EDITORIALS:

Peter Douglas Slinger

Acute Lung Injury After Pulmonary Resection: More Pieces of the Puzzle
Anesth Analg 2003 97: 1555-1557. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Marc Licker, Marc de Perrot, Anastase Spiliopoulos, John Robert, John Diaper, Catherine Chevalley, and Jean-Marie Tschopp

Risk Factors for Acute Lung Injury After Thoracic Surgery for Lung Cancer
Anesth Analg 2003 97: 1558-1565. [Abstract] [Full Text]  

IMPLICATIONS: In an observational study including all patients undergoing lung surgery, we describe two clinical forms of acute lung injury (ALI): a delayed-onset form triggered by intercurrent complications and an early form associated with preoperative alcohol consumption, pneumonectomy, high intraoperative pressure index, and excessive fluid intake over the first 24 h.

Madhav Swaminathan, Catherine K. Lineberger, Richard L. McCann, and Joseph P. Mathew

The Importance of Intraoperative Transesophageal Echocardiography in Endovascular Repair of Thoracic Aortic Aneurysms
Anesth Analg 2003 97: 1566-1572. [Abstract] [Full Text] [VIDEOS] [VIDEO] [VIDEOS]   

IMPLICATIONS: Endovascular repair is an emerging alternative to open surgery for aortic aneurysms. We found transesophageal echocardiography to be a valuable imaging tool for guiding placement of the endograft, detecting leaks around the endograft, and supplementing information derived from angiography during endograft deployment.

M. Susan Mandell, Janette Durham, David Kumpe, James F. Trotter, Gregory T. Everson, and Claus U. Niemann

The Effects of Desflurane and Propofol on Portosystemic Pressure in Patients with Portal Hypertension
Anesth Analg 2003 97: 1573-1577. [Abstract] [Full Text]  

IMPLICATIONS: Desflurane reduces the blood pressure difference between the portal and systemic circulations. This can cause errors in assessment of the success of medical therapy of portal hypertension. Propofol has less effect on the difference between the portal and systemic circulation.

Jonathan H. Waters, Paul Potter, and Donna F. Hobson

A Comparison of Red Cell Recovery Between Two Different Methods of Red Cell Washing
Anesth Analg 2003 97: 1578-1581. [Abstract] [Full Text]  

IMPLICATIONS: This study compared two types of cell salvage equipment. Pneumatic disk processing may offer advantages over traditional devices when small blood loss is anticipated.

Joachim Boldt, Torsten Brenner, Johannes Lang, Bernhard Kumle, and Frank Isgro

Kidney-Specific Proteins in Elderly Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass
Anesth Analg 2003 97: 1582-1589. [Abstract] [Full Text]  

IMPLICATIONS: Measurement of kidney-specific proteins demonstrated that patients >70 yr (mean, 77 {+/-} 3 yr) undergoing cardiac surgery with cardiopulmonary bypass had moderate and transient alterations in kidney integrity compared with patients aged <60 yr (mean, 54 {+/-} 4 yr). These abnormalities were not detected with standard measures of kidney function (e.g., creatinine concentrations).

Robert G. Hahn and Dan Drobin

Rapid Water and Slow Sodium Excretion of Acetated Ringer’s Solution Dehydrates Cells
Anesth Analg 2003 97: 1590-1594. [Abstract] [Full Text]  

IMPLICATIONS: The kidney promotes slight cellular dehydration after infusion of Ringer's acetate solution by rapid excretion of water, whereas natriuresis occurs more slowly. In volunteers, this translocation amounted to 18% of the infused fluid volume and persisted for at least 2 h.

Joachim Boldt

New Light on Intravascular Volume Replacement Regimens: What Did We Learn from the Past Three Years?
Anesth Analg 2003 97: 1595-1604. [Abstract] [Full Text]  

IMPLICATIONS: By using a MEDLINE search covering the last 3 yr, the present knowledge on volume replacement regimens was analyzed. Forty studies in humans were identified. New hydroxyethyl starch preparations have shed light on this topic, whereas no additional data supporting the use of albumin have been presented.

Iulian Musat, Cornelia Hieber, Anton Kepka, Petrus Novotny, Peter Poslussny, Sylvia Schwarz, and Robert D. Fitzgerald

Intramural Left Atrial Hematoma After Aortocoronary Artery Surgery (Case Report)
Anesth Analg 2003 97: 1605-1607. [Abstract] [Full Text]  

IMPLICATIONS: The authors report the utility of transesophageal echocardiography for diagnosis and management of an intramural left atrial hematoma during coronary artery surgery.

