EDITORIALS:

Laurence E. Mather and Michael J. Cousins

The Site of Action of Epidural Fentanyl: What Can Be Learned by Studying the Difference Between Infusion and Bolus Administration? The Importance of History, One Hopes
Anesth Analg 2003 97: 1211-1213. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Bridget Phillip, Darwin Pastor, Wayne Bellows, and Jacqueline M. Leung

The Prevalence of Preoperative Diastolic Filling Abnormalities in Geriatric Surgical Patients
Anesth Analg 2003 97: 1214-1221. [Abstract] [Full Text]  

IMPLICATIONS: Although physicians' clinical assessment of systolic ejection fraction was generally accurate, geriatric patients with normal left ventricular (LV) ejection fraction often had isolated diastolic filling abnormalities that could not be predicted by clinical factors. These results suggest that evaluation of LV systolic function alone is not discriminatory in comprehensively characterizing LV function in geriatric surgical patients.

Olivia V. Carcoana, Joseph P. Mathew, Elizabeth Davis, Daniel W. Byrne, John P. Hayslett, Roberta L. Hines, and Susan Garwood

Mannitol and Dopamine in Patients Undergoing Cardiopulmonary Bypass: A Randomized Clinical Trial
Anesth Analg 2003 97: 1222-1229. [Abstract] [Full Text]  

IMPLICATIONS: In many clinical settings, an increased beta-2-microglobulin (ß2M) excretion rate indicates renal tubular injury. In this cardiopulmonary bypass (CPB) study, a dopamine infusion (alone or with mannitol) resulted in an increased ß2M excretion rate. It is unclear whether this dopamine-related increase implies renal injury after CPB, and further investigations are required to examine the mechanism/clinical relevance of this observation.

Jean-Luc Hanouz, Alexandra Yvon, Frédéric Flais, René Rouet, Pierre Ducouret, Henri Bricard, and Jean-Louis Gérard

Propofol Decreases Reperfusion-Induced Arrhythmias in a Model of "Border Zone" Between Normal and Ischemic-Reperfused Guinea Pig Myocardium
Anesth Analg 2003 97: 1230-1238. [Abstract] [Full Text]  

IMPLICATIONS: In isolated guinea pig ventricular myocardium propofol, but not Intralipid(R), attenuated the ischemia-induced shortening of action potential and, thus, the dispersion of repolarization and decreased the occurrence of spontaneous ventricular arrhythmia related to reperfusion injury. This result may be important for propofol-based anesthesia in patients at high risk for intraoperative ischemia.

Shigeaki Kobayashi, Masayuki Endou, Fumika Sakuraya, Naoyuki Matsuda, Xiao-Hong Zhang, Mitsue Azuma, Noriyuki Echigo, Osamu Kemmotsu, Yuichi Hattori, and Satoshi Gando

The Sympathomimetic Actions of l-Ephedrine and d-Pseudoephedrine: Direct Receptor Activation or Norepinephrine Release?
Anesth Analg 2003 97: 1239-1245. [Abstract] [Full Text]  

IMPLICATIONS: The indirectly sympathomimetic property of l-ephedrine may be one of the mechanisms to explain why ephedrine is preferred over {alpha}-adrenergic agonists as a vasopressor for treatment of intraspinal anesthesia-induced hypotension in obstetrics.

Björn Reinsfelt, Anne Westerlind, Erik Houltz, Sonny Ederberg, Mikael Elam, and Sven-Erik Ricksten

The Effects of Isoflurane-Induced Electroencephalographic Burst Suppression on Cerebral Blood Flow Velocity and Cerebral Oxygen Extraction During Cardiopulmonary Bypass
Anesth Analg 2003 97: 1246-1250. [Abstract] [Full Text]  

IMPLICATIONS: The effects of isoflurane on cerebral blood flow velocity (CBFV) and oxygen extraction (COE) as a function of perfusion pressure were studied. When added to fentanyl anesthesia, isoflurane induced a 27% and 13% decrease in CBFV and COE, respectively. CBFV became more pressure-dependent with isoflurane indicating an impaired autoregulation.

Ferenc Puskas, Enrico M. Camporesi, Colleen E. O’Leary, Michael Hauser, and Fadi V. Nasrallah

Intrathecal Clonidine and Severe Hypotension After Cardiopulmonary Bypass (Case Report)
Anesth Analg 2003 97: 1251-1253. [Abstract] [Full Text]  

The authors report a case of severe hypotension after cardiopulmonary bypass in a patient receiving intrathecal clonidine infusion for chronic neuropathic pain.

Dominic J. Cottrell, E. Stuart Cornett, Marc S. Seifer, Edward H. Kincaid, and David A. Zvara

Diagnosis of an Intraoperative Aortic Dissection by Transesophageal Echocardiography During Routine Coronary Artery Bypass Grafting Surgery (Case Report)
Anesth Analg 2003 97: 1254-1266. [Abstract] [Full Text] [VIDEO]   

IMPLICATIONS: Acute aortic dissection during coronary artery bypass grafting (CABG), though rare causes frequent morbidity and mortality. We report a case of postcardiopulmonary bypass aortic dissection in a 73-yr-old man who presented for CABG. Diagnosis made by transesophageal echocardiography allowed immediate treatment of the potentially lethal complication.

