EDITORIALS:

Evan D. Kharasch

Perioperative COX-2 Inhibitors: Knowledge and Challenges
Anesth Analg 2004 98: 1-3. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Suryanarayana Pothula, Vajubhai T. Sanchala, Basavaraj Nagappala, and Mario A. Inchiosa, Jr.

The Effect of Preoperative Antiplatelet/Anticoagulant Prophylaxis on Postoperative Blood Loss in Cardiac Surgery
Anesth Analg 2004 98: 4-10. [Abstract] [Full Text]  

IMPLICATIONS: The objective of this study was to determine whether preoperative treatment with antiplatelet and/or anticoagulant drugs influences the extent of blood loss in the 24-h period after cardiac surgery.

Elmar Berendes, Christoph Schmidt, Hugo Van Aken, Maike Grosse Hartlage, Markus Rothenburger, Stefan Wirtz, Hans Heinrich Scheld, Gerhard Brodner, and Michael Walter

A-Type and B-Type Natriuretic Peptides in Cardiac Surgical Procedures
Anesth Analg 2004 98: 11-19. [Abstract] [Full Text]  

IMPLICATIONS: A-type natriuretic peptide is primarily influenced by volume reloading of the heart after cross-clamp, whereas the secretion of B-type natriuretic peptide (BNP) is related to the duration of ischemia and long-term left ventricular pressure and/or volume overload. Preoperative BNP, but not postoperative BNP, concentrations predict long-term outcome after coronary artery bypass grafting.

Bernhard J. Riedel, Janos Gal, Gillian Ellis, Paul J. Marangos, Anthony W. Fox, and David Royston

Myocardial Protection Using Fructose-1,6-Diphosphate During Coronary Artery Bypass Graft Surgery: A Randomized, Placebo-Controlled Clinical Trial
Anesth Analg 2004 98: 20-29. [Abstract] [Full Text]  

IMPLICATIONS: Fructose-1,6-diphosphate (FDP) may increase high-energy phosphate levels under anaerobic conditions and therefore ameliorate ischemic injury. A dose-ranging safety study for FDP was conducted in patients undergoing coronary artery surgery. Preischemic provision of FDP significantly improved cardiac function and reduced perioperative ischemic injury. These myocardial protective effects may improve patient outcome after cardiac surgery.

Shunji Takahashi, Sungsam Cho, Tetsuya Hara, Hiroyuki Ureshino, Shiro Tomiyasu, and Koji Sumikawa

The Interaction of MCI-154, a Calcium Sensitizer, and Isoflurane on Systemic and Coronary Hemodynamics in Chronically Instrumented Dogs
Anesth Analg 2004 98: 30-36. [Abstract] [Full Text]  

IMPLICATIONS: MCI-154, a calcium sensitizer, restores the myocardial contractility depressed by isoflurane and enhances the coronary vasodilating effect of isoflurane in chronically instrumented dogs.

Yurie T. Kawamata, Tomoyuki Kawamata, Keiichi Omote, Eiji Homma, Tatsuo Hanzawa, Toshifumi Kaneko, and Akiyoshi Namiki

Endoscopic Thoracic Sympathectomy Suppresses Baroreflex Control of Heart Rate in Patients with Essential Hyperhidrosis
Anesth Analg 2004 98: 37-39. [Abstract] [Full Text]  

IMPLICATIONS: Endoscopic thoracic sympathectomy suppressed the baroreflex control of heart rate during pressor and depressor tests in patients with palmar or axillary hyperhidrosis.

Dean A. Cowie, J. Kevin Shoemaker, and Adrian W. Gelb

Orthostatic Hypotension Occurs Frequently in the First Hour After Anesthesia
Anesth Analg 2004 98: 40-45. [Abstract] [Full Text]  

IMPLICATIONS: Orthostatic hypotension, a failure to maintain blood pressure on assuming an upright posture, is common after general anesthesia for minor surgery and may be the major cause of postoperative orthostatic intolerance.

Zongfu Chen, Andrew W. Murray, and Joseph J. Quinlan

Pituitary Apoplexy Presenting as Unilateral Third Cranial Nerve Palsy After Coronary Artery Bypass Surgery (Case Report)
Anesth Analg 2004 98: 46-48. [Abstract] [Full Text]  

IMPLICATIONS: Unilateral pupil dilation is a rare perioperative complication after coronary artery bypass surgery. We report a case of pituitary apoplexy that presented clinically as unilateral dilated pupil, ptosis, and visual loss shortly after coronary artery bypass surgery.

