EDITORIALS:

Jerrold H. Levy

Anaphylactic Reactions to Neuromuscular Blocking Drugs: Are We Making the Correct Diagnosis?
Anesth Analg 2004 98: 881-882. [Full Text] [PDF] [Request Permissions]  

CARDIOVASCULAR ANESTHESIA:

Charles W. Buffington and Elisabet U. M. Nystrom

Neither the Accuracy nor the Precision of Thermal Dilution Cardiac Output Measurements Is Altered by Acute Tricuspid Regurgitation in Pigs
Anesth Analg 2004 98: 884-890. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Cardiac output is a valuable measurement that guides the medical care of patients with heart and lung disease. This study demonstrates that the thermal dilution technique of determining cardiac output is valid when acute tricuspid valve regurgitation is present in pigs.

Andrew D. Maslow, Meredith M. Regan, Carl Schwartz, Arthur Bert, and Arun Singh

Inotropes Improve Right Heart Function in Patients Undergoing Aortic Valve Replacement for Aortic Stenosis
Anesth Analg 2004 98: 891-902. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Compared with placebo, both epinephrine and milrinone similarly improved biventricular performance after aortic valve replacement, with a greater impact on right ventricular function. Choice of either inotropic drug should be driven by blood pressure and hemodynamic goals in this setting.

Leanne Groban, Jason C. Vernon, and John Butterworth

Intrathecal Morphine Reduces Infarct Size in a Rat Model of Ischemia-Reperfusion Injury
Anesth Analg 2004 98: 903-909. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Our findings suggest that spinally-administered morphine provides a previously unrecognized cardioprotective benefit. In anesthetized rats subjected to ischemia-reperfusion injury, we show that very small doses of intrathecal morphine reduce infarct size in rats, and this benefit is as great as that provided by much larger doses of IV morphine.

Koung-Shing Chu, Jong-Hau Hsu, Shie-Shan Wang, Chao-Shun Tang, Kuang-I Cheng, Chien-Kuo Wang, and Jiunn-Ren Wu

Accurate Central Venous Port-A Catheter Placement: Intravenous Electrocardiography and Surface Landmark Techniques Compared by Using Transesophageal Echocardiography
Anesth Analg 2004 98: 910-914. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Intravenous electrocardiography guidance to position catheters obtains a satisfactory catheter tip placement that is in accordance with transesophageal echocardiography views. The surface landmark technique does not result in reliable placement at the superior vena cava-right atrium junction.

Rumi Katai, Isao Tsuneyoshi, Junichirou Hamasaki, Masanori Onomoto, Shoichi Suehiro, Ryuzo Sakata, and Yuichi Kanmura

The Variable Effects of Dopamine Among Human Isolated Arteries Commonly Used for Coronary Bypass Grafts
Anesth Analg 2004 98: 915-920. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Differing affinities of dopamine for dopamine A1- and {alpha}1-adrenergic receptors may lead to it having variable contractile and vasorelaxant effects among the arteries supplying grafts for coronary bypass surgery.

Claude Lentschener, Alexandra Gomola, Sophie Grabar, Olivier Soubrane, Bertrand Dousset, Pierre-Philippe Massault, Catherine Penhoud, and Yves Ozier

The Effect of Erythropoietin on Allogeneic Blood Requirement in Patients Undergoing Elective Liver Resection: A Model Simulation
Anesth Analg 2004 98: 921-926. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A mathematical model simulation suggests that the routine preoperative administration of erythropoietin to patients scheduled for major and median liver resection presenting with a preoperative hemoglobin concentration in the range 10-13 g/dL could reduce blood transfusion requirements. However, the cost/benefit ratio warrants consideration.

Edward Lowenstein

Cardiac Anesthesiology, Professionalism and Ethics: A Microcosm of Anesthesiology and Medicine (Special Article)
Anesth Analg 2004 98: 927-934. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Cardiac anesthesiologists have contributed to enhanced survival and decreased morbidity of patients with heart disease undergoing surgery. These achievements do not by themselves fulfill the moral obligations incurred by the concept of Civic Professionalism, however. Cardiac anesthesiologists, in common with all physicians, must share the obligation to advocate for the human right of universal access to health care.