Jiyeon Kim, Wonsik Ahn, and Jae-Hyon Bahk

Hemomediastinum Resulting from Subclavian Artery Laceration During Internal Jugular Catheterization (Case Report)
Anesth Analg 2003 97: 1257-1259. [Abstract] [Full Text]  

IMPLICATIONS: The authors describe the delayed presentation of hemomediastinum resulting from subclavian artery laceration after internal jugular vein catheterization.

Steven G. Venticinque, Vikram S. Kashyap, and Robert J. O’Connell

Chemical Burn Injury Secondary to Intraoperative Transesophageal Echocardiography (Case Report)
Anesth Analg 2003 97: 1260-1261. [Abstract] [Full Text]  

IMPLICATIONS: We describe a case of aerodigestive tract chemical injury resulting from a probable post-processing residual of the high level disinfectant solution Cidex(R) OPA (ortho-phthalaldehyde) used to disinfect the transesophageal echocardiogram probe used during general anesthesia.

Giuseppe Carbutti, Jacques-André Romand, Jean-Sébastien Carballo, Si-M’hamed Bendjelid, Peter M. Suter, and Karim Bendjelid

Transcranial Doppler: An Early Predictor of Ischemic Stroke After Cardiac Arrest? (Case Report)
Anesth Analg 2003 97: 1262-1265. [Abstract] [Full Text]  

IMPLICATIONS: Clinical neurological examination is often of limited value in deeply sedated patients. This case report describes the early diagnosis of an ischemic stroke by using transcranial Doppler after cardiac surgery. Thus, transcranial Doppler could be used systematically for cerebral perfusion monitoring in patients who have undergone major hemodynamic instabilities.

Javier H. Campos

An Update on Bronchial Blockers During Lung Separation Techniques in Adults (Review Article)
Anesth Analg 2003 97: 1266-1274. [Full Text]  

PEDIATRIC ANESTHESIA:

Dominique A. Bettex, Daniel Schmidlin, Marc-André Bernath, René Prêtre, Michel Hurni, Rolf Jenni, Pierre-Guy Chassot, and Edith R. Schmid

Intraoperative Transesophageal Echocardiography in Pediatric Congenital Cardiac Surgery: A Two-Center Observational Study
Anesth Analg 2003 97: 1275-1282. [Abstract] [Full Text]  

IMPLICATIONS: Transesophageal echocardiography (TEE) is an essential monitoring and diagnostic device for the care of children undergoing cardiac surgery. The surgical and medical impact of TEE is demonstrated in a large series of patients. This service can be performed by appropriately trained cardiac anesthesiologists.

Aman Mahajan, Afshin Shabanie, Judi Turner, Michael J. Sopher, and Jure Marijic

Pulse Contour Analysis for Cardiac Output Monitoring in Cardiac Surgery for Congenital Heart Disease
Anesth Analg 2003 97: 1283-1288. [Abstract] [Full Text]  

IMPLICATIONS: Our results suggest that the pulse contour analysis cardiac output (CO) monitoring in patients undergoing congenital heart surgery may not provide as accurate or reliable measures of CO as previously suggested. The volume-based variable of preload intrathoracic blood volume index (ITBI) has better correlation with cardiac index (CI) than the central venous pressure, suggesting that ITBI may be a better indicator of preload.

Bruce E. Miller, Nina A. Guzzetta, Steven R. Tosone, Jennifer L. Miller, Annabel R. Flunker, Eva M. Silvey, and Jerrold H. Levy

Tissue Factor-Activated Thromboelastograms in Children Undergoing Cardiac Surgery: Baseline Values and Comparisons
Anesth Analg 2003 97: 1289-1293. [Abstract] [Full Text]  

IMPLICATIONS: Baseline values for tissue factor-activated thromboelastograms in young children undergoing cardiac surgery have been established and will permit accurate use and interpretation of this thromboelastogram modification in evaluating and managing coagulopathies.

Jiin-Tarng Liou, Jee-Ching Hsu, Fu-Chao Liu, Daniel Ching-Wah Sum, and Ping-Wing Lui

Pretreatment with Small-Dose Ketamine Reduces Withdrawal Movements Associated with Injection of Rocuronium in Pediatric Patients
Anesth Analg 2003 97: 1294-1297. [Abstract] [Full Text]  

IMPLICATIONS: Pretreatment with small-dose ketamine 0.2 mg/kg provides a simple and safe means of reducing the incidence of withdrawal movements induced by the injection of rocuronium, a short-acting nondepolarizing muscle relaxant.

Lisa Muraika, Julius S. Heyman, and Yuri Shevchenko

Fiberoptic Tracheal Intubation Through a Laryngeal Mask Airway in a Child with Treacher Collins Syndrome (Case Report)
Anesth Analg 2003 97: 1298-1299. [Abstract] [Full Text]  

IMPLICATIONS: The laryngeal mask airway reliably provides a patent airway in children with potentially difficult and normal airways. We additionally describe its utility as a conduit for fiberoptic intubation of the trachea, specifically, in a child with Treacher Collins syndrome.

