EDITORIALS:

Neill Adhikari and William Sibbald

The Large Cost of Critical Care: Realities and Challenges
Anesth Analg 2003 96: 311-314. [Full Text] [PDF] [Request Permissions]  

Oscar A. de Leon-Casasola

When It Comes to Outcome, We Need to Define What a Perioperative Epidural Technique Is
Anesth Analg 2003 96: 315-318. [Full Text] [PDF] [Request Permissions]  

Jeremy Sugarman

Missing the Informed in Consent
Anesth Analg 2003 96: 319-320. [Full Text] [PDF] [Request Permissions]  

CARDIOVASCULAR ANESTHESIA:

Peter Svenarud, Mikael Persson, and Jan van der Linden

Intermittent or Continuous Carbon Dioxide Insufflation for De-Airing of the Cardiothoracic Wound Cavity? An Experimental Study with a New Gas-Diffuser
Anesth Analg 2003 96: 321-327. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Carbon dioxide insufflation into a cardiothoracic wound model was studied with a new device. Efficient air removal (<=0.65% remaining air) required a continuous carbon dioxide flow of >=5 L/min after initial filling during 1 min at 10 L/min. A conventional tube failed to provide efficient de-airing (>=82% remaining air).

Nahum Nesher, Eli Zisman, Tamir Wolf, Ram Sharony, Gil Bolotin, Miriam David, Gideon Uretzky, and Reuven Pizov

Strict Thermoregulation Attenuates Myocardial Injury During Coronary Artery Bypass Graft Surgery as Reflected by Reduced Levels of Cardiac-Specific Troponin I
Anesth Analg 2003 96: 328-335. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Maintenance of normothermia throughout the nonbypass phases of coronary artery bypass graft surgery is important in the attenuation of myocardial ischemic injury as assessed by intraoperative cardiac-specific troponin I measurements. It may also provide a method of assessing the efficacy of current cardioprotective strategies, as well as of future pharmacological and mechanical approaches.

Andreas Lehmann, Julia Karzau, Joachim Boldt, Elfi Thaler, Johannes Lang, and Frank Isgro

Bispectral Index-Guided Anesthesia in Patients Undergoing Aortocoronary Bypass Grafting
Anesth Analg 2003 96: 336-343. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:Bispectral index (BIS)-guided anesthesia may allow reductions in anesthetic medication and costs without increasing the risk of intraoperative awareness. However, total costs may be increased by monitoring BIS.

Gregory A. Nuttall, William C. Oliver, Jr, Paula J. Santrach, Robert D. McBane, Daniel B. Erpelding, Christina L. Marver, and Kenton J. Zehr

Patients with a History of Type II Heparin-Induced Thrombocytopenia with Thrombosis Requiring Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Observational Case Series
Anesth Analg 2003 96: 344-350. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report a case series of 12 patients with a clinical history of type II heparin-induced thrombocytopenia and describe their hematologic management during cardiac surgery with cardiopulmonary bypass.

Jürgen T. Lutz, Camino Valentín-Gamazo, Klaus Görlinger, Massimo Malagó, and Jürgen Peters

Blood-Transfusion Requirements and Blood Salvage in Donors Undergoing Right Hepatectomy for Living Related Liver Transplantation
Anesth Analg 2003 96: 351-355. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Avoidance of heterogenous blood transfusion in the donor operation for living donor liver transplantation is crucial. We describe our experience with the first 44 liver donors under special consideration of state-of-the-art blood-saving techniques applied.

Jan F.A. Hendrickx, Michael K. Dishart, and Andre M. De Wolf

Isoflurane and Desflurane Uptake During Liver Resection and Transplantation
Anesth Analg 2003 96: 356-362. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:The uptake of isoflurane and desflurane during prolonged surgery did not consistently correlate with cardiac output and patient characteristics and differed from two frequently used uptake models. The slowly decreasing rate of uptake implies that the number of vaporizer adjustments during prolonged low-flow anesthesia should be limited.