Dominic A. Cave and Barry A. Finegan

Massive Gastrointestinal Bleeding Complicating Portal Vein Cross-Clamping During Liver Transplantation (Case Report)
Anesth Analg 2004 98: 935-936. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A case of severe bleeding during liver transplantation is described in a patient who had a history of bleeding from the stomach before surgery. The importance of understanding surgical options and the ability to provide rapid massive transfusion in the management of this complication are discussed.

James E. Baker, Greg Stratmann, Charles Hoopes, R. Donateillo, Elaine Tseng, and I. A. Russell

Profound Hypoxemia Resulting from Shunting Across an Inadvertent Atrial Septal Tear After Left Ventricular Assist Device Placement (Case Report)
Anesth Analg 2004 98: 937-940. [Abstract] [Full Text] [PDF] [VIDEOS]  [Request Permissions]  

IMPLICATIONS: A traumatic atrial septal defect after atrial cannulation caused a right-to-left intracardiac shunt on initiation of left ventricular assist device support that was further aggravated by chest closure and pleural suction, culminating in severe hypoxemia.

PEDIATRIC ANESTHESIA:

Egbert Huettemann, Thomas Junker, Kyriasis P. Chatzinikolaou, Gritta Petrat, Samir G. Sakka, Lothar Vogt, and Konrad Reinhart

The Influence of Anthracycline Therapy on Cardiac Function During Anesthesia
Anesth Analg 2004 98: 941-947. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Previous treatment with anthracylines, a group of chemotherapeutic drugs in use for childhood cancer, may enhance the myocardial depressive effect of anesthetics even in children and adolescents with normal resting cardiac function.

Olivier Raux, Alain Rochette, Estelle Morau, Christophe Dadure, Christine Vergnes, and Xavier Capdevila

The Effects of Spread of Block and Adrenaline on Cardiac Output After Epidural Anesthesia in Young Children: A Randomized, Double-Blind, Prospective Study
Anesth Analg 2004 98: 948-955. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Epidural anesthesia may induce significant hemodynamic changes, well documented in adults. Using noninvasive hemodynamic monitoring in children, we reported an increase in cardiac output and a decrease in arterial blood pressure only when epinephrine was added to epidurally-injected local anesthetics.

Joseph D. Tobias

A Review of Intrathecal and Epidural Analgesia After Spinal Surgery in Children (Review Article)
Anesth Analg 2004 98: 956-965. [Abstract] [Full Text] [PDF] [Request Permissions]  

David A. Rosen, Denzil W. Hawkinberry, II, Kathleen R. Rosen, Robert A. Gustafson, Jeffery P. Hogg, and Lynn M. Broadman

An Epidural Hematoma in an Adolescent Patient After Cardiac Surgery (Case Report)
Anesth Analg 2004 98: 966-969. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Epidural hematoma is a rare complication of epidural anesthesia and has not been reported in pediatric patients undergoing cardiac surgery. The successful treatment of this complication requires swift recognition, diagnosis, and surgical intervention.

AMBULATORY ANESTHESIA:

Hong Ma, Jun Tang, Paul F. White, Alan Zaentz, Ronald H. Wender, Alexander Sloninsky, Robert Naruse, Robert Kariger, Raymond Quon, Dennis Wood, and Brendan J. Carroll

Perioperative Rofecoxib Improves Early Recovery After Outpatient Herniorrhaphy
Anesth Analg 2004 98: 970-975. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Rofecoxib (50 mg per os), given before and after surgery, was effective in improving postoperative pain management, as well as the speed and quality of recovery after outpatient inguinal herniorrhaphy. However, it failed to accelerate the postdischarge resumption of normal activities of daily living.