PEDIATRIC ANESTHESIA:

Stephen A. Stayer, Laura K. Diaz, Debora L. East, Jill N. Gouvion, Tracie L. Vencill, E. Dean McKenzie, Charles D. Fraser, and Dean B. Andropoulos

Changes in Respiratory Mechanics Among Infants Undergoing Heart Surgery
Anesth Analg 2004 98: 49-55. [Abstract] [Full Text]  

IMPLICATIONS: The benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of cardiopulmonary bypass on respiratory mechanics in infants.

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

Clonidine Prolongs Spinal Anesthesia in Newborns: A Prospective Dose-Ranging Study
Anesth Analg 2004 98: 56-59. [Abstract] [Full Text]  

IMPLICATIONS: Spinal anesthesia is suitable but often too short for complete surgery in newborns. This controlled, randomized, prospective, dose-ranging study was conducted in 75 neonates to test the hypothesis that clonidine could significantly lengthen bupivacaine spinal block. Clonidine 1 {micro}g/kg, added to spinal isobaric bupivacaine, doubles the duration of the block without significant deleterious hemodynamic or respiratory side effects.

Mauricio E. Ibacache, Hernán R. Muñoz, Verena Brandes, and Anita L. Morales

Single-Dose Dexmedetomidine Reduces Agitation After Sevoflurane Anesthesia in Children
Anesth Analg 2004 98: 60-63. [Abstract] [Full Text]  

IMPLICATIONS: In children undergoing surgery using sevoflurane anesthesia, dexmedetomidine 0.3 {micro}g/kg administered in 10 min after induction reduced the incidence of emergence agitation from 37% in the control group to 10%. No adverse effects attributable to dexmedetomidine were observed.

Hannu Kokki, Paula Ylönen, Marja Heikkinen, and Matti Reinikainen

Levobupivacaine for Pediatric Spinal Anesthesia (Brief Report)
Anesth Analg 2004 98: 64-67. [Abstract] [Full Text]  

IMPLICATIONS: This noncomparative, descriptive study showed that levobupivacaine, the S(-)-enantiomer of bupivacaine, has equivalent clinical efficacy in spinal anesthesia in children to that of racemic bupivacaine.

Binnaz Ay, Arzu Gerçek, Varlik I. Dogan, Gürsu Kiyan, and Yilmaz F. Gögüs

Pyloromyotomy in a Patient with Paramyotonia Congenita (Case Report)
Anesth Analg 2004 98: 68-69. [Abstract] [Full Text]  

IMPLICATIONS: The literature concerning general anesthesia in paramyotonic patients is limited. We report a case of paramyotonia congenita in a 2-mo-old male infant undergoing surgery for pyloric stenosis and inguinal hernia after an uneventful anesthesia.

AMBULATORY ANESTHESIA:

Kimberly B. Na and Dan J. Kopacz

Spinal Chloroprocaine Solutions: Density at 37° C and pH Titration
Anesth Analg 2004 98: 70-74. [Abstract] [Full Text]  

IMPLICATIONS: Dextrose-free 2-chloroprocaine is hyperbaric relative to cerebrospinal fluid at 37{degrees}C, and therefore can be used for spinal anesthesia without dextrose. Bisulfite-free 2-chloroprocaine remains very acidic (pH <4.0). The pH can be increased to more than 7.0 with a small amount of bicarbonate (0.25-0.33 mL/10 mL).

Mary E. Kouri and Dan J. Kopacz

Spinal 2-Chloroprocaine: A Comparison with Lidocaine in Volunteers
Anesth Analg 2004 98: 75-80. [Abstract] [Full Text]  

IMPLICATIONS: The spinal anesthetic profile of chloroprocaine (40 mg) compares favorably with the same dose of spinal lidocaine. Reliable sensory and motor blockade with predictable duration and minimal side effects and without signs of transient neurological symptoms make chloroprocaine an attractive choice for outpatient spinal anesthesia.

