EDITORIALS:

Paul F. White

Can the Use of Specific Isomers Improve the Safety and Efficacy of Nonsteroidal Antiinflammatory Drugs?
Anesth Analg 2003 97: 309-310. [Full Text]  

C. W. Vaughan and M. Connor

In Search of a Role for the Morphine Metabolite Morphine-3-Glucuronide
Anesth Analg 2003 97: 311-312. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Daniel M. Thys

Clinical Competence in Echocardiography (Special Article)
Anesth Analg 2003 97: 313-322. [Full Text]  

Armin Schubert, Robert J. Przybelski, John F. Eidt, Larry C. Lasky, Kenneth E. Marks, Matthew Karafa, Andrew C. Novick, Jerome F. O’Hara, Jr., Michael E. Saunders, John W. Blue, John E. Tetzlaff, and Edward Mascha

Diaspirin-Crosslinked Hemoglobin Reduces Blood Transfusion in Noncardiac Surgery: A Multicenter, Randomized, Controlled, Double-Blinded Trial (Special Article)
Anesth Analg 2003 97: 323-332. [Abstract] [Full Text]  

IMPLICATIONS: In a randomized, double-blinded red blood cell controlled, multicenter trial, diaspirin-crosslinked hemoglobin spared allogeneic transfusion in 23% of patients undergoing elective noncardiac surgery. The observed side-effect profile indicates a need for improvement in hemoglobin development.

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

The Role of K⁺ Channels in Vasorelaxation Induced by Hypoxia and the Modulator Effects of Lidocaine in the Rat Carotid Artery (Special Article)
Anesth Analg 2003 97: 333-338. [Abstract] [Full Text]  

IMPLICATIONS: In rat carotid artery, levcromakalim produced vasorelaxation mediated by adenosine triphosphate (ATP)-sensitive K+ channels, whereas hypoxia induced it partly via these channels. Lidocaine inhibited vasorelaxation induced by an ATP-sensitive K+ channel opener but not by hypoxia, indicating the differential mechanisms of modulatory effects of this antiarrhythmic drug on vasodilation via ATP-sensitive K+ channels activated by pathophysiological and pharmacological stimuli.

Lothar A. Schwarte and Matthias Hartmann

Intentional Circulatory Arrest to Facilitate Surgical Repair of a Massively Bleeding Artery (Case Report)
Anesth Analg 2003 97: 339-340. [Abstract] [Full Text]  

IMPLICATIONS: Cardiocirculatory arrest can be induced by adenosine and maintained over several minutes by application of high positive end-expiratory pressure to allow surgical control of a near hemorrhage from a large ruptured artery.

Greg Stratmann and George A. Gregory

Neurogenic and Humoral Vasoconstriction in Acute Pulmonary Thromboembolism (Review Article)
Anesth Analg 2003 97: 341-354. [Full Text]  

PEDIATRIC ANESTHESIA:

Donald Schwartz, Neil Roy Connelly, P. Manikantan, and J. H. Nichols

Hyperkalemia and Pyloric Stenosis
Anesth Analg 2003 97: 355-357. [Abstract] [Full Text]  

IMPLICATIONS: A significant number of infants with pyloric stenosis have a serum potassium value above the normal limit.

Sandra L. Barcelona, Fatima Vilich, and Charles J. Coté

A Comparison of Flow Rates and Warming Capabilities of the Level 1 and Rapid Infusion System with Various-Size Intravenous Catheters
Anesth Analg 2003 97: 358-363. [Abstract] [Full Text]  

IMPLICATIONS: The rapid infusion system is superior to the Level 1 for warming and flow of crystalloid for IV catheters >18 gauge in vitro. The rapid infusion system provides no advantage with catheters typically used in small children (<=18 gauge). Safety and cost are additional factors to be considered when choosing one system over the other.

Joseph P. Cravero, Michael Beach, Brian Thyr, and Kate Whalen

The Effect of Small Dose Fentanyl on the Emergence Characteristics of Pediatric Patients After Sevoflurane Anesthesia Without Surgery
Anesth Analg 2003 97: 364-367. [Abstract] [Full Text]  

IMPLICATIONS: The addition of a small dose of fentanyl given to patients undergoing nonsurgical sevoflurane anesthesia resulted in a significant decrease in emergence agitation in a prospective, randomized, and controlled trial involving pediatric patients.