Andrew T. Gray, Adam B. Collins, and Ingeborg Schafhalter-Zoppoth

Sciatic Nerve Block in a Child: A Sonographic Approach (Case Report)
Anesth Analg 2003 97: 1300-1302. [Abstract] [Full Text]  

IMPLICATIONS: In this case report, ultrasound was used to identify the sciatic nerve and guide local anesthetic injection in the subgluteal region of a child. Sonographic guidance may be especially useful for peripheral nerve blocks in children because the neural imaging is often excellent and reference landmarks are variable.

AMBULATORY ANESTHESIA:

Paul F. White, Tijani Issioui, Gary D. Skrivanek, John S. Early, and Cynthia Wakefield

The Use of a Continuous Popliteal Sciatic Nerve Block After Surgery Involving the Foot and Ankle: Does It Improve the Quality of Recovery?
Anesth Analg 2003 97: 1303-1309. [Abstract] [Full Text]  

IMPLICATIONS: A continuous infusion of bupivacaine 0.25% (versus saline) at the popliteal fossa by using a simple elastomeric pump is an effective method of decreasing postoperative pain, reducing the opioid analgesic requirement, and increasing patient satisfaction with pain management after orthopedic surgery involving the foot and ankle. More importantly, the use of the continuous sciatic nerve block in the popliteal fossa facilitated an earlier discharge after lower extremity surgery.

Chau P. Wong, Po T. Chui, and Manoj K. Karmakar

Facial Skin Injuries Caused by Adhesive Tapes in a Patient Receiving Cosmetic Skin Exfoliants (Case Report)
Anesth Analg 2003 97: 1310-1311. [Abstract] [Full Text]  

IMPLICATIONS: We report a young woman with fragile facial skin after using cosmetics containing skin peeling agents. Removal of adhesive tapes applied to her face under general anesthesia caused patchy areas of skin loss. The complication may best be avoided by not applying adhesive tapes to the face.

ANESTHETIC PHARMACOLOGY:

Chi-Yuan Li, Chien-Sung Tsai, Ping-Ching Hsu, Sheau-Huei Chueh, Chih-Shung Wong, and Shung-Tai Ho

Lidocaine Attenuates Monocyte Chemoattractant Protein-1 Production and Chemotaxis in Human Monocytes: Possible Mechanisms for Its Effect on Inflammation
Anesth Analg 2003 97: 1312-1316. [Abstract] [Full Text]  

IMPLICATIONS: Monocyte chemoattractant protein-1 (MCP-1) plays important roles in the inflammatory processes. Lidocaine may modulate MCP-1-induced monocyte response, as reflected by chemotaxis, cytosolic-free calcium, and lipopolysaccharide-induced MCP-1 production by human monocytic THP-1 cells.

Deniz Poyraz, Michael E. Bräu, Friederike Wotka, Birgit Puhlmann, Andreas M. Scholz, Prof. Gunter Hempelmann, Prof. Wolfgang J. Kox, and Prof. Claudia D. Spies

Lidocaine and Octanol Have Different Modes of Action at Tetrodotoxin-Resistant Na⁺ Channels of Peripheral Nerves
Anesth Analg 2003 97: 1317-1324. [Abstract] [Full Text]  

IMPLICATIONS: Lidocaine and octanol have different inhibitory effects on the function of tetrodotoxin-resistant Na+ channels in rat dorsal root ganglion cells, as well as noncompetitive modes of action, as investigated by the whole-cell patch-clamp method, and therefore are likely to have different binding sites on the channel.

Jacques T. Ya Deau, Christine M. Morelli, and Soléenne Desravines

Inhibition by Propofol of Intracellular Calcium Mobilization in Cultured Mouse Pituitary Cells
Anesth Analg 2003 97: 1325-1330. [Abstract] [Full Text]  

IMPLICATIONS: Propofol may block both entry of calcium into cells and release of calcium from intracellular stores, thereby inhibiting regulated secretion of neuropeptides. Study of the effects of propofol on intracellular calcium metabolism may increase understanding of how propofol alters brain function and may aid development of better IV anesthetics.

Rivka Melamed, Shahar Bar-Yosef, Guy Shakhar, Keren Shakhar, and Shamgar Ben-Eliyahu

Suppression of Natural Killer Cell Activity and Promotion of Tumor Metastasis by Ketamine, Thiopental, and Halothane, but Not by Propofol: Mediating Mechanisms and Prophylactic Measures
Anesth Analg 2003 97: 1331-1339. [Abstract] [Full Text]  

IMPLICATIONS: This study in a rat model of pulmonary metastasis demonstrates that some anesthetics, but not others, increase susceptibility to tumor metastasis, apparently by suppressing natural killer cell activity. Ketamine was most deleterious, and its effects were prevented by peripheral blockade of ß-adrenoceptors combined with low levels of immunostimulation.