PEDIATRIC ANESTHESIA:

Emmanuel Antok, Fabienne Bordet, Frédéric Duflo, Sabine Lansiaux, Sylvie Combet, Patricia Taylor, Agnes Pouyau, Brigitte Paturel, Robert James, Bernard Allaouchiche, and Dominique Chassard

Patient-Controlled Epidural Analgesia Versus Continuous Epidural Infusion with Ropivacaine for Postoperative Analgesia in Children
Anesth Analg 2003 97: 1608-1611. [Abstract] [Full Text]  

IMPLICATIONS: We studied patient-controlled epidural analgesia (PCEA) and continuous epidural infusion analgesia (CEA) with 0.2% ropivacaine during the postoperative period in children. We found that either PCEA or CEA with plain ropivacaine 0.2% provided adequate pain relief in children during the first 48-h postoperative course. However, adequate analgesia was obtained with 50% less volume infused with PCEA compared with CEA.

Marie-Louise Felten, Emmanuelle Schmautz, Sonia Delaporte-Cerceau, Gilles A. Orliaguet, and Pierre A. Carli

Endotracheal Tube Cuff Pressure Is Unpredictable in Children
Anesth Analg 2003 97: 1612-1616. [Abstract] [Full Text]  

IMPLICATIONS: Free inflation of the tracheal tube cuff, controlled only by the palpation of the pilot balloon, is not reliable and results in extremely variable (and sometimes very high) initial cuff pressures in children. In addition, nitrous oxide anesthesia may result in cuff hyperinflation requiring numerous gas removals.

Lori A. Aronson

Transnasal Placement of Biplane Transesophageal Echocardiography Probe Intraoperatively in an Adolescent with Congenital Heart Disease (Case Report)
Anesth Analg 2003 97: 1617-1619. [Abstract] [Full Text]  

IMPLICATIONS: Transnasal transesophageal echocardiography (TEE) is being used in various settings in the adult population. The author describes its use intraoperatively in an adolescent undergoing surgery for congenital heart disease after unsuccessful transoral attempts.

AMBULATORY ANESTHESIA:

W. Heinrich Wurm, Mercedes Concepcion, Andrew Sternlicht, Jean Marie Carabuena, Gary Robelen, Leonidas C. Goudas, Scott A. Strassels, and Daniel B. Carr

Preoperative Interscalene Block for Elective Shoulder Surgery: Loss of Benefit over Early Postoperative Block After Patient Discharge to Home
Anesth Analg 2003 97: 1620-1626. [Abstract] [Full Text]  

IMPLICATIONS: Preoperative interscalene block with levobupivacaine provides safe and effective analgesia for same-day elective shoulder surgery, but the benefit of this one-time intervention does not persist.

D. Janet Pavlin, Karen D. Horvath, Edward G. Pavlin, and Kristien Sima

Preincisional Treatment to Prevent Pain After Ambulatory Hernia Surgery
Anesth Analg 2003 97: 1627-1632. [Abstract] [Full Text]  

IMPLICATIONS: Outpatients undergoing inguinal hernia repair under general anesthesia report moderate-to-severe pain after surgery. Triple preincisional therapy that included rofecoxib, 50 mg PO, ketamine, 0.2 mg/kg IV, and local anesthetic field block reduced pain scores and analgesic use in the first 24 h after discharge.

Paul F. White, Baoguo Wang, Jun Tang, Ronald H. Wender, Robert Naruse, and Alexander Sloninsky

The Effect of Intraoperative Use of Esmolol and Nicardipine on Recovery After Ambulatory Surgery
Anesth Analg 2003 97: 1633-1638. [Abstract] [Full Text]  

IMPLICATIONS: The adjunctive use of the ß-adrenergic blocker esmolol to control the acute sympathetic responses during desflurane-based anesthesia provided a more rapid awakening from anesthesia, reduced the postoperative opioid analgesic requirement, and decreased the time to discharge home after ambulatory laparoscopic surgery.

ANESTHETIC PHARMACOLOGY:

Tamotsu Nagakawa, Mitsuaki Yamazaki, Noboru Hatakeyama, and Thomas A. Stekiel

The Mechanisms of Propofol-Mediated Hyperpolarization of In Situ Rat Mesenteric Vascular Smooth Muscle
Anesth Analg 2003 97: 1639-1645. [Abstract] [Full Text]  

IMPLICATIONS: The results of this study indicate that propofol-mediated hyperpolarization in vascular smooth muscle can be attributed to the activation of calcium-activated, adenosine triphosphate-sensitive potassium channels, the nitric oxide, and cyclic guanosine monophosphate pathways.

