CARDIOVASCULAR ANESTHESIA:

Maher J. Albahrani, Madhav Swaminathan, Barbara Phillips-Bute, Peter K. Smith, Mark F. Newman, Joseph P. Mathew, and Mark Stafford-Smith

Postcardiac Surgery Complications: Association of Acute Renal Dysfunction and Atrial Fibrillation
Anesth Analg 2003 96: 637-643. [Abstract] [Full Text]  

IMPLICATIONS: We found an independent association between new-onset atrial fibrillation and postoperative creatinine increase that is influenced by age. The degree to which atrial fibrillation is associated with postoperative creatinine increase diminishes with advancing age. This interaction suggests that a common etiology for these two complications may be more important in younger patients.

H. Tarik Kiziltan, Mehmet Baltali, Ahmet Bilen, Gülsah Seydaoglu, Muzaffer Incesoz, Atilay Tasdelen, and Sait Aslamaci

Comparison of Alpha-Stat and pH-Stat Cardiopulmonary Bypass in Relation to Jugular Venous Oxygen Saturation and Cerebral Glucose-Oxygen Utilization
Anesth Analg 2003 96: 644-650. [Abstract] [Full Text]  

IMPLICATIONS: A prospective, randomized study in 52 patients during cardiopulmonary bypass revealed that pH-stat increased jugular venous oxygen saturation and decreased arteriovenous oxygen-glucose differences. There was no difference in the incidence of jugular venous desaturation. These findings suggest an increased cerebral blood flow with no protection against jugular venous desaturation during pH-stat.

Masayoshi Uchida, Hiroki Iida, Mami Iida, and Shuji Dohi

Changes in Cerebral Microcirculation During and After Abdominal Aortic Cross-Clamping in Rabbits: The Role of Thromboxane A₂ Receptor
Anesth Analg 2003 96: 651-656. [Abstract] [Full Text]  

IMPLICATIONS: Abdominal aortic unclamping after a 20-min clamp caused an initial dilation followed by a sustained constriction of pial arterioles. Seratrodast, a thromboxane A2 receptor antagonist, attenuated the vasoconstriction suggesting that it is at least partly mediated by thromboxane A2 washed out from the region rendered ischemic by clamping.

Henriëtte M. Willigers, Frits W. Prinzen, Paul M. Roekaerts, Simon de Lange, and Marcel E. Durieux

Dexmedetomidine Decreases Perioperative Myocardial Lactate Release in Dogs
Anesth Analg 2003 96: 657-664. [Abstract] [Full Text]  

IMPLICATIONS: Dexmedetomidine decreases plasma catecholamines and heart rate during emergence from anesthesia. In dogs with a coronary stenosis, these sympatholytic effects decrease myocardial lactate release and, therefore, minimize emergence-related myocardial ischemia.

Thomas Peter Weber, Maike Anja Große Hartlage, Norbert Rolf, Michael Booke, Elmar Berendes, Hugo Van Aken, and Andreas Meißner

Short-Term Administration of Ethanol Does Not Affect Functional Recovery from Myocardial Stunning in Awake Dogs
Anesth Analg 2003 96: 665-672. [Abstract] [Full Text]  

IMPLICATIONS: In contrast to previous experiments in anesthetized dogs, short-term administration of ethanol does not alter myocardial stunning in conscious dogs.

Yoshiki Kimoto, Hiroyuki Kinoshita, Katsutoshi Nakahata, Mayuko Dojo, Hiroshi Iranami, and Yoshio Hatano

Mexiletine Differentially Modulates Vasorelaxation Mediated by Adenosine Triphosphate-Sensitive K⁺ Channels in Aortas from Normotensive and Hypertensive Rats
Anesth Analg 2003 96: 673-679. [Abstract] [Full Text]  

IMPLICATIONS: Mexiletine induces augmentation of vasodilation mediated by adenosine triphosphate (ATP)-sensitive K+ channels activated by the opener as well as a nitric oxide donor in normotensive, but not hypertensive, rat aortas, partly by the soluble guanylate cyclase-independent action of nitric oxide on ATP-sensitive K+ channels of vascular smooth muscle cells.