Giorgio Ivani, Pasquale De Negri, Per-Arne Lonnqvist, Staffan Eksborg, Valeria Mossetti, Roberto Grossetti, Simona Italiano, Franca Rosso, Federica Tonetti, and Luigi Codipietro

A Comparison of Three Different Concentrations of Levobupivacaine for Caudal Block in Children
Anesth Analg 2003 97: 368-371. [Abstract] [Full Text]  

IMPLICATIONS: The use of 0.125% levobupivacaine for caudal blockade (1 mL/kg) in children (1-7 yr) was associated with less early postoperative motor blockade but a shorter duration of postoperative analgesia compared with 0.20% and 0.25% solutions.

Kumiko Ogasawara, Makoto Tanaka, and Toshiaki Nishikawa

Choice of Electrocardiography Lead Does Not Affect the Usefulness of the T-Wave Criterion for Detecting Intravascular Injection of an Epinephrine Test Dose in Anesthetized Children
Anesth Analg 2003 97: 372-376. [Abstract] [Full Text]  

IMPLICATIONS: To determine whether an epidurally administered local anesthetic has been accidentally injected into a blood vessel, a small dose of epinephrine is often added to a local anesthetic. We found that increases in T-wave amplitude in leads I, II, III, and V5 of the electrocardiogram are equally sensitive and specific for detecting intravascular injection of the epinephrine-containing test dose in sevoflurane-anesthetized infants and children.

Eric Wodey, Lotfi Senhadji, Patrick Pladys, François Carre, and Claude Ecoffey

The Relationship Between Expired Concentration of Sevoflurane and Sympathovagal Tone in Children
Anesth Analg 2003 97: 377-382. [Abstract] [Full Text]  

IMPLICATIONS: The effects of sevoflurane on parasympathetic activity could explain the difference in heart-rate changes described between infants and children during induction. This study describes the changes in heart rate and its variability induced by sevoflurane in children and shows that these changes are related to parasympathetic tone before the induction of anesthesia.

Harry A. Seifert, David R. Jobes, Thomas Ten Have, Stephen E. Kimmel, Lisa M. Montenegro, James M. Steven, Susan C. Nicolson, and Brian L. Strom

Adverse Events After Protamine Administration Following Cardiopulmonary Bypass in Infants and Children
Anesth Analg 2003 97: 383-389. [Abstract] [Full Text]  

IMPLICATIONS: Systemic hypotension after protamine administration occurred in 1.76%-2.88% of pediatric patients having cardiac surgery. Female sex, larger protamine dose, and smaller heparin dose were each associated with increased risk. The development of protamine alternatives or prophylactic therapies may be useful for reducing the frequency of these events.

AMBULATORY ANESTHESIA:

Olutoyin Olutoye, Ellen C. Jantzen, Rhonda Alexis, Donna Rajchert, Mark S. Schreiner, and Mehernoor F. Watcha

A Comparison of the Costs and Efficacy of Ondansetron and Dolasetron in the Prophylaxis of Postoperative Vomiting in Pediatric Patients Undergoing Ambulatory Surgery
Anesth Analg 2003 97: 390-396. [Abstract] [Full Text]  

IMPLICATIONS: This randomized double-blinded dose-ranging study concluded that dolasetron, 350 {micro}g/kg IV, was the smallest dose that provided acceptable equivalent efficacy and patient satisfaction scores to ondansetron, 100 {micro}g/kg IV, for the prophylaxis of postoperative vomiting in children undergoing outpatient surgery. However, with this dose, the costs to the institution for managing postoperative vomiting were less.

Julia E. Pollock, Michael F. Mulroy, Elyssa Bent, and Nayak L. Polissar

A Comparison of Two Regional Anesthetic Techniques for Outpatient Knee Arthroscopy (Brief Report)
Anesth Analg 2003 97: 397-401. [Abstract] [Full Text]  

IMPLICATIONS: Small dose lidocaine spinal anesthesia and 3% 2-chloroprocaine epidural anesthesia provided comparable discharge times for outpatient knee arthroscopy. The incidence of transient neurologic symptoms with small-dose lidocaine spinal anesthesia was 12%.

