynynen

Supplemental Oxygen Does Not Reduce the Incidence of Postoperative Nausea and Vomiting After Ambulatory Gynecologic Laparoscopy
Anesth Analg 2003 96: 91-96. [Abstract] [Full Text]  

IMPLICATIONS: Supplemental 80% oxygen administration during surgery and until 1 h after surgery compared with 30% oxygen administration did not prevent postoperative nausea and vomiting after ambulatory gynecologic laparoscopy.

ANESTHETIC PHARMACOLOGY:

Yi Zhang, Michael J. Laster, Koji Hara, R. Adron Harris, Edmond I. Eger, II, Caroline R. Stabernack, and James M. Sonner

Glycine Receptors Mediate Part of the Immobility Produced by Inhaled Anesthetics
Anesth Analg 2003 96: 97-101. [Abstract] [Full Text]  

IMPLICATIONS:In vitro, halothane potentiates glycine's effect on strychnine-sensitive glycine receptors more than isoflurane and isoflurane more than cyclopropane. The present in vivo work indicates that antagonism of the glycine receptor with strychnine increases minimum alveolar anesthetic concentration for halothane more than isoflurane and isoflurane more than cyclopropane. Such results support the notion that glycine receptors may mediate part of the immobility produced by inhaled anesthetics.

Caroline Stabernack, James M. Sonner, Michael Laster, Yi Zhang, Yilei Xing, Manohar Sharma, and Edmond I. Eger, II

Spinal N-Methyl-D-Aspartate Receptors May Contribute to the Immobilizing Action of Isoflurane
Anesth Analg 2003 96: 102-107. [Abstract] [Full Text]  

IMPLICATIONS: Spinal cord NMDA receptors may mediate a portion of the immobilizing effect of isoflurane. Blockade of NMDA receptors in the cord by MK 801 has a MAC-sparing effect, but MK 801 does not, by itself, produce complete anesthesia.

Erin M. Rada, Elizabeth C. Tharakan, and Pamela Flood

Volatile Anesthetics Reduce Agonist Affinity at Nicotinic Acetylcholine Receptors in the Brain
Anesth Analg 2003 96: 108-111. [Abstract] [Full Text]  

IMPLICATIONS: Volatile anesthetics reduce the activation of nicotinic acetylcholine receptors by an unknown mechanism. We have demonstrated that although isoflurane and sevoflurane inhibit agonist affinity, the concentrations required are too large to be responsible for the dynamic changes observed.

Douglas E. Raines, Robert J. Claycomb, and Stuart A. Forman

Modulation of GABA_A Receptor Function by Nonhalogenated Alkane Anesthetics: The Effects on Agonist Enhancement, Direct Activation, and Inhibition
Anesth Analg 2003 96: 112-118. [Abstract] [Full Text]  

IMPLICATIONS: When normalized to either their in vivo anesthetic potencies or hydrophobicities, cyclopropane and butane are 1-1.5 orders of magnitude less potent enhancers of agonist action on {alpha}1ß2{gamma}2L GABAA receptors than isoflurane. Additionally, cyclopropane and butane fail to directly activate or inhibit receptors, even at near aqueous saturating concentrations. Thus, it is unlikely that either enhancement or inhibition of the most common GABAA receptor subtype in the brain accounts for the behavioral activities of cyclopropane and butane.

Klaus E. Hecker, Matthias Reyle-Hahn, Jan H. Baumert, Nicola Horn, Nicole Heussen, and Rolf Rossaint

Minimum Alveolar Anesthetic Concentration of Isoflurane with Different Xenon Concentrations in Swine
Anesth Analg 2003 96: 119-124. [Abstract] [Full Text]  

IMPLICATIONS: We investigated the influence of the anesthetic gas xenon on the minimum alveolar anesthetic concentration (MAC) for isoflurane (another anesthetic gas). The study was performed in 10 swine ventilated with fixed xenon and various concentrations of isoflurane. The isoflurane MAC is decreased by inhalation of xenon in a nonlinear relationship.

Daisuke Yoshikawa, Masataka Kuroda, Hiroshi Tsukagoshi, Ken-ichiro Takahashi, Shigeru Saito, Koichi Nishikawa, and Fumio Goto

The Effects of Volatile Anesthetics on Nonadrenergic, Noncholinergic Depressor Responses in Rats
Anesth Analg 2003 96: 125-131. [Abstract] [Full Text]  

IMPLICATIONS: The anesthetics isoflurane and halothane attenuate nonadrenergic, noncholinergic depressor responses mediated by calcitonin gene-related peptide in the rat without affecting the release of the peptide.

