EDITORIALS:

Richard W. Rosenquist and David J. Birnbach

Epidural Insertion in Anesthetized Adults: Will Your Patients Thank You?
Anesth Analg 2003 96: 1545-1546. [Full Text]  

REGIONAL ANESTHESIA:

Terese T. Horlocker, Martin D. Abel, Joseph M. Messick, Jr, and Darrell R. Schroeder

Small Risk of Serious Neurologic Complications Related to Lumbar Epidural Catheter Placement in Anesthetized Patients
Anesth Analg 2003 96: 1547-1552. [Abstract] [Full Text]  

IMPLICATIONS: We report no neurologic complications in 4298 patients undergoing epidural catheter placement while under general anesthesia. Although the risk of neurologic complications associated with lumbar epidural catheter placement in anesthetized patients is small, the relative risk compared with epidural catheterization in awake patients is unknown.

Tanja A. Treschan, Akiko Taguchi, Syed Z. Ali, Neeru Sharma, Barbara Kabon, Daniel I. Sessler, and Andrea Kurz

The Effects of Epidural and General Anesthesia on Tissue Oxygenation
Anesth Analg 2003 96: 1553-1557. [Abstract] [Full Text]  

IMPLICATIONS: Epidural anesthesia significantly increased subcutaneous tissue oxygenation in the thigh both with and without general anesthesia. Although each increase was statistically significant, previous work suggests that the magnitude of these changes is unlikely to markedly reduce the risk of surgical wound infection.

CARDIOVASCULAR ANESTHESIA:

Elizabeth G. VanDenKerkhof, Brian Milne, and Joel L. Parlow

Knowledge and Practice Regarding Prophylactic Perioperative Beta Blockade in Patients Undergoing Noncardiac Surgery: A Survey of Canadian Anesthesiologists
Anesth Analg 2003 96: 1558-1565. [Abstract] [Full Text]  

IMPLICATIONS: This survey found that anesthesiologists were aware of and supported the use of prophylactic perioperative ß blockers in patients with risk factors or known coronary artery disease; however, only 57% frequently prescribed perioperative ß blockers. A lack of awareness of the current "best" evidence was not a barrier to use.

Lucio Glantz, Tiberiu Ezri, Yitzhak Cohen, Sergio Konichezky, Abraham Caspi, Daniel Geva, and Amos Leviav

Perioperative Myocardial Ischemia in Patients Undergoing Sternectomy Shortly After Coronary Artery Bypass Grafting
Anesth Analg 2003 96: 1566-1571. [Abstract] [Full Text]  

IMPLICATIONS: This study demonstrates an increased incidence of myocardial ischemia when sternectomy for mediastinitis is performed within one week of coronary artery bypass graft surgery, and this ischemia is associated with a 25% incidence of myocardial infarction.

David R. McIlroy and Evan D. Kharasch

Acute Intravascular Volume Expansion with Rapidly Administered Crystalloid or Colloid in the Setting of Moderate Hypovolemia
Anesth Analg 2003 96: 1572-1577. [Abstract] [Full Text]  

IMPLICATIONS: Under conditions of moderate hypovolemia, the maximal acute intravascular volume expansion with the rapid infusion of 1000 mL of lactated Ringer's solution is slightly more than half that achieved with the same volume of 6% Hetastarch.

Per Halvorsen, Johan Ræder, Paul F. White, Sven M. Almdahl, Kenneth Nordstrand, Kjell Saatvedt, and Terje Veel

The Effect of Dexamethasone on Side Effects After Coronary Revascularization Procedures
Anesth Analg 2003 96: 1578-1583. [Abstract] [Full Text]  

IMPLICATIONS: Dexamethasone (8 mg IV) was beneficial in reducing emetic symptoms and increasing appetite after cardiac surgery. However, this dose of the corticosteroid failed to decrease postoperative pain or the incidence of new-onset atrial fibrillation.

Su-Man Lin, Shen-Kou Tsai, Jou-Kou Wang, Yin-Yi Han, Wei-horng Jean, and Yu-Chang Yeh

Supplementing Transesophageal Echocardiography with Transthoracic Echocardiography for Monitoring Transcatheter Closure of Atrial Septal Defects with Attenuated Anterior Rim: A Case Series
Anesth Analg 2003 96: 1584-1588. [Abstract] [Full Text]  

IMPLICATIONS: Transesophageal echocardiography can be useful for confirming successful deployment of the occluder in the majority of patients with atrial septal defect. In a small number of atrial septal defects with attenuated anterior superior rim which have unusual anterior inferior morphology, supplemental transthoracic echocardiography is required to verify successful deployment of the occluder when transesophageal echocardiography visualization fails to reliably diagnose adequate placement of the occluder.