ANESTHETIC PHARMACOLOGY:

A. Bonabello, M. R. Galmozzi, R. Canaparo, G. C. Isaia, L. Serpe, E. Muntoni, and G. P. Zara

Dexibuprofen (S(+)-Isomer Ibuprofen) Reduces Gastric Damage and Improves Analgesic and Antiinflammatory Effects in Rodents
Anesth Analg 2003 97: 402-408. [Abstract] [Full Text]  

IMPLICATIONS: Ibuprofen is a nonsteroidal antiinflammatory drug often prescribed as a racemic formulation. We studied the analgesic and antiinflammatory effects of the active S(+)-isomer. The S(+)-ibuprofen was found to be more potent than the racemic formulation and produced less acute gastric damage.

Sandra Kampe, Carsten Poetter, Shariah Buzello, Hans-Martin Wenchel, Matthias Paul, Peter Kiencke, and Stefan-Mario Kasper

Ropivacaine 0.1% with Sufentanil 1 µg/mL Inhibits In Vitro Growth of Pseudomonas Aeruginosa and Does Not Promote Multiplication of Staphylococcus Aureus
Anesth Analg 2003 97: 409-411. [Abstract] [Full Text]  

IMPLICATIONS: This laboratory study demonstrated that compared with saline, ropivacaine 0.1% with 1 {micro}g/mL of sufentanil inhibited growth of Pseudomonas aeruginosa and did not promote multiplication of Staphylococcus aureus at room temperature. With respect to bacterial infection with these two strains, the mixture seems to be safe for continuous epidural administration if prepared under aseptic conditions and after alcohol hand rub.

Jonathan Stewart, Norma Kellett, and Dan Castro

The Central Nervous System and Cardiovascular Effects of Levobupivacaine and Ropivacaine in Healthy Volunteers
Anesth Analg 2003 97: 412-416. [Abstract] [Full Text]  

IMPLICATIONS: This study compared directly, for the first time, the toxicity of levobupivacaine and ropivacaine in healthy volunteers. Levobupivacaine and ropivacaine produced similar central nervous system and cardiovascular effects when infused IV at equal concentrations, milligram doses, and infusion rates.

Masanori Yamauchi, Steven G. Shimada, Hiroshi Sekiyama, and J. G. Collins

Neither Spinal -Aminobutyric Acid-A nor Strychnine-Sensitive Glycine Receptor Systems Are the Sole Mediators of Halothane Depression of Spinal Dorsal Horn Sensory Neurons
Anesth Analg 2003 97: 417-423. [Abstract] [Full Text]  

IMPLICATIONS: The results of this study support the hypothesis that halothane depression of spinal sensory neurons is mediated, but not completely, by the anesthetic effects on {gamma}-aminobutyric acid type A and strychnine-sensitive glycine neurotransmitter systems.

Masahiro Irifune, Tohru Takarada, Yoshitaka Shimizu, Chie Endo, Sohtaro Katayama, Toshihiro Dohi, and Michio Kawahara

Propofol-Induced Anesthesia in Mice Is Mediated by -Aminobutyric Acid-A and Excitatory Amino Acid Receptors
Anesth Analg 2003 97: 424-429. [Abstract] [Full Text]  

IMPLICATIONS: We examined behaviorally the effects of GABAergic and glutamatergic drugs on propofol-induced anesthesia in mice. The results suggest that propofol anesthesia is mediated, at least in part, by both GABAA and excitatory amino acid receptors.

Piet W. L. Tas, Christiane Stößel, and Norbert Roewer

The Volatile Anesthetic Isoflurane Inhibits the Histamine-Induced Ca²⁺ Influx in Primary Human Endothelial Cells
Anesth Analg 2003 97: 430-435. [Abstract] [Full Text]  

IMPLICATIONS: In response to vasoactive agents, endothelial cells produce nitric oxide (NO), which relaxes the underlying smooth muscle cells. Inhaled anesthetics inhibit this system by an unknown mechanism. Using primary human endothelial cells, we showed that the anesthetic isoflurane depresses a Ca2+ influx, which is responsible for the activation of the endothelial NO synthase.