Patrick Ziemann-Gimmel, Bud Pygon, Frank Hurley, Ronald F. Albrecht, and David E. Schwartz

Treatment of Life-Threatening Hyperkalemia Using Hemoconcentration in Parallel to Venovenous Bypass During Orthotopic Liver Transplantation (Case Report)
Anesth Analg 2003 96: 680-682. [Abstract] [Full Text]  

IMPLICATIONS: The elimination of potassium in patients with end-stage kidney failure is limited. An increase in potassium concentrations can lead to lethal arrhythmias. In the described case, a large potassium concentration was treated during a liver transplantation using a new technical approach.

Su-Man Lin, Wen-Kuei Chang, Cheng-Ming Tsao, Ching-Huei Ou, Kwok-Hon Chan, and Shen-Kou Tsai

Carbon Dioxide Embolism Diagnosed by Transesophageal Echocardiography During Endoscopic Vein Harvesting for Coronary Artery Bypass Grafting (Case Report)
Anesth Analg 2003 96: 683-685. [Abstract] [Full Text]  

IMPLICATIONS: We describe a case of massive carbon dioxide embolism with an abrupt decrease in arterial blood pressure and continuous mixed venous oxygen saturation during endoscopic vein harvesting that was immediately diagnosed by intraoperative transesophageal echocardiography.

PEDIATRIC ANESTHESIA:

Patrick K. Birmingham, Melissa Wheeler, Santhanam Suresh, Richard M. Dsida, Bronwyn R. Rae, Jennifer Obrecht, Vicki A. Andreoni, Steven C. Hall, and Charles J. Coté

Patient-Controlled Epidural Analgesia in Children: Can They Do It?
Anesth Analg 2003 96: 686-691. [Abstract] [Full Text]  

IMPLICATIONS: A descriptive analysis of prospectively recorded data in 132 children receiving patient-controlled epidural analgesia for postoperative pain relief demonstrates satisfactory analgesia without serious toxicity or side effects in children as young as 5 yr. This modality should be considered as another strategy in pediatric postoperative pain management.

Laura A. Hastings and Gerald A. Bushman

An Unusual Cause of Arterial Desaturation in the Premature Infant Undergoing Patent Ductus Arteriosus Ligation (Case Report)
Anesth Analg 2003 96: 692-693. [Abstract] [Full Text]  

IMPLICATIONS: A premature infant undergoing ligation of a patent ductus arteriosus had arterial desaturation during surgical retraction, which was caused by a previously unrecognized vascular ring anomaly.

Santhanam Suresh, Melissa Wheeler, and Arti Patel

Case Series: IV Regional Anesthesia with Ketorolac and Lidocaine: Is It Effective for the Management of Complex Regional Pain Syndrome 1 in Children and Adolescents? (Case Report)
Anesth Analg 2003 96: 694-695. [Abstract] [Full Text]  

IMPLICATIONS: We report our experience with ketorolac/lidocaine IV regional anesthesia (Bier block) (IVRA) in two adolescents with complex regional pain syndrome 1. IVRA resulted in complete resolution of symptoms.

Ah-Young Oh, Won-Kyoung Kwon, Kyoung-Ok Kim, Hee-Soo Kim, and Chong-Sung Kim

Single-Lung Ventilation with a Cuffed Endotracheal Tube in a Child with a Left Mainstem Bronchus Disruption (Case Report)
Anesth Analg 2003 96: 696-697. [Abstract] [Full Text]  

IMPLICATIONS:We report a case of management of ventilation during operative repair of a traumatic left mainstem bronchial disruption in a pediatric patient. With the use of a conventional cuffed endotracheal tube, with the cuff partially in the right mainstem bronchus and partially in the trachea, we successfully managed the case with single-lung ventilation.

Mark A. Rosen, Michael H. Andreae, and Alison G. Cameron

Nitroglycerin for Fetal Surgery: Fetoscopy and Ex Utero Intrapartum Treatment Procedure with Malignant Hyperthermia Precautions (Case Report)
Anesth Analg 2003 96: 698-700. [Abstract] [Full Text]  

IMPLICATIONS: We report the administration of two anesthetics to a patient potentially at risk for malignant hyperthermia undergoing fetal surgery and an ex utero intrapartum treatment procedure. Management of anesthesia and intraoperative uterine relaxation with IV nitroglycerin to avoid volatile anesthetics are discussed.