Da Zheng, Richard N. Upton, and Allison M. Martinez

The Contribution of the Coronary Concentrations of Propofol to Its Cardiovascular Effects in Anesthetized Sheep
Anesth Analg 2003 96: 1589-1597. [Abstract] [Full Text]  

IMPLICATIONS:With use of selective coronary artery infusions in sheep, the coronary concentrations of propofol were shown to be the major contributor to the cardiac depression caused by propofol but were a less significant contributor to the hypotension caused by this drug. Models of the cardiovascular effects of propofol should account for these relationships.

Pablo Motta, Emad Mossad, and Robert Savage

Right Ventricular Exclusion Surgery for Arrhythmogenic Right Ventricular Dysplasia with Cardiomyopathy (Case Report)
Anesth Analg 2003 96: 1598-1602. [Abstract] [Full Text]  

IMPLICATIONS: The authors describe the management of a patient with arrhythmogenic right ventricular dysplasia treated with right ventricular exclusion surgery.

Lars G. Fischer, Hugo Van Aken, and Hartmut Bürkle

Management of Pulmonary Hypertension: Physiological and Pharmacological Considerations for Anesthesiologists (Review Article)
Anesth Analg 2003 96: 1603-1616. [Full Text]  

PEDIATRIC ANESTHESIA:

Wang Jian, Liu Su, and Liang Yiwu

The Effects of Magnesium Prime Solution on Magnesium Levels and Potassium Loss in Open Heart Surgery
Anesth Analg 2003 96: 1617-1620. [Abstract] [Full Text]  

IMPLICATIONS: In our study, we demonstrate that a magnesium prime solution can prevent hypomagnesemia during and after cardiopulmonary bypass (CPB) and decrease the urinary potassium loss after CPB in pediatric patients undergoing open heart surgery.

Ana Lucia Pappas, Elaine M. Fluder, Steve Creech, Andrew Hotaling, and Albert Park

Postoperative Analgesia in Children Undergoing Myringotomy and Placement Equalization Tubes in Ambulatory Surgery
Anesth Analg 2003 96: 1621-1624. [Abstract] [Full Text]  

IMPLICATIONS: We compared four different analgesics in the management of pain after placement of pressure equalization tubes during myringotomy in children and demonstrated that ketorolac or butorphanol provided superior analgesia when compared with acetaminophen with codeine or plain acetaminophen. Children who received ketorolac versus butorphanol had less vomiting in the 24 h after surgery.

Terri Voepel-Lewis, Shobha Malviya, and Alan R. Tait

A Prospective Cohort Study of Emergence Agitation in the Pediatric Postanesthesia Care Unit
Anesth Analg 2003 96: 1625-1630. [Abstract] [Full Text]  

IMPLICATIONS: Children may become agitated after general anesthesia. This study describes several factors that may increase the risk for agitation. These data are important in planning anesthesia care for young children.

AMBULATORY ANESTHESIA:

Alejandro Recart, Tijani Issioui, Paul F. White, Kevin Klein, Mehernoor F. Watcha, Louis Stool, and Mary Shah

The Efficacy of Celecoxib Premedication on Postoperative Pain and Recovery Times After Ambulatory Surgery: A Dose-Ranging Study
Anesth Analg 2003 96: 1631-1635. [Abstract] [Full Text]  

IMPLICATIONS: Oral premedication with celecoxib 400 mg was more effective than 200 mg in reducing postoperative pain and the need for rescue analgesic medication in the early postoperative period. However, neither dose of celecoxib was more effective than a placebo in facilitating the recovery process after outpatient surgery.