Takashi Horiguchi and Toshiaki Nishikawa

Propofol-Nitrous Oxide Anesthesia Enhances the Heart Rate Response to Intravenous Isoproterenol Infusion
Anesth Analg 2003 96: 132-135. [Abstract] [Full Text]  

IMPLICATIONS: We demonstrated that the heart rate response to IV isoproterenol infusion is enhanced during propofol-nitrous oxide anesthesia. This suggests that continuous isoproterenol infusion may be useful when a large dose of atropine is ineffective for restoration of normal heart rate in patients receiving propofol-nitrous oxide anesthesia.

Tadahiko Ishiyama, Satoshi Kashimoto, Takeshi Oguchi, Takashi Matsukawa, and Teruo Kumazawa

The Effects of Clonidine Premedication on the Blood Pressure and Tachycardiac Responses to Ephedrine in Elderly and Young Patients During Propofol Anesthesia
Anesth Analg 2003 96: 136-141. [Abstract] [Full Text]  

IMPLICATIONS: Clonidine premedication augments the pressor and tachycardiac responses to ephedrine in elderly patients during standard or large doses of propofol anesthesia but does not augment during small doses of propofol anesthesia. Clonidine, age, and propofol could be involved in the augmentation of the pressor and tachycardiac responses to ephedrine.

Jörgen Bruhn, Thomas W. Bouillon, Heiko Röpcke, and Andreas Hoeft

A Manual Slide Rule for Target-Controlled Infusion of Propofol: Development and Evaluation
Anesth Analg 2003 96: 142-147. [Abstract] [Full Text]  

IMPLICATIONS: We describe the development and evaluation of a simple slide rule that enables the bedside determination of the required infusion rate for a particular target plasma concentration. This pocket-sized target-controlled infusion slide rule combines the advantages of minimal financial and technical cost with reasonable accuracy.

Munehiro Masuzawa, Shinichi Nakao, Etsuko Miyamoto, Makiko Yamada, Kouhei Murao, Kenichirou Nishi, and Koh Shingu

Pentobarbital Inhibits Ketamine-Induced Dopamine Release in the Rat Nucleus Accumbens: A Microdialysis Study
Anesth Analg 2003 96: 148-152. [Abstract] [Full Text]  

IMPLICATIONS: Ketamine increased dopamine release in the nucleus accumbens, which was inhibited by pentobarbital. The mesolimbic dopamine system may be involved in the psychotomimetic effects of ketamine, and the suppression of ketamine emergence reactions by barbiturates may be because of the inhibition of ketamine-induced dopamine release in the nucleus accumbens.

Saiid Bina, Stephen Holman, and Sheila M. Muldoon

Extending the Skeletal Muscle Viability Period in the Malignant Hyperthermia Test
Anesth Analg 2003 96: 153-158. [Abstract] [Full Text]  

IMPLICATIONS: Varying conditions for storage of muscle were investigated to extend the viability period of muscle in the malignant hyperthermia (MH) test from 5 to 24 h. Muscles stored for 24 h under tension at room temperature remained viable and correctly diagnosed MH susceptibility in all patients.

Tomoki Nishiyama, Hisayoshi Tamai, and Kazuo Hanaoka

Serum and Cerebrospinal Fluid Concentrations of Midazolam After Epidural Administration in Dogs
Anesth Analg 2003 96: 159-162. [Abstract] [Full Text]  

IMPLICATIONS: Midazolam, which has spinally mediated analgesic potency, was epidurally administered in dogs, and serum and cerebrospinal fluid concentrations were measured. Epidurally administered midazolam enters the cerebrospinal fluid, but concentrations are only 3% of those in the systemic circulation.

Jun-ichi Hattori, Naoyuki Fujimura, Noriaki Kanaya, Kayoko Okazaki, and Akiyoshi Namiki

Bronchospasm Induced by Propofol in a Patient with Sick House Syndrome (Case Report)
Anesth Analg 2003 96: 163-164. [Abstract] [Full Text]  

IMPLICATIONS: Propofol is often used in patients with asthma, but it can induce bronchospasm. We report a patient with sick house syndrome (nonspecific complaints of mucosal irritation, headache, nausea, and chest symptoms) who suffered bronchospasm. This case suggests that propofol is not always a safe anesthetic for patients with asthma, especially drug-induced asthma.