AMBULATORY ANESTHESIA:

Rachel W. Eshima, Anya Maurer, Travis King, Bor-Kang Lin, James E. Heavner, Martin S. Bogetz, and Alan D. Kaye

A Comparison of Airway Responses During Desflurane and Sevoflurane Administration via a Laryngeal Mask Airway for Maintenance of Anesthesia (Brief Report)
Anesth Analg 2003 96: 701-705. [Abstract] [Full Text]  

IMPLICATIONS: Although sevoflurane is less pungent than desflurane at larger concentrations, neither anesthetic seems to irritate the airway when administered at the smaller concentrations often used during maintenance of anesthesia. Both anesthetics may be delivered effectively via a laryngeal mask airway, with minimal evidence of airway irritation.

ANESTHETIC PHARMACOLOGY:

James M. Sonner, Yi Zhang, Caroline Stabernack, Wella Abaigar, Yilei Xing, and Michael J. Laster

GABA_A Receptor Blockade Antagonizes the Immobilizing Action of Propofol but Not Ketamine or Isoflurane in a Dose-Related Manner
Anesth Analg 2003 96: 706-712. [Abstract] [Full Text]  

IMPLICATIONS: IV picrotoxin and gabazine antagonized the immobilizing action of propofol in a dose-related manner, whereas antagonism of the immobilizing action of ketamine and isoflurane was similar, smaller than for propofol, and not dose-related. These results are consistent with a role for {gamma}-amino-n-butyric acid subtype A receptors in mediating propofol anesthesia but not ketamine or isoflurane anesthesia.

D. Mendez, J.P. De La Cruz, M.M. Arrebola, A. Guerrero, J.A. González-Correa, E. García-Temboury, and F. Sánchez de la Cuesta

The Effect of Propofol on the Interaction of Platelets with Leukocytes and Erythrocytes in Surgical Patients
Anesth Analg 2003 96: 713-719. [Abstract] [Full Text]  

IMPLICATIONS:In vitro experiments have shown that propofol inhibits platelet aggregation and increases nitric oxide production. This study shows that doses habitually used to induce or maintain anesthesia also have these effects. These findings have potential applications for patients at increased risk for bleeding and may partly explain the hypotensive effect of propofol.

Andrew Ronald Gordon Muncaster, James Wallace Sleigh, and Murray Williams

Changes in Consciousness, Conceptual Memory, and Quantitative Electroencephalographical Measures During Recovery from Sevoflurane- and Remifentanil-Based Anesthesia
Anesth Analg 2003 96: 720-725. [Abstract] [Full Text] [Appendix]   

IMPLICATIONS: During the recovery phase from a remifentanil-based anesthetic, the bispectral index is not reliably predictive of the depth of consciousness, because of suppression ratio artifacts. Entropy measures of the electroencephalogram show promise, but there is still no gold standard to estimate anesthetic depth.

Martin Luginbühl, Andrea Gerber, Thomas W. Schnider, Steen Petersen-Felix, Lars Arendt-Nielsen, and Michele Curatolo

Modulation of Remifentanil-Induced Analgesia, Hyperalgesia, and Tolerance by Small-Dose Ketamine in Humans
Anesth Analg 2003 96: 726-732. [Abstract] [Full Text]  

IMPLICATIONS: Coadministration of ketamine and morphine for pain relief is still controversial. Our experimental pain study with volunteers showed that ketamine enhances opioid analgesia without increasing sedation and reduces respiratory depression. Opioid-induced hyperalgesia and tolerance were not affected by ketamine and depended on the type of nociceptive stimulus. This may explain the conflicting results on opioid tolerance in previous studies.

Yuri Nakae, Satoshi Fujita, and Akiyoshi Namiki

Modulation of Myofilament Ca²⁺ Sensitivity by - and -Opioid Agonists in Intact Guinea Pig Hearts
Anesth Analg 2003 96: 733-739. [Abstract] [Full Text]  

IMPLICATIONS: Our results indicate that {delta}- and {kappa}-opioid agonists enhance myofilament Ca2+ sensitivity despite decreasing available intracellular Ca2+ concentrations in intact isolated guinea pig beating hearts, and these effects are mediated by {delta}- and {kappa}-opioid receptor stimulation.

Claire Gatecel, Marie-Reine Losser, and Didier Payen

The Postoperative Effects of Halothane Versus Isoflurane on Hepatic Artery and Portal Vein Blood Flow in Humans
Anesth Analg 2003 96: 740-745. [Abstract] [Full Text]  

IMPLICATIONS: Volatile anesthetics may alter liver circulation with serious adverse effects. Using implanted pulsed Doppler probes in six anesthetized patients, we showed that halothane acted mainly as a vasoconstrictor of the liver vascular bed, whereas isoflurane was a vasodilator, confirming the beneficial effect of isoflurane on liver oxygen supply.

