EDITORIALS:

John Butterworth and Curt D. Furberg

Improving Cardiac Outcomes After Noncardiac Surgery
Anesth Analg 2003 97: 613-615. [Full Text] [PDF] [Request Permissions]  

Neil L. Harrison

Knockin’ on the Door of General Anesthetic Mechanisms: But Will U.S. Researchers Be Shut Out?
Anesth Analg 2003 97: 616-618. [Full Text] [PDF] [Request Permissions]  

Gary J. Bennett

Neuropathic Pain: A Crisis of Definition?
Anesth Analg 2003 97: 619-620. [Full Text] [PDF] [Request Permissions]  

Alan C. Santos and David J. Birnbach

Spinal Anesthesia in the Parturient with Severe Preeclampsia: Time for Reconsideration
Anesth Analg 2003 97: 621-622. [Full Text] [PDF] [Request Permissions]  

CARDIOVASCULAR ANESTHESIA:

Robert D. Stevens, Haran Burri, and Martin R. Tramèr

Pharmacologic Myocardial Protection in Patients Undergoing Noncardiac Surgery: A Quantitative Systematic Review
Anesth Analg 2003 97: 623-633. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Among the drugs that have been tested in randomized-controlled trials, ß-blockers, clonidine, and mivazerol are effective in preventing cardiac complications in patients undergoing noncardiac surgery. For ß-blockers, high-risk patients are most likely to benefit from treatment. Valid studies are required to directly compare the efficacy of these classes of drug and determine how dose, timing, and duration of treatment influence outcome.

Duminda N. Wijeysundera and W. Scott Beattie

Calcium Channel Blockers for Reducing Cardiac Morbidity After Noncardiac Surgery: A Meta-Analysis
Anesth Analg 2003 97: 634-641. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This meta-analysis evaluated the efficacy of calcium channel-blockers (CCB) for preventing cardiac complications after noncardiac surgery. Eleven relevant randomized controlled trials were identified. Overall, CCBs reduced major cardiac morbid events, with most benefits being attributable to diltiazem.

Madhav Swaminathan, Barbara G. Phillips-Bute, and Joseph P. Mathew

An Assessment of Two Different Methods of Left Ventricular Ejection Time Measurement by Transesophageal Echocardiography
Anesth Analg 2003 97: 642-647. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Left ventricular ejection time is an important component of cardiac function assessment. Using transesophageal echocardiography, we found that the M-mode modality is comparable to Doppler assessment in determining ejection time and is a useful alternative when Doppler velocity gradients cannot be easily obtained.

Raymond M. Planinsic, Ramona Nicolau-Raducu, John C. Caldwell, Shushma Aggarwal, and Ibtesam Hilmi

Transesophageal Echocardiography-Guided Placement of Internal Jugular Percutaneous Venovenous Bypass Cannula in Orthotopic Liver Transplantation (Technical Communication)
Anesth Analg 2003 97: 648-649. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: During orthotopic liver transplantation, a venovenous bypass cannula is inserted into the internal jugular vein as a conduit for venous return. This article describes how the use of transesophageal echocardiography can facilitate the insertion and minimize the complications associated with its use.

Özcan Erdemli, Ihsan Ayik, Ümit Karadeniz, Bülent Yamak, Cemal Levent Birincioglu, and Kubilay Çaglar

A Double-Orifice Atrioventricular Valve Case: Intraoperative Transesophageal Echocardiography in Diagnosis and Treatment (Case Report)
Anesth Analg 2003 97: 650-653. [Abstract] [Full Text] [PDF] [Request Permissions]  

Intraoperative transesophageal echocardiography facilitated diagnosis of a double-orifice left atrioventricular valve that was undetected by preoperative transthoracic echocardiography and angiography before repair of an atrial septal defect.

Brian J. Swanton, David Keane, Gus J. Vlahakes, and Scott C. Streckenbach

Intraoperative Transesophageal Echocardiography in the Early Detection of Acute Tamponade After Laser Extraction of a Defibrillator Lead (Case Report)
Anesth Analg 2003 97: 654-656. [Abstract] [Full Text] [PDF] [VIDEO]  [Request Permissions]  

IMPLICATIONS: Laser-assisted intracardiac lead extraction is associated with a 1%-2% incidence of pericardial tamponade. Because of this risk, many of these procedures are being performed in an operating room with a cardiac surgeon immediately available. Transesophageal echocardiography is a useful intraoperative monitor during these procedures.

