EDITORIALS:

David S. Warner

Perioperative Neuroprotection: Are We Asking the Right Questions?
Anesth Analg 2004 98: 563-565. [Full Text]  

Michael Imhoff

The Spaghetti Syndrome Revisited
Anesth Analg 2004 98: 566-567. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Rainer Röhrig, Axel Junger, Bernd Hartmann, Joachim Klasen, Lorenzo Quinzio, Andreas Jost, Matthias Benson, and Gunter Hempelmann

The Incidence and Prediction of Automatically Detected Intraoperative Cardiovascular Events in Noncardiac Surgery
Anesth Analg 2004 98: 569-577. [Abstract] [Full Text]  

IMPLICATIONS: The objective of this study was to evaluate prognostic models for quality assurance purposes to predict the occurrence of automatically detected intraoperative cardiovascular events in 58,458 patients undergoing noncardiac surgery. Two newly developed models showed good discrimination but, because of reduced calibration, their clinical use is limited. The ASA physical status classification and the Revised Cardiac Risk Index are unsuitable for the prediction of intraoperative cardiovascular events.

Hilde Pleym, Roar Stenseth, Alexander Wahba, Lise Bjella, Arve Tromsdal, Asbjørn Karevold, and Ola Dale

Prophylactic Treatment with Desmopressin Does Not Reduce Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Before Surgery
Anesth Analg 2004 98: 578-584. [Abstract] [Full Text]  

IMPLICATIONS: Continuation of aspirin until the day before coronary artery bypass grafting may increase postoperative bleeding. The administration of desmopressin to these patients after the neutralization of heparin with protamine sulfate does not reduce postoperative bleeding.

George Djaiani, Barbara Phillips-Bute, Mihai Podgoreanu, Robert H. Messier, Joseph P. Mathew, Fiona Clements, and Mark F. Newman

The Association of Patent Foramen Ovale and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery
Anesth Analg 2004 98: 585-589. [Abstract] [Full Text]  

IMPLICATIONS: The presence of patent foramen ovale is associated with new-onset postoperative atrial fibrillation after coronary artery bypass graft surgery. This finding requires further validation in future prospective trials.

Nicolas Dalibon, Marc Moutafis, Ngai Liu, Jean-Dominique Law-Koune, Stéphanie Monsel, and Marc Fischler

Treatment of Hypoxemia During One-Lung Ventilation Using Intravenous Almitrine
Anesth Analg 2004 98: 590-594. [Abstract] [Full Text]  

IMPLICATIONS: IV almitrine improves oxygenation during one-lung ventilation without hemodynamic modification. Such treatment could be used when conventional ventilatory strategy fails to treat hypoxemia or cannot be used.

Alexandre Ouattara, Gilles Boccara, Patrick Lecomte, Rachid Souktani, Philippe Le Cosquer, Stéphane Mouren, Pierre Coriat, and Bruno Riou

Amplification by Hyperoxia of Coronary Vasodilation Induced by Propofol
Anesth Analg 2004 98: 595-603. [Abstract] [Full Text]  

IMPLICATIONS: Propofol induced a coronary vasodilation that was amplified in the presence of hyperoxia. This phenomenon does not seem to be related to previous coronary vasoconstriction. The myocardial effects of propofol were not significantly modified in the presence of hyperoxia.

Emmanuel Marret, Philippe Bonnin, Elisabeth Mazoyer, Bruno Riou, Ted Jacobs, Pierre Coriat, and Charles-Marc Samama

The Effects of a Polymerized Bovine-Derived Hemoglobin Solution in a Rabbit Model of Arterial Thrombosis and Bleeding
Anesth Analg 2004 98: 604-610. [Abstract] [Full Text]  

IMPLICATIONS: In a rabbit thrombosis and hemorrhagic model, a polymerized bovine-derived hemoglobin solution and a gelatin solution infusion decreased arterial thrombosis and lengthened bleeding time.

James P. Hofmann and Thomas J. Papadimos

Transesophageal Echocardiographic Diagnosis of a Liver Laceration Accompanied by Hemodynamic Instability (Case Report)
Anesth Analg 2004 98: 611-613. [Abstract] [Full Text]  

We report the diagnosis of a liver laceration in a trauma patient by novel use of the transesophageal echocardiographic imaging modality.