Paul F. White, Shivani Rawal, Alejandro Recart, Larry Thornton, Mark Litle, and Louis Stool

Can the Bispectral Index Be Used to Predict Seizure Time and Awakening After Electroconvulsive Therapy?
Anesth Analg 2003 96: 1636-1639. [Abstract] [Full Text]  

IMPLICATIONS: The bispectral index (BIS) value immediately before the electroconvulsive therapy (ECT) stimulus correlates with the duration of the motor and electroencephalogram (EEG) seizure activity during methohexital anesthesia. In addition, the increase in the BIS value during the ECT-induced seizure was proportional to the duration of EEG seizure activity. However, the BIS value on awakening from anesthesia varied widely, from 29 to 97.

ANESTHETIC PHARMACOLOGY:

Jan-Uwe Schreiber, Thomas Mencke, Andreas Biedler, Oliver Fürst, Stefan Kleinschmidt, Heiko Buchinger, and Thomas Fuchs-Buder

Postoperative Myalgia After Succinylcholine: No Evidence for an Inflammatory Origin
Anesth Analg 2003 96: 1640-1644. [Abstract] [Full Text]  

IMPLICATIONS: Administration of dexamethasone before succinylcholine was not effective in decreasing the incidence or the severity of succinylcholine-induced postoperative myalgia. Furthermore, there was no significant relationship between postoperative myalgia and time course of interleukin-6 concentrations, a marker of inflammation. Pretreatment with dexamethasone is not justified to prevent postoperative myalgia after succinylcholine.

Randa K. Noseir, David J. Ficke, Anjana Kundu, Shahbaz R. Arain, and Thomas J. Ebert

Sympathetic and Vascular Consequences from Remifentanil in Humans
Anesth Analg 2003 96: 1645-1650. [Abstract] [Full Text]  

IMPLICATIONS: Remifentanil occasionally has been associated with hypotension, the mechanism of which is unclear. This study found that remifentanil directly causes the forearm arterial vasculature to dilate.

Hiroko Iwakiri, Osamu Nagata, Takashi Matsukawa, Makoto Ozaki, and Daniel I. Sessler

Effect-Site Concentration of Propofol for Recovery of Consciousness Is Virtually Independent of Fentanyl Effect-Site Concentration
Anesth Analg 2003 96: 1651-1655. [Abstract] [Full Text]  

IMPLICATIONS:The effect-site concentration for propofol at awakening was virtually independent of the fentanyl effect-site concentration over the range of 0.8 to 3.0 ng/mL; however, 0.8 ng/mL of fentanyl was associated with inadequate postoperative analgesia, and 3.0 ng/mL of fentanyl was associated with respiratory toxicity. The optimal postoperative fentanyl effect-site concentration during recovery from propofol general anesthesia for laparotomy thus appears to be near 2 ng/mL.

Kazuyoshi Hirota, Darren Smart, and David G. Lambert

The Effects of Local and Intravenous Anesthetics on Recombinant Rat VR1 Vanilloid Receptors
Anesth Analg 2003 96: 1656-1660. [Abstract] [Full Text]  

IMPLICATIONS: Vanilloid receptors (VR1) are activated by capsaicin, the pain-producing component of hot chili peppers. We suggest that local (but not IV general) anesthetics may have inhibitory actions on this receptor.

Edmond I Eger, II, Yilei Xing, Michael J. Laster, and James M. Sonner

-2 Adrenoreceptors Probably Do Not Mediate the Immobility Produced by Inhaled Anesthetics
Anesth Analg 2003 96: 1661-1664. [Abstract] [Full Text]  

IMPLICATIONS: Although stimulation (agonism) of {alpha}-2 adrenoreceptors can decrease the inhaled anesthetic concentration required to produce immobility in the face of noxious stimulation, blockade of {alpha}-2 adrenoreceptors minimally affects the concentration. Thus, augmentation of the effect of {alpha}-2 adrenoreceptors is not an appreciable part of the mechanism whereby inhaled anesthetics produce immobility.

Mark A. Punke, Thomas Licher, Olaf Pongs, and Patrick Friederich

Inhibition of Human TREK-1 Channels by Bupivacaine
Anesth Analg 2003 96: 1665-1673. [Abstract] [Full Text]  

IMPLICATIONS: The interaction of bupivacaine with human TREK-1 channels was studied with the patch-clamp technique. Bupivacaine inhibited TREK-1 channels and depolarized the membrane potential of cells expressing TREK-1 channels in a concentration-dependent and reversible manner. Both effects may contribute to conductance block caused by bupivacaine.