Stephanie B. Jones, Charles W. Whitten, George J. Despotis, and Terri G. Monk

The Influence of Crystalloid and Colloid Replacement Solutions in Acute Normovolemic Hemodilution: A Preliminary Survey of Hemostatic Markers
Anesth Analg 2003 96: 363-368. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Lactated Ringer's solution, albumin, dextran, and hetastarch were compared as replacement fluids in an acute normovolemic hemodilution protocol in adult patients undergoing radical prostatectomy. Differences in coagulation measurements suggest that dextran and hetastarch may attenuate surgically induced hypercoagulability.

Thalia Palmer, Joyce A. Wahr, Michael O’Reilly, and Mary Lou V.H. Greenfield

Reducing Unnecessary Cross-Matching: A Patient-Specific Blood Ordering System Is More Accurate in Predicting Who Will Receive a Blood Transfusion Than the Maximum Blood Ordering System
Anesth Analg 2003 96: 369-375. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Currently, many units of blood set aside for surgery are never required, resulting in extra work and expense for blood banks. A formula that included patient weight and hematocrit and typical surgery blood loss was used to predict who would require transfusions. We reduced the predicted number of patients who had blood set aside from 178 to 21.

Joachim Boldt and Hans-Joachim Priebe

Intravascular Volume Replacement Therapy with Synthetic Colloids: Is There an Influence on Renal Function? (Medical Intelligence)
Anesth Analg 2003 96: 376-382. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Articles on volume replacement published between 1981 and 2001 were analyzed. Albumin and gelatin do not predispose to development of kidney dysfunction. Modern hydroxyethyl starch (HES) solutions can be used safely in patients without kidney dysfunction even in large doses. Safety of HES in patients with preexisting altered kidney function still remains unclear.

Andreas Koster, Derek Chew, Marcus Gründel, Matthias Bauer, Herman Kuppe, and Bruce D. Spiess

Bivalirudin Monitored with the Ecarin Clotting Time for Anticoagulation During Cardiopulmonary Bypass (Case Report)
Anesth Analg 2003 96: 383-386. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:Bivalirudin, a new short-acting direct thrombin inhibitor, provides an elimination mechanism independent of specific organ function. We successfully used this new drug, monitored at the point of care via the ecarin clotting time, for anticoagulation during cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia heparin allergy and impaired renal function.

PEDIATRIC ANESTHESIA:

Charles J. Coté, Andrew G. Roth, Melissa Wheeler, Carolyn ter Rahe, Bronwyn R. Rae, Richard M. Dsida, and H. J. Przybylo

Traditional Versus New Needle Retractable IV Catheters in Children: Are They Really Safer, and Whom Are They Protecting?
Anesth Analg 2003 96: 387-391. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:Use of retractable needle safety IV catheters may increase rather than decrease exposure to blood. The choice of IV system should be left to the clinician's best judgment to balance the efficient establishment of venous access with the least potential for blood contamination.

Keith K. Brosius and Carolyn F. Bannister

Midazolam Premedication in Children: A Comparison of Two Oral Dosage Formulations on Sedation Score and Plasma Midazolam Levels
Anesth Analg 2003 96: 392-395. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: IV midazolam mixed in Syrpalta(R) syrup produces a greater sedative effect and higher plasma midazolam levels than the commercially available syrup when used as an oral anesthetic premedication in pediatric surgical patients.

W.Y. Choi, M.G. Irwin, T.W.C. Hui, H.H. Lim, and K.L. Chan

EMLA^® Cream Versus Dorsal Penile Nerve Block for Postcircumcision Analgesia in Children
Anesth Analg 2003 96: 396-399. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study shows that topical application of EMLA(R) cream before circumcision is simple and effective with few side effects.

Luis J. Goldman

Anesthetic Uptake of Sevoflurane and Nitrous Oxide During an Inhaled Induction in Children
Anesth Analg 2003 96: 400-406. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:The wash-in of sevoflurane and nitrous oxide in healthy children during the mask induction of anesthesia showed a more rapid equilibrium between alveolar and inspired gas concentrations than in adults. Consistent with their respective blood/gas partition coefficients, the alveolar concentration for nitrous oxide increased more rapidly to its inspired concentration than that for sevoflurane. A concentration effect was confirmed with nitrous oxide and a brief, second gas effect, probably explained by the higher solubility of sevoflurane.