Yoko Masaki, Makoto Tanaka, and Toshiaki Nishikawa

Physicochemical Compatibility of Propofol-Lidocaine Mixture
Anesth Analg 2003 97: 1646-1651. [Abstract] [Full Text]  

IMPLICATIONS: The addition of lidocaine to propofol results in time- and dose-dependent increases in oil droplet diameters in emulsion. This mixture is physicochemically unstable over time and may cause pulmonary embolism, depending on the dose of lidocaine.

Merlin D. Larson

The Effect of Antiemetics on Pupillary Reflex Dilation During Epidural/General Anesthesia
Anesth Analg 2003 97: 1652-1656. [Abstract] [Full Text]  

IMPLICATIONS: Miosis is often considered an effect of opioid administration during general anesthesia, but other drugs, such as antiemetics, might produce a similar effect on the pupil. This study demonstrates that 2 antiemetics, droperidol and metoclopramide, constrict the pupil and block the pupillary dilation brought about by nociceptive stimuli.

Hiroyuki Kinoshita, Hiroshi Iranami, Keisuke Fujii, Akinori Yamazaki, Manabu Shimogai, Katsutoshi Nakahata, Yasuo Hironaka, and Yoshio Hatano

The Use of Bone Cement Induces an Increase in Serum Astroglial S-100B Protein in Patients Undergoing Total Knee Arthroplasty
Anesth Analg 2003 97: 1657-1660. [Abstract] [Full Text]  

IMPLICATIONS: Serum S-100B protein was significantly increased 15 min after a pneumatic tourniquet deflation in patients undergoing knee arthroplasty with bone cement, but not in those undergoing reamed intramedullary nailing for tibial fracture without bone cement. These results suggest that bone cement may transiently induce astroglial injury.

Jennifer J. Davis, Kenward B. Johnson, Talmage D. Egan, Daniel P. Vezina, Timothy E. Snell, and Jeffrey D. Swenson

Preoperative Fentanyl Infusion with Pharmacokinetic Simulation for Anesthetic and Perioperative Management of an Opioid-Tolerant Patient (Case Report)
Anesth Analg 2003 97: 1661-1662. [Abstract] [Full Text]  

IMPLICATIONS: A preinduction fentanyl infusion used in conjunction with pharmacokinetic simulation can be a useful tool for assessing individual limits of opioid tolerance, as well as determining an appropriate dose for acute pain management in opioid-tolerant patients.

Yoshikazu Yasuda, Akiko Takeda, Satoru Fukuda, Hisato Suzuki, Masayuki Ishimoto, Yoshiteru Mori, Hirotake Eguchi, Ritsuko Saitoh, Hideyoshi Fujihara, Kazumasa Honda, and Takashi Higuchi

Orexin A Elicits Arousal Electroencephalography Without Sympathetic Cardiovascular Activation in Isoflurane-Anesthetized Rats (Brief Report)
Anesth Analg 2003 97: 1663-1666. [Abstract] [Full Text]  

IMPLICATIONS: The novel neuropeptides orexins induce arousal associated with activation of the sympathetic nervous system in conscious rats. It is not known whether orexins affect the electroencephalogram (EEG), autonomic nerve activity, or both under anesthesia. Orexin A induced EEG arousal without sympathetic cardiovascular activation in the isoflurane-anesthetized rat. Orexin A might influence the depth of anesthesia.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Alejandro Recart, Irina Gasanova, Paul F. White, Tojo Thomas, Babatunde Ogunnaike, Mohammed Hamza, and Agnes Wang

The Effect of Cerebral Monitoring on Recovery After General Anesthesia: A Comparison of the Auditory Evoked Potential and Bispectral Index Devices with Standard Clinical Practice
Anesth Analg 2003 97: 1667-1674. [Abstract] [Full Text]  

IMPLICATIONS: Compared with standard monitoring practices, use of an auditory evoked potential or bispectral index monitor to titrate the volatile anesthetic led to a significant reduction in the anesthetic requirement. The anesthetic-sparing effect of cerebral monitoring resulted in a shorter postanesthesia care unit stay and improved quality of recovery from the patient's perspective.

Maria J. Colomina, Carmen Godet, Ferran Pellisé, Joan Bagó, and Carlos Villanueva

Transcranial Doppler Monitoring During Laparoscopic Anterior Lumbar Interbody Fusion
Anesth Analg 2003 97: 1675-1679. [Abstract] [Full Text]  

IMPLICATIONS: This study assessed the consequences of lengthy laparoscopic surgery with head-down (Trendelenburg) positioning on cerebral blood circulation by transcranial Doppler ultrasound, a noninvasive technique. It is important to investigate whether there are cerebral hemodynamic changes because these may be detrimental to some patients for whom this surgery is considered.