Kahoru Nishina, Katsuya Mikawa, Shun-ichi Kodama, Tetsuro Kagawa, Takanobu Uesugi, and Hidefumi Obara

The Effects of Enflurane, Isoflurane, and Intravenous Anesthetics on Rat Diaphragmatic Function and Fatigability
Anesth Analg 2003 96: 1674-1678. [Abstract] [Full Text]  

IMPLICATIONS: Enflurane did not change contraction or relaxation in fresh isolated rat diaphragm, but enhanced diaphragmatic fatigability itself and fatigue-induced impairment of twitch characteristics and tetanic tensions. Isoflurane, midazolam, ketamine, propofol, and thiopental had no direct effects on diaphragmatic functions under unfatigued and fatigued conditions. Isoflurane and these IV anesthetics may be advantageous over enflurane to anesthetize and/or sedate patients who are predisposed to diaphragmatic fatigue.

Aki Uemura, Yoshitaka Fujii, Hidenori Toyooka, Setsuko Suzuki, Kohei Sawada, and Hideyuki Adachi

Olprinone for the Treatment, but Not Prevention, of Fatigue-Induced Changes in Guinea-Pig Diaphragmatic Contractility
Anesth Analg 2003 96: 1679-1782. [Abstract] [Full Text]  

IMPLICATIONS: Olprinone is effective for the treatment, but not prevention, of fatigue-induced changes in guinea-pig diaphragmatic contractility.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Chiharu Negishi, Kenji Hasegawa, Shihoko Mukai, Fumitoshi Nakagawa, Makoto Ozaki, and Daniel I. Sessler

Resistive-Heating and Forced-Air Warming Are Comparably Effective
Anesth Analg 2003 96: 1683-1687. [Abstract] [Full Text]  

IMPLICATIONS: Efficacy was similar for forced-air and resistive heating, and both maintained intraoperative core temperature far better than circulating-water mattresses. We thus conclude that even during major abdominal surgery, resistive heating maintains core temperature as effectively as forced air.

Takashi Matsukawa, Takahisa Goto, Makoto Ozaki, Daniel I. Sessler, Akira Takeuchi, Tomoki Nishiyama, and Teruo Kumazawa

Core Temperature Monitoring with New Ventilatory Devices
Anesth Analg 2003 96: 1688-1691. [Abstract] [Full Text]  

IMPLICATIONS: Temperatures measured on airway devices correlated well with independent measurements of core body temperature. Thus, body temperature measured on the cuffs of airway devices is sufficiently accurate for routine use.

Takanori Sakamoto, Masahiko Kawaguchi, Meiko Kakimoto, Satoki Inoue, Masahiro Takahashi, and Hitoshi Furuya

The Effect of Hypothermia on Myogenic Motor-Evoked Potentials to Electrical Stimulation with a Single Pulse and a Train of Pulses Under Propofol/Ketamine/Fentanyl Anesthesia in Rabbits
Anesth Analg 2003 96: 1692-1697. [Abstract] [Full Text]  

IMPLICATIONS: Intraoperative monitoring of myogenic motor-evoked potentials (MEPs) may be required under hypothermic conditions because of its neuroprotective efficacy. However, data on the influence of hypothermia on myogenic MEPs are limited. The results indicate that multipulse stimulation may be better than single-pulse stimulation when monitoring MEPs during hypothermia.

Thomas M. Hemmerling and and Martin Desrosiers

Interference of Electromagnetic Operating Systems in Otorhinolaryngology Surgery with Bispectral Index Monitoring (Case Report)
Anesth Analg 2003 96: 1698-1699. [Abstract] [Full Text]  

IMPLICATIONS: Electromagnetic operating systems interfere with bispectral index monitoring in creating incorrectly large values; clinicians have to keep this in mind whenever these systems are used.

PAIN MEDICINE:

Allen H. Hord, Donald D. Denson, Amale G. Chalfoun, and M. Isabel Azevedo

The Effect of Systemic Zonisamide (Zonegran^TM) on Thermal Hyperalgesia and Mechanical Allodynia in Rats with an Experimental Mononeuropathy
Anesth Analg 2003 96: 1700-1706. [Abstract] [Full Text]  

IMPLICATIONS: Zonisamide causes a dose-related decrease in heat sensitivity in a rat model of neuropathic pain, but relieves mechanical sensitivity only in a dose that is sedating to the rat. Zonisamide may be useful in the treatment of some types of neuropathic pain.