Takako Masuda, Yoshinobu Tomiyama, Hiroshi Kitahata, Yasuhiro Kuroda, and Shuzo Oshita

Propofol Inhibits Volume-Sensitive Chloride Channels in Human Coronary Artery Smooth Muscle Cells (Case Report)
Anesth Analg 2003 97: 657-662. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Propofol inhibits human coronary artery smooth muscle volume-sensitive chloride channels in a dose-dependent manner.

Daisuke Yoshikawa, Fuminori Kawahara, Nobuhiro Okano, Haruhiko Hiraoka, Yuji Kadoi, Nao Fujita, Toshihiro Morita, and Fumio Goto

Increased Plasma Concentrations of the Mature Form of Adrenomedullin During Cardiac Surgery and Hepatosplanchnic Hypoperfusion (Case Report)
Anesth Analg 2003 97: 663-670. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Plasma adrenomedullin has been reported to increase during and after cardiac surgery. We found that the concentration of the biologically active mature form of adrenomedullin in the hepatic vein is significantly larger than in the radial artery or jugular bulb and that it shows a significant negative correlation with oxygen tension and saturation of hepatic venous blood.

Yves Ozier, Fabienne Pessione, Emmanuel Samain, and Françoise Courtois

Institutional Variability in Transfusion Practice for Liver Transplantation (Case Report)
Anesth Analg 2003 97: 671-679. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We evaluated transfusion practices in liver transplantation at eight centers. There is a marked heterogeneity in blood component use which is unrelated to differences in the preoperative recipient status and, partly, to differences in blood loss.

Engelbert Deusch, Thomas Gamsjäger, Hans-Georg Kress, and Sibylle A. Kozek-Langenecker

Binding of Hydroxyethyl Starch Molecules to the Platelet Surface (Case Report)
Anesth Analg 2003 97: 680-683. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Hydroxyethyl starch solutions are widely used for fluid replacement in patients undergoing surgery but may compromise blood coagulation. The present study demonstrates that one of the mechanisms for this unwanted side effect is related to the binding of hydroxyethyl starch to the outer surface of blood platelets.

Madhusudan P. Rao and Rory Bell

Pulmonary Hemorrhage After Radioablation of Liver Metastases (Case Report)
Anesth Analg 2003 97: 684-686. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Radiofrequency ablation of liver metastases is a minimally invasive new technique that is useful in high-risk patients unfit for surgery. Pulmonary hemorrhage occurred in a patient during this procedure. The patient made an uneventful recovery. We believe that radiofrequency energy caused lung injury.

PEDIATRIC ANESTHESIA:

Christophe Dadure, Philippe Pirat, Olivier Raux, Rachel Troncin, Alain Rochette, Christine Ricard, and Xavier Capdevila

Perioperative Continuous Peripheral Nerve Blocks with Disposable Infusion Pumps in Children: A Prospective Descriptive Study
Anesth Analg 2003 97: 687-690. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In children, continuous nerve blocks with disposable pumps allow optimal analgesia and early ambulation after orthopedic surgeries.

Christophe Dadure, Olivier Raux, Rachel Troncin, Alain Rochette, and Xavier Capdevila

Continuous Infraclavicular Brachial Plexus Block for Acute Pain Management in Children (Case Report)
Anesth Analg 2003 97: 691-693. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Continuous infraclavicular brachial plexus blocks provide optimal anesthesia and analgesia in children.

C. Karsli, E. Wilson-Smith, I. Luginbuehl, and B. Bissonnette

The Effect of Nitrous Oxide on Cerebrovascular Reactivity to Carbon Dioxide in Children During Propofol Anesthesia (Case Report)
Anesth Analg 2003 97: 694-698. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Nitrous oxide, which increases cerebral blood flow, does not affect cerebrovascular reactivity to carbon dioxide (CCO2R) in children anesthetized with propofol. When preservation of CCO2R is required, the combination of nitrous oxide with propofol anesthesia in children may be suitable.

Douglas G. Ririe, Lisa R. David, Steven S. Glazier, Timothy E. Smith, and Louis C. Argenta

Surgical Advancement Influences Perioperative Care: A Comparison of Two Surgical Techniques for Sagittal Craniosynostosis Repair (Case Report)
Anesth Analg 2003 97: 699-703. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study compares the perioperative management of two different surgical procedures for the repair of sagittal craniosynostosis. Progress in surgical technique results in differences in perioperative care that directly impact anesthetic management.

Koichi Nakazawa, Daisuke Ikeda, Seiji Ishikawa, and Koshi Makita

A Case of Difficult Airway Due to Lingual Tonsillar Hypertrophy in a Patient with Down’s Syndrome (Case Report)
Anesth Analg 2003 97: 704-705. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report a case of airway management of symptomatic lingual tonsillar hypertrophy (LTH) in a patient with Down's syndrome. Fiberoptic nasotracheal intubation while maintaining spontaneous breathing under inhaled anesthesia may be preferable in pediatric or uncooperative patients with LTH.