Shinji Akada, Shinhiro Takeda, and Ryo Ogawa

Salicylate Action on Medullary Inspiratory Neuron Activity in a Brainstem-Spinal Cord Preparation from Newborn Rats
Anesth Analg 2003 96: 407-411. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We investigated salicylate effects on the medullary respiratory center. Small-dose salicylate (1 mM) directly stimulated the respiratory center. Large-dose salicylate (10 mM) caused central respiratory depression involving a GABAergic mechanism.

Christian Seefelder, David R. Hill, Robert C. Shamberger, and Robert S. Holzman

Awake Caudal Anesthesia for Inguinal Surgery in One Conjoined Twin (Case Report)
Anesth Analg 2003 96: 412-413. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Conjoined twins have some cross-circulation, which makes general anesthesia for only one patient impossible. Using caudal anesthesia in the awake patient, we were able to provide anesthesia for an inguinal central venous catheter placement in one patient without having to unnecessarily anesthetize the other twin.

AMBULATORY ANESTHESIA:

Xavier Capdevila, Philippe Macaire, Philippe Aknin, Christophe Dadure, Nathalie Bernard, and Sandrine Lopez

Patient-Controlled Perineural Analgesia After Ambulatory Orthopedic Surgery: A Comparison of Electronic Versus Elastomeric Pumps (Technical Communication)
Anesth Analg 2003 96: 414-417. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Patient-controlled perineural analgesia techniques using Infusor LV5(R) disposable elastomeric or two types of electronic pumps provide efficient pain relief at home after ambulatory orthopedic procedures. Elastomeric pumps resulted in fewer technical problems and led to better patient satisfaction scores than Microjet(R) electronic pumps.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Eric L. Bloomfield

The Impact of Economics on Changing Medical Technology with Reference to Critical Care Medicine in the United States (Review Article)
Anesth Analg 2003 96: 418-425. [Full Text] [PDF] [Request Permissions]  

Tom Pedersen, Ann M. Møller, and Bente D. Pedersen

Pulse Oximetry for Perioperative Monitoring: Systematic Review of Randomized, Controlled Trials (Review Article)
Anesth Analg 2003 96: 426-431. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:We sought to clarify the effect of monitoring oxygen in the blood in surgical patients and to identify the adverse outcomes. A small percentage of oxygen in the blood (hypoxemia) was reduced in a pulse oximetry group; however, the incidence of postoperative complications was the same in a control group. We confirmed that pulse oximetry can detect hypoxemia.

Hikaru Kohase, Hiroshi Sehata, Hirohito Inada, Yoko Ikeda, and Masahiro Umino

Endotracheal Intubation Device with a Charge Couple Device Camera (Review Article)
Anesth Analg 2003 96: 432-434. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We developed an orotracheal intubation device equipped with a charge couple device (CCD) camera, providing a wide field of vision. We used this device to perform endotracheal intubations in 62 anesthetized patients undergoing dental treatment and oral surgery. Endotracheal intubation can be easily performed with this device.

Ian J. Welsby, J. Mark Ryan, John V. Booth, Ellen Flanagan, Robert H. Messier, and Cecil O. Borel

The Bispectral Index in the Diagnosis of Perioperative Stroke: A Case Report and Discussion (Case Report)
Anesth Analg 2003 96: 435-437. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We describe a case where the frequently used bispectral index (BIS) monitor provided the first indication of a massive stroke. The diagnosis of stroke should be considered in the event of an unexplained, sudden, and sustained decrease in the BIS.

ANESTHETIC PHARMACOLOGY:

Kyo S. Kim, Jeong W. Jeon, Myoung S. Koh, Jae H. Shim, Sang Y. Cho, and Jung K. Suh

The Duration of Immobilization Causes the Changing Pharmacodynamics of Mivacurium and Rocuronium in Rabbits
Anesth Analg 2003 96: 438-442. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In the present study, we examined, in vivo, whether the duration of immobilization can alter the pharmacodynamics of mivacurium and rocuronium in an immobilized limb and/or a contralateral limb in rabbits. The immobilization disuse atrophy produced by casting led to the development of resistance to both drugs but no resistance was shown in the contralateral limb.