Ghassem E. Larijani, Michael E. Goldberg, Mohammadreza Hojat, Behnam Khaleghi, Jeffrey B. Dunn, and Alex T. Marr

Modafinil Improves Recovery After General Anesthesia
Anesth Analg 2004 98: 976-981. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Modafinil significantly reduces fatigue and improves feelings of alertness and energy in postoperative patients. Patients recovering from general anesthesia can significantly benefit from modafinil administration.

Young-Chang P. Arai and Wasa Ueda

Warm Steaming Enhances the Topical Anesthetic Effect of Lidocaine
Anesth Analg 2004 98: 982-985. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We showed that the skin pretreatment with a steamed towel (at 45{degrees}C) enhanced the anesthetic effect of a topical lidocaine tape in female volunteers.

ANESTHETIC PHARMACOLOGY:

Gilles Dhonneur, Xavier Combes, Didier Chassard, and Jean Claude Merle

Skin Sensitivity to Rocuronium and Vecuronium: A Randomized Controlled Prick-Testing Study in Healthy Volunteers
Anesth Analg 2004 98: 986-989. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Building concentration-skin response curves to prick tests with rocuronium and vecuronium in healthy, nonatopic, anesthesia-naive male and female volunteers demonstrated that the nonreactive concentration for both muscle relaxants is the 1:1000 dilution of the stock solutions. Our observation calls into question the past practice of prick-testing skin for sensitivity to neuromuscular blocking drugs by using undiluted solutions.

Tomoki Nishiyama, Takahiro Fujimoto, and Kazuo Hanaoka

A Comparison of Liver Function After Hepatectomy in Cirrhotic Patients Between Sevoflurane and Isoflurane in Anesthesia with Nitrous Oxide and Epidural Block
Anesth Analg 2004 98: 990-993. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In cirrhotic patients with Child-Pugh Grade A, isoflurane induced more of an increase in serum concentrations of liver enzymes after surgery than sevoflurane when combined with nitrous oxide and epidural block. However, the increases were small, and there was no clinical liver damage.

Soichiro Yamashita, Hiroshi Yamaguchi, Yu Hisajima, Kazuhiro Ijima, Kaori Saito, Ai Chiba, and Toru Yasunaga

Preoperative Oral Dextromethorphan Attenuated Tourniquet-Induced Arterial Blood Pressure and Heart Rate Increases in Knee Cruciate Ligament Reconstruction Patients Under General Anesthesia
Anesth Analg 2004 98: 994-998. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We demonstrated that preoperative oral dextromethorphan 30 mg significantly attenuated arterial blood pressure and heart rate increases at 60 min during tourniquet inflation in patients undergoing knee cruciate ligament reconstruction under general anesthesia.

John K. Hayes, Dmytro M. Havaleshko, Roman V. Plachinta, and George F. Rich

Isoflurane Pretreatment Supports Hemodynamics and Leukocyte Rolling Velocities in Rat Mesentery During Lipopolysaccharide-Induced Inflammation
Anesth Analg 2004 98: 999-1006. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Isoflurane pretreatment supported hemodynamics and increased leukocyte rolling velocities in the mesenteric microcirculation during lipopolysaccharide-induced inflammation. Faster rolling velocities may reduce the incidence of inflammation by decreasing leukocyte-endothelial interactions and cellular injury.

Lothar W. de Rossi, Martina Brueckmann, Steffen Rex, Marco Barderschneider, Wolfgang Buhre, and Rolf Rossaint

Xenon and Isoflurane Differentially Modulate Lipopolysaccharide-Induced Activation of the Nuclear Transcription Factor KB and Production of Tumor Necrosis Factor- and Interleukin-6 in Monocytes
Anesth Analg 2004 98: 1007-1012. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study has shown that monocytes respond to lipopolysaccharide (LPS) in the presence of xenon with an increased activation of nuclear transcription factor (NF)-{kappa}B, whereas isoflurane inhibits LPS-induced activation of NF-{kappa}B. These findings suggest a possible molecular mechanism for the different effects of both anesthetics on monocyte tumor necrosis factor-{alpha} and interleukin-6 production.