AMBULATORY ANESTHESIA:

Brian M. Ilfeld, Timothy E. Morey, and F. Kayser Enneking

Continuous Infraclavicular Perineural Infusion with Clonidine and Ropivacaine Compared with Ropivacaine Alone: A Randomized, Double-Blinded, Controlled Study
Anesth Analg 2003 97: 706-712. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Clonidine is often added to long-acting local anesthetic perineural infusions in an effort to improve postoperative analgesia. This randomized, double-blinded, controlled study did not find evidence of clinically relevant benefits from adding clonidine to ropivacaine infraclavicular brachial plexus perineural infusions in ambulatory patients after moderately painful upper extremity surgery.

A. McCluskey, B. A. Currer, and I. Sayeed

The Efficacy of 5% Lidocaine-Prilocaine (EMLA) Cream on Pain During Intravenous Injection of Propofol (Brief Report)
Anesth Analg 2003 97: 713-714. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Topical local anesthesia with 60% lidocaine tape reduces the incidence of propofol injection pain. However, we found no reduction after pretreatment with topical 5% lidocaine-prilocaine (EMLA) cream.

Chester C. Buckenmaier, III, Stephen M. Klein, Karen C. Nielsen, and Susan M. Steele

Continuous Paravertebral Catheter and Outpatient Infusion for Breast Surgery (Case Report)
Anesth Analg 2003 97: 715-717. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Paravertebral somatic nerve block is an alternative to general anesthesia for breast surgery. We describe a novel needle system for paravertebral catheter insertion linked to a disposable infusion pump for prolonged analgesia at home after breast surgery.

ANESTHETIC PHARMACOLOGY:

James M. Sonner, Joseph F. Antognini, Robert C. Dutton, Pamela Flood, Andrew T. Gray, R. Adron Harris, Gregg E. Homanics, Joan Kendig, Beverley Orser, Douglas E. Raines, James Trudell, Bryce Vissel, and Edmond I Eger, II

Inhaled Anesthetics and Immobility: Mechanisms, Mysteries, and Minimum Alveolar Anesthetic Concentration (Review Article)
Anesth Analg 2003 97: 718-740. [Abstract] [Full Text] [PDF] [Request Permissions]  

Emma E. Johnson, Helen Gibson, Beverley Nicol, Johannes Zanzinger, Peter Widdowson, Mark Hawthorn, Géza Toth, Judit Farkas, Remo Guerrini, and David G. Lambert

Characterization of Nociceptin/Orphanin FQ Binding Sites in Dog Brain Membranes (Review Article)
Anesth Analg 2003 97: 741-747. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Experimentally, the dog represents a species used in various anesthetic studies, yet little is known regarding the expression of nociceptin receptors (with opioid-like activity) in this model. In comparison with rat, dog membranes express a small density of pharmacologically identical binding sites whose functional activity remains to be determined.

Yoshikazu Ikeda, Kiyonobu Nishikawa, Kenji Ohashi, Takashi Mori, and Akira Asada

Epidural Clonidine Suppresses the Baroreceptor-Sympathetic Response Depending on Isoflurane Concentrations in Cats (Review Article)
Anesth Analg 2003 97: 748-754. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Epidural clonidine reduces blood pressure, heart rate, and sympathetic nerve activity but suppresses baroreflex gain, depending on background isoflurane anesthesia.

Yoshitaka Fujii, Aki Uemura, and Hidenori Toyooka

Midazolam-Induced Muscle Dysfunction and Its Recovery in Fatigued Diaphragm in Dogs (Review Article)
Anesth Analg 2003 97: 755-758. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Midazolam, widely used for sedation and anesthesia, inhibits diaphragm muscle function in fatigued diaphragm in dogs in a dose-dependent manner.

Katsumi Okuyama, Takashi Matsukawa, Makoto Ozaki, Daniel I. Sessler, Tomoki Nishiyama, Makoto Imamura, and Teruo Kumazawa

Doxapram Produces a Dose-Dependent Reduction in the Shivering Threshold in Rabbits (Review Article)
Anesth Analg 2003 97: 759-762. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Doxapram produced a substantial and dose-dependent reduction in the shivering threshold. The magnitude of this inhibition, if similar in humans, would be clinically important. Clinical studies are thus indicated to determine whether the drug might help defeat thermoregulatory defenses during induction of therapeutic hypothermia.