Jacques H. Abraini, Badreddine Kriem, Norbert Balon, Jean-Claude Rostain, and Jean-Jacques Risso

Gamma-Aminobutyric Acid Neuropharmacological Investigations on Narcosis Produced by Nitrogen, Argon, or Nitrous Oxide
Anesth Analg 2003 96: 746-749. [Abstract] [Full Text]  

IMPLICATIONS: We studied the effects in the rat of {gamma}-aminobutyric acid (GABA) receptor antagonists on narcosis induced by nitrogen and argon that act only at high pressures. Our results show that the GABA A receptor may play a significant role, suggesting that some mechanisms might be similar to those of clinical inhaled anesthetics.

Zohar A. Dotan, Rene Hana, Daniel Simon, Daniel Geva, Reuven A. Pfeffermann, and Tiberiu Ezri

The Effect of Vecuronium Is Enhanced by a Large Rather than a Modest Dose of Gentamicin as Compared with No Preoperative Gentamicin
Anesth Analg 2003 96: 750-754. [Abstract] [Full Text]  

IMPLICATIONS: We demonstrated that the neuromuscular relaxant effect of vecuronium is enhanced by a large (4 mg/kg) rather than a modest (1.2 mg/kg) dose of gentamicin as compared with no gentamicin given before surgery.

Emmanuel Boselli, Frédéric Duflo, Richard Debon, Bernard Allaouchiche, Dominique Chassard, Luc Thomas, and Jacques Portoukalian

The Induction of Apoptosis by Local Anesthetics: A Comparison Between Lidocaine and Ropivacaine (Brief Report)
Anesth Analg 2003 96: 755-756. [Abstract] [Full Text]  

IMPLICATIONS: This study suggests that lidocaine can induce apoptosis (detected by dual staining with Annexin V and propidium iodide) on T-cell line cultures in a time-dependent manner. This was not observed with ropivacaine.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Elena J. Holak, David A. Mei, Marshall B. Dunning, III, Rao Gundamraj, Randa Noseir, Lu Zhang, and Harvey J. Woehlck

Carbon Monoxide Production from Sevoflurane Breakdown: Modeling of Exposures Under Clinical Conditions
Anesth Analg 2003 96: 757-764. [Abstract] [Full Text]  

IMPLICATIONS: Sevoflurane breakdown in desiccated absorbents is expected to result in only mild carbon monoxide (CO) exposure. Completely dry absorbent and high minute ventilation rates may degrade sevoflurane to extremely large CO concentrations. Serious CO poisoning or spontaneous ignition of flammable gases within the breathing circuit are possible in extreme circumstances.

Masayasu Nakayama, Noriaki Kanaya, Hiromichi Ichinose, Shuji Yamamoto, and Akiyoshi Namiki

Intravenous Droperidol Causes a Reduction in the Bispectral Index in Propofol-Sedated Patients During Spinal Anesthesia
Anesth Analg 2003 96: 765-768. [Abstract] [Full Text]  

IMPLICATIONS: An antiemetic dose of IV droperidol causes a decrease in the bispectral index in patients sedated with propofol during spinal anesthesia. We conclude that droperidol may enhance the hypnotic effect of propofol.

Mira Dernedde, Michaela Stadler, Francoise Bardiau, and Jean G. Boogaerts

Continuous Epidural Infusion of Large Concentration/Small Volume Versus Small Concentration/Large Volume of Levobupivacaine for Postoperative Analgesia
Anesth Analg 2003 96: 796-801. [Abstract] [Full Text]  

IMPLICATIONS: We demonstrated that a large concentration/small volume of levobupivacaine given as a continuous thoracic epidural infusion provided an equal quality of postoperative analgesia as a small-concentration/large-volume infusion and induced less motor blockade and fewer hemodynamic repercussions.

PAIN MEDICINE:

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

Intrathecal Administration of Morphine, but Not Small Dose, Induced Spastic Paraparesis After a Noninjurious Interval of Aortic Occlusion in Rats
Anesth Analg 2003 96: 769-775. [Abstract] [Full Text]  

IMPLICATIONS: Spinal administration of large-dose morphine after transient aortic occlusion may be associated with a potential risk of irreversible spinal neuronal degeneration and the corresponding development of neurological dysfunction.