Mark D. Graham, Philip M. Hopkins, and Simon M. Harrison

The Effects of Alfentanil on Cytosolic Ca²⁺ and Contraction in Rat Ventricular Myocytes
Anesth Analg 2004 98: 1013-1016. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Alfentanil, at concentrations achieved in clinical practice, increased contraction in ventricular cells by a mechanism involving an increase in the sensitivity of the contractile apparatus to Ca2+.

Tetsuro Shirasaka, Yasuhiro Yoshimura, De-Lai Qiu, and Mayumi Takasaki

The Effects of Propofol on Hypothalamic Paraventricular Nucleus Neurons in the Rat
Anesth Analg 2004 98: 1017-1023. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We investigated the actions of propofol on the rat hypothalamic paraventricular nucleus neurons, which are involved in the control of cardiovascular and sympathetic functions. The results suggest that propofol enhancement of gamma-aminobutyric acidA-receptor mediated currents and inhibition of voltage-gated Ca2+ currents at the central level may be, at least in part, involved in general anesthetic-induced cardiovascular and sympathetic depression.

Takashi Kawasaki, Chika Kawasaki, Masanori Ogata, and Akio Shigematsu

The Effect of Local Anesthetics on Monocyte mCD14 and Human Leukocyte Antigen-DR Expression
Anesth Analg 2004 98: 1024-9. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Monocyte surface receptors have a crucial role in the host response to microbial infection. We investigated the effects of local anesthetics on monocyte mCD14 and human leukocyte antigen (HLA)-DR expression. Our results show that local anesthetics suppress HLA-DR expression on the surface of human monocytes.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Ryoichi Ochiai, Tatsuya Yamada, Shunya Kiyama, Takako Nakaoji, and Junzo Takeda

Bispectral Index as an Indicator of Seizure Inducibility in Electroconvulsive Therapy Under Thiopental Anesthesia
Anesth Analg 2004 98: 1030-1035. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We found that the bispectral index (BIS) score serves as an indicator of seizure inducibility in electroconvulsive therapy (ECT) under thiopental anesthesia and that the relationship between BIS score and seizure duration was not linear, suggesting that the pharmacological mechanisms by which thiopental and propofol suppress ECT seizure activity are different.

Satoshi Hagihira, Kenta Okitsu, and Maki Kawaguchi

Unusually Low Bispectral Index Values During Emergence from Anesthesia (Case Report)
Anesth Analg 2004 98: 1036-1038. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: When BIS values do not adequately correspond with clinical status, it is necessary to check raw electroencephalogram waveforms to more clearly characterize patient status.

PAIN MEDICINE:

Beyhan Karamanlioglu, Alparslan Turan, Dilek Memis, and Mevlüt Türe

Preoperative Oral Rofecoxib Reduces Postoperative Pain and Tramadol Consumption in Patients After Abdominal Hysterectomy
Anesth Analg 2004 98: 1039-1043. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study was designed to determine whether the administration of a preoperative dose of rofecoxib to patients undergoing abdominal hysterectomy would decrease patient-controlled analgesia tramadol use or enhance analgesia. We conclude that the preoperative administration of oral rofecoxib provided a significant analgesic benefit and decreased the opioid requirements in patients undergoing abdominal hysterectomy.

Rebecca F. K. Kwok, Jean Lim, Matthew T.V Chan, Tony Gin, and Wallace K.Y. Chiu

Preoperative Ketamine Improves Postoperative Analgesia After Gynecologic Laparoscopic Surgery
Anesth Analg 2004 98: 1044-1049. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In women undergoing laparoscopic gynecologic surgery, a small preoperative dose of ketamine (0.15 mg/kg) produced preemptive analgesia. There were no significant hemodynamic and psychological side effects with this dose.