Mohamed Naguib, Max T. Baker, Gilberto Spadoni, and Marc Gregerson

The Hypnotic and Analgesic Effects of 2-Bromomelatonin (Review Article)
Anesth Analg 2003 97: 763-768. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The IV administration of 2-bromomelatonin can exert both hypnotic and antinocifensive effects.

Jong Woo Park, Eun-Seok Park, Sang-Cheol Chi, Ho Yeong Kil, and Kyu-Hyun Lee

The Effect of Lidocaine on the Globule Size Distribution of Propofol Emulsions (Technical Communication)
Anesth Analg 2003 97: 769-771. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The globule size distribution of a propofol/lidocaine mixture was accurately measured by using a laser diffraction technique. The maximum diameter increased considerably from 0.97 {+/-} 0.01 {micro}m to 51.76 {+/-} 0.62 {micro}m at 6 h after the addition of 30 mg of lidocaine. The globule size did not exceed 3.0 {micro}m when L-lysine was used as a stabilizer in the propofol emulsion.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Susan Dabu-Bondoc, Jacqueline Drummond-Lewis, Dorothy Gaal, Maryanne McGinn, Alison A. Caldwell-Andrews, and Zeev N. Kain

Hemispheric Synchronized Sounds and Intraoperative Anesthetic Requirements
Anesth Analg 2003 97: 772-775. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Hemisync(R), a product marketed to reduce anesthetic consumption by synchronizing hemispheres of the brain, does not appear to reduce the anesthetic requirements of patients who undergo general anesthesia and surgery when depth of hypnosis is controlled by a bispectral index monitor.

Motoko Oshibuchi, Sungsam Cho, Tetsuya Hara, Shiro Tomiyasu, Tetsuji Makita, and Koji Sumikawa

A Comparative Evaluation of Transcutaneous and End-Tidal Measurements of CO₂ in Thoracic Anesthesia
Anesth Analg 2003 97: 776-779. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Our study indicates that transcutaneous CO2 is more accurate than end-tidal CO2 during either two- or one-lung ventilation in thoracic anesthesia.

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

Ephedrine, but Not Phenylephrine, Increases Bispectral Index Values During Combined General and Epidural Anesthesia
Anesth Analg 2003 97: 780-784. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study shows that compared with phenylephrine, ephedrine increases bispectral index during combined sevoflurane general and ropivacaine epidural anesthesia.

PAIN MEDICINE:

Misha-Miroslav Backonja

Defining Neuropathic Pain (Medical Intelligence)
Anesth Analg 2003 97: 785-790. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A practical definition of neuropathic pain based on the distinction between neuropathic and inflammatory pain mechanisms is suggested. Neuropathic pain is in this case is defined as pain occurring in an area of the body affected by neurological disease. In addition to pain, the patient is likely to have weakness and numbness at the same time.

Sabine M. Sator-Katzenschlager, Andreas W. Schiesser, Sibylle A. Kozek-Langenecker, Gerhard Benetka, Gudrun Langer, and Hans-Georg Kress

Does Pain Relief Improve Pain Behavior and Mood in Chronic Pain Patients? (Medical Intelligence)
Anesth Analg 2003 97: 791-797. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Severe chronic pain is associated with reduced behavioral and cognitive outcome measurements and mood. We demonstrated an improvement in behavioral and cognitive dimensions after significant reduction of pain intensity in chronic cancer and noncancer pain patients using conventional somatic pain therapy. However, psychological well-being and mood were not improved despite the reduction in pain intensity.

L. Winter, R. Nadeson, A. P. Tucker, and C. S. Goodchild

Antinociceptive Properties of Neurosteroids: A Comparison of Alphadolone and Alphaxalone in Potentiation of Opioid Antinociception (Medical Intelligence)
Anesth Analg 2003 97: 798-805. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Sedative effects of drugs that cause pain relief can limit the effective dose and also confuse results from animal experiments. This study separates the sedative and analgesic effects for two neurosteroids and three opioids given alone and in combination. The neurosteroid, alphadolone, increased the pain-relieving effects of opioids without any sedation.

Koung-Shing Chu, Jhi-Joung Wang, Oliver Yoa-Pu Hu, Shung-Tai Ho, and Yu-Wen Chen

The Antinociceptive Effect of Nalbuphine and Its Long-Acting Esters in Rats (Medical Intelligence)
Anesth Analg 2003 97: 806-809. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A long-acting analgesic effect is particularly desirable in patients with long-lasting pain. The aim of this study was to evaluate the antinociceptive effect and duration of action of three nalbuphine esters—nalbuphine propionate, enanthate, and decanoate—in rats. We found that nalbuphine esters produced relatively longer durations of action (5-50 h) than nalbuphine HCl (2 h).