Takahiro Suzuki, Kazuyoshi Ueta, Masahiro Sugimoto, Ichiro Uchida, and Takashi Mashimo

Nitrous Oxide and Xenon Inhibit the Human (₇)₅ Nicotinic Acetylcholine Receptor Expressed in Xenopus Oocyte
Anesth Analg 2003 96: 443-448. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:The neuronal nicotinic acetylcholine (nACh) receptors have received attention as a potential target for general anesthetics because many general anesthetics inhibit their functions. However, effects of gaseous anesthetics, nitrous oxide, and xenon on the ({alpha}7)5 receptor, a subtype of the nACh receptor, have not been examined. We report that these anesthetics inhibit the ({alpha}7)5 nACh receptor at clinical concentrations.

Michael H. Dueck, Aloys Oberthuer, Christoph Wedekind, Matthias Paul, and Ulf Boerner

Propofol Impairs the Central but Not the Peripheral Part of the Motor System
Anesth Analg 2003 96: 449-455. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Propofol bolus administration provides some degree of muscle relaxation in humans. We demonstrated a decrease of motoneuron excitability in the spinal cord, measured by F-wave analysis, a late electromyographic signal. No effects on neuromuscular transmission or muscle contractility, measured by electromyography and mechanomyography, were observed.

Zoë L. S Brookes, Nicola J. Brown, and Charles S. Reilly

The Dose-Dependent Effects of Fentanyl on Rat Skeletal Muscle Microcirculation In Vivo
Anesth Analg 2003 96: 456-462. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Fentanyl is used as a pain killing drug during surgery, but its effects on small blood vessels are uncertain. We implanted chambers into a skin flap in rats to study skeletal muscle microcirculation. Fentanyl caused a decrease in blood vessel diameter that could potentially reduce blood flow to tissues during surgery.

J. Antonio Aldrete

Epidural Injections of Indomethacin for Postlaminectomy Syndrome: A Preliminary Report
Anesth Analg 2003 96: 463-468. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Indomethacin is an antiinflammatory medication that seems to have similarly effective pain-relief action, when given epidurally, as one of the most frequently used corticosteroids which has limitations because of common side effects. An added advantage is that indomethacin seems to also "tame" pain transmission.

Roman Schumann, Scott Shikora, Jocelyn M. Weiss, Heinrich Wurm, Scott Strassels, and Daniel B. Carr

A Comparison of Multimodal Perioperative Analgesia to Epidural Pain Management After Gastric Bypass Surgery
Anesth Analg 2003 96: 469-474. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We compared pain intensity, analgesic consumption, length of stay, and patient satisfaction in patients undergoing gastric bypass surgery randomized to one of three treatment groups. In responders, infiltration analgesia as part of a multimodal postoperative pain management regimen offered a simple, safe, and inexpensive alternative to epidural pain control.

Pilar Taurá, Josep Fuster, Anabel Blasi, Julia Martinez-Ocon, Teresa Anglada, Joan Beltran, Jaume Balust, Javier Tercero, and Juan-Carlos Garcia-Valdecasas

Postoperative Pain Relief After Hepatic Resection in Cirrhotic Patients: The Efficacy of a Single Small Dose of Ketamine Plus Morphine Epidurally
Anesth Analg 2003 96: 475-480. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This is a clinical prospective and randomized trial. The study shows the efficacy and safety of a single-dose administration of epidural morphine plus small-dose ketamine given as the only treatment for postoperative pain relief in cirrhotic patients having liver resection.

Reginald Matejec, Ralph Ruwoldt, Rolf-Hasso Bödeker, Gunter Hempelmann, and Hansjörg Teschemacher

Release of ß-Endorphin Immunoreactive Material Under Perioperative Conditions into Blood or Cerebrospinal Fluid: Significance for Postoperative Pain?
Anesth Analg 2003 96: 481-486. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: ß-Endorphin immunoreactive material has been determined in plasma and cerebrospinal fluid under perioperative conditions. Its release into the cardiovascular compartment is related to postoperative pain severity, although its analgesic significance remains to be elucidated.