Bharathi H. Scott, Anthony J. Ippolito, and Irvin B. Krukenkamp

Damage to Pulmonary Artery Catheter During Transmyocardial Laser Revascularization (Case Report)
Anesth Analg 2004 98: 614-616. [Abstract] [Full Text]  

IMPLICATIONS: We report an unusual case of pulmonary artery catheter (PAC) damage during transmyocardial laser revascularization (TMLR). This observation should alert the anesthesiologist to the fact that the PAC may be damaged when TMLR is performed on the right side of the heart. We recommend that the PAC be withdrawn during this procedure.

PEDIATRIC ANESTHESIA:

Frederick A. Robertson and George M. Hoffman

Clinical Evaluation of the Effects of Signal Integrity and Saturation on Data Availability and Accuracy of Masimo SET® and Nellcor N-395 Oximeters in Children
Anesth Analg 2004 98: 617-622. [Abstract] [Full Text]  

IMPLICATIONS: We compared new pulse oximeters from Nellcor and Masimo and found that, with good signal conditions, both new devices performed similarly to older technology. Overall, Masimo reported less data as questionable than Nellcor. With poor signal conditions or during hypoxemia, the new devices are not clinically equivalent to each other or to the older technology.

C. Dadure, O. Raux, P. Gaudard, M. Sagintaah, R. Troncin, A. Rochette, and X. Capdevila

Continuous Psoas Compartment Blocks After Major Orthopedic Surgery in Children: A Prospective Computed Tomographic Scan and Clinical Studies
Anesth Analg 2004 98: 623-628. [Abstract] [Full Text]  

IMPLICATIONS: Continuous psoas compartment blocks provide optimal pain relief in children after major orthopedic surgery without major adverse events. The landmarks used, defined in a preliminary computed tomographic scan study, were more medial than conventional landmarks.

John C. Sanders, Ronald Gandhoke, and Michele Moro

Lumbar Epidural Blood Patch to Treat a Large, Symptomatic Postsurgical Cerebrospinal Fluid Leak of 5 Weeks Duration in a 3-Year-Old (Case Report)
Anesth Analg 2004 98: 629-631. [Abstract] [Full Text]  

IMPLICATIONS: An epidural blood patch successfully treated a large cerebrospinal fluid leak of long duration in a 3-yr-old. Considering the distress of such a leak to the patient, staff, and parents, epidural blood patch may be considered as an early treatment option.

AMBULATORY ANESTHESIA:

Anil Gupta, Tracey Stierer, Rhonda Zuckerman, Neal Sakima, Stephen D. Parker, and Lee A. Fleisher

Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review
Anesth Analg 2004 98: 632-641. [Abstract] [Full Text]  

IMPLICATIONS: A systematic analysis of the literature comparing postoperative recovery after propofol, isoflurane, desflurane, and sevoflurane-based anesthesia in adults demonstrated that early recovery was faster in the desflurane and sevoflurane groups. The incidence of nausea and vomiting were less frequent with propofol.

Martti Silvanto, Pekka Tarkkila, Marja-Leena Mäkelä, and Per H. Rosenberg

The Influence of Ambulation Time on the Incidence of Transient Neurologic Symptoms After Lidocaine Spinal Anesthesia
Anesth Analg 2004 98: 642-646. [Abstract] [Full Text]  

IMPLICATIONS: This study shows that early ambulation time does not increase the incidence of transient neurologic symptoms after spinal anesthesia with 50 mg of 2% lidocaine for elective knee arthroscopy.

ANESTHETIC PHARMACOLOGY:

Eiji Masaki, Masahito Kawamura, and Fusao Kato

Attenuation of Gap-Junction-Mediated Signaling Facilitated Anesthetic Effect of Sevoflurane in the Central Nervous System of Rats
Anesth Analg 2004 98: 647-652. [Abstract] [Full Text]  

IMPLICATIONS: The intracerebroventricular administration of the gap-junction inhibitor, carbenoxolone, reduced the MAC of sevoflurane, and sevoflurane suppressed the signaling through gap-junctions in the central nervous system. The inhibition of gap-junctions may be one of the mechanisms and the site of action of sevoflurane.

Robert J. Callahan, John D. Au, Matthias Paul, Canhui Liu, and C. Spencer Yost

Functional Inhibition by Methadone of N-Methyl-D-Aspartate Receptors Expressed in Xenopus Oocytes: Stereospecific and Subunit Effects
Anesth Analg 2004 98: 653-659. [Abstract] [Full Text]  

IMPLICATIONS: At clinically achievable concentrations, methadone inhibits functional N-methyl-D-aspartate receptors. These results indicate a unique mode of action by this opioid that may enhance its ability to treat chronic pain and to limit opioid tolerance.