Kristin N. Smith, Dan J. Kopacz, and Susan B. McDonald

Spinal 2-Chloroprocaine: A Dose-Ranging Study and the Effect of Added Epinephrine
Anesth Analg 2004 98: 81-88. [Abstract] [Full Text]  

IMPLICATIONS: Hyperbaric spinal 2-chloroprocaine is effective and has an anesthetic profile appropriate for use in the surgical outpatient over the dose range of 30-60 mg without signs of transient neurologic symptoms. The addition of epinephrine is not recommended because of the frequent incidence of side effects.

Julie S. Vath and Dan J. Kopacz

Spinal 2-Chloroprocaine: The Effect of Added Fentanyl
Anesth Analg 2004 98: 89-94. [Abstract] [Full Text]  

IMPLICATIONS: Spinal 2-chloroprocaine (40 mg) provides rapid onset and reliable blockade without signs of transient neurological symptoms, giving it a positive profile for ambulatory surgical settings. The addition of fentanyl appears to lengthen the regression to L1 dermatome and tourniquet time while minimally lengthening duration of block.

Daniel T. Warren and Dan J. Kopacz

Spinal 2-Chloroprocaine: The Effect of Added Dextrose
Anesth Analg 2004 98: 95-101. [Abstract] [Full Text]  

IMPLICATIONS: Spinal chloroprocaine provides adequate potency with reliable regression, seemingly without concerns of transient neurologic symptoms, and hence an appealing profile for outpatient surgery. The addition of dextrose does not alter peak block height or tolerance of thigh tourniquet, and increases the degree of residual bladder dysfunction.

ANESTHETIC PHARMACOLOGY:

Aaron F. Kopman, Lee M. Zank, Jennifer Ng, and George G. Neuman

Antagonism of Cisatracurium and Rocuronium Block at a Tactile Train-of-Four Count of 2: Should Quantitative Assessment of Neuromuscular Function Be Mandatory?
Anesth Analg 2004 98: 102-106. [Abstract] [Full Text]  

IMPLICATIONS: After the administration of cisatracurium or rocuronium, train-of-four (TOF) ratios <0.70 should rarely be observed in the postanesthesia care unit if neostigmine-assisted antagonism of residual block is delayed until the tactile TOF count at the thumb is 2 or more.

Dara S. Breslin, Kuiran Jiao, Ashraf S. Habib, John Schultz, and Tong J. Gan

Pharmacodynamic Interactions Between Cisatracurium and Rocuronium
Anesth Analg 2004 98: 107-110. [Abstract] [Full Text]  

IMPLICATIONS: We assessed the clinical effect of administering cisatracurium after an intubating dose of rocuronium in 60 patients undergoing isoflurane/nitrous oxide and oxygen anesthesia. The clinical duration of the first two maintenance doses of cisatracurium administered after rocuronium was significantly prolonged. This supports the contention that combinations of structurally dissimilar neuromuscular blocking drugs result in a synergistic effect.

Akira Kudoh, Hajime Takase, and Tomoko Takazawa

Chronic Treatment with Antipsychotics Enhances Intraoperative Core Hypothermia
Anesth Analg 2004 98: 111-115. [Abstract] [Full Text]  

IMPLICATIONS: Antipsychotics inhibit autonomic thermoregulation. This is caused by decreased heat production, increased heat loss, and impaired central action at the hypothalamus. Thus, schizophrenic patients receiving antipsychotics may have impaired intraoperative temperature regulation.

John J. Bates, Joseph F. Foss, and Damian B. Murphy

Are Peripheral Opioid Antagonists the Solution to Opioid Side Effects? (Medical Intelligence)
Anesth Analg 2004 98: 116-122. [Abstract] [Full Text]  

IMPLICATIONS: The major analgesic effects of opioid medication are mediated within the brain and spinal cord. Many of the side effects of opioids are caused by activation of receptors outside these areas. Recently developed peripherally restricted opioid antagonists have the ability to block many opioid side effects without affecting analgesia.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Gunter N. Schmidt, Petra Bischoff, Thomas Standl, Andreas Gerhardt, Gunnar Lankenau, and Jochen Schulte am Esch

Alaris AEP^TM Monitor’s "Click Detection" Does Not Help to Detect Inadvertent Disconnection of Headphones During Anesthesia
Anesth Analg 2004 98: 123-127. [Abstract] [Full Text]  

IMPLICATIONS: Signal transmission of auditory evoked potentials can be suppressed by anesthetics, but also by disconnection of headphones. In the present study, we demonstrate that even the Alaris AEPTM monitor with the very new feature "Click Detection" was not able to detect the loss of headphones during general anesthesia with propofol and remifentanil.