Masakazu Hayashida, Atsuo Fukunaga, and Kazuo Hanaoka

An Animal Model for Surgical Anesthesia and Analgesia: Characterization with Isoflurane Anesthesia and Remifentanil Analgesia
Anesth Analg 2003 97: 1340-1346. [Abstract] [Full Text]  

IMPLICATIONS: We have developed a rabbit model of surgical anesthesia and analgesia using both mechanical and electrical stimulation as simulated surgical stimuli, which allows for repeated, quantitative, and qualitative evaluation of the varying level of surgical anesthesia and analgesia, differentiation between sedative/hypnotic and analgesic components of drug actions, and simultaneous monitoring of all the clinically relevant physiological variables including cardiovascular and respiratory variables.

Masakazu Hayashida, Atsuo Fukunaga, and Kazuo Hanaoka

Detection of Acute Tolerance to the Analgesic and Nonanalgesic Effects of Remifentanil Infusion in a Rabbit Model
Anesth Analg 2003 97: 1347-1352. [Abstract] [Full Text]  

IMPLICATIONS: Using a new rabbit model, we found that during continuous, constant-rate remifentanil infusion acute tolerance developed within the first few hours, not only to its analgesic but also to its cardiovascular and respiratory effects, albeit in slightly different time courses.

Masami Sato, Hideo Hirakata, Takefumi Nakagawa, Kyoko Arai, and Kazuhiko Fukuda

Thiamylal and Pentobarbital Have Opposite Effects on Human Platelet Aggregation In Vitro
Anesth Analg 2003 97: 1353-1359. [Abstract] [Full Text]  

IMPLICATIONS: Thiamylal enhances but pentobarbital suppresses human platelet aggregation in vitro. These effects are attributed to altered arachidonic acid release from platelets, possibly by the effects of phospholipase A2, but not secondary to altered cytosolic free calcium concentration.

Dilek Memis, Alparslan Turan, Beyhan Karamanlioglu, Pinar Saral, Mevlüt Türe, and Zafer Pamukçu

The Effect of Intravenous Pantoprazole and Ranitidine for Improving Preoperative Gastric Fluid Properties in Adults Undergoing Elective Surgery
Anesth Analg 2003 97: 1360-1363. [Abstract] [Full Text]  

IMPLICATIONS: This randomized, controlled trial examined the effects of preoperative IV pantoprazole or ranitidine on gastric pH and volume. We concluded that IV pantoprazole and ranitidine, given 1 h before surgery, are effective in reducing gastric pH and volume.

Klaus E. Hecker, Jan H. Baumert, Nicola Horn, Matthias Reyle-Hahn, Nicole Heussen, and Rolf Rossaint

Minimum Anesthetic Concentration of Sevoflurane with Different Xenon Concentrations in Swine
Anesth Analg 2003 97: 1364-1369. [Abstract] [Full Text]  

IMPLICATIONS: We investigated the influence of the anesthetic gas, xenon, on the minimum alveolar concentration (MAC) for the volatile anesthetic sevoflurane. The study was performed in 10 swine ventilated with fixed xenon and various concentrations of isoflurane. The sevoflurane MAC is decreased by inhalation of xenon in a linear relationship.

Wouter de Ruijter, René J.P. Musters, Christa Boer, Ger J. M. Stienen, Warner S. Simonides, and Jaap J. de Lange

The Cardioprotective Effect of Sevoflurane Depends on Protein Kinase C Activation, Opening of Mitochondrial K⁺_ATP Channels, and the Production of Reactive Oxygen Species
Anesth Analg 2003 97: 1370-1376. [Abstract] [Full Text]  

IMPLICATIONS: Protein kinase C, mitochondrial K+ATP channels and reactive oxygen species act within one downstream signaling pathway in mediating the cardioprotective effect of sevoflurane.

Mahmut Durmus, Erol Karaaslan, Erdogan Ozturk, Mukaddes Gulec, Mustafa Iraz, Naci Edali, and M. Ozcan Ersoy

The Effects of Single-Dose Dexamethasone on Wound Healing in Rats
Anesth Analg 2003 97: 1377-1380. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated the effects of dexamethasone on wound healing in a prospective, randomized, experimental animal model. Our results show that dexamethasone at 1 mg/kg may have negative effects on wound healing.

David L. Hepner and Mariana C. Castells

Anaphylaxis During the Perioperative Period (Review Article)
Anesth Analg 2003 97: 1381-1395. [Abstract] [Full Text]  

TECHNOLOGY, COMPUTING, AND SIMULATION:

Terence W. Picton, M. Sasha John, David W. Purcell, and Gilles Plourde

Human Auditory Steady-State Responses: The Effects of Recording Technique and State of Arousal
Anesth Analg 2003 97: 1396-1402. [Abstract] [Full Text]  

IMPLICATIONS: Auditory steady-state responses to stimuli presented at rates near 40 Hz can be used to monitor anesthesia. These responses can be quickly and reliably recorded during both sleep and wakefulness, provided that appropriate averaging techniques are used.