Antonio González-Arévalo, Juan I. Gómez-Arnau, Javier delaCruz, Felix Lacoma, Pedro Galdos, and Santiago García-del-Valle

Oxygen Consumption Measurement: Agreement Between the Closed-Circuit PhysioFlex Anesthesia Machine and the Deltatrac II Indirect Calorimeter
Anesth Analg 2003 97: 1680-1685. [Abstract] [Full Text]  

IMPLICATIONS: The PhysioFlex anesthesia machine (Drager Inc., Lubeck, Germany) is a closed circuit anesthesia delivery device. The oxygen delivered by this device to maintain a steady-state inspired oxygen concentration is therefore a measure of the patient's oxygen consumption. This study was designed to evaluate the accuracy of the PhysioFlex for measuring oxygen consumption by comparing it with an established technology (Deltatrac II Calorimeter) for making this measurement.

Horst G. Wagner-Berger, Volker Wenzel, Wolfgang G. Voelckel, Klaus Rheinberger, Karl H. Stadlbauer, Tilko Müller, Sven Augenstein, Achim von Goedecke, Karl H. Lindner, and Christian Keller

A Pilot Study to Evaluate the SMART BAG®: A New Pressure-Responsive, Gas-Flow Limiting Bag-Valve-Mask Device (Technical Communication)
Anesth Analg 2003 97: 1686-1689. [Abstract] [Full Text]  

IMPLICATIONS: The SMART BAG(R), a new pressure-responsive, peak inspiratory gas flow-limiting bag-valve mask device, limits inspiratory gas flow from up to 120 L/min in a standard self-inflating bag to ~40 L/min. It is designed for use by all levels of health care professionals and has been proven in a clinical pilot study to effectively ventilate patients in respiratory arrest.

Pamela J. Morgan, Doreen Cleave-Hogg, Susan DeSousa, and Jordan Tarshis

Identification of Gaps in the Achievement of Undergraduate Anesthesia Educational Objectives Using High-Fidelity Patient Simulation (Technical Communication)
Anesth Analg 2003 97: 1690-1694. [Abstract] [Full Text]  

IMPLICATIONS: This study involved the use of high-fidelity patient simulation that offers standardized clinical experiences that can detect gaps in medical students' knowledge base and clinical performance. This information can be used by faculty to focus their teaching efforts to ensure competency in important educational areas.

Michael A. Seropian

General Concepts in Full Scale Simulation: Getting Started (Special Article)
Anesth Analg 2003 97: 1695-1705. [Abstract] [Full Text]  

IMPLICATIONS: Medical simulation replicates normal and abnormal physiology and pathology. It is a tool that is intended to increase experiential learning. Establishing a functional and useful simulation program involves many factors. This paper presents a detailed introduction to the concepts and methodology of simulation in medicine.

Barbara G. Jericho and George P. Skaria

Contact Dermatitis After the Use of the PronePositioner^TM (Case Report)
Anesth Analg 2003 97: 1706-1708. [Abstract] [Full Text]  

IMPLICATIONS: We present the first case report of allergic contact dermatitis from the PronePositionerTM. We caution its repeated use in a single patient secondary to concerns of sensitization to the urethane in the PronePositionerTM.

PAIN MEDICINE:

P. M. Murphy, D. Stack, B. Kinirons, and J. G. Laffey

Optimizing the Dose of Intrathecal Morphine in Older Patients Undergoing Hip Arthroplasty
Anesth Analg 2003 97: 1709-1715. [Abstract] [Full Text]  

IMPLICATIONS: The dosage of intrathecal morphine that provides the best balance between analgesic efficacy and side effect profile in the older patient undergoing hip arthroplasty is not known. This prospective, randomized, controlled, double-blinded clinical trial demonstrates that a dose of 100 {micro}g of intrathecal morphine provides the best balance between efficacy and side effects, compared with doses of 0, 50, and 200 {micro}g of morphine, in this patient population.

Young-Jin Lim, Woo-Seok Sim, Yong-Chul Kim, Sang-Chul Lee, and Yoon-La Choi

The Neurotoxicity of Epidural Hyaluronic Acid in Rabbits: A Light and Electron Microscopic Examination
Anesth Analg 2003 97: 1716-1720. [Abstract] [Full Text]  

IMPLICATIONS: We performed a pre-clinical trial evaluation on the neurotoxicity of hyaluronic acid administered epidurally by light microscopy and electron microscopy in rabbits. Epidurally-administered hyaluronic acid did not produce any sign of neurotoxicity in rabbits.