Ercan Gürses, Hülya Sungurtekin, Erkan Tomatir, and Hakan Dogan

Assessing Propofol Induction of Anesthesia Dose Using Bispectral Index Analysis (Brief Report)
Anesth Analg 2004 98: 128-131. [Abstract] [Full Text]  

IMPLICATIONS: Hypotension during induction of anesthesia with propofol is common. This study has shown that propofol requirement assessed by bispectral index analysis during anesthesia induction may decrease the dose and side effects and provide for satisfactory depth of anesthesia.

A. K. Bhargava, R. Setlur, and D. Sreevastava

Correlation of Bispectral Index and Guedel’s Stages of Ether Anesthesia (Technical Communication)
Anesth Analg 2004 98: 132-134. [Abstract] [Full Text]  

IMPLICATIONS: For the first time, bispectral index (BIS) has been studied in patients being anesthetized solely with ether. Ether both causes an increase and decrease in BIS during induction and emergence. The index observed during the surgical stage of ether anesthesia is probably the correct value for the depth of hypnosis because no other volatile anesthetic can produce the true anesthetic state when used alone. This value could be taken as the value to be attained when balanced anesthesia is being practiced.

PAIN MEDICINE:

Raymond S. Sinatra, Qiheng J. Shen, Thomas Halaszynski, Martha A. Luther, and Yasser Shaheen

Preoperative Rofecoxib Oral Suspension as an Analgesic Adjunct After Lower Abdominal Surgery: The Effects on Effort-Dependent Pain and Pulmonary Function
Anesth Analg 2004 98: 135-140. [Abstract] [Full Text]  

IMPLICATIONS: Rofecoxib belongs to class of analgesics known as cyclooxygenase-2 inhibitors that reduce pain and inflammation with less risk of bleeding than standard nonsteroidal antiinflammatory drugs. We found that patients treated with rofecoxib 25 or 50 mg before open abdominal surgery required less IV morphine during the first day of recovery. Despite reductions in morphine requirements, rofecoxib-treated patients reported lower pain intensity scores at rest and after a vigorous cough. In the 50-mg group, improvements in pain control correlated with greater preservation of baseline cough effectiveness (vital capacity) at 12 h. These findings may offer clinical advantages in patients with preexisting pulmonary disease.

Winfried Meissner, Thomas Weiss, Ralf H. Trippe, Holger Hecht, Clemens Krapp, and Wolfgang H. Miltner

Acupuncture Decreases Somatosensory Evoked Potential Amplitudes to Noxious Stimuli in Anesthetized Volunteers
Anesth Analg 2004 98: 141-147. [Abstract] [Full Text]  

IMPLICATIONS: This double-blinded study demonstrates that electric needle acupuncture, as compared with sham treatment, significantly decreases the magnitudes of late somatosensory evoked potential amplitudes with electrical noxious stimulation in anesthetized subjects, suggesting a specific analgesic effect of acupuncture.

H. Ayben Korkmaz, Fikret Maltepe, Serhat Erbayraktar, Osman Yilmaz, Merih Güray, M. Serefettin Canda, Ali Günerli, and Necati Gökmen

Antinociceptive and Neurotoxicologic Screening of Chronic Intrathecal Administration of Ketorolac Tromethamine in the Rat
Anesth Analg 2004 98: 148-152. [Abstract] [Full Text]  

IMPLICATIONS: The present study is unique because it has demonstrated that chronic intrathecal administration of ketorolac tromethamine in rats, even at considerably large doses, showed a potent analgesic effect during the formalin test without exhibiting any neurotoxic side effect.

Shahbaz R. Arain, Renée M. Ruehlow, Toni D. Uhrich, and Thomas J. Ebert

The Efficacy of Dexmedetomidine Versus Morphine for Postoperative Analgesia After Major Inpatient Surgery
Anesth Analg 2004 98: 153-158. [Abstract] [Full Text]  

IMPLICATIONS: The use of dexmedetomidine for postoperative analgesia resulted in significantly less additional pain medication (morphine) and slower heart rates than a control group receiving only morphine. These outcomes may prove advantageous for patients who might be placed at higher risk by tachycardia or large doses of morphine.