James Agutter, Frank Drews, Noah Syroid, Dwayne Westneskow, Rob Albert, David Strayer, Julio Bermudez, and Matthew B. Weinger

Evaluation of Graphic Cardiovascular Display in a High-Fidelity Simulator
Anesth Analg 2003 97: 1403-1413. [Abstract] [Full Text]  

IMPLICATIONS: A graphic representation of monitored data may provide better support for detection, diagnosis, and treatment. A user-centered design process led to a novel object-oriented graphic display of hemodynamic variables containing emergent features and functional relationships. In a simulated environment, this display appeared to support clinicians' ability to diagnose, manage, and treat a critical cardiovascular event in a simulated environment. We designed a graphic display to show hemodynamic variables. The study provides some support for the hypothesis that providing clinical information graphically in a display designed with emergent features and functional relationships can improve clinicians' ability to detect, diagnosis, mange, and treat critical cardiovascular events in a simulated environment.

Abraham Rosenbaum and Peter H. Breen

Novel, Adjustable, Clinical Bymixer Measures Mixed Expired Gas Concentrations in Anesthesia Circle Circuit
Anesth Analg 2003 97: 1414-1420. [Abstract] [Full Text]  

IMPLICATIONS: A new clinical bymixer (inline mixing chamber) provides a fast response and accurate measurements of mixed expired gas fractions in the anesthesia circle circuit. A novel parallel design facilitates adjustable response, easy cleaning, and construction from standard airway circuit components. The new clinical bymixer may facilitate widespread introduction of indirect calorimetry during anesthesia.

Wei-Dong Mi, Hironori Ishihara, Tetsuhiro Sakai, and Akitomo Matsuki

Possible Overestimation of Indocyanine Green-Derived Plasma Volume Early After Induction of Anesthesia with Propofol/Fentanyl
Anesth Analg 2003 97: 1421-1427. [Abstract] [Full Text]  

IMPLICATIONS: An approximate 11% overestimation in indocyanine green derived plasma volume was observed after induction of anesthesia using propofol and fentanyl. Simultaneous measurement of the initial distribution volume of glucose may help investigate the presence of overestimation in indocyanine green derived plasma volume.

PAIN MEDICINE:

Yehuda Ginosar, Edward T. Riley, and Martin S. Angst

The Site of Action of Epidural Fentanyl in Humans: The Difference Between Infusion and Bolus Administration
Anesth Analg 2003 97: 1428-1438. [Abstract] [Full Text]  

IMPLICATIONS: In an experimental pain study in volunteers, epidural fentanyl caused segmental analgesia when administered as a bolus and nonsegmental systemic analgesia when administered as a continuous infusion. This finding may help resolve the long-standing controversy surrounding the site of action of epidural fentanyl.

Yehuda Ginosar, Malachy O. Columb, Sheila E. Cohen, Edward Mirikatani, Martha S. Tingle, Emily F. Ratner, Martin S. Angst, and Edward T. Riley

The Site of Action of Epidural Fentanyl Infusions in the Presence of Local Anesthetics: A Minimum Local Analgesic Concentration Infusion Study in Nulliparous Labor
Anesth Analg 2003 97: 1439-1445. [Abstract] [Full Text]  

IMPLICATIONS: This study determined the median effective concentration for epidural infusions of bupivacaine during labor analgesia. Coadministered epidural fentanyl infusions were more than three times more potent than IV fentanyl infusions, suggesting a predominantly spinal mechanism of opioid action under these study conditions.

Jean L. Joris, Eric A. Jacob, Daniel I. Sessler, Jean-François J. Deleuse, Abdourahamane Kaba, and Maurice L. Lamy

Spinal Mechanisms Contribute to Analgesia Produced by Epidural Sufentanil Combined with Bupivacaine for Postoperative Analgesia
Anesth Analg 2003 97: 1446-1451. [Abstract] [Full Text]  

IMPLICATIONS: When combined with epidural bupivacaine, the sufentanil requirement was 50% less when given epidurally than IV. Epidural sufentanil thus appears to have a spinal mechanism of action.

James P. Rathmell, Carlos A. Pino, Richard Taylor, Terri Patrin, and Bruce A. Viani

Intrathecal Morphine for Postoperative Analgesia: A Randomized, Controlled, Dose-Ranging Study After Hip and Knee Arthroplasty
Anesth Analg 2003 97: 1452-1457. [Abstract] [Full Text]  

IMPLICATIONS: This series examined the need for supplemental analgesics, the quality of analgesia, and the incidence of side effects with intrathecal morphine sulfate (ITMS) for analgesia after hip and knee arthroplasty. Analgesic needs are greater after knee arthroplasty than hip arthroplasty. Combining small-dose (0.2 mg) ITMS with standard doses of PCA morphine provided good to excellent pain control in most patients and reduced patient-controlled analgesia morphine use after hip, but not knee, arthroplasty.