Christian W. Hoenemann, Tobias B. Halene-Holtgraeve, Michael Booke, Frank Hinder, Fritz Daudel, Alexander Reich, and Hugo Van Aken

Delayed Onset of Malignant Hyperthermia in Desflurane Anesthesia (Case Report)
Anesth Analg 2003 96: 165-167. [Abstract] [Full Text]  

IMPLICATIONS: Animal-experimental studies demonstrate desflurane's trigger effect for malignant hyperthermia (MH). In contrast to other anesthetics, the time interval from exposure to the occurrence of symptoms is much longer with desflurane. This case report focuses on MH induced by desflurane alone.

Ismail Kati, C. Bekir Demirel, Omer Anlar, Urfettin A. Hüseyinoglu, Emin Silay, and Kamuran Elcicek

An Unusual Complication of Total Intravenous Anesthesia: Mutism (Case Report)
Anesth Analg 2003 96: 168-170. [Abstract] [Full Text]  

IMPLICATIONS: We report a case of mutism secondary to total IV anesthesia with propofol, as an unusual complication that we have not found in the literature.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Siew-Fong Ng, Cheng-Sim Oo, Khiam-Hong Loh, Poh-Yan Lim, Yiong-Huak Chan, and Biauw-Chi Ong

A Comparative Study of Three Warming Interventions to Determine the Most Effective in Maintaining Perioperative Normothermia
Anesth Analg 2003 96: 171-176. [Abstract] [Full Text]  

IMPLICATIONS: Perioperative hypothermia has deleterious effects on patient recovery. We found in patients having knee surgery that reflective technology was less effective than using two cotton blankets, whereas active surface warming with the forced-air method was most effective in maintaining normothermia.

Harvey Woehlck, Dave Herrmann, and Olga Kaslow

Safe Use of Pulse Oximetry During Verteporphin Therapy (Case Report)
Anesth Analg 2003 96: 177-178. [Abstract] [Full Text]  

IMPLICATIONS: Pulse oximetry may produce skin damage after the administration of photosensitizing chemotherapeutic drugs. Surgery must often be performed in near darkness during photodynamic therapy. Limiting the duration of pulse oximetry and rotating sites allowed successful use of pulse oximetry in a long anesthetic during which verteporphin was administered.

Eric Parisod, Robin F. Murray, and Michael J. Cousins

Conversion Disorder After Implant of a Spinal Cord Stimulator in a Patient with a Complex Regional Pain Syndrome (Case Report)
Anesth Analg 2003 96: 201-206. [Abstract] [Full Text]  

IMPLICATIONS: This case history describes the treatment of a patient suffering with persistent pain. He was treated surgically with implantation of a spinal cord stimulator. After surgery, a partial paralysis that could not be explained medically and that was probably related to emotional factors occurred, and cognitive behavioral treatment was begun. This paper discusses the importance of considering social and psychological factors when medical treatment options are considered.

Klaus Westphal, Diana Maeser, Gert Scheifler, Volker Lischke, and Christian Byhahn

PercuTwist: A New Single-Dilator Technique for Percutaneous Tracheostomy (Brief Report)
Anesth Analg 2003 96: 229-232. [Abstract] [Full Text]  

IMPLICATIONS: PercuTwist is a new technique for percutaneous tracheostomy in that stoma dilation is achieved with a unique screwlike dilating device. We describe the technique itself and our first clinical experiences with PercuTwist.

PAIN MEDICINE:

Françoise M. Bardiau, Nicole F. Taviaux, Adelin Albert, Jean G. Boogaerts, and Michaela Stadler

An Intervention Study to Enhance Postoperative Pain Management
Anesth Analg 2003 96: 179-185. [Abstract] [Full Text]  

IMPLICATIONS: The implementation of an acute pain service, including pain assessment by a visual analog scale, standard multimodal pain treatment, and continuous quality evaluation, improved postoperative pain relief. Establishing teams of surgeons, anesthesiologists, and nurses is the prerequisite for this improvement.