Toshiyuki Tobita, Manabu Okamoto, Miyako Shimizu, Tomohiro Yamakura, Hideyoshi Fujihara, Koki Shimoji, and Hiroshi Baba

The Effects of Isoflurane on Conditioned Inhibition by Dorsal Column Stimulation
Anesth Analg 2003 97: 436-441. [Abstract] [Full Text]  

IMPLICATIONS: To investigate how anesthetics affect supraspinal modulation of sensory transmission in the spinal cord, the spinal cord potential (SCP) evoked by dorsal cord stimulation (DCS) and segmentally evoked SCP conditioned by DCS were recorded in intact and spinal cord-transected rats during isoflurane anesthesia.

Hiroo Shimono, Teruko Goromaru, Yoshitami Kadota, Takeshi Tsurumaru, and Yuichi Kanmura

Propofol Displays No Protective Effect Against Hypoxia/Reoxygenation Injury in Rat Liver Slices
Anesth Analg 2003 97: 442-448. [Abstract] [Full Text]  

IMPLICATIONS: Propofol had no hepatotoxic effect under no-hypoxia conditions in rat liver slices, nor did it have a protective effect against hypoxia/reoxygenation-induced hepatic injury.

Munehiro Shiraishi, Kouichiro Minami, Izumi Shibuya, Yasuhito Uezono, Junichi Ogata, Takashi Okamoto, Osamu Murasaki, Muneshige Kaibara, Yoichi Ueta, and Akio Shigematsu

The Inhibitory Effects of Alphaxalone on M₁ and M₃ Muscarinic Receptors Expressed in Xenopus Oocytes
Anesth Analg 2003 97: 449-455. [Abstract] [Full Text]  

IMPLICATIONS: Alphaxalone, a neurosteroid anesthetic, inhibited the function of muscarinic M1 and M3 receptors and the specific binding of [3H]quinuclidinyl benzilate ([3H]QNB) to oocytes expressing these receptors. These findings suggest that alphaxalone inhibits these receptors by interfering with the QNB binding sites.

Zen’ichiro Wajima, Toshiya Shiga, Tatsusuke Yoshikawa, Akira Ogura, Kazuyuki Imanaga, Tetsuo Inoue, and Ryo Ogawa

Intravenous Alprostadil, an Analog of Prostaglandin E₁, Prevents Thiamylal-Fentanyl-Induced Bronchoconstriction in Humans
Anesth Analg 2003 97: 456-460. [Abstract] [Full Text]  

IMPLICATIONS:IV alprostadil, an analog of prostaglandin E1, prevents thiamylal-fentanyl-induced bronchoconstriction in humans. This finding suggests that IV alprostadil has a bronchodilator effect.

Li-Hoon Tan and Nian-Chih Hwang

The Effect of Mixing Lidocaine with Propofol on the Dose of Propofol Required for Induction of Anesthesia
Anesth Analg 2003 97: 461-464. [Abstract] [Full Text]  

IMPLICATIONS: Adding lidocaine to propofol destabilizes the propofol emulsion. A randomized double-blinded trial found no statistically significant difference in the doses of propofol required for the induction of anesthesia whether administered as a freshly prepared propofol 1%/lidocaine 1% 10:1 mixture or as a separate injection after a dose of lidocaine.

Manuela J. M. de Klaver, Mary-Gordon Buckingham, and George F. Rich

Lidocaine Attenuates Cytokine-Induced Cell Injury in Endothelial and Vascular Smooth Muscle Cells
Anesth Analg 2003 97: 465-70. [Abstract] [Full Text]  

IMPLICATIONS: This study demonstrates that lidocaine attenuates cytokine-induced injury of endothelial and vascular smooth muscle cells via mechanisms involving adenosine triphosphate-sensitive potassium channels. Protection of the vasculature from cytokine-induced inflammation may preserve important physiological endothelial and vascular smooth muscle functions.

Hany A. Mowafi, Abdulmohsin Al-Ghamdi, and Adel Rushood

Intraocular Pressure Changes During Laparoscopy in Patients Anesthetized with Propofol Total Intravenous Anesthesia Versus Isoflurane Inhaled Anesthesia
Anesth Analg 2003 97: 471-474. [Abstract] [Full Text]  

IMPLICATIONS: In this study, we examined the effect of two anesthetic techniques on the intraocular pressure changes during laparoscopic surgery in healthy subjects. Propofol IV anesthesia protected against increases in intraocular pressure with pneumoperitoneum and head-down position.