David D. Hood, Regina Curry, and James C. Eisenach

Intravenous Remifentanil Produces Withdrawal Hyperalgesia in Volunteers with Capsaicin-Induced Hyperalgesia (Medical Intelligence)
Anesth Analg 2003 97: 810-815. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Remifentanil infusion in normal volunteers acutely reduces hypersensitivity induced by capsaicin, but after cessation of remifentanil infusion, hypersensitivity increases beyond baseline, consistent with growing animal and human literature suggesting that acute exposure to opioids, such as during surgery, can exacerbate subsequent pain.

Xavier Culebras, Jean-Baptiste Corpataux, Giovanni Gaggero, and Martin R. Tramèr

The Antiemetic Efficacy of Droperidol Added to Morphine Patient-Controlled Analgesia: A Randomized, Controlled, Multicenter Dose-Finding Study (Medical Intelligence)
Anesth Analg 2003 97: 816-821. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In a patient-controlled analgesia (PCA) pump, droperidol 5 {micro}g/mg of morphine is not antiemetic, antipruritic, or sedative. Droperidol 15 {micro}g shows some antiemetic efficacy, is antipruritic, and is not sedative. Droperidol 50 {micro}g is clearly antiemetic, is no more antipruritic than 15 {micro}g, and is clearly sedative. In a PCA pump with morphine, the optimal dose of droperidol is 15-50 {micro}g/mg of morphine.

Benzion Beilin, Yehuda Shavit, Evelyn Trabekin, Boris Mordashev, Eduard Mayburd, Alexander Zeidel, and Hanna Bessler

The Effects of Postoperative Pain Management on Immune Response to Surgery (Medical Intelligence)
Anesth Analg 2003 97: 822-827. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The present study compared the effects of three pain management techniques, intermittent opiate regimen, patient-controlled analgesia, and patient-controlled epidural analgesia on several immune functions. Patients of the patient-controlled epidural analgesia group exhibited reduced postoperative pain, reduced suppression of lymphocyte proliferative response to mitogens, and attenuated proinflammatory cytokine response to surgery.

Elad Schiff and Elon Eisenberg

Can Quantitative Sensory Testing Predict the Outcome of Epidural Steroid Injections in Sciatica? A Preliminary Study (Medical Intelligence)
Anesth Analg 2003 97: 828-832. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Quantitative sensory testing has the potential to become an important tool in the selection of appropriate treatment for lumbar radiculopathy and to assist in identifying the mechanisms of pain generation in these patients.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Amr E. Abouleish, Donald S. Prough, Charles W. Whitten, and Mark H. Zornow

The Effects of Surgical Case Duration and Type of Surgery on Hourly Clinical Productivity of Anesthesiologists
Anesth Analg 2003 97: 833-838. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Although type of surgery (base units per case) and surgical duration determine hourly clinical productivity, our study results demonstrated that surgical duration has more influence on the hourly clinical productivity.

CRITICAL CARE AND TRAUMA:

Claudia Coimbra, Manon Choinière, and Thomas M. Hemmerling

Patient-Controlled Sedation Using Propofol for Dressing Changes in Burn Patients: A Dose-Finding Study
Anesth Analg 2003 97: 839-842. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Patient-controlled sedation with propofol is safe and can be used in burn patients undergoing nonoperative procedures. To provide an effective sedation state, we suggest to initially titrate the bolus to achieve a significant decrease of bispectral index or a clinically effective state of sedation and to abolish the lockout interval.

Nicolas Guillou, Michèle Tanguy, Philippe Seguin, Bernard Branger, Jean-Pierre Campion, and Yannick Mallédant

The Effects of Small-Dose Ketamine on Morphine Consumption in Surgical Intensive Care Unit Patients After Major Abdominal Surgery
Anesth Analg 2003 97: 843-847. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In a randomized, double-blinded study, we evaluated the effect of adding small-dose ketamine in combination with morphine patient-controlled analgesia in the management of pain after major abdominal surgery. For the same level of analgesia, the addition of ketamine reduced the consumption of morphine without side effects and may be a useful adjunct.

Tim M. Cook, Matt Taylor, Caleb McKinstry, Stephen R. Laver, and Jerry P. Nolan

Use of the ProSeal Laryngeal Mask Airway to Initiate Ventilation During Intensive Care and Subsequent Percutaneous Tracheostomy (Case Report)
Anesth Analg 2003 97: 848-850. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This report details the management of two patients requiring mechanical ventilation in an intensive care unit. Both were managed with a new airway device, the ProSeal Laryngeal Mask Airway. This device allowed mechanical ventilation and performance of a tracheostomy at the bedside without requiring placement of a tube inside the patient's trachea.