Anna Haderer, Peter Gerner, Grace Kao, Venkatesh Srinivasa, and Ging Kuo Wang

Cutaneous Analgesia After Transdermal Application of Amitriptyline Versus Lidocaine in Rats
Anesth Analg 2003 96: 1707-1710. [Abstract] [Full Text]  

IMPLICATIONS: The tricyclic antidepressant amitriptyline, often used perorally for the management of chronic pain, is shown here to be more potent than lidocaine in providing cutaneous analgesia when applied transdermally with an occlusive dressing in rats.

Chung-Ren Lin, Lin-Cheng Yang, Huey-Ling You, Chien-Te Lee, Ming-Hong Tai, Ping-Heng Tan, Ming-Wei Lin, and Jiin-Tsuey Cheng

Antinociceptive Potentiation and Attenuation of Tolerance by Intrathecal Electric Stimulation in Rats
Anesth Analg 2003 96: 1711-1716. [Abstract] [Full Text]  

IMPLICATIONS: Control of chronic pain is a major health problem. We show here that direct electrical stimulation of the spinal cord in rats enhances analgesia and attenuates naloxone-induced withdrawal symptoms. This may warrant further investigation in the context of long-term use of intrathecal opioids for controlling chronic pain.

William J. Perkins, Dudley H. Davis, Marc A. Huntoon, and Terese T. Horlocker

A Retained Racz® Catheter Fragment After Epidural Neurolysis: Implications During Magnetic Resonance Imaging (Case Report)
Anesth Analg 2003 96: 1717-1719. [Abstract] [Full Text]  

IMPLICATIONS: A retained ferromagnetic catheter used for epidurolysis obscured diagnostic magnetic resonance imaging of the lumbar spine. The implications of this are discussed in light of other reports of retained catheter fragments obtained from the Food and Drug Administration Manufacturer and Facility Device Experience Database (http://www.fda.gov/cdrh/maude.html).

Noor M. Gajraj

Cyclooxygenase-2 Inhibitors (Review Article)
Anesth Analg 2003 96: 1720-1738. [Full Text]  

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Haim Berkenstadt, Amitai Ziv, Daphna Barsuk, Inbal Levine, Amir Cohen, and Amir Vardi

The Use of Advanced Simulation in the Training of Anesthesiologists to Treat Chemical Warfare Casualties
Anesth Analg 2003 96: 1739-1742. [Abstract] [Full Text]  

IMPLICATIONS: Advanced medical simulation can be used to train anesthesiologists to treat nonconventional warfare casualties. The limitations of medical performance in full protective gear can be learned from this training.

CRITICAL CARE AND TRAUMA:

Karl H. Stadlbauer, Horst G. Wagner-Berger, Volker Wenzel, Wolfgang G. Voelckel, Anette C. Krismer, Günter Klima, Klaus Rheinberger, Sebastian Pechlaner, Viktoria D. Mayr, and Karl H. Lindner

Survival with Full Neurologic Recovery After Prolonged Cardiopulmonary Resuscitation with a Combination of Vasopressin and Epinephrine in Pigs
Anesth Analg 2003 96: 1743-1749. [Abstract] [Full Text]  

IMPLICATIONS: We present a study to evaluate the effects of a combination of vasopressin and epinephrine during prolonged cardiopulmonary resuscitation on neurological outcome in pigs. We found that all pigs treated with a combination of vasopressin and epinephrine could be resuscitated and had full neurologic recovery observed over an entire period of 5 days.

Luis A. Gaitini, Sonia J. Vaida, Mostafa Somri, Victor Kaplan, Boris Yanovski, Robert Markovits, and Carin A. Hagberg

An Evaluation of the Laryngeal Tube® During General Anesthesia Using Mechanical Ventilation
Anesth Analg 2003 96: 1750-1755. [Abstract] [Full Text]  

IMPLICATIONS: In 96.6% of patients intubated with the Laryngeal Tube(R), it was possible to maintain oxygenation, ventilation, and respiratory mechanics during mechanical ventilation.