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

Blockade of 5-HT2A Receptors May Mediate or Modulate Part of the Immobility Produced by Inhaled Anesthetics
Anesth Analg 2003 97: 475-479. [Abstract] [Full Text]  

IMPLICATIONS: A subset of serotonin receptors, 5HT2A receptors, may mediate or modulate a minor portion of the immobility produced by inhaled anesthetics.

Ryu Komatsu, Osamu Nagata, Makoto Ozaki, and Daniel I. Sessler

Ephedrine Fails to Accelerate the Onset of Neuromuscular Block by Vecuronium
Anesth Analg 2003 97: 480-483. [Abstract] [Full Text]  

IMPLICATIONS: Ephedrine increased cardiac index but failed to speed onset of neuromuscular block with vecuronium. We conclude that ephedrine administration does not shorten the onset time of vecuronium.

Michael J. Bishop, J. T. O’Donnell, and J. R. Salemi

Mivacurium and Bronchospasm (Case Report)
Anesth Analg 2003 97: 484-485. [Abstract] [Full Text]  

IMPLICATIONS: Because of case reports of severe bronchospasm after the use of mivacurium, we used the Food and Drug Administration MedWatch database to determine the frequency of bronchospasm as an adverse event after the use of nondepolarizing muscle relaxants.

Jans Bouw, Karin Leendertse, Marina A. J. Tijssen, and Misa Dzoljic

Stiff Person Syndrome and Anesthesia: Case Report (Case Report)
Anesth Analg 2003 97: 486-487. [Abstract] [Full Text]  

IMPLICATIONS: This case report describes the successful perioperative management of a patient with a rare and disabling neurologic disorder, the stiff person syndrome. The patient had a delayed emergence despite apparent full reversal of neuromuscular blockade. We suggest an interaction between the GABAergic effects of baclofen and volatile anesthetics as a possible cause.

TECHNOLOGY, COMPUTING, AND SIMULATION:

M. Messner, U. Beese, J. Romstöck, M. Dinkel, and K. Tschaikowsky

The Bispectral Index Declines During Neuromuscular Block in Fully Awake Persons
Anesth Analg 2003 97: 488-491. [Abstract] [Full Text]  

IMPLICATIONS: The bispectral index (BIS) is an electroencephalographic variable intended for measuring depth of anesthesia. Electromyographic activity influences the calculation of BIS. We found that the administration of a muscle relaxant to unanesthetized volunteers decreases the bispectral index value. Thus, awareness in totally paralyzed patients cannot be excluded.

CASE REPORTS:

Denis L. Bourke and David Tolentino

Inadvertent Positive End-Expiratory Pressure Caused by a Malfunctioning Ventilator Relief Valve
Anesth Analg 2003 97: 492-493. [Abstract] [Full Text]  

IMPLICATIONS: During anesthesia, a nurse draped several gas hoses over the ventilator relief valve on the back of the anesthesia machine, causing a malfunction. Unintended positive end-expiratory pressure was administered to the patient. Causes of this mishap, anesthesia machine design, and nonanesthesiologist familiarity with anesthesia machine components and their function, are discussed.

PAIN MEDICINE:

Kamondanai Hemstapat, Gregory R. Monteith, Deborah Smith, and Maree T. Smith

Morphine-3-Glucuronide’s Neuro-Excitatory Effects Are Mediated via Indirect Activation of N-Methyl-D-Aspartic Acid Receptors: Mechanistic Studies in Embryonic Cultured Hippocampal Neurones
Anesth Analg 2003 97: 494-505. [Abstract] [Full Text]  

IMPLICATIONS: Large systemic doses of morphine administered to some patients for cancer pain management have been reported to produce myoclonus and allodynia. Indirect evidence implicates the major morphine metabolite, morphine-3-glucuronide (M3G), in these neuro-excitatory side effects. Hence, this study was designed to gain insight into the cellular mechanism responsible for M3G's neuro-excitatory actions.