John Streiff, David O. Warner, Elena Klimtchuk, William J. Perkins, Kristofer Jones, and Keith A. Jones

The Effects of Hexanol on G_i Subunits of Heterotrimeric G Proteins
Anesth Analg 2004 98: 660-7. [Abstract] [Full Text]  

IMPLICATIONS: Although the {alpha} subunit of heterotrimeric G proteins is a potential target of anesthetics, we found no evidence that hexanol affects the ability of the G{alpha}i subunit to bind or hydrolyze guanosine triphosphate, either in purified subunits or in subunits derived from smooth muscle cell membranes. This finding implies that this is not a mechanism by which hexanol interferes with receptor-G protein function.

Vance G. Nielsen and John P. Crow

Peroxynitrite Decreases Rabbit Tissue Factor Activity In Vitro
Anesth Analg 2004 98: 668-671. [Abstract] [Full Text]  

IMPLICATIONS: Tissue factor (TF) initiates physiological coagulation in vivo. Hepatoenteric ischemia-reperfusion injury is associated with peroxynitrite (OONO-) formation, coagulopathy and decreased TF activity in rabbits. We determined that OONO- decreased rabbit TF activity in vitro via thrombelastography(R).

Yukari Sudoh, Elaine Elliott Cahoon, Umberto De Girolami, and Ging Kuo Wang

Local Anesthetic Properties of a Novel Derivative, N-Methyl Doxepin, Versus Doxepin and Bupivacaine
Anesth Analg 2004 98: 672-676. [Abstract] [Full Text]  

IMPLICATIONS: N-methyl doxepin and doxepin are both potent Na+ channel blockers; they elicit rat sciatic nerve block lasting longer than that induced by bupivacaine and seem to be nontoxic to peripheral nerves at concentrations up to 10 mM.

Yutaka Oda, Tomoharu Funao, Katsuaki Tanaka, and Akira Asada

Vasodilation Increases the Threshold for Bupivacaine-Induced Convulsions in Rats
Anesth Analg 2004 98: 677-682. [Abstract] [Full Text]  

IMPLICATIONS: Bupivacaine, a long-acting local anesthetic, induces central nervous system toxicity when its plasma concentration is increased. Nicardipine and phentolamine increased the cumulative dose but did not affect the threshold plasma concentrations, required for bupivacaine-induced convulsions, suggesting that both nicardipine and phentolamine inhibited the increase in the plasma concentration of bupivacaine by inducing peripheral vasodilation.

Anil Agarwal, Mohammad F. Ansari, Devendra Gupta, Ravindra Pandey, Mehdi Raza, Prabhat K. Singh, Shiopriye, Sanjay Dhiraj, and Uttam Singh

Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection
Anesth Analg 2004 98: 683-686. [Abstract] [Full Text]  

IMPLICATIONS: Pain associated with IV injection of propofol is seen in 28%-90% patients. Pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg after manual venous occlusion for 1 min effectively attenuated pain associated with propofol injection. Thiopental 0.5 mg/kg was the most effective in prevention of propofol pain and can be used routinely.

Dajun Song, Mohamed Hamza, Paul F. White, Kevin Klein, Alejandro Recart, and Omeed Khodaparast

The Pharmacodynamic Effects of a Lower-Lipid Emulsion of Propofol: A Comparison with the Standard Propofol Emulsion
Anesth Analg 2004 98: 687-691. [Abstract] [Full Text]  

IMPLICATIONS: The pharmacodynamic profile of a lower-lipid containing emulsion of propofol (Ampofol(R)) was compared with Diprivan(R) when administered for induction and maintenance of general anesthesia. This preliminary study demonstrated that the two formulations of propofol were equivalent with respect to their induction and maintenance properties. However, Ampofol(R) was associated with a more frequent incidence of pain on injection.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Sascha Kreuer, Wolfram Wilhelm, Ulrich Grundmann, Reinhard Larsen, and Jörgen Bruhn

Narcotrend Index Versus Bispectral Index as Electroencephalogram Measures of Anesthetic Drug Effect During Propofol Anesthesia
Anesth Analg 2004 98: 692-697. [Abstract] [Full Text]  

IMPLICATIONS: This study in 18 adult patients undergoing radical prostatectomy describes the relationship between Narcotrend index and bispectral index versus predicted propofol effect compartment concentrations. In terms of prediction probability, the performance of the Narcotrend index and the bispectral index to predict propofol effect site concentrations was comparable.