Hugo Van Aken, L. Thys, Luc Veekman, and Hartmut Buerkle

Assessing Analgesia in Single and Repeated Administrations of Propacetamol for Postoperative Pain: Comparison with Morphine After Dental Surgery
Anesth Analg 2004 98: 159-165. [Abstract] [Full Text]  

IMPLICATIONS: After moderately painful surgical procedures, IV paracetamol, administered as propacetamol, may be an asset in the control of acute postoperative pain.

Margherita Bianconi, Luca Ferraro, Riccardo Ricci, Gustavo Zanoli, Tiziana Antonelli, Bighetti Giulia, Aurelia Guberti, and Leo Massari

The Pharmacokinetics and Efficacy of Ropivacaine Continuous Wound Instillation After Spine Fusion Surgery
Anesth Analg 2004 98: 166-172. [Abstract] [Full Text]  

IMPLICATIONS: Postoperative pain after lumbar arthrodesis is related to soft tissue and muscle dissection and to manipulations and removal at the operation site. By blocking noxious stimuli from the surgical area, infiltration and wound perfusion with ropivacaine were more effective in controlling pain than systemic analgesia.

Burkhard Gustorff, Sebastian Anzenhofer, Thomas Sycha, Stephan Lehr, and Hans G. Kress

The Sunburn Pain Model: The Stability of Primary and Secondary Hyperalgesia Over 10 Hours in a Crossover Setting
Anesth Analg 2004 98: 173-177. [Abstract] [Full Text]  

IMPLICATIONS: The sunburn pain model provides a long time course of stable hyperalgesia with a high within-day stability and between-day repeatability for primary and secondary hyperalgesia.

Sukdeb Datta, Taruna Waghray, Maria Torres, and Silvio Glusman

Amiodarone Decreases Heat, Cold, and Mechanical Hyperalgesia in a Rat Model of Neuropathic Pain
Anesth Analg 2004 98: 178-184. [Abstract] [Full Text]  

IMPLICATIONS: Amiodarone was found to produce a statistically significant decrease in heat, cold, and mechanical hyperalgesia in a rat model of neuropathic pain after intraperitoneal injection. Considering its long half-life in humans, amiodarone has the potential to provide long lasting pain relief in neuropathic pain states.

Arda Tasatargil and Gulay Sadan

Reduction in [D-Ala², NMePhe⁴, Gly-ol⁵]Enkephalin-Induced Peripheral Antinociception in Diabetic Rats: The Role of the L-Arginine/Nitric Oxide/Cyclic Guanosine Monophosphate Pathway
Anesth Analg 2004 98: 185-192. [Abstract] [Full Text]  

IMPLICATIONS: This is the first study on the role of the nitric oxide (NO)/cyclic guanosine monophosphate pathway on [D-Ala2, NMePhe4, Gly-ol5]enkephalin (DAMGO)-induced peripheral antinociception and the effect of diabetes on this pathway. The study suggests a possible role of DAMGO as a peripherally-acting analgesic drug.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Glenn S. Murphy, Joseph W. Szokol, Mark Franklin, Jesse H. Marymont, Michael J. Avram, and Jeffery S. Vender

Postanesthesia Care Unit Recovery Times and Neuromuscular Blocking Drugs: A Prospective Study of Orthopedic Surgical Patients Randomized to Receive Pancuronium or Rocuronium
Anesth Analg 2004 98: 193-200. [Abstract] [Full Text]  

IMPLICATIONS: Clinical recovery may be delayed in surgical patients administered long-acting neuromuscular blocking drugs. During the postanesthesia care unit admission, patients randomized to receive pancuronium (versus rocuronium) were more likely to exhibit symptoms of muscle weakness, develop hypoxemia, and require more time to meet discharge criteria.

TECHNICAL COMMUNICATIONS:

Dale F. Szpisjak, Paul S. Potter, and Bruce P. Capehart

Economic Analysis of an Intraoperative Cell Salvage Service
Anesth Analg 2004 98: 201-205. [Abstract] [Full Text]  

IMPLICATIONS: Cross-training an employee as a cell salvage technician is more economical than outsourcing when caseload exceeds 55 per year.