Yuri A. Kolesnikov, Roger S. Wilson, and Gavril W. Pasternak

The Synergistic Analgesic Interactions Between Hydrocodone and Ibuprofen
Anesth Analg 2003 97: 1721-1723. [Abstract] [Full Text]  

IMPLICATIONS: Opioids are frequently used in combination with nonsteroidal antiinflammatory drugs clinically. These studies demonstrate strong interactions between ibuprofen and hydrocodone, implying synergy between the two drugs, which may help explain their utility when given together.

Tz-Chong Chou, Li-Ping Chang, Chi-Yuan Li, Chih-Shung Wong, and Shih-Ping Yang

The Antiinflammatory and Analgesic Effects of Baicalin in Carrageenan-Evoked Thermal Hyperalgesia
Anesth Analg 2003 97: 1724-1729. [Abstract] [Full Text]  

IMPLICATIONS: Our results showed that baicalin possesses an analgesic effect in carrageenan-evoked thermal hyperalgesia. The possible mechanisms of action of baicalin may be associated with the inhibition of proinflammatory mediator overproduction, including cytokines, nitric oxide, and prostaglandin E2, as well as neutrophil infiltration. This implies that baicalin may be a potential therapeutic analgesic for inflammatory pain.

Graham Hocking and Michael J. Cousins

Ketamine in Chronic Pain Management: An Evidence-Based Review (Review Article)
Anesth Analg 2003 97: 1730-1739. [Abstract] [Full Text]  

Hans Juha Exner, Jürgen Peters, and Matthias Eikermann

Epidural Analgesia at End of Life: Facing Empirical Contraindications (Case Report)
Anesth Analg 2003 97: 1740-1742. [Abstract] [Full Text]  

IMPLICATIONS: We report a patient with severe visceral and neurogenic pain from metastatic carcinoma of the colon resistant to multimodal oral analgesic therapy. Although there were empirical contraindications, epidural analgesia was successful, allowing the patient's end-of-life planning of an "aware" death surrounded by the family.

CRITICAL CARE AND TRAUMA:

Alexander H. Petter, René L. Chioléro, Tiziano Cassina, Pierre-Guy Chassot, Xavier M. Müller, and Jean-Pierre Revelly

Automatic "Respirator/Weaning" with Adaptive Support Ventilation: The Effect on Duration of Endotracheal Intubation and Patient Management
Anesth Analg 2003 97: 1743-1750. [Abstract] [Full Text]  

IMPLICATIONS: Adaptive support ventilation (ASV), a ventilatory mode providing automatic adjustment of the settings was compared with standard management for rapid tracheal extubation after cardiac surgery. The two approaches were equal in terms of outcome. In ASV, we observed fewer ventilator settings manipulations and a smaller amount of alarms, suggesting that this automatic mode may simplify postoperative respiratory management without delaying extubation.

Katsuya Mikawa, Kahoru Nishina, Yumiko Takao, and Hidefumi Obara

ONO-1714, a Nitric Oxide Synthase Inhibitor, Attenuates Endotoxin-Induced Acute Lung Injury in Rabbits
Anesth Analg 2003 97: 1751-1755. [Abstract] [Full Text]  

IMPLICATIONS: An excess of nitric oxide is thought to play a crucial role in the pathogenesis of acute organ injury in endotoxemia. Early posttreatment with ONO-1714, a nitric oxide synthase inhibitor, attenuated physiological, biochemical, and pathological changes in endotoxin-induced acute lung injury in rabbits.

Tero J. Martikainen, Jyrki J. Tenhunen, Ari Uusaro, and Esko Ruokonen

The Effects of Vasopressin on Systemic and Splanchnic Hemodynamics and Metabolism in Endotoxin Shock
Anesth Analg 2003 97: 1756-1763. [Abstract] [Full Text]  

IMPLICATIONS: Although vasopressin induces vasoconstriction in visceral region, its effects on splanchnic circulation and metabolism during septic-endotoxin shock are still poorly characterized. We evaluated the metabolic and hemodynamic effects of vasopressin and norepinephrine within the splanchnic area in porcine endotoxin shock.

Andrea Morelli, Monica Rocco, Giorgio Conti, Alessandra Orecchioni, Roberto Alberto De Blasi, Flaminia Coluzzi, and Paolo Pietropaoli

Monitoring Renal Oxygen Supply in Critically-Ill Patients Using Urinary Oxygen Tension
Anesth Analg 2003 97: 1764-1768. [Abstract] [Full Text]  

IMPLICATIONS: Acute renal failure in critically-ill patients is associated with frequent mortality. Prolonged renal hypoperfusion cannot be detected by current systemic hemodynamic indexes. Using continuous measurement of urinary oxygen tension, which could indirectly provide real-time data regarding renal oxygenation, our study showed that fenoldopam increases the ratio between oxygen supply and demand.