Spyros D. Mentzelopoulos, Spyros G. Zakynthinos, Charris Roussos, Maria J. Tzoufi, and Argyris S. Michalopoulos

Prone Position Improves Lung Mechanical Behavior and Enhances Gas Exchange Efficiency in Mechanically Ventilated Chronic Obstructive Pulmonary Disease Patients
Anesth Analg 2003 96: 1756-1767. [Abstract] [Full Text]  

IMPLICATIONS: By assessing respiratory mechanics, inspiratory work, hemodynamics, and gas exchange, we showed that prone positioning of mechanically ventilated chronic obstructed pulmonary disease patients improves oxygenation and lung mechanics during sigh versus semirecumbent positioning. Furthermore, certain pronation-related benefits versus preprone-supine positioning (reduced lung elastance and improved oxygenation) are maintained in the postprone supine position.

James C. Russell and Ken G. Lowry

Presentation of Non-Hodgkin’s Lymphoma as Acute Hypoxia Caused by Right Ventricular Compression (Case Report)
Anesth Analg 2003 96: 1768-1771. [Abstract] [Full Text]  

IMPLICATIONS: A case is presented of a woman developing acute right ventricular outflow tract obstruction because of mediastinal non-Hodgkin's lymphoma. Systemic blood flow was possible through a patent foramen ovale.

NEUROSURGICAL ANESTHESIA:

S. C. Kettner, C. Sitzwohl, M. Zimpfer, S. A. Kozek, A. Holzer, C. K. Spiss, and U. M. Illievich

The Effect of Graded Hypothermia (36°C–32°C) on Hemostasis in Anesthetized Patients Without Surgical Trauma
Anesth Analg 2003 96: 1772-1776. [Abstract] [Full Text]  

IMPLICATIONS: This study investigated the isolated effects of hypothermia in healthy anesthetized humans. We found only minor effects of body temperature reduction to 32{degrees}C on assessed coagulation variables, indicating only minor effects in otherwise healthy humans.

Satoshi Matsumoto, Mishiya Matsumoto, Atsuo Yamashita, Kazunobu Ohtake, Kazuyoshi Ishida, Yasuhiro Morimoto, and Takefumi Sakabe

The Temporal Profile of the Reaction of Microglia, Astrocytes, and Macrophages in the Delayed Onset Paraplegia After Transient Spinal Cord Ischemia in Rabbits
Anesth Analg 2003 96: 1777-1784. [Abstract] [Full Text]  

IMPLICATIONS: Microglia and macrophages play a role in removing tissue debris after transient spinal cord ischemia. Disturbance of astrocytic defense mechanism, breakdown of the blood-spinal cord barrier, or both seemed to be involved in the development of delayed motor dysfunction.

Zoran Rodi, Ivan Straus, Kata Denic, Vedran Deletis, and David B. Vodusek

Transient Paraplegia Revealed by Intraoperative Neurophysiological Monitoring: Was It Caused by the Epidural Anesthetic or an Epidural Hematoma? (Case Report)
Anesth Analg 2003 96: 1785-1788. [Abstract] [Full Text]  

IMPLICATIONS: Our case report describes the electrophysiological features associated with the development of a spinal epidural hematoma during surgery of the lumbar spine. It stresses the importance of the evaluation of nonsurgical factors, which can potentially affect intraoperative evoked potentials; in this case, epidural local anesthetic or epidural hematoma.

OBSTETRIC ANESTHESIA:

Somrat Charuluxananan, Oranuch Kyokong, Wanna Somboonviboon, Arunchai Narasethakamol, and Pissamai Promlok

Nalbuphine Versus Ondansetron for Prevention of Intrathecal Morphine-Induced Pruritus After Cesarean Delivery
Anesth Analg 2003 96: 1789-1793. [Abstract] [Full Text]  

IMPLICATIONS: Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery.

Yaakov Beilin, Sabera Hossain, and Carol A. Bodian

The Numeric Rating Scale and Labor Epidural Analgesia
Anesth Analg 2003 96: 1794-1798. [Abstract] [Full Text]  

IMPLICATIONS: This study demonstrated that unless the score of the verbal numeric 0-10 rating scale (NRS) is 0 or 1, most women want more analgesic medication for labor epidural analgesia. Additionally, we found that grouping the NRS values into 3 categories for analysis (0 or 1, 2 or 3, and > 3) is more useful to the clinician than using the full spectrum of NRS scores.