Steven L. Jinks, Joseph F. Antognini, and Earl Carstens

Spectral Analysis of Movement Patterns During Anesthesia (Technical Communication)
Anesth Analg 2004 98: 698-702. [Abstract] [Full Text]  

IMPLICATIONS: Complex movement can occur when a noxious stimulus is applied to an anesthetized animal. The frequency components of these movement patterns can be described and quantified by spectral analysis, thus providing a useful tool to investigate the immobilizing properties of anesthetics.

Thierry Girard and Miodrag Filipovic

From the Echocardiography Machine to the Lecture Room: A Simple Method for Transferring Echocardiographic Frames and Loops to a Personal Computer (Technical Communication)
Anesth Analg 2004 98: 703-705. [Abstract] [Full Text]  

IMPLICATIONS: The transfer of frames and loops from echocardiographic machines to personal computers is often useful for publication, teaching, and educational purposes. We present an easy and cost-effective method for transferring frames and loops from any echocardiography machine into a personal computer using a digital video camera.

Paul S. Myles and Sesto Cairo

Artifact in the Bispectral Index in a Patient with Severe Ischemic Brain Injury (Case Report)
Anesth Analg 2004 98: 706-707. [Abstract] [Full Text]  

IMPLICATIONS: The bispectral index (BIS) can be prone to artifact. In this report we found that electrocardiogram artifact led to an apparent normal BIS in a patient with complete burst-suppression associated with severe brain injury.

PAIN MEDICINE:

Martin Schuster, André Gottschalk, Marc Freitag, and Thomas Standl

Cost Drivers in Patient-Controlled Epidural Analgesia for Postoperative Pain Management After Major Surgery
Anesth Analg 2004 98: 708-713. [Abstract] [Full Text]  

IMPLICATIONS: Patient-controlled epidural analgesia is increasingly used as first-line treatment for postoperative pain management. In this study, costs and cost drivers are analyzed for the first time for this new technique, based on 350 cases of pain therapy after major surgery in a university hospital.

Avi A. Weinbroum, Benjamin Bender, Alexander Nirkin, Shoshana Chazan, Isaac Meller, and Yehuda Kollender

Dextromethorphan-Associated Epidural Patient-Controlled Analgesia Provides Better Pain- and Analgesics-Sparing Effects than Dextromethorphan-Associated Intravenous Patient-Controlled Analgesia After Bone-Malignancy Resection: A Randomized, Placebo-Controlled, Double-Blinded Study
Anesth Analg 2004 98: 714-722. [Abstract] [Full Text]  

IMPLICATIONS: Patients undergoing bone-malignancy surgery under combined general and epidural anesthesia received randomly patient-controlled epidural analgesia (PCEA) or IV patient-controlled analgesia (PCA) postoperatively and dextromethorphan (DM) 90 mg or placebo double-blindly for 3 days (n = 30/group/set). The DM effect was recorded with minimal untoward effects: it afforded better pain control and reduced the demand for analgesics compared with the placebo, especially when associated with PCEA. DM patients ambulated earlier than placebo recipients.

Siobhan Hermanussen, MyHong Do, and Peter John Cabot

Reduction of ß-Endorphin-Containing Immune Cells in Inflamed Paw Tissue Corresponds with a Reduction in Immune-Derived Antinociception: Reversible by Donor Activated Lymphocytes
Anesth Analg 2004 98: 723-729. [Abstract] [Full Text]  

IMPLICATIONS: The immune system not only contributes to inflammation, but also provides localized analgesia. A depleted immune system results in a reduction of immune-derived analgesia and a potentiation of inflammatory pain. Donor activated lymphocytes reverse these effects, highlighting the importance of a functional immune system in inflammatory pain.

Vladimir Nekhendzy, Christo P. Fender, M. Frances Davies, Hendrikus J. M. Lemmens, Michael S. Kim, Donna M. Bouley, and Mervyn Maze

The Antinociceptive Effect of Transcranial Electrostimulation with Combined Direct and Alternating Current in Freely Moving Rats
Anesth Analg 2004 98: 730-737. [Abstract] [Full Text]  

IMPLICATIONS: Transcranial electrostimulation produces a significant, frequency-dependent antinociceptive effect that may be mediated by cutaneous nerves of the scalp.

I. Dobrydnjov, K. Axelsson, L. Berggren, J. Samarütel, and B. Holmström

Intrathecal and Oral Clonidine as Prophylaxis for Postoperative Alcohol Withdrawal Syndrome: A Randomized Double-Blinded Study
Anesth Analg 2004 98: 738-744. [Abstract] [Full Text]  

IMPLICATIONS: In this randomized, double-blinded study, clonidine 150 {micro}g both intrathecally and orally prevented postoperative alcohol-withdrawal symptoms in alcohol-dependent men. The effect was superior to that with a single dose of diazepam 10 mg orally.