Takumi Taniguchi, Yasuhiro Takemoto, Hiroko Kanakura, Yoko Kidani, and Ken Yamamoto

The Dose-Related Effects of Ketamine on Mortality and Cytokine Responses to Endotoxin-Induced Shock in Rats (Brief Report)
Anesth Analg 2003 97: 1769-1772. [Abstract] [Full Text]  

IMPLICATIONS: IV administered ketamine dose-independently inhibited hypotension, metabolic acidosis, and proinflammatory cytokine responses, and improved survival rates of rats receiving a single IV bolus of endotoxin.

William H. Rosenblatt

The Use of the LMA-ProSeal^TM in Airway Resuscitation (Case Report)
Anesth Analg 2003 97: 1773-1775. [Abstract] [Full Text]  

IMPLICATIONS: Although the Laryngeal Mask Airway (LMATM) has become a standard tool in the airway resuscitation armamentarium, lack of access to the gastrointestinal tract can limit its utility. A new LMA (LMA-ProSealTM) overcomes this limitation. In the current case, reducing gastric distension reversed inadequate oxygenation after failed intubation and face mask ventilation.

NEUROSURGICAL ANESTHESIA:

Zhizheng Zhang, Tsung-Ying Chen, Jeffrey R. Kirsch, Thomas J. K. Toung, Richard J. Traystman, Raymond C. Koehler, Patricia D. Hurn, and Anish Bhardwaj

Kappa-Opioid Receptor Selectivity for Ischemic Neuroprotection with BRL 52537 in Rats
Anesth Analg 2003 97: 1776-1783. [Abstract] [Full Text]  

IMPLICATIONS: The neuroprotective effect of selective {kappa}-opioid agonists in transient focal ischemia is via a selective action at the kappa-opioid receptors.

Helene G. Logginidou, Bai-Han Li, De-Pei Li, Jeffrey S. Lohmann, H. Gregg Schuler, Nicole A. DiVittore, Sarah Kreiser, and Arthur J. Cronin

Propofol Suppresses the Cortical Somatosensory Evoked Potential in Rats
Anesth Analg 2003 97: 1784-1788. [Abstract] [Full Text]  

IMPLICATIONS: Rats demonstrate dose-dependent somatosensory evoked potential (SEP) suppression with propofol but not with remifentanil. However, SEP suppression by 50% occurred only at large (1.5 EC50) concentrations of propofol, and a measurable SEP was present in 8 of 18 rats, even at 10.8 EC50.

Robert J. Byrick, J. Colin Kay, C. David Mazer, Zhilan Wang, and J. Brendan Mullen

Dynamic Characteristics of Cerebral Lipid Microemboli: Videomicroscopy Studies in Rats
Anesth Analg 2003 97: 1789-1794. [Abstract] [Full Text] [VIDEO]   

IMPLICATIONS: Marrow lipid may pass through the lung during orthopedic surgery, creating cerebral lipid microemboli (LME). We created a cranial window in rats to study LME flowing through pial-cortical vessels. Cerebral LME appeared after resuscitation from hypotension and vessel occlusion was transient. This model may be useful in studying cerebral LME.

OBSTETRIC ANESTHESIA:

Alice C. S. Law, Kwok K. Lam, and Michael G. Irwin

The Effect of Right Versus Left Lateral Decubitus Positions on Induction of Spinal Anesthesia for Cesarean Delivery
Anesth Analg 2003 97: 1795-1799. [Abstract] [Full Text]  

IMPLICATIONS: We conducted a double-blinded randomized trial comparing the spread of spinal anesthesia placed with a parturient in either the right or left lateral position. There was a faster onset in the left lateral group; however, the maximum block heights and the time taken to achieve them were similar in both groups.

Jean-Marc Bernard, Daniel Le Roux, and Jacques Frouin

Ropivacaine and Fentanyl Concentrations in Patient-Controlled Epidural Analgesia During Labor: A Volume-Range Study
Anesth Analg 2003 97: 1800-1807. [Abstract] [Full Text]  

IMPLICATIONS: There is no clinical reason for increasing the concentration of the patient-controlled epidural analgesia (PCEA) solution when labor becomes active provided that an effective dose is already being administered with each demand. The quality of PCEA depends on the drug mass given with each demand rather than the concentration of the pump solution.