Ildiko Dobos, Kalman Toth, Gabriella Kekesi, Gabriella Joo, Emese Csullog, Walter Klimscha, Gyorgy Benedek, and Gyongyi Horvath

The Significance of Intrathecal Catheter Location in Rats
Anesth Analg 2003 96: 487-492. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study has shown that detection of the paralytic and/or antinociceptive effect of small-dose lidocaine before planned experiments is a simple and reliable method for prediction of the location of the catheter tip. We suggest that the position of the catheter might cause side differences in the drug effect.

Masatomo Sakurai, Muhammad-Irfan Suleman, Nobutada Morioka, Ozan Akça, and Daniel I. Sessler

Minute Sphere Acupressure Does Not Reduce Postoperative Pain or Morphine Consumption
Anesth Analg 2003 96: 493-497. [Abstract] [Full Text] [PDF] [Request Permissions]  

Minute sphere therapy is a form of acupuncture. We tested whether minute spheres placed on three acupressure points relevant to abdominal surgery reduced pain and morphine requirements after abdominal surgery. Treatment and control patients received a similar covering. Neither pain nor morphine requirements were different between the groups.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Tanja A. Treschan, Thomas Scheck, Alexander Kober, Edith Fleischmann, Beatrice Birkenberg, Brigitte Petschnigg, Ozan Akça, Franz X. Lackner, Elisabeth Jandl-Jager, and Daniel I. Sessler

The Influence of Protocol Pain and Risk on Patients’ Willingness to Consent for Clinical Studies: A Randomized Trial
Anesth Analg 2003 96: 498-506. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We tested the hypothesis that the risk or discomfort associated with a clinical trial influence a patient's decision to participate. Patients who understand the risks involved are twice as likely to consent. In contrast, those who feel pressured do not agree to participate. Many patients are willing to participate in risky or painful studies, apparently for altruistic reasons.

Franklin Dexter, Rodney D. Traub, and Alex Macario

How to Release Allocated Operating Room Time to Increase Efficiency: Predicting Which Surgical Service Will Have the Most Underutilized Operating Room Time
Anesth Analg 2003 96: 507-512. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: When a service has filled its allocated operating room (OR) time and has a new case to schedule, OR efficiency is maximized by scheduling the case into the OR time of another service. The service whose OR time is released can be the service with the largest difference between allocated and scheduled OR time at the time when the new case is scheduled.

Joseph W. Szokol, Glenn S. Murphy, Michael J. Avram, Martin Nitsun, Theodore M. Wynnychenko, and Jeffery S. Vender

Declining Proportion of Publications by American Authors in Major Anesthesiology Journals
Anesth Analg 2003 96: 513-517. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In the period 1980-2000, there was an increase in the number of research articles published in the three main anesthesia journals: Anesthesiology, Anesthesia & Analgesia, and Pain. Despite this increase in research activity, there was a significantly disproportionate decrease in the United States versus non-US authorship.

CRITICAL CARE AND TRAUMA:

Chi-Yuan Li, Tz-Chong Chou, Chian-Her Lee, Chien-Sung Tsai, Shih-Hurng Loh, and Chih-Shung Wong

Adrenaline Inhibits Lipopolysaccharide-Induced Macrophage Inflammatory Protein-1 in Human Monocytes: The Role of ß-Adrenergic Receptors
Anesth Analg 2003 96: 518-523. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Macrophage inflammatory protein-1{alpha} (MIP-1{alpha}) has an important role in the development of inflammatory responses. In this study, adrenaline was found to inhibit lipopolysaccharide-induced MIP-1{alpha} production and messenger RNA expression via ß-adrenergic receptors in human monocytes. Our results suggest that adrenaline may modulate MIP-1{alpha} production in inflammatory diseases and sepsis.