NEUROSURGICAL ANESTHESIA:

Andrew D. McLeod, Farrell Igielman, Clare Elwell, Mark Cope, and Martin Smith

Measuring Cerebral Oxygenation During Normobaric Hyperoxia: A Comparison of Tissue Microprobes, Near-Infrared Spectroscopy, and Jugular Venous Oximetry in Head Injury
Anesth Analg 2003 97: 851-856. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We compared simultaneous measurements of jugular venous saturation, brain tissue oxygen tension, and cerebral tissue oxygen index during normobaric hyperoxia in brain-injured patients. PaO2 influences the output of monitors of cerebral oxygenation, but this does not necessarily equate to improved brain oxygenation.

Kamatham A. Naidu, Eugene S. Fu, E. Truitt Sutton, Leon D. Prockop, and Alan Cantor

The Therapeutic Effects of Epidural Intercellular Adhesion Molecule-1 Monoclonal Antibody in a Rabbit Model: Involvement of the Intercellular Adhesion Molecule-1 Pathway in Spinal Cord Ischemia
Anesth Analg 2003 97: 857-862. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Spinal cord ischemia increased intercellular adhesion molecule-1 (ICAM-1) expression and leukocyte recruitment. Epidural administration of ICAM-1 monoclonal antibody ablated leukocyte recruitment and reduced neurological deficits.

Harald G. Fritz, Dietmar Kuehn, Nils Haberland, and Rolf Kalff

Anesthesia Management for Spine Surgery Using Spinal Navigation in Combination with Computed Tomography (Brief Report)
Anesth Analg 2003 97: 863-866. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Spine surgery using intraoperative neuronavigation in combination with intraoperative computed tomography is of benefit to the patient. Problems encountered during the procedure were patient positioning, limited patient access, long tubing, and therefore the need for adequate monitoring.

OBSTETRIC ANESTHESIA:

Antoine G. M. Aya, Roseline Mangin, Nathalie Vialles, Jean-Michel Ferrer, Colette Robert, Jacques Ripart, and Jean-Emmanuel de La Coussaye

Patients with Severe Preeclampsia Experience Less Hypotension During Spinal Anesthesia for Elective Cesarean Delivery than Healthy Parturients: A Prospective Cohort Comparison
Anesth Analg 2003 97: 867-872. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This prospective cohort study shows that the incidence and severity of hypotension are less in severely preeclamptic patients, as compared with healthy parturients, undergoing spinal anesthesia for cesarean delivery. However, larger studies are required to meaningfully document the safety of spinal anesthesia in this setting.

Wendy H. L. Teoh and Alex T. H. Sia

Hyperbaric Bupivacaine 2.5 mg Prolongs Analgesia Compared with Plain Bupivacaine When Added to Intrathecal Fentanyl 25 µg in Advanced Labor
Anesth Analg 2003 97: 873-877. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: For late labor pain, the effect of intraspinal injection of bupivacaine with a higher density than cerebral spinal fluid lasts longer than a similar dose of bupivacaine with a lower density. There were no additional side effects with this technique.

Lena S. Sun, Shin Takuma, Rui Lui, and Shunichi Homma

The Effect of Maternal Cocaine Exposure on Neonatal Rat Cardiac Function
Anesth Analg 2003 97: 878-882. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Perinatal cocaine exposure decreases the cardiac response to adrenaline-like drugs often used to improve contractile function but has no effect on the ability of these drugs to increase heart rate in the neonatal rat.

Joseph W. Szokol, David Alspach, Manoj K. Mehta, Barbara V. Parilla, and Michael J. Liptay

Intermittent Airway Obstruction and Superior Vena Cava Syndrome in a Patient with an Undiagnosed Mediastinal Mass After Cesarean Delivery (Case Report)
Anesth Analg 2003 97: 883-884. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Patients with an undiagnosed chest mass may present for general anesthesia. This case report demonstrates that when airway obstruction occurs during any procedure involving the esophagus, the presence of a chest mass should be considered.

Daniel Castillo and Lawrence C. Tsen

Epidural Blood Patch Placed in the Presence of an Unknown Cervical Epidural Hematoma (Case Report)
Anesth Analg 2003 97: 885-887. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The suitability and outcome of an epidural blood patch in the combined setting of a postdural puncture headache and a neuraxial hematoma deserves consideration and further investigation.