Inas A. M. Radwan, Shigeru Saito, and Fumio Goto

Neurotrophic Factors Can Partially Reverse Morphological Changes Induced by Mepivacaine and Bupivacaine in Developing Sensory Neurons
Anesth Analg 2003 97: 506-511. [Abstract] [Full Text]  

IMPLICATIONS: Three neurotrophic factors (NTFs) can partially support the reversibility of mepivacaine- and bupivacaine-induced growth cone collapse in growing primary cultured sensory neurons. The effect of NTFs is more apparent after mepivacaine than after bupivacaine washout.

Atsuo Yamashita, Mishiya Matsumoto, Satoshi Matsumoto, Makoto Itoh, Koji Kawai, and Takefumi Sakabe

A Comparison of the Neurotoxic Effects on the Spinal Cord of Tetracaine, Lidocaine, Bupivacaine, and Ropivacaine Administered Intrathecally in Rabbits
Anesth Analg 2003 97: 512-519. [Abstract] [Full Text]  

IMPLICATIONS: Large concentrations of local anesthetics administered intrathecally increased glutamate concentrations in the cerebrospinal fluid. The margin of safety may be smallest with lidocaine.

Kris Vissers, Hugo Adriaensen, Roland De Coster, Cathy De Deyne, and Theo F. Meert

A Chronic-Constriction Injury of the Sciatic Nerve Reduces Bilaterally the Responsiveness to Formalin in Rats: A Behavioral and Hormonal Evaluation
Anesth Analg 2003 97: 520-525. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated the changes in the behavioral reactions and the hormonal effects of a noxious chemical stimulus, i.e., formalin injection in animals with previously induced chronic constriction injury to the sciatic nerve. The effect in animals injected at the ipsilateral and contralateral site, sham-operated and controls, were compared.

Clive H. Wilder-Smith, Lauren Hill, Robert A. Dyer, Gregory Torr, and Ed Coetzee

Postoperative Sensitization and Pain After Cesarean Delivery and the Effects of Single IM Doses of Tramadol and Diclofenac Alone and in Combination
Anesth Analg 2003 97: 526-533. [Abstract] [Full Text]  

IMPLICATIONS: The parenteral combination of tramadol and diclofenac resulted in more prolonged and pronounced postoperative analgesia and reduced sensory sensitization compared with the single drugs, with no increase in side effects.

Jeffrey L. Apfelbaum, Connie Chen, Shilpa S. Mehta, and Tong J. Gan

Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged
Anesth Analg 2003 97: 534-540. [Abstract] [Full Text]  

IMPLICATIONS: A survey of 250 US adults who had undergone a recent surgical procedure asked about their postoperative pain experience. Approximately 80% of patients experienced pain after surgery. Of these patients, 86% had moderate, severe, or extreme pain. Additional efforts are required to improve patients' postoperative pain experience.

Hazem Adel Ashmawi, Felipe S. Chambergo, Cláudia C. Araújo Palmeira, and Irimar de Paula Posso

The Effects of Pyrilamine and Cimetidine on mRNA C-Fos Expression and Nociceptive Flinching Behavior in Rats
Anesth Analg 2003 97: 541-546. [Abstract] [Full Text]  

IMPLICATIONS: Histamine receptor antagonists present antinociceptive effects when administered peripherally. These effects are observed through a nociceptive flinching behavior test and mRNA c-fos expression. Pyrilamine (H1 receptor antagonist) has a greater antinociceptive effect than cimetidine (H2 receptor antagonist).

Nikhil Thakkar, Neil Roy Connelly, and Peter Vieira

Gastrointestinal Symptoms Secondary to Implanted Spinal Cord Stimulators (Case Report)
Anesth Analg 2003 97: 547-549. [Abstract] [Full Text]  

IMPLICATIONS: We report severe gastrointestinal symptoms in two patients who had implanted spinal cord stimulators. These side effects were severe enough to require cessation of the stimulation, even though the patients reported significantly improved analgesia. It is important for clinicians caring for patients with these devices to be aware of these potentially severe side effects.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Ramsey C. Cheung, Frank Hsieh, Yajie Wang, and John B. Pollard

The Impact of Hepatitis C Status on Postoperative Outcome
Anesth Analg 2003 97: 550-554. [Abstract] [Full Text]  

IMPLICATIONS: In this large study at a Veterans Administration medical center, the urgency of surgery, age, ASA physical status, length of surgery, and preoperative hematocrit were all independently associated with postoperative complications. However, hepatitis C infection was not an independent risk factor for postoperative complications.