NEUROSURGICAL ANESTHESIA:

Kristin Engelhard, Christian Werner, Eva Eberspächer, Monika Bachl, Manfred Blobner, Eberhard Hildt, Peter Hutzler, and Eberhard Kochs

The Effect of the ₂-Agonist Dexmedetomidine and the N-Methyl-D-Aspartate Antagonist S(+)-Ketamine on the Expression of Apoptosis-Regulating Proteins After Incomplete Cerebral Ischemia and Reperfusion in Rats
Anesth Analg 2003 96: 524-531. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study shows that dexmedetomidine and S(+)-ketamine influence the expression of apoptosis-regulating proteins in rat brains 4 h after cerebral ischemia/reperfusion. Therefore, it is possible that the neuroprotection seen with dexmedetomidine and S(+)-ketamine might also involve antiapoptotic mechanisms in addition to reducing necrotic cell death.

Toru Goyagi, Anish Bhardwaj, Raymond C. Koehler, Richard J. Traystman, Patricia D. Hurn, and Jeffrey R. Kirsch

Potent ₁-Receptor Ligand 4-Phenyl-1-(4-Phenylbutyl) Piperidine Provides Ischemic Neuroprotection Without Altering Dopamine Accumulation In Vivo in Rats
Anesth Analg 2003 96: 532-538. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: {varsigma}1-Receptor ligands decrease infarction size in the striatum when given before or after onset of stroke without affecting ischemia-evoked dopamine efflux.

OBSTETRIC ANESTHESIA:

Nobukazu Sato, Kenichi A. Tanaka, Fania Szlam, Atsushi Tsuda, Maria E. Arias, and Jerrold H. Levy

The Vasodilatory Effects of Hydralazine, Nicardipine, Nitroglycerin, and Fenoldopam in the Human Umbilical Artery
Anesth Analg 2003 96: 539-544. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We conclude that currently used drugs to treat acute hypertension have no adverse effects on umbilical artery tone; however, larger concentrations (>=10-5 M) of fenoldopam may produce contraction of the umbilical artery.

John P. R. Loughrey, Sunil Eappen, and Lawrence C. Tsen

Spinal Anesthesia for Cesarean Delivery Shortly After an Epidural Blood Patch (Case Report)
Anesth Analg 2003 96: 545-547. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The use of central neuraxial anesthesia techniques shortly after an epidural blood patch (EBP) has not been described. The authors discuss the potential concerns and report a unique case of a patient who underwent a cesarean delivery under spinal anesthesia 6 h after an EBP.

REGIONAL ANESTHESIA:

Philip J. Peyton, Paul S. Myles, Brendan S. Silbert, John A. Rigg, Konrad Jamrozik, and and Richard Parsons

Perioperative Epidural Analgesia and Outcome After Major Abdominal Surgery in High-Risk Patients
Anesth Analg 2003 96: 548-54. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Secondary analysis of data from a large randomized trial of perioperative epidural analgesia demonstrates no beneficial effect on major postsurgical morbidity or mortality from epidural analgesia.

Ralph Lattermann, Franco Carli, Linda Wykes, and Thomas Schricker

Perioperative Glucose Infusion and the Catabolic Response to Surgery: The Effect of Epidural Block
Anesth Analg 2003 96: 555-562. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:We investigated the effect of epidural block on perioperative glucose and protein kinetics in patients receiving IV glucose infusion. Endogenous glucose production and plasma glucose concentration were smaller in the presence of epidural block. However, epidural block did not modify perioperative protein metabolism during the administration of IV glucose.

Pertti Pere, Merja Salonen, Mika Jokinen, Per H. Rosenberg, Pertti J. Neuvonen, and Juhani Haasio

Pharmacokinetics of Ropivacaine in Uremic and Nonuremic Patients After Axillary Brachial Plexus Block
Anesth Analg 2003 96: 563-569. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In uremic patients, enhanced absorption and reduced clearance of ropivacaine and reduced urinary excretion of the ropivacaine metabolites could lead to toxicity. Increased plasma protein binding of ropivacaine in uremic patients reduces elimination of the local anesthetic but may protect against acute toxicity despite large total plasma concentrations of ropivacaine.

Åsa Österlund Modalen, Lars Westman, Eva Arlander, Lars I. Eriksson, and Sten G. E. Lindahl

Hypercarbic and Hypoxic Ventilatory Responses After Intrathecal Administration of Bupivacaine and Sameridine
Anesth Analg 2003 96: 570-575. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Intrathecal administration of sameridine, a new molecule with both local anesthetic and opioid properties, compared with bupivacaine, a well-known local anesthetic, produces similar and minor effects on respiration over a 24-h observation period.