CRITICAL CARE AND TRAUMA:

Alexander Kober, Barbara Schubert, Petra Bertalanffy, Laszlo Gorove, Tivadar Puskas, Burkhard Gustorff, Alma Joldzo, and Klaus Hoerauf

Capnography in Non-Tracheally Intubated Emergency Patients as an Additional Tool in Pulse Oximetry for Prehospital Monitoring of Respiration
Anesth Analg 2004 98: 206-210. [Abstract] [Full Text]  

IMPLICATIONS: Capnography is a useful tool to improve respiratory monitoring in nonintubated trauma victims on emergency transport and an easy to use supplement to pulse oximetry.

Rolf Dembinski, Dietrich Henzler, Ralf Bensberg, Berit Prüsse, Rolf Rossaint, and Ralf Kuhlen

Ventilation-Perfusion Distribution Related to Different Inspiratory Flow Patterns in Experimental Lung Injury
Anesth Analg 2004 98: 211-219. [Abstract] [Full Text]  

IMPLICATIONS: In acute lung injury, mechanical ventilation with decelerating flow has been suggested to improve ventilation-perfusion distribution when compared with constant flow. We tested this hypothesis in an animal model. Contrary to the hypothesis, we found a more favorable ventilation-perfusion distribution during constant flow when compared with decelerating flow.

Petra Bertalanffy, Klaus Hoerauf, Roman Fleischhackl, Helmut Strasser, Franziska Wicke, Manfred Greher, Burkhard Gustorff, and Alexander Kober

Korean Hand Acupressure for Motion Sickness in Prehospital Trauma Care: A Prospective, Randomized, Double-Blinded Trial in a Geriatric Population
Anesth Analg 2004 98: 220-223. [Abstract] [Full Text]  

IMPLICATIONS: Korean hand acupressure at the K-K9 point was effective in reducing nausea and subjective symptoms of motion sickness in emergency trauma transport of patients at high risk of motion sickness.

OBSTETRIC ANESTHESIA:

Stéphane Frenea, Christine Chirossel, Raphaël Rodriguez, Jean-Philippe Baguet, Claude Racinet, and Jean-Francois Payen

The Effects of Prolonged Ambulation on Labor with Epidural Analgesia
Anesth Analg 2004 98: 224-229. [Abstract] [Full Text]  

IMPLICATIONS: This study compared the duration of labor and pain relief between parturients receiving epidural analgesia who were ambulated or were recumbent. Whereas walking had no impact on either duration of labor or pain relief, it was associated with a reduction in both bupivacaine and oxytocin requirements.

Jean-Denis Roy, Michel Girard, and Pierre Drolet

Intrathecal Meperidine Decreases Shivering During Cesarean Delivery Under Spinal Anesthesia
Anesth Analg 2004 98: 230-234. [Abstract] [Full Text]  

IMPLICATIONS: Previous studies have suggested that IV meperidine is helpful for treating intraoperative shivering. This study was undertaken to evaluate spinal meperidine and found that it decreases the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery.

Yvonne Lim, Cecilia E. Ocampo, and Alex T. Sia

A Comparison of Duration of Analgesia of Intrathecal 2.5 mg of Bupivacaine, Ropivacaine, and Levobupivacaine in Combined Spinal Epidural Analgesia for Patients in Labor
Anesth Analg 2004 98: 235-239. [Abstract] [Full Text]  

IMPLICATIONS: Intrathecal 2.5 mg bupivacaine significantly prolongs the duration of analgesia in laboring patients compared with ropivacaine or levobupivacaine. This suggests that, at clinically relevant doses, bupivacaine may have greater potency.

James H. Williams and David L. Hepner

Risperidone and Exaggerated Hypotension During a Spinal Anesthetic (Case Report)
Anesth Analg 2004 98: 240-241. [Abstract] [Full Text]  

IMPLICATIONS: Parturients receiving neuraxial blocks may be taking antipsychotic medications. Although the therapeutic effects of antipsychotic medications are mediated by dopaminergic and serotonergic antagonism, many possess alpha-adrenergic antagonist properties. We report a case of exaggerated hypotension during a spinal anesthetic for cesarean delivery that may have been a result of the alpha-adrenergic antagonism of risperidone.