Jeffrey S. Kroin, Robert J. McCarthy, Richard D. Penn, Timothy J. Lubenow, and Anthony D. Ivankovich

Continuous Intrathecal Clonidine and Tizanidine in Conscious Dogs: Analgesic and Hemodynamic Effects
Anesth Analg 2003 96: 776-782. [Abstract] [Full Text]  

IMPLICATIONS: Clonidine is an effective spinal analgesic, but it is dose-limited by cardiovascular side effects. We compared the analgesic properties and side effects of clonidine with those of a similar drug, tizanidine. Continuous spinal infusion of tizanidine produced similar analgesia as clonidine, but with fewer adverse effects on blood pressure and heart rate.

I-Ming Jou, Koung-Shing Chu, Hsing-Hong Chen, Pei-Jung Chang, and Yu-Chuan Tsai

The Effects of Intrathecal Tramadol on Spinal Somatosensory-Evoked Potentials and Motor-Evoked Responses in Rats
Anesth Analg 2003 96: 783-788. [Abstract] [Full Text]  

IMPLICATIONS: Spinal somatosensory-evoked potentials and evoked compound muscle action potential were used to evaluate the effects of intrathecal tramadol on sensory and motor neural conduction. Intrathecal tramadol dose-dependently reduced the amplitude and delayed the latency of both spinal somatosensory-evoked potentials and compound muscle action potential. These results indicate that tramadol exerts a dose-related central neural blockade.

Avi A. Weinbroum

A Single Small Dose of Postoperative Ketamine Provides Rapid and Sustained Improvement in Morphine Analgesia in the Presence of Morphine-Resistant Pain
Anesth Analg 2003 96: 789-795. [Abstract] [Full Text]  

IMPLICATIONS: A small-dose ketamine and morphine regimen interrupted severe postoperative pain that was not relieved previously by morphine. Ketamine reduced morphine consumption and provided rapid and sustained improvement in morphine analgesia and in subjective feelings of well-being, without unacceptable side effects.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Amr E. Abouleish, Donald S. Prough, Steven J. Barker, Charles W. Whitten, Tatsuo Uchida, and Jeffrey L. Apfelbaum

Organizational Factors Affect Comparisons of the Clinical Productivity of Academic Anesthesiology Departments
Anesth Analg 2003 96: 802-812. [Abstract] [Full Text]  

IMPLICATIONS: Organizational factors, including type of hospital, number of operating rooms, and type of surgical staff, influence the clinical productivity of academic anesthesiology departments. Reporting quartile data by focused grouping variables allows anesthesiology groups to compare their clinical productivity with groups practicing in similar clinical settings.

Amr E. Abouleish, Sharon L. Hensley, Mark H. Zornow, and Donald S. Prough

Inclusion of Turnover Time Does Not Influence Identification of Surgical Services that Over- and Underutilize Allocated Block Time
Anesth Analg 2003 96: 813-818. [Abstract] [Full Text]  

IMPLICATIONS: Turnover time is difficult to determine from existing operating room information systems. This study determined the use of block time with and without turnover time for each surgical service in a large academic hospital. Turnover time did not change identification of surgical services that over- (one service) or underused (three services) allocated block time.

CRITICAL CARE AND TRAUMA:

Rudolph H. de Jong

Nerve Gas Terrorism: A Grim Challenge to Anesthesiologists (Special Article)
Anesth Analg 2003 96: 819-825. [Abstract] [Full Text]  

IMPLICATIONS: The 1995 Tokyo subway strike proved nerve gas to be a fearsome terrorist weapon of mass destruction. Because the clear liquid is easily hidden until released, rescuers must aid nonbreathing casualties near instantly. Anesthesiologists are uniquely qualified to train these rescue squads and to manage nerve gas victims in the hospital.

Suneerat Kongsayreepong, Crirapha Chaibundit, Jittika Chadpaibool, Chulaluk Komoltri, Suwannee Suraseranivongse, Pudsadee Suwannanonda, Em-orn Raksamanee, Pensri Noocharoen, Aurasa Silapadech, Sudta Parakkamodom, Chusri Pum-In, and Lilanuch Sojeoyya

Predictor of Core Hypothermia and the Surgical Intensive Care Unit (Special Article)
Anesth Analg 2003 96: 826-833. [Abstract] [Full Text]  

IMPLICATIONS: In an effort to decrease the frequent incidence of core hypothermia at the time of admission to the general surgical intensive care unit, this prospective study showed that high ASA physical status, the use of a combined epidural and general anesthesia, surgery lasting longer than 2 h, and extensive surgery were the important risk factors, whereas heavier body weight, higher preoperative body temperature, and warmer ambient operating room temperature were important protective factors.