Dan J. Kopacz, Peter G. Lacouture, Danlin Wu, Partha Nandy, Ruth Swanton, and Craig Landau

The Dose Response and Effects of Dexamethasone on Bupivacaine Microcapsules for Intercostal Blockade (T9 to T11) in Healthy Volunteers
Anesth Analg 2003 96: 576-582. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The incorporation of dexamethasone into bupivacaine-loaded microcapsules reduces the onset time and prolongs the duration of bupivacaine analgesia over the 0.3125%-5.0% dose range. Bupivacaine microcapsules appear safe for use in intercostal blockade in this preliminary study in volunteers.

GENERAL ARTICLES:

Kawalpreet Manku, Peter Bacchetti, and Jacqueline M. Leung

Prognostic Significance of Postoperative In-Hospital Complications in Elderly Patients. I. Long-Term Survival
Anesth Analg 2003 96: 583-589. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Elderly surgical patients who have had an in-hospital postoperative complication have increased mortality, particularly in the first 3 mo after surgery. Efforts to improve perioperative care delivery to elderly surgical patients must include measures to minimize in-hospital postoperative complications, particularly those involving the pulmonary and renal systems.

Kawalpreet Manku and Jacqueline M. Leung

Prognostic Significance of Postoperative In-Hospital Complications in Elderly Patients. II. Long-Term Quality of Life
Anesth Analg 2003 96: 590-594. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In a group of geriatric patients, the occurrence of postoperative complications did not independently predict long-term quality of life or functional status. The important independent predictors were co-morbid conditions, age, and new hospitalization after discharge.

Zahid Hussain Khan, Arash Kashfi, and Elham Ebrahimkhani

A Comparison of the Upper Lip Bite Test (a Simple New Technique) with Modified Mallampati Classification in Predicting Difficulty in Endotracheal Intubation: A Prospective Blinded Study
Anesth Analg 2003 96: 595-599. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Airway management continues to be a challenge despite substantial advances in this field. We found that the upper lip bite test, a reasonably easy test, was more predictive of a difficult airway than the modified Mallampati score.

Eduardo Figueredo, Miguel Martínez, and Teresa Pintanel

A Comparison of the ProSeal^TM Laryngeal Mask and the Laryngeal Tube^® in Spontaneously Breathing Anesthetized Patients
Anesth Analg 2003 96: 600-605. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this prospective, randomized study, we found that the ProSealTM laryngeal mask airway was easier to insert and permitted a better delivery of hands-free anesthesia than the Laryngeal Tube(R). The incidence of postoperative laryngopharyngeal discomfort was similar for both devices.

Fujio Karasawa, Akira Takita, Tomohisa Mori, Isao Takamatsu, Yasushi Kawatani, and Takashi Oshima

The Brandt^TM Tube System Attenuates the Cuff Deflationary Phenomenon After Anesthesia with Nitrous Oxide
Anesth Analg 2003 96: 606-610. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We demonstrated that the BrandtTM tube system attenuates a decrease in cuff pressure after cessation of nitrous oxide (N2O) administration, whereas a method of repeated cuff deflation to avoid excessive pressure during N2O anesthesia causes deflationary phenomenon of the cuff after cessation of N2O administration, resulting in possible risk of air leaks.

Eugene W. Moretti, Kerri M. Robertson, Habib El-Moalem, and Tong J. Gan

Intraoperative Colloid Administration Reduces Postoperative Nausea and Vomiting and Improves Postoperative Outcomes Compared with Crystalloid Administration
Anesth Analg 2003 96: 611-617. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Intraoperative resuscitation with colloid reduces postoperative nausea and vomiting and improves the quality of postoperative recovery when compared with crystalloid resuscitation.