REGIONAL ANESTHESIA:

Bernhard Urbanek, Andreas Duma, Oliver Kimberger, Gudrun Huber, Peter Marhofer, Michael Zimpfer, and Stephan Kapral

Onset Time, Quality of Blockade, and Duration of Three-in-One Blocks with Levobupivacaine and Bupivacaine
Anesth Analg 2003 97: 888-892. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this randomized, controlled study, we determined important pharmacodynamic variables (onset time, quality of blockade, and duration of blockade) of levobupivacaine 0.5% and 0.25% in the three-in-one block compared with bupivacaine 0.5% by pinprick testing.

Shigeo Ohmura, Akiko Sugano, Masayuki Kawada, and Ken Yamamoto

Pulmonary Uptake of Ropivacaine and Levobupivacaine in Rabbits
Anesth Analg 2003 97: 893-897. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Local anesthetic toxicity produced by an inadvertent IV injection is attenuated by the pulmonary uptake of local anesthetics. The extent of pulmonary uptake may influence the occurrence of local anesthetic toxicity. We compared the pulmonary uptake of ropivacaine and levobupivacaine after a bolus injection in rabbits.

CASE REPORTS:

Steven C. Borene, Richard W. Rosenquist, Robert Koorn, Naeem Haider, and André P. Boezaart

An Indication for Continuous Cervical Paravertebral Block (Posterior Approach to the Interscalene Space)
Anesth Analg 2003 97: 898-900. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this case report, we describe a patient who received perioperative analgesia with continuous nerve block for shoulder disarticulation, performed as a last option for management of intractable pain. As the result of anatomic considerations, a continuous cervical paravertebral block (posterior approach to the interscalene space) was performed.

Stephen M. Klein, Trenton Pierce, Yair Rubin, Karen C. Nielsen, and Susan M. Steele

Successful Resuscitation After Ropivacaine-Induced Ventricular Fibrillation
Anesth Analg 2003 97: 901-903. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This case documents the successful cardiopulmonary resuscitation of a patient after accidental ropivacaine-induced ventricular fibrillation. Despite techniques used to detect intravascular injection, toxicity may still occur; early intervention is essential for an optimal outcome.

GENERAL ARTICLES:

Anette-Marie Machata, Christopher Gonano, Andrea Holzer, Dorothea Andel, Christian K. Spiss, Michael Zimpfer, and Udo M. Illievich

Awake Nasotracheal Fiberoptic Intubation: Patient Comfort, Intubating Conditions, and Hemodynamic Stability During Conscious Sedation with Remifentanil
Anesth Analg 2003 97: 904-908. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Short-acting, and therefore easily titratable, analgesics are excellent choices for awake nasotracheal fiberoptic intubation. We found that remifentanil 0.75 {micro}g/kg in bolus followed by continuous infusion of 0.075 {micro}g {middle dot} kg-1 {middle dot} min-1 supplemented with midazolam provided adequate patient comfort, sedation, and intubating conditions.

Matthias Paul, Michael Dueck, Sandra Kampe, and Frank Petzke

Failure to Detect an Unusual Obstruction in a Reinforced Endotracheal Tube with Fiberoptic Examination (Case Report)
Anesth Analg 2003 97: 909-910. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This report describes an unusual obstruction of a reinforced endotracheal tube caused by a partial detachment of the inner coating from the embedded spiral. Fiberoptic inspection is a recommended procedure for a suspected obstruction, but failed to identify this valve-like detachment. This detachment was likely caused by re-autoclavation of the tube, which was a specified single-use product.

Ibtesam A. Hilmi, Erin Sullivan, Joseph Quinlan, and Saraswathy Shekar

Esophageal Tear: An Unusual Complication After Difficult Endotracheal Intubation (Case Report)
Anesth Analg 2003 97: 911-914. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We describe two case reports of esophageal injury after difficult endotracheal intubation. Whenever there is a traumatic intubation with inadvertent esophageal intubation, the possibility of esophageal injury should be considered.