Jonathan H. Waters, Egle Lukauskiene, and Michael E. Anderson

Intraoperative Blood Salvage During Cesarean Delivery in a Patient with ß Thalassemia Intermedia (Case Report)
Anesth Analg 2003 97: 1808-1809. [Abstract] [Full Text]  

IMPLICATIONS: This case report details the safe administration of cell salvage in a patient with ß thalassemia undergoing cesarean delivery. Cell salvage is the collection, washing, and re-administration of blood lost during surgery. This process has not been previously reported in a patient with this type of blood disease.

Moeen K. Panni, William Camann, and Kodali Bhavani Shankar

Hyperbaric Therapy for a Postpartum Patient with Prolonged Epidural Blockade and Tomographic Evidence of Epidural Air (Case Report)
Anesth Analg 2003 97: 1810-1811. [Abstract] [Full Text]  

IMPLICATIONS: We report a case of prolonged motor and sensory block after labor analgesia using "loss of resistance to air" technique. The presence of epidural air on tomography resulted in the patient undergoing hyperbaric therapy. The use of loss of resistance to air technique complicated the differential diagnosis of prolonged sensory and motor block.

REGIONAL ANESTHESIA:

Barbara Kabon, Edith Fleischmann, Tanja Treschan, Akiko Taguchi, Stephan Kapral, and Andrea Kurz

Thoracic Epidural Anesthesia Increases Tissue Oxygenation During Major Abdominal Surgery
Anesth Analg 2003 97: 1812-1817. [Abstract] [Full Text]  

IMPLICATIONS: Thoracic epidural anesthesia blunts the decrease of subcutaneous tissue oxygen tension caused by surgical stress and adrenergic vasoconstriction during major abdominal surgery. Consequently, combined general and epidural anesthesia helps to provide sufficient tissue oxygenation.

Koichiroh Nandate, Masanori Ogata, Masahiro Nishimura, Takefumi Katsuki, Shinichi Kusuda, Kohji Okamoto, Naoki Nagata, and Akio Shigematsu

The Difference Between Intramural and Arterial Partial Pressure of Carbon Dioxide Increases Significantly During Laparoscopic Cholecystectomy: The Effect of Thoracic Epidural Anesthesia
Anesth Analg 2003 97: 1818-1823. [Abstract] [Full Text]  

IMPLICATIONS: We investigated the effect of pneumoperitoneum on gastric submucosal perfusion by measuring PCO2 gap with the use of gas tonometry. PCO2 gap significantly increased during and after the pneumoperitoneum compared with the control level. Thoracic epidural anesthesia did not attenuate this inhibition.

Dierk A. Vagts, Thomas Iber, Marcus Puccini, Bela Szabo, Jörg Haberstroh, Florian Villinger, Klaus Geiger, and Gabriele F. E. Nöldge-Schomburg

The Effects of Thoracic Epidural Anesthesia on Hepatic Perfusion and Oxygenation in Healthy Pigs During General Anesthesia and Surgical Stress
Anesth Analg 2003 97: 1824-1832. [Abstract] [Full Text]  

Mei-Yung Tsou, Yun-Hui Teng, Lok-Hi Chow, Chiu-Ming Ho, and Shen-Kou Tsai

Fatal Gas Embolism During Transurethral Incision of the Bladder Neck Under Spinal Anesthesia (Case Report)
Anesth Analg 2003 97: 1833-1834. [Abstract] [Full Text]  

IMPLICATIONS: We report a patient undergoing transurethral incision of the bladder neck who developed a fatal gas embolism. This report is presented in an attempt to remind anesthesiologists of this unusual but potentially fatal complication that may occur during common transurethral surgery.

GENERAL ARTICLES:

Marco Rusca, Stefania Proietti, Pierre Schnyder, Philippe Frascarolo, Göran Hedenstierna, Donat R. Spahn, and Lennart Magnusson

Prevention of Atelectasis Formation During Induction of General Anesthesia
Anesth Analg 2003 97: 1835-1839. [Abstract] [Full Text]  

IMPLICATIONS: Application of positive end-expiratory pressure during the induction of general anesthesia prevents atelectasis formation. Furthermore, it improves oxygenation and probably increases the margin of safety before intubation. Therefore, this technique should be considered for all anesthesia induction, at least in patients at risk of difficult airway management during the anesthesia induction.

Jonathan G. Hardman and Alan R. Aitkenhead

Validation of an Original Mathematical Model of CO₂ Elimination and Dead Space Ventilation
Anesth Analg 2003 97: 1840-1845. [Abstract] [Full Text]  

IMPLICATIONS: We present an original, mathematical model of ventilation and gas exchange. We validate it against previously published clinical data to allow its use in future theoretical investigations where data may be unavailable from patients.