Thomas Meuser, Thorsten Giesecke, Anja Gabriel, Maria Horsch, Rainer Sabatowski, Jürgen Hescheler, Stefan Grond, and Pamela Pierce Palmer

Mu-Opioid Receptor mRNA Regulation During Morphine Tolerance in the Rat Peripheral Nervous System
Anesth Analg 2003 97: 1458-1463. [Abstract] [Full Text]  

IMPLICATIONS: The peripheral nervous system is a possible site of opioid receptor tolerance. We show the development of behavioral tolerance and mu-opioid receptor mRNA down-regulation in the dorsal root ganglia in rats after chronic morphine treatment. Both this mRNA down-regulation and behavioral tolerance reverse after 24 h of naloxone treatment.

M. Soledad Cepeda and Daniel B. Carr

Women Experience More Pain and Require More Morphine Than Men to Achieve a Similar Degree of Analgesia
Anesth Analg 2003 97: 1464-1468. [Abstract] [Full Text]  

IMPLICATIONS: The effect of sex on opioid response is not clear. To determine the effect of sex on morphine consumption and morphine analgesia, we designed a cohort study. We found that women had more intense pain and required 30% more morphine to achieve a similar degree of analgesia compared with men.

Sabine M. Sator-Katzenschlager, Jozef C. Szeles, Gisela Scharbert, Andrea Michalek-Sauberer, Alexander Kober, Georg Heinze, and Sibylle A. Kozek-Langenecker

Electrical Stimulation of Auricular Acupuncture Points Is More Effective Than Conventional Manual Auricular Acupuncture in Chronic Cervical Pain: A Pilot Study
Anesth Analg 2003 97: 1469-1473. [Abstract] [Full Text]  

IMPLICATIONS: Continuous electrical stimulation of auricular acupuncture points by using the new point stimulation device P-STIMTM significantly decreases pain intensity and significantly improves psychological well-being, activity, and sleep in chronic cervical pain patients.

Gary J. McCleane, Rie Suzuki, and Anthony H. Dickenson

Does a Single Intravenous Injection of the 5HT3 Receptor Antagonist Ondansetron Have an Analgesic Effect in Neuropathic Pain? A Double-Blinded, Placebo-Controlled Cross-Over Study
Anesth Analg 2003 97: 1474-1478. [Abstract] [Full Text]  

IMPLICATIONS: The selective 5HT3 receptor antagonist ondansetron, currently used as an antiemetic, may also have analgesic properties. Side effects with a single IV injection are infrequent and usually mild.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Christopher Gonano, Christian Sitzwohl, Franz Pusch, Stephan C. Kettner, Christian Weinstabl, and Michael Zimpfer

Educational or Organizational Approach: Which Is More Effective in Changing Blood-Sampling Habits?
Anesth Analg 2003 97: 1479-1482. [Abstract] [Full Text]  

IMPLICATIONS: Organizational change is more effective than educational programs to reduce diagnostic blood loss. Organizational implementation of smaller syringes reduces the amount of discarded blood and can save money.

CRITICAL CARE AND TRAUMA:

J. Paul Curry, C. William Hanson, III, Michael W. Russell, Cheryl Hanna, Gayle Devine, and E. Andrew Ochroch

The Use and Effectiveness of Electrocardiographic Telemetry Monitoring in a Community Hospital General Care Setting
Anesth Analg 2003 97: 1483-1487. [Abstract] [Full Text]  

IMPLICATIONS: The application of standard criteria to electrocardiogram telemetry admissions found that the majority of abnormal heart rhythms were found when patients met appropriate criteria.

Shinichi Kihara, Tetsuya Komatsuzaki, Joseph R. Brimacombe, Yuichi Yaguchi, Noriko Taguchi, and Seiji Watanabe

A Silicone-Based Wire-Reinforced Tracheal Tube with a Hemispherical Bevel Reduces Nasal Morbidity for Nasotracheal Intubation
Anesth Analg 2003 97: 1488-1491. [Abstract] [Full Text]  

IMPLICATIONS: The pharyngeal and tracheal placement phases of nasotracheal intubation require fewer attempts with a silicone-based wire-reinforced tracheal tube with a hemispherical bevel than with a polyvinyl chloride-based precurved tracheal tube with a conventional diagonal bevel, but the glottic placement phase requires more attempts. Nasal morbidity is less common with the silicone tracheal tube.

Ko Takakura, Wen Xiaohong, Kenji Takeuchi, and Satoru Fukuda

Peroxynitrite Decreases Dopamine’s Vasoconstrictive Activity
Anesth Analg 2003 97: 1492-1496. [Abstract] [Full Text]  

IMPLICATIONS: Peroxynitrite (ONOO-1) reacts with dopamine to form an oxidized derivative. We investigated the vasoconstrictive activity of this derivative with functional examinations using rat thoracic aorta and found the activity decreased. As ONOO-1 formation increases in septic shock, our results may account for dopamine's limitation as a vasoconstrictor in septic shock.

Luc Foubert, Daniël De Wolf, Koen Reyntjens, Yves Van Belleghem, Filip De Somer, Guido Van Nooten, and Eric Mortier

Intermittent Nitric Oxide Combined with Intravenous Dipyridamole in a Piglet Model of Acute Pulmonary Hypertension
Anesth Analg 2003 97: 1497-1500. [Abstract] [Full Text]  

IMPLICATIONS: IV dipyridamole prolongs the action of inhaled nitric oxide (NO) in a piglet model of acute pulmonary hypertension. Intermittent NO inhalation combined with IV dipyridamole decreases pulmonary artery pressure for a prolonged period of time and reduces exposure to NO.