Leonardo Kapural, Salim M. Hayek, Michael Stanton-Hicks, and Nagy Mekhail

Decreased Insulin Requirements with Spinal Cord Stimulation in a Patient with Diabetes (Case Report)
Anesth Analg 2004 98: 745-746. [Abstract] [Full Text]  

IMPLICATIONS: Spinal cord stimulation when used for control of chronic pain in diabetics may provide additional benefits of improving glycemic control and insulin requirements.

Bruce Ben-David, Kevin Schmalenberger, and Jacques E. Chelly

Analgesia After Total Knee Arthroplasty: Is Continuous Sciatic Blockade Needed in Addition to Continuous Femoral Blockade? (Brief Report)
Anesth Analg 2004 98: 747-749. [Abstract] [Full Text]  

IMPLICATIONS: A child with neurofibromatosis, scoliosis, and a chest wall deformity presenting for spinal fusion developed severe hypotension while prone. This was due to compression of the heart by the sternum, not compression of the great vessels by neurofibromas. Sternal pressure in prone patients with chest wall deformities should be avoided. Unique management included the use of transesophageal echocardiography to determine the cause of the hypotension.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

J. P. Abenstein, Kirsten Hall Long, Brian P. McGlinch, and Niki M. Dietz

Is Physician Anesthesia Cost-Effective?
Anesth Analg 2004 98: 750-757. [Abstract] [Full Text]  

IMPLICATIONS: Recent outcome studies suggest improved patient outcomes when physicians medically direct nurse anesthetists versus anesthesia care delivered with nonmedically directed nurses. The relative cost-effectiveness of this practice model is, however, unknown. This economic analysis suggests that outcome gains with physician anesthesia may be obtained at cost savings or, under conservative assumptions, at a cost deemed reasonable by society.

Franklin Dexter and Alex Macario

When to Release Allocated Operating Room Time to Increase Operating Room Efficiency
Anesth Analg 2004 98: 758-762. [Abstract] [Full Text]  

IMPLICATIONS: Provided operating room (OR) time is allocated and cases are scheduled based on maximizing OR efficiency, then whether OR time is released five days or one day before the day of surgery has a negligible effect on OR efficiency.

CRITICAL CARE AND TRAUMA:

Mats K. E. B. Wallin and Samson Wajntraub

Evaluation of Bluetooth as a Replacement for Cables in Intensive Care and Surgery (Technical Communication)
Anesth Analg 2004 98: 763-767. [Abstract] [Full Text]  

IMPLICATIONS: Bluetooth, a new radio technology transmitting at 2.4 GHz, was tested in a clinical setting. The study showed that a single Bluetooth link was robust and electromagnetically compatible with the tested electronic medical devices.

Jie Tian, Xin Lin, Ren Guan, and Jian-Guo Xu

The Effects of Hydroxyethyl Starch on Lung Capillary Permeability in Endotoxic Rats and Possible Mechanisms (Technical Communication)
Anesth Analg 2004 98: 768-774. [Abstract] [Full Text]  

IMPLICATIONS: A randomized, controlled laboratory experiment indicated that hydroxyethyl starch (HES) could reduce increased lung capillary permeability in endotoxemia. This effect may be due to an antiinflammatory effect of HES.

Hermann Wrigge, Ulrike Uhlig, Jörg Zinserling, Elisabeth Behrends-Callsen, Gunther Ottersbach, Matthias Fischer, Stefan Uhlig, and Christian Putensen

The Effects of Different Ventilatory Settings on Pulmonary and Systemic Inflammatory Responses During Major Surgery (Technical Communication)
Anesth Analg 2004 98: 775-781. [Abstract] [Full Text]  

IMPLICATIONS: In 62 patients undergoing elective major thoracic or abdominal surgery, mechanical ventilation with low tidal volumes and positive end-expiratory pressure or high tidal volumes and zero end-expiratory pressure did not result in different pulmonary or systemic levels of measured inflammatory markers.

Christian Rylander, Marieann Högman, Gaetano Perchiazzi, Anders Magnusson, and Göran Hedenstierna

Functional Residual Capacity and Respiratory Mechanics as Indicators of Aeration and Collapse in Experimental Lung Injury (Technical Communication)
Anesth Analg 2004 98: 782-789. [Abstract] [Full Text]  

IMPLICATIONS: Lung injury was quantified on computed tomography and related to monitored values of functional residual capacity and mechanical properties of the respiratory system. We found the functional residual capacity to be a more sensitive marker of the lung perturbations than the compliance. It might be of value to include functional residual capacity in the monitoring of acute lung injury.