Masataka Saito, Yoshiaki Terao, Makoto Fukusaki, Tetsuji Makita, Osamu Shibata, and Koji Sumikawa

Sequential Use of Midazolam and Propofol for Long-Term Sedation in Postoperative Mechanically Ventilated Patients (Special Article)
Anesth Analg 2003 96: 834-838. [Abstract] [Full Text]  

IMPLICATIONS: Our study indicates that sequential use of midazolam and propofol could reduce the incidence of agitation compared with midazolam alone.

NEUROSURGICAL ANESTHESIA:

Takashi Kiyoshima, Shiro Fukuda, Mishiya Matsumoto, Yasuhiko Iida, Satoe Oka, Kazuhiko Nakakimura, and Takefumi Sakabe

Lack of Evidence for Apoptosis as a Cause of Delayed Onset Paraplegia After Spinal Cord Ischemia in Rabbits
Anesth Analg 2003 96: 839-846. [Abstract] [Full Text]  

IMPLICATIONS: Although the possibility of apoptotic motor neuron death cannot be completely excluded, delayed onset paraplegia after transient spinal cord ischemia is largely associated with necrotic cell death.

Sally M. Hancock, Ravi P. Mahajan, and Labros Athanassiou

Noninvasive Estimation of Cerebral Perfusion Pressure and Zero Flow Pressure in Healthy Volunteers: The Effects of Changes in End-Tidal Carbon Dioxide
Anesth Analg 2003 96: 847-851. [Abstract] [Full Text]  

IMPLICATIONS: Increasing end-tidal CO2 increases the estimated cerebral perfusion pressure and vice versa. These results are opposite to those expected from the known effects of CO2 on intracranial pressure. Thus, we support the suggestion that, in the absence of intracranial hypertension, vascular tone remains a major determinant of effective downstream pressure and cerebral perfusion.

OBSTETRIC ANESTHESIA:

Dirk Meininger, Christian Byhahn, Paul Kessler, Jonas Nordmeyer, Yasmin Alparslan, Brian A. Hall, and Dorothee H. Bremerich

Intrathecal Fentanyl, Sufentanil, or Placebo Combined with Hyperbaric Mepivacaine 2% for Parturients Undergoing Elective Cesarean Delivery
Anesth Analg 2003 96: 852-858. [Abstract] [Full Text]  

IMPLICATIONS: Sensory, motor, and analgesic block characteristics of the local anesthetic mepivacaine alone or combined with intrathecal opioids were studied in parturients undergoing elective cesarean delivery in a randomized, double-blinded clinical trial. Mepivacaine was found to be an acceptable local anesthetic for spinal anesthesia in parturients undergoing cesarean delivery. In combination with sufentanil 5 {micro}g, complete and effective analgesia were significantly prolonged.

Marcel P. Vercauteren, Hilde C. Coppejans, and Luc Sermeus

Anaphylactoid Reaction to Hydroxyethylstarch During Cesarean Delivery in a Patient with HELLP Syndrome (Case Report)
Anesth Analg 2003 96: 859-861. [Abstract] [Full Text]  

IMPLICATIONS: This case report describes an allergic reaction attributed to colloid administration before a semi-urgent cesarean delivery. The most challenging part of this event was related to the anesthetic and obstetric treatment options to avoid further compromise of both mother and fetus.

REGIONAL ANESTHESIA:

Øivind Klaastad, Timothy R. VadeBoncouer, Terje Tillung, and Örjan Smedby

An Evaluation of the Supraclavicular Plumb-Bob Technique for Brachial Plexus Block by Magnetic Resonance Imaging
Anesth Analg 2003 96: 862-867. [Abstract] [Full Text]  

IMPLICATIONS: In magnetic resonance images of volunteers, simulated needle passes with the "plumb-bob" approach to the supraclavicular brachial plexus block were analyzed for precision and risk profile. To avoid needle contact with the lung, the subclavian vein, and the subclavian artery, our results suggest a change in the method's initial needle direction.