Neil Roy Connelly, Robert K. Parker, Thomas Pedersen, Thenu Manikantan, Tanya Lucas, Stelian Serban, Mervat El-Mansouri, Scott DuBois, Edgar Delos Santos, Asad Rizvi, and Charles Gibson

Diluent Volume for Epidural Fentanyl and Its Effect on Analgesia in Early Labor
Anesth Analg 2003 96: 1799-1804. [Abstract] [Full Text]  

IMPLICATIONS: In early laboring patients, the volume in which 100 {micro}g of epidural fentanyl (after a lidocaine-epinephrine test dose) is administered does not affect the onset or duration of ambulatory analgesia.

Isuta Nishio, Gordon L. Mandell, Sivam Ramanathan, and Jules H. Sumkin

Epidural Labor Analgesia for a Patient with Disseminated Lymphangiomatosis (Case Report)
Anesth Analg 2003 96: 1805-1808. [Abstract] [Full Text]  

IMPLICATIONS: We describe a case of a parturient with disseminated lymphangiomatosis involving the thorax, retroperitoneum, and lumbar vertebrae who received epidural labor analgesia. Clinical presentations vary depending on the organ systems involved, the extent of the disease, and the stage of pregnancy. Anesthetic implications are discussed.

Mostafa Somri, Christian B. Teszler, Sonia J. Vaida, Boris Yanovski, Diana Gaitini, Riad Tome, Milo Fradis, and Luis A. Gaitini

Postdural Puncture Headache: An Imaging-Guided Management Protocol (Case Report)
Anesth Analg 2003 96: 1809-1812. [Abstract] [Full Text]  

IMPLICATIONS: We propose an imaging-based algorithm for the management of headache caused by the inadvertent puncture of dura that occurs sporadically during epidural analgesia. Its implementation can identify those postdural puncture headache cases that cannot benefit from epidural blood patches, and their unnecessary application can consequently be avoided.

GENERAL ARTICLES:

Ahsanul K. Khan, Jonathan S. Jahr, Susmita Nesargi, Stephen J. Rothenberg, Zuping Tang, Anthony Cheung, Robert A. Gunther, Gerald J. Kost, and Bernd Driessen

Does Lead Interfere with Hemoglobin-Based Oxygen Carrier (HBOC) Function? A Pilot Study of Lead Concentrations in Three Approved or Tested HBOCs and Oxyhemoglobin Dissociation with HBOCs and/or Bovine Blood with Varying Lead Concentrations
Anesth Analg 2003 96: 1813-1820. [Abstract] [Full Text]  

IMPLICATIONS: Gunshot wounds rapidly increase circulating lead concentrations. Lead concentrations are small in three hemoglobin-based oxygen carriers (HBOCs), and HBOCs and/or bovine blood do not appear to be affected by lead concentrations in terms of immediate oxygen on-loading and off-loading. HBOCs may be useful in patients with gunshot wounds.

Donald M. Miller and Derek Light

Storage Capacities of the Laryngeal Mask and Laryngeal Tube Compared and Their Relevance to Aspiration Risk During Positive Pressure Ventilation (Brief Report)
Anesth Analg 2003 96: 1821-1822. [Abstract] [Full Text]  

IMPLICATIONS: Supraglottic airways used for positive pressure ventilation run the occasional risk of regurgitated liquid entering the lungs (aspiration). A dynamic model described here shows that the laryngeal tube has a larger liquid storage capacity between the two cuffs than the bowl of the laryngeal mask, with a consequent smaller aspiration risk.

David J. Cook and G. Alec Rooke

Priorities in Perioperative Geriatrics (Review Article)
Anesth Analg 2003 96: 1823-1836. [Full Text]  

LETTERS TO THE EDITOR:

David O. Warner and Paul F. White

Are Pharmaceutical Representatives Reliable Guides to the Medical Literature? • Response
Anesth Analg 2003 96: 1837. [Full Text]  

Gregory A. Liguori, James D. Beckman, Andrew C. Lee, and Gavin Martin

A Teaching Model for Training in Regional Anesthesia—or in Peripheral Nerve Blockade? • Response
Anesth Analg 2003 96: 1837-1838. [Full Text]  

Federico Bilotta and Giovanni Rosa

Magnesium Sulfate and Neuroprotection
Anesth Analg 2003 96: 1838. [Full Text]  

David H. Wong and Jeffrey R. Hodgson

Another Cause of Pseudohypotension
Anesth Analg 2003 96: 1838-1839. [Full Text]  