Guy Weinberg, Chanannait Paisanthasan, Douglas Feinstein, and William Hoffman

The Effect of Bupivacaine on Myocardial Tissue Hypoxia and Acidosis During Ventricular Fibrillation (Technical Communication)
Anesth Analg 2004 98: 790-795. [Abstract] [Full Text]  

IMPLICATIONS: In this animal study pretreatment with bupivacaine attenuated the progression of myocardial acidosis during ventricular fibrillation. The dogs regained normal hemodynamic variables after lipid infusion. The findings suggest such that bupivacaine may protect the heart against ischemic acidosis.

Anastasia Anthi, Chrisostomos Katsenos, Stavroula Georgopoulou, and Konstantinos Mandragos

Massive Rupture of a Hepatic Hydatid Cyst Associated with Mechanical Ventilation (Case Report)
Anesth Analg 2004 98: 796-797. [Abstract] [Full Text]  

IMPLICATIONS: We present a case of massive rupture of hepatic Echinococcus cyst associated with mechanical ventilation. We believe that the use of a double-lumen endotracheal tube could be crucial in the management of the hydatid cysts of the liver with thoracic involvement.

NEUROSURGICAL ANESTHESIA:

Masahiko Kawaguchi, John C. Drummond, Daniel J. Cole, Paul J. Kelly, Mark P. Spurlock, and Piyush M. Patel

Effect of Isoflurane on Neuronal Apoptosis in Rats Subjected to Focal Cerebral Ischemia
Anesth Analg 2004 98: 798-805. [Abstract] [Full Text]  

IMPLICATIONS: The effect of isoflurane on neuronal apoptosis was investigated in rats subjected to focal cerebral ischemia. In isoflurane-anesthetized animals, ischemia-induced apoptosis occurred during the later stages of postischemic recovery. Isoflurane did not inhibit postischemic neuronal apoptosis.

Douglas V. Brown, L. Penfield Faber, and Kenneth J. Tuman

Perioperative Stroke Caused by Arterial Tumor Embolism (Case Report)
Anesth Analg 2004 98: 806-809. [Abstract] [Full Text]  

IMPLICATIONS: We present a case of stroke diagnosed in the recovery room after lung cancer resection. The cause of the stroke was tumor that embolized from the lung to the middle cerebral artery. Tumor embolism should be considered in the differential diagnosis of immediate postoperative stroke after lung cancer surgery.

OBSTETRIC ANESTHESIA:

Eileen Lew, Seow-Woon Yeo, and Easaw Thomas

Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean Delivery: A Prospective, Randomized, Double-Blind Study
Anesth Analg 2004 98: 810-814. [Abstract] [Full Text]  

IMPLICATIONS: When compared with conventional, single-shot spinal anesthesia, epidural volume extension of a small-dose spinal block provides satisfactory anesthesia for cesarean delivery with only 55% of the bupivacaine dose required and is associated with faster motor recovery of the lower limbs.

Warwick D. Ngan Kee, Kim S. Khaw, Floria F. Ng, and Bee B. Lee

Prophylactic Phenylephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery
Anesth Analg 2004 98: 815-821. [Abstract] [Full Text]  

IMPLICATIONS: In patients receiving spinal anesthesia for elective cesarean delivery, a prophylactic infusion of phenylephrine 100 {micro}g/min decreased the incidence, frequency, and magnitude of hypotension with equivalent neonatal outcome compared with a control group receiving IV bolus phenylephrine.

Sidney Benlolo, Cécile Lefoll, Vahan Katchatouryan, Didier Payen, and Alexandre Mebazaa

Successful Use of Levosimendan in a Patient with Peripartum Cardiomyopathy (Case Report)
Anesth Analg 2004 98: 822-824. [Abstract] [Full Text]  

IMPLICATIONS: Acute heart failure is a life-threatening event that only rarely occurs during childbirth. We report a case of a woman who experienced cardiovascular collapse during vaginal delivery. We determined that she met current diagnostic criteria for peripartum cardiomyopathy, and we successfully treated her with levosimendan, a calcium-sensitizing drug with additional vasodilation properties.

Sandrine Wiertlewski, Armelle Magot, Sophie Drapier, Jean-Marc Malinovsky, and Yann Péréon

Worsening of Neurologic Symptoms After Epidural Anesthesia for Labor in a Guillain-Barré Patient (Case Report)
Anesth Analg 2004 98: 825-827. [Abstract] [Full Text]  

IMPLICATIONS: Because of the potential interaction between regional anesthesia and Guillain-Barre syndrome in pregnant women, the risks of worsening neurologic status and alternative analgesia options should be discussed with the parturient.