Marion R. McMillan, Thomas Doud, and W. Nugent

Catheter-Associated Masses in Patients Receiving Intrathecal Analgesic Therapy
Anesth Analg 2003 96: 186-190. [Abstract] [Full Text]  

IMPLICATIONS: Catheter-associated intrathecal masses were detected in three of seven patients receiving long-term intrathecal analgesia. In the two asymptomatic patients, timely clinical intervention was associated with the avoidance of subsequent neurologic injury and spontaneous resolution of one of the occult masses.

Dawn R. Conklin and James C. Eisenach

Intrathecal Ketorolac Enhances Antinociception from Clonidine
Anesth Analg 2003 96: 191-194. [Abstract] [Full Text]  

IMPLICATIONS: Spinal injection of the {alpha}2-adrenergic agonist clonidine and the cyclooxygenase inhibitor ketorolac results in a synergistic interaction for antinociception in normal animals, suggesting that the combination of these drugs will enhance rather than detract from the analgesia of either alone.

M. Frances Davies, Fawzi Haimor, Geoffrey Lighthall, and J. David Clark

Dexmedetomidine Fails to Cause Hyperalgesia After Cessation of Chronic Administration
Anesth Analg 2003 96: 195-200. [Abstract] [Full Text]  

IMPLICATIONS: The cessation of the administration of opioids is associated with hyperalgesia in both humans and other animals. However, antinociceptive dexmedetomidine does not seem to be associated with this type of hyperalgesia syndrome during periods of abstinence.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Armin Schubert, Gifford Eckhout, Jr., and Kevin Tremper

An Updated View of the National Anesthesia Personnel Shortfall
Anesth Analg 2003 96: 207-214. [Abstract] [Full Text]  

IMPLICATIONS: With updates from training programs, surgical activity, and other sources, our previously described model estimates a continuing shortfall of 1000-3800 anesthesiologists in 2002 and 500-3900 in 2005, assuming that service demand growth is 1.5% or 2% annually. If service growth >1.5% is likely, entry into the specialty should be encouraged beyond current levels.

Christopher Lysakowski, Lionel Dumont, Martin R. Tramèr, and Edömer Tassonyi

A Needle-Free Jet-Injection System with Lidocaine for Peripheral Intravenous Cannula Insertion: A Randomized Controlled Trial with Cost-Effectiveness Analysis
Anesth Analg 2003 96: 215-219. [Abstract] [Full Text]  

IMPLICATIONS: Insertion of an IV cannula is painful. Four-hundred patients were randomly allocated to test the analgesic efficacy, adverse effects, and cost-effectiveness of the needle-free intradermal drug delivery system (J-Tip(R); Jet). Jet with lidocaine is effective, but its application is not painless. Costs to achieve one patient with no more than moderate pain (numerical verbal scale <=3 of 10) on insertion of an IV cannula are $10.

CRITICAL CARE AND TRAUMA:

Marcelo Gama de Abreu, Manuel Heintz, Axel Heller, Roswitha Széchényi, Detlev Michael Albrecht, and Thea Koch

One-Lung Ventilation with High Tidal Volumes and Zero Positive End-Expiratory Pressure Is Injurious in the Isolated Rabbit Lung Model
Anesth Analg 2003 96: 220-228. [Abstract] [Full Text]  

IMPLICATIONS: One-lung ventilation with high tidal volumes and zero positive end-expiratory pressure (PEEP) is injurious in the isolated rabbit lung model. A ventilatory strategy with tidal volumes and PEEP set to avoid lung overdistension and collapse minimizes lung injury during one-lung ventilation in this model.

NEUROSURGICAL ANESTHESIA:

Lize Xiong, Yu Zheng, Mingchun Wu, Lichao Hou, Zhenghua Zhu, Xijing Zhang, and Zhihong Lu

Preconditioning with Isoflurane Produces Dose-Dependent Neuroprotection via Activation of Adenosine Triphosphate-Regulated Potassium Channels After Focal Cerebral Ischemia in Rats
Anesth Analg 2003 96: 233-237. [Abstract] [Full Text]  

IMPLICATIONS: Brief isoflurane anesthesia induces ischemic tolerance in the brain. The effect was found to be dose dependent in a rat focal cerebral ischemia model. Ischemic tolerance induced by isoflurane preconditioning is dependent on activation of adenosine triphosphate-regulated potassium channels.