Jonathan G. Hardman and Alan R. Aitkenhead

Estimating Alveolar Dead Space from the Arterial to End-Tidal CO₂ Gradient: A Modeling Analysis
Anesth Analg 2003 97: 1846-1851. [Abstract] [Full Text]  

IMPLICATIONS: Using an original, validated, high-fidelity model of pulmonary physiology, we have demonstrated that the arterial to end-tidal carbon dioxide pressure gradient may be used to robustly and accurately quantify alveolar dead space. After clinical validation, its use could replace that of conventionally calculated alveolar dead space fraction, particularly in the critically ill.

LETTERS TO THE EDITOR:

Robert E. Johnstone

CO₂ Removal: A Concern with New Anesthesia Machines
Anesth Analg 2003 97: 1852. [Full Text]  

Santhanam Suresh and James Park

Nasolacrimal Duct Probing in Infants and Children: An Easy Technique for Administering General Anesthesia
Anesth Analg 2003 97: 1852-1853. [Full Text]  

Edwin H. Rho, Timothy R. Long, and C. Thomas Wass

Inadequate Tidal Volume: Asymmetric Endotracheal Tube Cuff Inflation Resulting in a Massive Persistent Airway Leak
Anesth Analg 2003 97: 1853. [Full Text]  

David L. Hepner, Mariana C. Castells, Lawrence C. Tsen, Philip J. Balestrieri, and James E. Ferguson, II

Should Local Anesthetic Allergy Testing Be Routinely Performed During Pregnancy? • Response
Anesth Analg 2003 97: 1853-1854. [Full Text]  

Saffet Karaca, Ismail Kati, C. Bekir Demirel, Omer Anlar, Urfettin A. Hüseyinoglu, Emin Silay, and Kamuran Elcicek

Mutism as a Complication of Total Intravenous Anesthesia by Propofol • Response
Anesth Analg 2003 97: 1854-1855. [Full Text]  

Peter Rosenberger, Stanton K. Shernan, and Holger K. Eltzschig

Perioperative Pulmonary Embolism
Anesth Analg 2003 97: 1855. [Full Text]  

Altan Sahin and Ulku Aypar

Spinal Anesthesia in a Patient with Neurofibromatosis
Anesth Analg 2003 97: 1855-1856. [Full Text]  

Takafumi Horishita, Junichi Ogata, and Kouichiro Minami

Unique Anesthetic Management of a Patient with a Large Tracheoesophageal Fistula Using Fiberoptic Bronchoscopy
Anesth Analg 2003 97: 1856. [Full Text]  

Guillermo Lema, Jorge Urzua, Roberto Canessa, and Lucio Glantz

Sternectomy After Cardiac Surgery: Noncardiac Surgery? • Response
Anesth Analg 2003 97: 1856-1857. [Full Text]  

Jonathan V. Roth

Regional Anesthesia: Another Use for the Ultrasound Vessel Finder
Anesth Analg 2003 97: 1857. [Full Text]  

Anthony L. Kovac

Is There Rationale to Use an Antiemetic in the Same Class for the Treatment of Patients Who Experience Postoperative Nausea and Vomiting Despite Prophylaxis?
Anesth Analg 2003 97: 1857. [Full Text]  

Praveen Kumar Neema, Prabhat Kumar Sinha, Manikandan S, and Ramesh Chandra Rathod

Oversized Endotracheal Tube in Pediatric Anesthesia Practice: Its Objective Detection
Anesth Analg 2003 97: 1857-1858. [Full Text]  

Kazuhida Uchida, Takeshi Tateda, Hirofumi Hino, and Osamu Ookawa

Presence of a Foreign Substance in Anesthesia Machines
Anesth Analg 2003 97: 1858. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Amy Kemp and William Rosenblatt

Perioperative Organ Protection • Principles of Airway Management, 3rd ed. • Books and Multimedia Received
Anesth Analg 2003 97: 1859-1860. [Full Text]  

GUEST REVIEWERS, AUTHOR AND SUBJECT INDEXES:

GUEST REVIEWER LIST April 1, 2003 to September 30, 2003
Anesth Analg 2003 97: 1861-1865. [Full Text]  

Author Index
Anesth Analg 2003 97: 1866-1887. [Full Text]  

Subject Index
Anesth Analg 2003 97: 1888-1910. [Full Text]  

ERRATA:

Correction
Anesth Analg 2003 97: 1557. [Full Text]  

Correction
Anesth Analg 2003 97: 1577. [Full Text]  

Correction
Anesth Analg 2003 97: 1860. [Full Text]  

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