Mauricio Palacios, Gregory M. Janelle, and Nikolaus Gravenstein

Strategies to Prevent Arterial Injury Caused by Dilator Should Be Integrated into Routine Clinical Practice
Anesth Analg 2003 96: 1839. [Full Text]  

Matthew T. V. Chan, Tony Gin, Albert K. K. Chui, W. Y. Lau, M. Susan Mandell, Michael Wachs, Thomas K. Henthorn, and Claus U. Niemann

Pitfalls of Indocyanine Green Dye Elimination to Assess Graft Function During Liver Transplantation • Response
Anesth Analg 2003 96: 1839-1841. [Full Text]  

Leonidas C. Goudas, Daniel B. Carr, Suellen M. Walker, and Michael J. Cousins

Combination Spinal Analgesic Chemotherapy: An Additional Clinical Trial of Opioid Plus Local Anesthetic
Anesth Analg 2003 96: 1841. [Full Text]  

Jay B. Brodsky, Harry J. M. Lemmens, John G. Brock-Utne, Lawrence J. Saidman, Richard Levitan, Babatunde O. Ogunnaike, Stephanie B. Jones, Charles W. Whitten, Daniel B. Jones, and David Provost

Anesthetic Considerations for Bariatric Surgery: Proper Positioning is Important for Laryngoscopy • Response
Anesth Analg 2003 96: 1841-1842. [Full Text]  

X. Márquez and A. Márquez

A New Laryngeal Tube
Anesth Analg 2003 96: 1842. [Full Text]  

Gökcen Basaranoglu, Veysel Erden, Hamdi Delatioglu, and Hironori Itoh

Anesthesia of a Patient with Cured Myasthenia Gravis • Response
Anesth Analg 2003 96: 1842-1843. [Full Text]  

Karel G.M. Moons, Wilton van Klei, and Cornelis J. Kalkman

Preoperative Risk Factors of Intraoperative Hypothermia in Major Surgery Under General Anesthesia
Anesth Analg 2003 96: 1843-1844. [Full Text]  

Donald Oxorn and Solomon Aronson

Certification in Perioperative TEE • Response
Anesth Analg 2003 96: 1844. [Full Text]  

David Schwartz, Timothy VadeBoncouer, Guy Weinberg, Avery Tung, Bobbie Jean Sweitzer, and Thomas W. Cutter

Was Case Report a Case of Unrecognized Local Anesthetic Toxicity? • Response
Anesth Analg 2003 96: 1844-1845. [Full Text]  

Jae-Hyon Bahk, Ho-Geol Ryu, Chongdoo Park, Peter Szmuk, and Tiberiu Ezri

Use of Gum Elastic Bougie During Difficult Airway Management • Response
Anesth Analg 2003 96: 1845-1846. [Full Text]  

Gilles Godet, Ioana Arhanghelschi, Catherine Chevalley, and Marc Licker

The Impact of a Cardioprotective Protocol on the Incidence of Cardiac Complications After Aortic Abdominal Surgery • Response
Anesth Analg 2003 96: 1846. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

S. Craighead Alexander, Gordon H. Morewood, J. Kent Garman, Noor M. Gajraj, Keith J Ruskin, and James H. Philip

Holding Court with the Ghost of Gilman Terrace: Selected Writings of Ralph Milton Waters • TEE on CD: An Interactive Resource • Clinical Anesthesia for the PDA • Radiographic Imaging for Regional Anesthesia and Pain Management • Harvard Electronic Anesthesia Library • The Pharmacology of Inhaled Anesthetics • Books and Multimedia Received
Anesth Analg 2003 96: 1847-1850. [Full Text]  

GUEST REVIEWERS, AUTHOR AND SUBJECT INDEXES:

GUEST REVIEWERS LIST October 1, 2002 TO March 31, 2003
Anesth Analg 2003 96: 1851-1854. [Full Text]  

Author Index
Anesth Analg 2003 96: 1857-1876. [Full Text]  

Subject Index
Anesth Analg 2003 96: 1877-1901. [Full Text]  

ERRATA:

Correction
Anesth Analg 2003 96: 1552. [Full Text]  

Correction
Anesth Analg 2003 96: 1552. [Full Text]  

To see an article, click its [Full Text] 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.