REGIONAL ANESTHESIA:

Manuel Taboada, Julián Álvarez, Joaquín Cortés, Jaime Rodríguez, Susana Rabanal, Francisco Gude, Alexander Atanassoff, and Peter G. Atanassoff

The Effects of Three Different Approaches on the Onset Time of Sciatic Nerve Blocks with 0.75% Ropivacaine
Anesth Analg 2004 98: 242-247. [Abstract] [Full Text]  

IMPLICATIONS: Comparing three different approaches to the sciatic nerve with 0.75% ropivacaine, the classic and subgluteal approaches exhibited a faster onset time of sensory and motor blockade than the lateral popliteal approach.

Tetsuya Sakai, Shiro Tomiyasu, Hiroyuki Yamada, Takeshi Ono, and Koji Sumikawa

Quantitative and Selective Evaluation of Differential Sensory Nerve Block After Transdermal Lidocaine
Anesth Analg 2004 98: 248-251. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated the effect of transdermal lidocaine on differential sensory nerve block in healthy volunteers. Our results show that the sensitivity of nerves to local anesthetics is proportional to the axon diameter.

Øivind Klaastad, Hans-Jørgen Smith, Örjan Smedby, Eldrid H. Winther-Larssen, Per Brodal, Harald Breivik, and Erik T. Fosse

A Novel Infraclavicular Brachial Plexus Block: The Lateral and Sagittal Technique, Developed by Magnetic Resonance Imaging Studies (Technical Communication)
Anesth Analg 2004 98: 252-256. [Abstract] [Full Text]  

IMPLICATIONS: A new infraclavicular brachial plexus block method was investigated using magnetic resonance imaging without inserting needles in the volunteers. The study suggests two needle directions for performance of the block and that the risk of lung injury should be minimal. Expectations need to be confirmed by a clinical study.

GENERAL ARTICLES:

Markus Renner, Matthias Hohlrieder, Thomas Wölk, Friedrich Pühringer, Axel T. Kleinsasser, Christian Keller, and Arnulf Benzer

Administration of 100% Oxygen Before Removal of the Laryngeal Mask Airway Does Not Affect Postanesthetic Arterial Partial Pressure of Oxygen
Anesth Analg 2004 98: 257-259. [Abstract] [Full Text]  

IMPLICATIONS: The endotracheal tube and laryngeal mask airway are substantially different artificial airways used to ventilate the lungs of anesthetized patients. Breathing 100% oxygen before removing the endotracheal tube results in lung function defects. This study shows that oxygen breathing before removing the laryngeal mask airway has no effect on pulmonary function.

Achim von Goedecke, Wolfgang G. Voelckel, Volker Wenzel, Christoph Hörmann, Horst G. Wagner-Berger, Volker Dörges, Karl H. Lindner, and Christian Keller

Mechanical Versus Manual Ventilation via a Face Mask During the Induction of Anesthesia: A Prospective, Randomized, Crossover Study
Anesth Analg 2004 98: 260-263. [Abstract] [Full Text]  

IMPLICATIONS: In this model of apneic patients with an unprotected airway, pressure-controlled ventilation resulted in reduced inspiratory peak flow rates and lower peak airway pressures when compared with circle system ventilation, thus providing an additional patient safety effect during face-mask ventilation.

LETTERS TO THE EDITOR:

Alexandre Yazigi, Viviane Chalhoub, Samia Madi-Jebara, Fadia Haddad, Somrat Charuluxananan, Oranuch Kyokong, Wanna Somboonviboon, Arunchai Narasethakamol, and Pissamai Promlok

Ondansetron for Prevention of Intrathecal Opioids-Induced Pruritus, Nausea and Vomiting after Cesarean Delivery • Response
Anesth Analg 2004 98: 264. [Full Text]  

James M. Rich

Use of an Elevation Pillow to Produce the Head-Elevated Laryngoscopy Position for Airway Management in Morbidly Obese and Large-Framed Patients
Anesth Analg 2004 98: 264-265. [Full Text]  

Ziya Salihoglu, Sener Demiroluk, Yalim Dikmen, and Mustafa Taskin

Intramucosal pH Measurements for Extremely Obese Patients During Laparoscopic Bariatric Surgery
Anesth Analg 2004 98: 265-266. [Full Text]  

Carlos A. Dias-Junior, André Martineau, Pierre Couture, and André Denault

Pharmacologic Therapy of Acute Pulmonary Embolism • Response
Anesth Analg 2004 98: 266-267. [Full Text]  

NavParkash S. Sandhu, Deepal S. Sidhu, and Levon M. Capan

The Cost Comparison of Infraclavicular Brachial Plexus Block by Nerve Stimulator and Ultrasound Guidance
Anesth Analg 2004 98: 267-268. [Full Text]  