Kai-Michael Scheufler, Christof Thees, Joachim Nadstawek, and Josef Zentner

S(+)-Ketamine Attenuates Myogenic Motor-Evoked Potentials at or Distal to the Spinal -Motoneuron
Anesth Analg 2003 96: 238-244. [Abstract] [Full Text]  

IMPLICATIONS: S(+)-Ketamine combines several anesthetic properties suitable for total IV neuroanesthesia, including minimal effects on neurophysiological monitoring. Recording of neural and myogenic responses after electrical stimulation of the motor cortex indicates that S(+)-ketamine modulates myogenic motor-evoked potentials by a peripheral mechanism at or distal to the spinal {alpha}-motoneuron.

Johnathan J. Edwards, David Samuels, and Eugene S. Fu

Forearm Compartment Syndrome from Intravenous Mannitol Extravasation During General Anesthesia (Case Report)
Anesth Analg 2003 96: 245-246. [Abstract] [Full Text]  

IMPLICATIONS: Complications of IV mannitol administration resulting in compartment syndrome may warrant surgical intervention. Compartment syndrome is difficult to diagnose in the anesthetized patient. Infusing mannitol in an observed IV site permits discontinuation of mannitol before complications ensue. Early recognition and surgical intervention averted potential impairment in our patient.

REGIONAL ANESTHESIA:

Bradley D. Bergman, James R. Hebl, Jay Kent, and Terese T. Horlocker

Neurologic Complications of 405 Consecutive Continuous Axillary Catheters
Anesth Analg 2003 96: 247-252. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated the risk of neurologic complications in 368 patients undergoing 405 consecutive continuous axillary blocks. New neurologic deficits were reported in four patients. This series suggests that the risk of neurologic complications associated with continuous axillary block is similar to that of single-dose techniques.

Andrea Casati, Battista Borghi, Guido Fanelli, Nicoletta Montone, Roberto Rotini, Gianfranco Fraschini, Federico Vinciguerra, Giorgio Torri, and Jacques Chelly

Interscalene Brachial Plexus Anesthesia and Analgesia for Open Shoulder Surgery: A Randomized, Double-Blinded Comparison Between Levobupivacaine and Ropivacaine
Anesth Analg 2003 96: 253-259. [Abstract] [Full Text]  

IMPLICATIONS: This prospective, randomized, double-blinded study demonstrates that 30 mL of 0.5% levobupivacaine produces an interscalene brachial plexus block of similar onset and quality as the one produced by the same volume of 0.5% ropivacaine. When prolonging the block after surgery, 0.125% levobupivacaine provides adequate pain relief and recovery of motor function after open shoulder surgery, with less volume infused during the first 24 h after surgery than 0.2% ropivacaine.

Henri Iskandar, Antoine Benard, Joelle Ruel-Raymond, Gyslaine Cochard, and Bertrand Manaud

The Analgesic Effect of Interscalene Block Using Clonidine as an Analgesic for Shoulder Arthroscopy
Anesth Analg 2003 96: 260-262. [Abstract] [Full Text]  

IMPLICATIONS: Clonidine administered via an interscalene catheter enhanced analgesia compared with systemic administration. Nevertheless, the adverse effect of clonidine at this dose limits its use for routine management for postoperative analgesia.

REVIEW ARTICLES:

Spencer S. Liu and Francis V. Salinas

Continuous Plexus and Peripheral Nerve Blocks for Postoperative Analgesia
Anesth Analg 2003 96: 263-272. [Full Text]  

CASE REPORTS:

Heinrich Rüschen, Fion D. Bremner, and Caroline Carr

Complications After Sub-Tenon’s Eye Block
Anesth Analg 2003 96: 273-277. [Abstract] [Full Text]  

IMPLICATIONS: The use of blunt instead of sharp needles for ophthalmic local anesthesia techniques has reduced the incidence of injury to intra-orbital structures. This case review of complications from blunt needle sub-Tenon's block suggests that sight-threatening or even life-threatening complications can still occur.

GENERAL ARTICLES:

Tiberiu Ezri, Vadim Hazin, David Warters, Peter Szmuk, and Avi A. Weinbroum

The Endotracheal Tube Moves More Often in Obese Patients Undergoing Laparoscopy Compared with Open Abdominal Surgery
Anesth Analg 2003 96: 278-282. [Abstract] [Full Text]  

IMPLICATIONS: Abdominal insufflation and changes in table position lead to more frequent movements of the endotracheal tube in obese patients undergoing laparoscopic versus open gastroplasty. The RapiscopeTM identifies all these changes, but not the clinically available variables.