CRITICAL CARE AND TRAUMA:

Jyrki J. Tenhunen, Ari Uusaro, Vesa Kärjä, Niku Oksala, Stephan M. Jakob, and Esko Ruokonen

Apparent Heterogeneity of Regional Blood Flow and Metabolic Changes Within Splanchnic Tissues During Experimental Endotoxin Shock
Anesth Analg 2003 97: 555-563. [Abstract] [Full Text]  

IMPLICATIONS:Surrogate regional markers of tissue perfusion over one region do not reflect the state of perfusion over another. Therefore, regional metabolic monitoring (microdialysis) in multiple locations is needed. Although tonometry does not differentiate between macro-level regional perfusion defect and tissue injury, intestinal luminal microdialysis detects mucosal lactate release, which may be associated with epithelial injury. The degree of correlation or causality between the two remains to be evaluated.

NEUROSURGICAL ANESTHESIA:

Philip E. Bickler, David S. Warner, Greg Stratmann, and Jennifer A. Schuyler

-Aminobutyric Acid-A Receptors Contribute to Isoflurane Neuroprotection in Organotypic Hippocampal Cultures
Anesth Analg 2003 97: 564-571. [Abstract] [Full Text]  

IMPLICATIONS: Isoflurane is neuroprotective in rodent brain ischemia models, but the mechanisms for this effect remain incompletely defined. In organotypic cultures of rat hippocampus, we show that protection of CA1, CA3, and dentate neurons by 1% isoflurane from death caused by oxygen and glucose deprivation involves GABAA receptors.

Luzius A. Steiner, Andrew J. Johnston, Doris A. Chatfield, Marek Czosnyka, Martin R. Coleman, Jonathan P. Coles, Arun K. Gupta, John D. Pickard, and David K. Menon

The Effects of Large-Dose Propofol on Cerebrovascular Pressure Autoregulation in Head-Injured Patients
Anesth Analg 2003 97: 572-576. [Abstract] [Full Text]  

IMPLICATIONS: Propofol is used for sedation and control of intracranial pressure in head-injured patients. In contrast to previous data from healthy individuals, we show a deterioration of cerebrovascular pressure autoregulation with fast propofol infusion rates after head injury. Large propofol doses may increase the injured brain's vulnerability to secondary insults.

Chun-Chang Yeh, Ching-Tang Wu, Chueng-He Lu, Chih-Ping Yang, and Chih-Shung Wong

Early Use of Small-Dose Vasopressin for Unstable Hemodynamics in an Acute Brain Injury Patient Refractory to Catecholamine Treatment: A Case Report (Case Report)
Anesth Analg 2003 97: 577-579. [Abstract] [Full Text]  

IMPLICATIONS: Small-dose IV vasopressin infusion may be beneficial in acute brain injury patients with unstable hemodynamics who are refractory to fluid resuscitation and catecholamine vasopressors.

OBSTETRIC ANESTHESIA:

Ingrid M. Browne and David J. Birnbach

Neurocysticercosis: A New Differential in the Diagnosis of Postdural Puncture Headache
Anesth Analg 2003 97: 580-582. [Abstract] [Full Text]  

IMPLICATIONS: Positional headache after spinal anesthesia is considered pathognomonic for postdural puncture headache. This report describes a patient who developed a positional headache after spinal anesthesia that was due to neurocysticercosis, a parasitic central nervous system infestation caused by the tapeworm Taenia solium.

REGIONAL ANESTHESIA:

Salvatore Sia, Francesca Sarro, Antonella Lepri, and Maurizio Bartoli

The Effect of Exogenous Epinephrine on the Incidence of Hypotensive/Bradycardic Events During Shoulder Surgery in the Sitting Position During Interscalene Block
Anesth Analg 2003 97: 583-588. [Abstract] [Full Text]  

IMPLICATIONS: Sudden hypotensive and/or bradycardic events occur during shoulder surgery in the sitting position during interscalene block. In this study, we demonstrated that the presence of epinephrine in the local anesthetic mixture significantly increases the incidence of these events.