TECHNICAL COMMUNICATIONS:

Volker Dörges, Hartmut Ocker, Volker Wenzel, Markus Steinfath, and Klaus Gerlach

The Laryngeal Tube S: A Modified Simple Airway Device
Anesth Analg 2003 96: 618-621. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The Laryngeal Tube S, fitted with a second lumen serving for suctioning and free gastric drainage, but not for ventilation, as with the Combitube, can be inserted without additional equipment, and was proven in a preliminary clinical trial to effectively ventilate patients with respiratory arrest and to evacuate stomach contents.

SPECIAL ARTICLES:

Theodore A. Alston

The Contributions of A. W. Hofmann
Anesth Analg 2003 96: 622-625. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A. W. Hofmann broadly influenced anesthesiology through his seminal work on amine structures and synthetic amine drugs. Many drugs in addition to atracurium should invoke his memory.

LETTERS TO THE EDITOR:

James C. Eisenach, Tony L. Yaksh, Peter Marhofer, and Margot Semsroth

Epidural Ketamine in Healthy Children—What’s the Point? • Response
Anesth Analg 2003 96: 626-627. [Full Text] [PDF] [Request Permissions]  

Wasimul Huda, Rashid M. Kahn, Moied Ahmad, and Manpreet Singh

Yet Another Bend in the Wand!
Anesth Analg 2003 96: 627-628. [Full Text] [PDF] [Request Permissions]  

Hernán R. Muñoz, Mauricio E. Ibacache, and Ira Todd Cohen

Agitation After Desflurane and Dixon and Massey Up-and-Down Method • Response
Anesth Analg 2003 96: 628. [Full Text] [PDF] [Request Permissions]  

Dominic Harmon, Wei Lan, K. Hahnenkamp, and C. W. Hoenemann

Effects of Systemic Local Anesthetics on Perioperative Ischemia Reperfusion May Be Beneficial • Response
Anesth Analg 2003 96: 629. [Full Text] [PDF] [Request Permissions]  

Bee Beng Lee

A Misleading Conclusion and Abstract
Anesth Analg 2003 96: 629. [Full Text] [PDF] [Request Permissions]  

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

Combined Spinal and Epidural Anesthesia for Cesarean Section in a Patient with Hypertrophic Obstructive Cardiomyopathy
Anesth Analg 2003 96: 629-630. [Full Text] [PDF] [Request Permissions]  

Javier H. Campos and Kemp H. Kernstine

A Structural Complication in the Torque Control Blocker Univent^®: Fracture of the Blocker Cap Connector
Anesth Analg 2003 96: 630-631. [Full Text] [PDF] [Request Permissions]  

Tetsuro Morishima, Kazuya Sobue, Hajime Arima, Sayuki Tanaka, MinHye So, Hiroshi Ando, and Hirotada Katsuya

Profound Pain Due to Propofol Injection Triggered Myocardial Ischemia in a Patient with a Suspected Pheochromocytoma
Anesth Analg 2003 96: 631. [Full Text] [PDF] [Request Permissions]  

Robyn Lim

Rapacuronium: Premarket Drug Evaluation Can Be Very Effective for the Identification of Drug Risks
Anesth Analg 2003 96: 631-632. [Full Text] [PDF] [Request Permissions]  

G. D. Puri, Jay W. Johansen, and Peter S. Sebel

Other Stimuli Add to Effect of Remifentanil on BIS • Response
Anesth Analg 2003 96: 632. [Full Text] [PDF] [Request Permissions]  

Carla St. Laurent, Daniel Lee, and Jonathan Benumof

Kinking of the Pilot Tube Prevents Inflation of the Cuff
Anesth Analg 2003 96: 632-633. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Malignant Hyperthermia • Notable Names in Anesthesia • Anesthesia Pearls • Books and Multimedia Received
Anesth Analg 2003 96: 634-635. [Full Text] [PDF] [Request Permissions]  

RETRACTIONS:

Anesth Analg 2003 96: 318. [Full Text] [PDF] [Request Permissions]  

ERRATA:

Anesth Analg 2003 96: 531. [Full Text] [PDF] [Request Permissions]  

To see an article, click its [Full Text] or [PDF] link. To review many abstracts, check the boxes to the left of the titles you want, and click the 'Get All Checked Abstract(s)' button. To see one abstract at a time, click its [Abstract] link.