Dietrich Henzler, Rolf Rossaint, Ralf Kuhlen, Juraj Sprung, and Denis L. Bourke

Is There a Need for a Recruiting Strategy in Morbidly Obese Patients Undergoing Laparoscopic Surgery? • Response
Anesth Analg 2004 98: 268-269. [Full Text]  

Michael J. Jacka, Thomas Schricker, Brian Warriner, Anthony Boulton, Robert Hudson, Joel L. Parlow, Brian Milne, and Elizabeth G. VanDenKerkhof

More Conclusive Large-Scale Trials Necessary Before Recommending Use of Beta Blockade in Patients at Risk • Response
Anesth Analg 2004 98: 269-270. [Full Text]  

Nobuhide Kin, Kaori Tarui, and Kazuo Hanaoka

Successful Lung Isolation with One Bronchial Blocker in a Patient with Tracheal Bronchus
Anesth Analg 2004 98: 270. [Full Text]  

Richard M. Effros and Peter D. Constable

Stewart Approach Is Not Always a Practical Clinical Tool • Response
Anesth Analg 2004 98: 271-272. [Full Text]  

Steven M. Katz and Michael J. Bishop

Mivacurium and Bronchospasm • Response
Anesth Analg 2004 98: 272. [Full Text]  

Tiberiu Ezri, Peter Szmuk, David Warters, Jeffrey Katz, Philippe Juvin, Elisabeth Lavaut, Hervé Dupont, Pascale Lefevre, Monique Demetriou, Jean-Louis Dumoulin, and Jean-Marie Desmonts

Tracheal Intubation in Obese Patients • Response
Anesth Analg 2004 98: 272-273. [Full Text]  

José Eduardo Tanus-Santos

Pharmacologic Therapy of Pulmonary Vasoconstriction in Acute Pulmonary Embolism
Anesth Analg 2004 98: 273. [Full Text]  

Ban C. H. Tsui

Thoracic Epidural Catheter Placement in Infants via the Caudal Approach Under Electrocardiographic Guidance: Simplification of the Original Technique
Anesth Analg 2004 98: 273. [Full Text]  

Yoshihisa Fujino and Shuichi Nosaka

Assessment of Pain During Venous Puncture Using a Visual Analog Scale and Problems Associated with Prolonged Attachment of the Lidocaine Patch (PENLES®)
Anesth Analg 2004 98: 274. [Full Text]  

Jonathan V. Roth, Sandra L. Barcelona, Fatima Vilich, and Charles J. Coté

Comparison Between Level 1 and Rapid Infusion System • Response
Anesth Analg 2004 98: 274. [Full Text]  

Valter Casati, Hilde Pleym, Roar Stenseth, Alexander Wahba, Lise Bjella, Asbjørn Karevold, and Ola Dale

Tranexamic Acid and Coronary Surgery • Response
Anesth Analg 2004 98: 275. [Full Text]  

Thomas Hackmann

Smaller Dose of 0.5 mg/kg IV Ketorolac Is Sufficient to Provide Pain Relief in Children
Anesth Analg 2004 98: 275-276. [Full Text]  

Ram Roth, Steve Neustein, Chakib M. Ayoub, Marwan S. Rizk, Chadi I. Yaacoub, Anis S. Baraka, and Antoine M. Lteif

Dueling Fiberoptic Bronchoscope Techniques • Response
Anesth Analg 2004 98: 276-277. [Full Text]  

Cynthia H. Shields, Kevin M. Creamer, and Robert H. Friesen

Validation of the BIS Monitor During Conscious Sedation and Deep Sedation in Children • Response
Anesth Analg 2004 98: 277-278. [Full Text]  

Nicolas Bouteau, Benoît Tavernier, Christoph Wiesenack, and Cornelius Keyl

Stroke Volume Variation as an Indicator of Fluid Responsiveness • Response
Anesth Analg 2004 98: 278-279. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Mary McHugh and Ann C. Still

Anesthesia: A Comprehensive Review, 3rd ed. • Pain Medicine, A Comprehensive Review, 2nd ed.
Anesth Analg 2004 98: 280. [Full Text]  

ERRATA:

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Anesth Analg 2004 98: 256. [Full Text]  

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