Alexandre Faust, Roxane Fournier, Elisabeth Van Gessel, Anne Weber, Pierre Hoffmeyer, and Zdravko Gamulin

Isobaric Versus Hypobaric Spinal Bupivacaine for Total Hip Arthroplasty in the Lateral Position
Anesth Analg 2003 97: 589-594. [Abstract] [Full Text]  

IMPLICATIONS: For total hip arthroplasty in the lateral position, spinal hypobaric bupivacaine compared with isobaric prolonged sensory block at the operative side and delayed the time to first analgesic.

GENERAL ARTICLE:

Philippe Juvin, Elisabeth Lavaut, Hervé Dupont, Pascale Lefevre, Monique Demetriou, Jean-Louis Dumoulin, and Jean-Marie Desmonts

Difficult Tracheal Intubation Is More Common in Obese Than in Lean Patients
Anesth Analg 2003 97: 595-600. [Abstract] [Full Text]  

IMPLICATIONS: We report a difficult intubation rate of 15.5% in obese patients and 2.2% in lean patients. None of the risk factors for difficult intubation described in the lean population was satisfactory in the obese patients. We also report a high risk of desaturation in obese patients with difficult intubation.

LETTERS TO THE EDITOR:

Deborah J. Culley, Gregory Crosby, John Butterworth, and John W. Hammon

Mechanisms of Postoperative Neurobehavioral Deficits and Stroke May Differ • Response
Anesth Analg 2003 97: 601. [Full Text]  

Thomas M. Hemmerling, Jean-Luc Choinière, Joanne D. Fortier, Ignatio Prieto, and Fadi Basile

Immediate Extubation After Aortic Valve Surgery Using High Thoracic Epidural Anesthesia: A Pilot Study
Anesth Analg 2003 97: 601. [Full Text]  

Sunita Goel, Manju Sinha, and William Splinter

Is Halothane the End of an Era? • Response
Anesth Analg 2003 97: 602. [Full Text]  

Micha Shamir, Charles Weissman, Mohammad Golparvar, and Mahmood Saghaei

Plethysmographic Waveform Variation as an Indicator to Hypovolemia • Response
Anesth Analg 2003 97: 602-603. [Full Text]  

Kyle Jones, Babatunde O. Ogunnaike, Stephanie B. Jones, Charles W. Whitten, Daniel B. Jones, and David Provost

Can the Morbidly Obese Have the Same "Standard Of Care"? • Response
Anesth Analg 2003 97: 603-604. [Full Text]  

S. Kreuer, W. Wilhelm, and J. Bruhn

The Influence of the Click Stimulus of the Alaris AEP Monitor on the Depth of Anesthesia
Anesth Analg 2003 97: 604. [Full Text]  

Alan G. Mowbray, Amr E. Abouleish, Mark H. Zornow, and Donald S. Prough

Time Required to Set Up for and Clean Up After a Case Should Be Attributed to the Actual Case in Measuring Turnover Time • Response
Anesth Analg 2003 97: 605. [Full Text]  

Marco Nadig, Stephan Blumenthal, Georgios Ekatodramis, Alain Borgeat, Andrea Casati, Guido Fanelli, and Jacques E. Chelly

Interscalene Brachial Plexus Anesthesia and Analgesia for Open Shoulder Surgery: What About Pharmacokinetics? • Response
Anesth Analg 2003 97: 605-606. [Full Text]  

Masato Hosoya, Shinichi Inomata, Iwao Sukegawa, Shigeyuki Saito, and Hidenori Toyooka

Pulmonary Artery Catheter Sutured to Pulmonary Artery Trunk During Cardiac Surgery
Anesth Analg 2003 97: 606-607. [Full Text]  

Zvi Herschman and Eric L. Bloomfield

Controlling Costs of Critical Care Requires New Focus • Response
Anesth Analg 2003 97: 607-608. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Peter L. McDertmott, Jukka Takala, and Myron Yaster

The History of Anesthesia: Proceedings of the Fifth International Symposium on the History of Anesthesia, Santiago, Spain 19-23 September 2001 • Critical Care Medicine, Principles of Diagnosis and Management in the Adult • Strategies in Pediatric Anesthesia Practice (an all original program for hand held devices) • Books and Multimedia Received
Anesth Analg 2003 97: 609-611. [Full Text]  

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