NEUROSURGICAL ANESTHESIA:

Jonathan P. Thompson, Philip Watt, Sunita Sanghavi, James W. Strupish, and David G. Lambert

A Comparison of Cerebrospinal Fluid and Plasma Urotensin II Concentrations in Normotensive and Hypertensive Patients Undergoing Urological Surgery During Spinal Anesthesia: A Pilot Study (Brief Report)
Anesth Analg 2003 97: 1501-1503. [Abstract] [Full Text]  

IMPLICATIONS: Urotensin II is the most potent known endogenous human vasoconstrictor. In this pilot study, we report for the first time that cerebrospinal fluid levels are smaller than plasma levels and that there may be some association with increased blood pressure.

OBSTETRIC ANESTHESIA:

Vernon H. Ross, Charles H. Moore, Peter H. Pan, Regina Y. Fragneto, Robert L. James, and Gina B. Justis

Reduced Duration of Intrathecal Sufentanil Analgesia in Laboring Cocaine Users
Anesth Analg 2003 97: 1504-1508. [Abstract] [Full Text]  

IMPLICATIONS: Intrathecal sufentanil administered as part of a combined spinal-epidural technique produces similar quality but reduced duration of labor analgesia in cocaine-abusing parturients compared with nonabusing parturients.

Héctor J. Lacassie and Malachy O. Columb

The Relative Motor Blocking Potencies of Bupivacaine and Levobupivacaine in Labor
Anesth Analg 2003 97: 1509-1513. [Abstract] [Full Text]  

IMPLICATIONS: We estimated the motor-blocking potency ratio of bupivacaine and levobupivacaine in labor and demonstrated that the S-enantiomer of bupivacaine is less potent at motor block than the racemate.

REGIONAL ANESTHESIA:

Vincent W. S. Chan, Anahi Perlas, Regan Rawson, and Olusegun Odukoya

Ultrasound-Guided Supraclavicular Brachial Plexus Block
Anesth Analg 2003 97: 1514-1517. [Abstract] [Full Text]  

IMPLICATIONS: Real-time ultrasound imaging during supraclavicular brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern of local anesthetic spread.

Stephan R. Williams, Philippe Chouinard, Geneviève Arcand, Patrick Harris, Monique Ruel, Daniel Boudreault, and François Girard

Ultrasound Guidance Speeds Execution and Improves the Quality of Supraclavicular Block
Anesth Analg 2003 97: 1518-1523. [Abstract] [Full Text]  

IMPLICATIONS: Ultrasound-guided neurostimulator-confirmed supraclavicular block is more rapidly performed and provides a block of better quality than supraclavicular block using anatomic landmarks and neurostimulator confirmation.

Ban C. H. Tsui and Brendan Finucane

Tensile Strength of 19- and 20-Gauge Arrow Epidural Catheters (Brief Report)
Anesth Analg 2003 97: 1524-1526. [Abstract] [Full Text]  

IMPLICATIONS: The 20-gauge Arrow epidural catheters had similar tensile strengths as the 19-gauge epidural catheters but fractured at the traction site rather than at the fixed site. Thus, the 20-gauge Arrow catheter may be a reasonable alternative to the 19-gauge Arrow catheter.

Joaquín Hernández-Palazón, Luis Fernando Falcón-Araña, and Mercedes García-Martínez

Transient Postoperative Neurologic Deficit After Lumbar Laminectomy (Case Report)
Anesth Analg 2003 97: 1527-1528. [Abstract] [Full Text]  

IMPLICATIONS: We report a patient who presented in the recovery room with a transient neurologic deficit likely resulting from surgical injection of local anesthetic after lumbar laminectomy. This uncommon complication should be considered in the differential diagnosis of postoperative neurological deficits. Early magnetic resonance imaging excluded more serious causes of this complication.

GENERAL ARTICLES:

Bahattin Tuncali, Ayse Karci, Abdul Kadir Bacakoglu, Binnur Erdalkiran Tuncali, and Ahmet Ekin

Controlled Hypotension and Minimal Inflation Pressure: A New Approach for Pneumatic Tourniquet Application in Upper Limb Surgery
Anesth Analg 2003 97: 1529-1532. [Abstract] [Full Text]  

IMPLICATIONS: Pneumatic tourniquets are associated with adverse effects resulting from high inflation pressures. Therefore, minimal inflation pressures are recommended in extremity surgery. To reach real minimal inflation pressure the patient's blood pressure must be reduced. We used controlled hypotension with remifentanil and propofol to reach minimal inflation pressures.