Brian O. Chan and Michael J. Paech

Persistent Cerebrospinal Fluid Leak: A Complication of the Combined Spinal-Epidural Technique (Case Report)
Anesth Analg 2004 98: 828-830. [Abstract] [Full Text]  

IMPLICATIONS: Combined spinal-epidural block can be complicated by persistent fluid leak from the skin insertion site. Testing for the presence of cerebrospinal fluid may be a useful aid to management.

REGIONAL ANESTHESIA:

Elisabeth Gaertner, Pablo Lascurain, Cyrille Venet, Xavier Maschino, Alina Zamfir, Radu Lupescu, and Admir Hadzic

Continuous Parasacral Sciatic Block: A Radiographic Study
Anesth Analg 2004 98: 831-834. [Abstract] [Full Text]  

IMPLICATIONS: The parasacral sciatic block results in a frequent success rate of blockade of all three major components of the sciatic plexus (tibial, common peroneal, and cutaneous nerve of thigh). A contrast radiography can be used to confirm the proper position of the catheter.

Dilek Memis, Alparslan Turan, Beyhan Karamanlioglu, Zafer Pamukçu, and Imran Kurt

Adding Dexmedetomidine to Lidocaine for Intravenous Regional Anesthesia
Anesth Analg 2004 98: 835-840. [Abstract] [Full Text]  

IMPLICATIONS: This study was designed to evaluate the effect of dexmedetomidine when added to lidocaine for IV regional anesthesia. This is the first clinical study demonstrating that the addition of 0.5 {micro}g/kg dexmedetomidine to lidocaine for IV regional anesthesia improves quality of anesthesia and intraoperative-postoperative analgesia without causing side effects.

Shigeru Saito, Inas A. M. Radwan, Koichi Nishikawa, Hideaki Obata, Tomonori Okamoto, Toshio Kanno, and Fumio Goto

Intracellular Calcium Increases in Growth Cones Exposed to Tetracaine
Anesth Analg 2004 98: 841-845. [Abstract] [Full Text]  

IMPLICATIONS: Tetracaine induced intracellular Ca2+ increases and growth cone collapse in dorsal root ganglion neurons. The Ca2+ hot spot in the growth cone expanded into the neurite from periphery towards the cell body.

Andrew Sukiennik, Daniel B. Carr, Iwona Bonney, James E. Marchand, Heinrich Wurm, and Grannum R. Sant

The Effect of Short-Term Epidural Local Anesthetic Blockade on Urinary Levels of Substance P in Interstitial Cystitis
Anesth Analg 2004 98: 846-850. [Abstract] [Full Text]  

IMPLICATIONS: Substance P levels in urine initially increased and then declined in a series of 5 patients who achieved pain control by epidural local anesthetic infusion during a flare-up of interstitial cystitis.

Michal Barak, Doron Fischer, Marina Gat, and Yeshayahu Katz

Retroperitoneal Hematoma After Spinal Anesthesia with the Paramedian Approach (Case Report)
Anesth Analg 2004 98: 851-853. [Abstract] [Full Text]  

IMPLICATIONS: We describe a case of a large retroperitoneal hematoma after the placement of an uneventful spinal block. The patient required four units of packed red blood cells despite having normal coagulation profiles throughout the event. The diagnosis and treatment of retroperitoneal hematoma are discussed.

GENERAL ARTICLES:

Christophe Baillard, Sylvie Bourdiau, Philippe Le Toumelin, Farid Ait Kaci, Bruno Riou, Michel Cupa, and C. Marc Samama

Assessing Residual Neuromuscular Blockade Using Acceleromyography Can Be Deceptive in Postoperative Awake Patients
Anesth Analg 2004 98: 854-7. [Abstract] [Full Text]  

IMPLICATIONS: Clinicians should be aware that acceleromyography as used in this study does not always provide precise train-of-four ratio measurements. Two isolated acceleromyograph train-of-four ratios are not an accurate representation of the neuromuscular status of the patient recovering from anesthesia.

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

The Intubating Laryngeal Mask Airway Facilitates Tracheal Intubation in the Lateral Position
Anesth Analg 2004 98: 858-861. [Abstract] [Full Text]  

IMPLICATIONS: Blind intubation via the intubating laryngeal mask airway (ILMA) offers frequent success and a clinically acceptable intubation time even in patients in the lateral position.