Javier H. Campos and Kemp H. Kernstine

A Comparison of a Left-Sided Broncho-Cath® with the Torque Control Blocker Univent and the Wire-Guided Blocker
Anesth Analg 2003 96: 283-289. [Abstract] [Full Text]  

IMPLICATIONS: We compared the latest design of double-lumen tubes Broncho-Cath(R), Univent(R), and Arndt(R) blockers during lung isolation. Our results show that the Arndt(R) blocker takes longer to position and longer to deflate the isolated lung. Once the lung was isolated, the management seemed to be similar for all three devices.

Chakib M. Ayoub, Marwan S. Rizk, Chadi I. Yaacoub, Anis S. Baraka, and Antoine M. Lteif

Advancing the Tracheal Tube over a Flexible Fiberoptic Bronchoscope by a Sleeve Mounted on the Insertion Cord
Anesth Analg 2003 96: 290-292. [Abstract] [Full Text]  

IMPLICATIONS: This report shows that a conical sleeve mounted on the insertion cord of a fiberoptic bronchoscope will facilitate advancing the endotracheal tube into the trachea.

Daelim Jee and So Young Park

Lidocaine Sprayed Down the Endotracheal Tube Attenuates the Airway-Circulatory Reflexes by Local Anesthesia During Emergence and Extubation
Anesth Analg 2003 96: 293-297. [Abstract] [Full Text]  

IMPLICATIONS: Lidocaine sprayed down the endotracheal tube suppresses the airway-circulatory reflex responses whereas using the same dose IV lidocaine does not. This effect seems to be from the direct local anesthesia rather than from systemic absorption from the airway.

TECHNICAL COMMUNICATIONS:

M. Carmen Unzueta, Ignacio Casas, Alfred Merten, and J. Manuel V. Landeira

Endobronchial High-Frequency Jet Ventilation for Endobronchial Laser Surgery: An Alternative Approach
Anesth Analg 2003 96: 298-300. [Abstract] [Full Text]  

IMPLICATIONS: We describe a technique of one-lung high-frequency jet ventilation surgery with continuous monitoring of airway pressures that achieves satisfactory operating conditions with less complications than other similar approaches.

LETTERS TO THE EDITOR:

J. Rieder, G. Gruber, F. Bodrogi, P. Lirk, G. Hoffmann, Jens Krombach, and Walter Buzello

Anaphylactoid Reaction to Cisatracurium May Be Explained by Atracurium Metabolites • Response
Anesth Analg 2003 96: 301. [Full Text]  

Lawrence J. Caruso, Nikolaus Gravenstein, A. Joseph Layon, Andrea Gabrielli, Dean B. Andropoulos, and Stephen A. Stayer

Central Venous Catheter Tip and Perforation • Response
Anesth Analg 2003 96: 301-302. [Full Text]  

Peter Kranke, Norbert Roewer, Dirk Rüsch, Swen N. Piper, Franz Pusch, and Eckart Wildling

Arterial Hypotension During Induction of Anesthesia May Not Be a Risk Factor for Postoperative Nausea and Vomiting • Response
Anesth Analg 2003 96: 302-303. [Full Text]  

Robert Y. Rauch and Craig E. Brener

Airway Management for Pediatric Esophagogastroduodenoscopy Using an Endoscopy Mask
Anesth Analg 2003 96: 303-304. [Full Text]  

Julian P. Stone and Jeremy Collyer

Aide-Memoir to Pharyngeal Pack Removal
Anesth Analg 2003 96: 304. [Full Text]  

Carlo D. Franco, Jerry D. Vloka, and Admir Hadzic

Posterior Approach to Popliteal Block • Response
Anesth Analg 2003 96: 304-306. [Full Text]  

Maurice S. Albin, Leon Bunegin, Nicolas Bruder, and Armin Schubert

The Insidiousness of Brain Retractor Pressure: Another "Smoking Gun"? • Response • Response
Anesth Analg 2003 96: 306-307. [Full Text]  

M. Ercan, C. Koksal, and David M. Eckmann

The Relationship Between Shear Rate and Vessel Diameter • Response
Anesth Analg 2003 96: 307-308. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

John Donlon and John C. Rowlingson

Ophthalmic Anesthesia • Practical Pain Management • Books Received
Anesth Analg 2003 96: 309-310. [Full Text]  

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