Anis S. Baraka, Samar K. Taha, Mohamad F. El-Khatib, Faraj M. Massouh, Dima G. Jabbour, and Mahmoud M. Alameddine

Oxygenation Using Tidal Volume Breathing After Maximal Exhalation (Brief Report)
Anesth Analg 2003 97: 1533-1535. [Abstract] [Full Text]  

IMPLICATIONS: Oxygenation by using maximal exhalation before tidal volume breathing produced a significantly faster increase in end-expiratory oxygen concentration than oxygenation with tidal volume breathing alone.

Ihab Dorotta, Ayman Basali, Michael Ritchey, Jerome F. O’Hara, Jr., and Juraj Sprung

Transurethral Resection Syndrome After Bladder Perforation (Case Report)
Anesth Analg 2003 97: 1536-1538. [Abstract] [Full Text]  

IMPLICATIONS: Transurethral bladder tumor resection may be complicated by bladder perforation with intraabdominal extravasation of irrigant. This complication ("TURBT syndrome") may be associated with water and electrolyte disturbance, which differs from that associated with "TURP syndrome."

Michael A. Cooper and Richard Fox

Anesthesia for Corrective Spinal Surgery in a Patient with Leigh’s Disease (Case Report)
Anesth Analg 2003 97: 1539-1541. [Abstract] [Full Text]  

IMPLICATIONS: Patients suffering from Leigh's disease are at high risk of serious postoperative respiratory morbidity. We present a case that demonstrates delayed respiratory complications and link this postoperative adverse outcome to aggressive reactivation of the underlying neurodegenerative condition.

LETTERS TO THE EDITOR:

Nancy Chang, Arthur Simone, Lester Schultheis, and Bob Rappaport

Reviewing Case Reports and the Droperidol Warning: FDA Response
Anesth Analg 2003 97: 1542. [Full Text]  

Mark Dershwitz, Ashraf S. Habib, and Tong J. Gan

There Should Be a Threshold Dose for the FDA Black-Box Warning on Droperidol • Response
Anesth Analg 2003 97: 1542-1543. [Full Text]  

Jonathan L. Benumof, Hsiu-chin Chou, and Tzu-lang Wu

Both a Large and Small Thyromental Distance Can Predict Difficult Intubation • Response
Anesth Analg 2003 97: 1543-1544. [Full Text]  

Thomas M. Hemmerling, Guillaume Michaud, Stephane Deschamps, Guillaume Trager, and Kyo Sang Kim

Do We Need to Intubate the Trachea 2 Minutes after Vecuronium 0.1 mg/kg in Elective Surgery? • Response
Anesth Analg 2003 97: 1544-1545. [Full Text]  

Yushi U. Adachi, Maiko Satomoto, Hideyuki Higuchi, and Kazuhiko Watanabe

Subhypnotic Dose of Droperidol May Increase Frequency of PONV After Propofol Anesthesia
Anesth Analg 2003 97: 1545. [Full Text]  

Jason S. Wakakuwa and Mark S. Shulman

Latex Allergy and Cardiac Surgery
Anesth Analg 2003 97: 1545. [Full Text]  

Samuel Metz, Glenn S. Murphy, Joseph W. Szokol, and Jeffery S. Vender

Omission of Muscle Relaxants Is Another Clinically Available Alternative in Fast-Track Cardiac Anesthesia • Response
Anesth Analg 2003 97: 1545-1546. [Full Text]  

Jawad Mustafa, Margaret M. Coleman, and James C. Crews

Safety of Levobupivacaine? • Response
Anesth Analg 2003 97: 1546. [Full Text]  

Peter Lierz, Anja Heinatz, Burkhard Gustorff, Peter Felleiter, Yavuz Gürkan, and Kamil Toker

Epidural Catheterization in General Anesthesia • Response
Anesth Analg 2003 97: 1547. [Full Text]  

Peter Kienbaum, Jürgen Peters, Norbert Scherbaum, Paul F. White, and Ronald H. Wender

Convincing Effects of Clonidine on Neurohumoral Withdrawal Symptoms During Antagonist-Supported Detoxification of Opioid Addicts • Response
Anesth Analg 2003 97: 1547-1548. [Full Text]  

Charles D. Collard and Simon C. Body

Endocarditis of a Left Ventricular Assist Device Resulting in Regurgitant Flow
Anesth Analg 2003 97: 1548-1549. [Full Text]  

Harvey K. Rosenbaum and Mark A. Rosen

Muscle Biopsy for Malignant Hyperthermia Testing Can Be Scheduled and Performed in 6 Weeks • Response
Anesth Analg 2003 97: 1549. [Full Text]  

L. Mario Vaquero, Francisco J. Sánchez-Montero, Clemente Muriel, Roman Schumann, Scott Shikora, Jocelyn M. Weiss, Heinrich Wurm, Scott Strassels, and Daniel B. Carr

The Importance of Methodology • Response
Anesth Analg 2003 97: 1549-1551. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Philip L. Liu, Andrew E. Ochroch, and Bernard V. Wetchler

NMS Clinical Manual of Anesthesiology • Thoracic Anesthesia • Ambulatory Anesthesia: Anesthesiology Clinics of North America, Volume 21, No. 2
Anesth Analg 2003 97: 1552-1553. [Full Text]  

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