Radha Sukhani, Kenneth D. Candido, Robert Doty, Jr., Edward Yaghmour, and Robert J. McCarthy

Infragluteal-Parabiceps Sciatic Nerve Block: An Evaluation of a Novel Approach Using a Single-Injection Technique
Anesth Analg 2003 96: 868-873. [Abstract] [Full Text]  

IMPLICATIONS: Sciatic nerve block using the infragluteal-parabiceps approach produces sensory loss and motor paralysis after a single 0.4 mL/kg injection of levobupivacaine 0.625% with epinephrine (1:200,000) in >90% of patients. The approach is reliable, uses consistent soft-tissue landmarks, is not typically painful, and does not produce significant complications.

W. Scott Jellish, Adam Abodeely, Elaine M. Fluder, and John Shea

The Effect of Spinal Bupivacaine in Combination with Either Epidural Clonidine and/or 0.5% Bupivacaine Administered at the Incision Site on Postoperative Outcome in Patients Undergoing Lumbar Laminectomy
Anesth Analg 2003 96: 874-880. [Abstract] [Full Text]  

IMPLICATIONS: Spinal anesthesia with supplemental epidural clonidine in combination with incision site subcutaneous bupivacaine was evaluated both intra- and postoperatively and compared with spinal anesthesia alone for lower lumbar spine procedures. Both epidural clonidine and subcutaneous incisional bupivacaine, added to spinal anesthesia for lumbar spine surgery, improves pain relief and reduces the need for postoperative opioids with their associated side effects.

Yurie Tohdoh Kawamata, Koki Nishikawa, Tomoyuki Kawamata, Keiichi Omote, Motohiko Igarashi, Masanori Yamauchi, Koichi Sato, Masayasu Nakayama, and Akiyoshi Namiki

A Comparison of Hyperbaric 1% and 3% Solutions of Small-Dose Lidocaine in Spinal Anesthesia
Anesth Analg 2003 96: 881-884. [Abstract] [Full Text]  

IMPLICATIONS: When the dose of lidocaine was kept constant at 30 mg, hyperbaric 1% lidocaine solution resulted in shorter times for recovery from motor block and to urination than did hyperbaric 3% lidocaine solution. Levels of sensory block were similar. Therefore, the more dilute lidocaine for spinal anesthesia may be suitable for day-care surgery and short duration surgery.

GENERAL ARTICLES:

Argyro Fassoulaki, Adia Paraskeva, Konstantinos Patris, Theodora Pourgiezi, and Georgia Kostopanagiotou

Pressure Applied on the Extra 1 Acupuncture Point Reduces Bispectral Index Values and Stress in Volunteers
Anesth Analg 2003 96: 885-890. [Abstract] [Full Text]  

IMPLICATIONS: This crossover study investigated the effect of pressure application on the acupuncture "extra 1" point in healthy volunteers. Acupressure applied for 10 min on the extra 1 point significantly reduced the BIS values and the verbal stress score when compared with acupressure applied on a control point.

S. Kihara, J. Brimacombe, Y. Yaguchi, S. Watanabe, N. Taguchi, and T. Komatsuzaki

Hemodynamic Responses Among Three Tracheal Intubation Devices in Normotensive and Hypertensive Patients
Anesth Analg 2003 96: 890-895. [Abstract] [Full Text]  

IMPLICATIONS: Both the intubating laryngeal mask airway FastrachTM and the TrachlightTM lightwand attenuate the hemodynamic stress response to tracheal intubation compared with the Macintosh laryngoscope in hypertensive, but not in normotensive, anesthetized paralyzed patients.

V. Dimitriou, G.S. Voyagis, C. Iatrou, and J. Brimacombe

Flexible Lightwand-Guided Intubation Using the Intubating Laryngeal Mask Airway^TM in the Supine, Right, and Left Lateral Positions in Healthy Patients by Experienced Users (Brief Report)
Anesth Analg 2003 96: 896-898. [Abstract] [Full Text]  

IMPLICATIONS: Flexible lightwand-guided intubation with the intubating laryngeal mask airwayTM is equally effective in the supine, right, and left lateral positions in healthy patients by experienced users.