LETTERS TO THE EDITOR:

Zvi Herschman, Zahid Hussain Khan, and Arash Kashfi

Evaluating a Patient’s Airway • Response
Anesth Analg 2003 97: 915-916. [Full Text] [PDF] [Request Permissions]  

Brian M. Ilfeld, Timothy E. Morey, Xavier Capdevila, Christophe Dadure, Nathalie Bernard, Sandrine Lopez, Philippe Macaire, and Philippe Aknin

Use of Term "Patient-Controlled" May Be Confusing in Study of Elastometric Pump • Response
Anesth Analg 2003 97: 916-917. [Full Text] [PDF] [Request Permissions]  

Shin Nakayama, Shinji Takahashi, and Hidenori Toyooka

Curved-End Guidewire for Central Venous Cannulation in Neonate
Anesth Analg 2003 97: 917-918. [Full Text] [PDF] [Request Permissions]  

Ulrike M. Stamer and Frank Stüber

Postoperative Epidural Analgesia: How About Quality Assessment?
Anesth Analg 2003 97: 918-919. [Full Text] [PDF] [Request Permissions]  

W. Scott Beattie, Neal H. Badner, and Peter T-L. Choi

Meta-Analysis Demonstrates Statistically Significant Reduction in Postoperative Myocardial Infarction with the Use of Thoracic Epidural Analgesia
Anesth Analg 2003 97: 919-920. [Full Text] [PDF] [Request Permissions]  

Brenna Stein and Patricia Fogarty Mack

Bronchospasm Due to Malpositioned Esophageal Temperature Probe
Anesth Analg 2003 97: 920-921. [Full Text] [PDF] [Request Permissions]  

Rakesh Kumar, Sunil Kumar, and Nirupma Bansal

A New Connector Assembly with the Potential to Make Endotracheal Intubation Using the Intubating Laryngeal Mask Airway Faster and Safer
Anesth Analg 2003 97: 921. [Full Text] [PDF] [Request Permissions]  

Marina Galeone, Bernhard Montreuil, John Stewart, and Thomas Schricker

Midazolam, Spinal Anesthesia, and Myoclonic Jerks
Anesth Analg 2003 97: 921-922. [Full Text] [PDF] [Request Permissions]  

Jonathan V. Roth

Another Way to Reduce Operating Room Gas Contamination
Anesth Analg 2003 97: 922. [Full Text] [PDF] [Request Permissions]  

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

The MASTER Trial Has Successfully Addressed Requirements of Protocols for Large Trials
Anesth Analg 2003 97: 922-923. [Full Text] [PDF] [Request Permissions]  

A. Rodgers, N. Walker, D. Bennett, S. Schug, Philip J. Peyton, John A. Rigg, Konrad Jamrozik, Paul S. Myles, Brendan S. Silbert, and Richard Parsons

Need for an Updated Overview to Assess the Benefits of Epidurals • Response
Anesth Analg 2003 97: 923-924. [Full Text] [PDF] [Request Permissions]  

G. L. Ludbrook and R. N. Upton

Pharmacokinetic Drug Interaction Between Propofol and Remifentanil?
Anesth Analg 2003 97: 924-925. [Full Text] [PDF] [Request Permissions]  

David L. Hepner

Latex-Free Pulmonary Artery Catheters
Anesth Analg 2003 97: 925. [Full Text] [PDF] [Request Permissions]  

Gregory Chernyak and Argyro Fassoulaki

Tender Active Acupoint Is Not an Ideal Control for Acupressure Study • Response
Anesth Analg 2003 97: 925-926. [Full Text] [PDF] [Request Permissions]  

W. Schummer, C. Schummer, and J. Fuchs

"Slow Puncture" of a Pulmonary Artery Catheter Balloon
Anesth Analg 2003 97: 926. [Full Text] [PDF] [Request Permissions]  

Jeffrey S. Lee, Dorothee H. Bremerich, and Dirk Meininger

Does Intrathecal Mepivacaine Cause Post Lumbar Puncture Headache? • Response
Anesth Analg 2003 97: 926-927. [Full Text] [PDF] [Request Permissions]  

Ralf Karger, Volker Kretschmer, Joyce A. Wahr, and Mary Lou Greenfield

Evaluation of Blood Ordering Algorithms • Response
Anesth Analg 2003 97: 927. [Full Text] [PDF] [Request Permissions]  

Stephan Blumenthal, Marco Nadig, Alain Borgeat, and Iskandar Henri

The Analgesic Effect of Interscalene Block Using Clonidine as an Analgesic for Shoulder Arthroscopy: Where Is the Catheter? • Response
Anesth Analg 2003 97: 928. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Robert R. Gaiser, Peter Bailey, and Paul F. White

The Anesthesia Patient Safety Foundation Anesthesia Machine Workbook, • Sedation and Analgesia for Diagnostic and Therapeutic Procedures • Anesthesia Outside the Operating Room: International Anesthesia Clinics, Volume 41, No. 2 • Books and Multimedia Received
Anesth Analg 2003 97: 929-931. [Full Text] [PDF] [Request Permissions]  

ERRATA:

Correction
Anesth Analg 2003 97: 683. [Full Text] [PDF] [Request Permissions]  

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