Satinder Gombar, Sukanya Mitra, Deepak Thapa, Kanti K. Gombar, and Richa Pathak

Anesthetic Considerations in Steroid-Induced Mediastinal Lipomatosis (Case Report)
Anesth Analg 2004 98: 862-864. [Abstract] [Full Text]  

IMPLICATIONS: This case report highlights problems during right internal jugular vein cannulation resulting from high back pressure and flow from superior vena cava obstruction in steroid-induced mediastinal lipomatosis. Other anesthetic considerations in mediastinal lipomatosis are also discussed.

MEETING REPORT:

Girish P. Joshi

The Society for Ambulatory Anesthesia: 18th Annual Meeting Report
Anesth Analg 2004 98: 865-869. [Full Text]  

LETTERS TO THE EDITOR:

Bingshuang Fang, James Norris, V. K. Grover, Rajesh Mahajan, Tiberiu Ezri, Peter Szmuk, Yitzhak Cohen, and Robert D. Warters

Class Zero Airway and Laryngoscopy • Response • Response
Anesth Analg 2004 98: 870-871. [Full Text]  

Steve Serlin

Check Your Tanks
Anesth Analg 2004 98: 871. [Full Text]  

Christoph N. Seubert, Michael E. Mahla, M. Messner, U. Beese, J. Romstöck, M. Dinkel, and K. Tschaikowsky

Bispectral Index Decline Caused by Neuromuscular Blockade • Response
Anesth Analg 2004 98: 871-872. [Full Text]  

Franklin Dexter, Richard H. Epstein, Amr E. Abouleish, Charles W. Whitten, and David A. Lubarsky

Impact of Reducing Turnover Times on Staffing Costs
Anesth Analg 2004 98: 872. [Full Text]  

Peter Bradley, Magdalena Hiler, David Menon, Chun-Chang Yeh, Ching-Tang Wu, and Chih-Shung Wong

Vasopressin in Acute Brain Injury: A Note of Caution • Response
Anesth Analg 2004 98: 872-873. [Full Text]  

N. Bruder, L. Velly, M. Rey, M. Messner, U. Beese, J. Romstöck, M. Dinkel, and K. Tschaikowsky

A Low Voltage EEG Signal May Give Low Bispectral Index Values • Response
Anesth Analg 2004 98: 873-874. [Full Text]  

Virginie Luce, Frédéric J. Mercier, and Dan Benhamou

Anesthetic Management for a Parturient Affected by the VACTERL Association
Anesth Analg 2004 98: 874. [Full Text]  

Majd Al Shamaa, Paul Jefferson, David R. Ball, K. Nakazawa, D. Ikeda, S. Ishikawa, and K. Makita

Lingual Tonsillar Hypertrophy: Airway Management Using Straight Blade Direct Laryngoscopy • Response
Anesth Analg 2004 98: 874-875. [Full Text]  

M. Saeed Dhamee, Wolfram Schummer, Claudia Schummer, and Jürgen Fuchs

Technique to Detect Small Leaks Before Insertion of Pulmonary Artery Catheter Balloon • Response
Anesth Analg 2004 98: 875. [Full Text]  

Richard P. Dutton, Clifford Boehm, Roger Shere-Wolfe, Mary Hyder, David Tarantino, Maureen McCunn, Richard W. Rosenquist, and David J. Birnbach

Epidural Catheter Placement May Also Benefit Intubated and Sedated Patients • Response
Anesth Analg 2004 98: 875-876. [Full Text]  

Prabhat Kumar Sinha, Praveen Kumar Neema, Sethuraman Manikandan, and K. P. Unnikrishnan

Physical Incompatibility of Injection Diclofenac Sodium with Isolyte P
Anesth Analg 2004 98: 876. [Full Text]  

Kahoru Nishina, Katsuya Mikawa, Yoji Yonemoto, Yasushi Sugimoto, Junichi Ogata, Toru Yokoyama, Takashi Okamoto, and Kouichiro Minami

The Efficacy of Bolus Administration of Landiolol for Attenuating Tachycardia in Pheochromocytoma • Response
Anesth Analg 2004 98: 876-878. [Full Text]  

CORRECTION:

Correction
Anesth Analg 2004 98: 878. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Patrick Neligan, Clifford Deutschman, and Douglas R. Bacon

Oh’s Intensive Care Manual, 5th Edition, A.D. Bersten & N. Soni, Butterworth Heinmann, 2003 • Anesthesia for Oral and Maxillofacial Surgery (Vol.41, No. 3, International Anesthesiology Clinics)
Anesth Analg 2004 98: 879. [Full Text]  

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