M. Tariq Bhatti and F. Kayser Enneking

Visual Loss and Ophthalmoplegia After Shoulder Surgery (Case Report)
Anesth Analg 2003 96: 899-902. [Abstract] [Full Text]  

IMPLICATIONS: Ophthalmic complications can occur after a variety of non-ocular surgery. The etiology of postoperative visual loss and eye movement dysfunction is complex and multifactorial. In many cases, more than one perioperative factor may be associated with an adverse ophthalmic outcome.

MEETING REPORT:

Girish P. Joshi

The Society for Ambulatory Anesthesia: 17th Annual Meeting Report
Anesth Analg 2003 96: 903-906. [Full Text]  

LETTERS TO THE EDITOR:

Sandra Kampe, Ute Hünseler, and J. S. P. van den Berg

Subdural Hygroma: A Rare Complication of Spinal Anesthesia Diagnosed after a Grand Mal Convulsion • Response
Anesth Analg 2003 96: 907. [Full Text]  

Joseph Rupreht

Cholinergic Transmission Not Involved in the Anesthetic State, But Deranged
Anesth Analg 2003 96: 907. [Full Text]  

Douglas G. Merrill, James P. Rathmell, John C. Rowlingson, Milan P. Stojanovic, Christine N. Sang, and Steven P. Cohen

Epidural Steroid Injections • Response
Anesth Analg 2003 96: 907-908. [Full Text]  

Francesco Pompei and Daniel I. Sessler

Insufficiency in Thermometer Data • Response
Anesth Analg 2003 96: 908-909. [Full Text]  

Patrick E. Benedict and Steven Lubitz

A Promising Technique for Treating Circulatory Arrest Associated Coagulopathy
Anesth Analg 2003 96: 909-910. [Full Text]  

Steven M. Dunn, Stephen B. Corn, and Moeen Panni

Reduction of Operating Room Anesthetic Gas Contamination • Response
Anesth Analg 2003 96: 910. [Full Text]  

Amitabh Dutta, S.K. Malhotra, and Vishal Kumar

A Fractured Clavicle and Vascular Compression: A Non-Orthopedic Indication of Figure–of–Eight Bandage
Anesth Analg 2003 96: 910. [Full Text]  

Anthony M.-H. Ho and Manoj K. Karmakar

Vascular Injury Secondary to Dilator Insertion during Internal Jugular Vein Cannulation
Anesth Analg 2003 96: 911. [Full Text]  

V. K. Grover, Rajesh Mahajan, and Monish Tomar

Class Zero Airway and Laryngoscopy
Anesth Analg 2003 96: 911. [Full Text]  

Guido K. Schuepfer, Jan I. Poelaert, Christoph Konrad, Peter Lierz, and Peter Felleiter

General Anesthesia or Phrenic Nerve Block for Treatment of Chronic Hiccups? • Response
Anesth Analg 2003 96: 911-912. [Full Text]  

Sebastian Schulz-Stubner

Bring the Doctor to the Patient...the German "Notarzt" System
Anesth Analg 2003 96: 912. [Full Text]  

Denis L. Bourke

System Failures
Anesth Analg 2003 96: 912-913. [Full Text]  

Mohammad A. Siyam and Dan Benhamou

Intubation in Morbidly Obese Patients
Anesth Analg 2003 96: 913. [Full Text]  

Vimi Rewari and Rajender Singh Rawat

Hanging By a Thread—The Tooth Solution
Anesth Analg 2003 96: 913. [Full Text]  

Barry L. Friedberg and Akira Kudoh

Hypnosis First, Then Dissociation • Response
Anesth Analg 2003 96: 913-914. [Full Text]  

R. Peter Alston, Mark Stafford-Smith, Madhav Swaminathan, and Barbara Phillips-Bute

Renal Dysfunction and Cognitive Function After Coronary Artery Bypass Graft Surgery • Response
Anesth Analg 2003 96: 914. [Full Text]  

R. Peter Alston and Yuji Kadoi

Rewarming Rate, Diabetes, Jugular Bulb Saturation, and Cognitive Outcome from CABG Surgery • Response
Anesth Analg 2003 96: 914-915. [Full Text]  

Amol Pradhan, Indu Sen, Y. K. Batra, and G. Biswas

Proteus Syndrome: A Concern for the Anesthesiologist
Anesth Analg 2003 96: 915-916. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Lawrence C. Tsen and Noor M. Gajraj

Textbook of Regional Anesthesia • Image-Guided Spine Intervention • Books and Multimedia Received
Anesth Analg 2003 96: 917. [Full Text]  

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