Wolfgang Koppert, Marc Weigand, Frank Neumann, Reinhard Sittl, Jürgen Schuettler, Martin Schmelz, and Werner Hering

Perioperative Intravenous Lidocaine Has Preventive Effects on Postoperative Pain and Morphine Consumption After Major Abdominal Surgery
Anesth Analg 2004 98: 1050-1055. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The perioperative administration of systemic small-dose lidocaine reduces pain during surgery associated with the development of pronounced central hyperalgesia, presumably by affecting mechanoinsensitive nociceptors, because these have been linked to the induction of central sensitization and were shown to be particularly sensitive to small-dose lidocaine.

Tomoki Nishiyama and Kazuo Hanaoka

Intrathecal Clonidine and Bupivacaine Have Synergistic Analgesia for Acute Thermally or Inflammatory-Induced Pain in Rats
Anesth Analg 2004 98: 1056-1061. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The analgesic interaction between intrathecally administered bupivacaine and clonidine was examined during acute thermal and inflammatory-induced pain in rats. The analgesia produced by the combination of these two drugs was synergistic in both acute thermal and inflammatory induced pain, with a decrease in behavioral side effects.

Mehmet Kizilkaya, Omer Selim Yildirim, Nazim Dogan, Husnu Kursad, and Ali Okur

Analgesic Effects of Intraarticular Sufentanil and Sufentanil Plus Methylprednisolone After Arthroscopic Knee Surgery
Anesth Analg 2004 98: 1062-1065. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The combined use of intraarticular sufentanil (10 {micro}g) and methylprednisolone (40 mg) in arthroscopic meniscectomy surgery reduced both postoperative pain scores and the use of additional analgesics.

Yi Lee, Hsien-Yung Lai, Pei-Chin Lin, Youh-Sun Lin, Shen-Jer Huang, and Ming-Hwang Shyr

A Dose Ranging Study of Dexamethasone for Preventing Patient-Controlled Analgesia-Related Nausea and Vomiting: A Comparison of Droperidol with Saline
Anesth Analg 2004 98: 1066-1071. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Morphine administration by patient-controlled analgesia (PCA) is often associated nausea and vomiting. In this double-blind study, the minimum effective dose of dexamethasone for reducing this complication was 8 mg. This was as effective as adding droperidol 0.1 mg/mL to the morphine PCA without causing drowsiness, restlessness or arrhythmias.

Joel L. Parlow, Ioana Costache, Nicole Avery, and Kim Turner

Single-Dose Haloperidol for the Prophylaxis of Postoperative Nausea and Vomiting After Intrathecal Morphine
Anesth Analg 2004 98: 1072-1076. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this randomized, double-blinded, placebo-controlled trial, a single, small IM dose of haloperidol 1 mg or 2 mg reduced the incidence of postoperative nausea and vomiting after spinal anesthesia with local anesthetic and intrathecal morphine.

Olivier Cuignet, Jean Pirson, Jenna Boughrouph, and Diane Duville

The Efficacy of Continuous Fascia Iliaca Compartment Block for Pain Management in Burn Patients Undergoing Skin Grafting Procedures
Anesth Analg 2004 98: 1077-81. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:Postoperative pain at the split skin donor sites is often more intense than the pain at the grafted site. This prospective, randomized, double-blind study assessed the efficacy of a continuous fascia iliaca compartment block in reducing the pain at the thigh donor site.

Alex M. Blaicher, Harald T. Landsteiner, Olga Al-Falaki, Jochen Zwerina, Ivo Volf, Diego Gruber, Michael Zimpfer, and Klaus Hoerauf

Acetylsalicylic Acid, Diclofenac, and Lornoxicam, but Not Rofecoxib, Affect Platelet CD 62 Expression
Anesth Analg 2004 98: 1082-1085. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We compared the effect of rofecoxib and three nonselective nonsteroidal antiinflammatory drugs on platelet function, measured by CD 62 P expression. Platelet function was not altered by rofecoxib, but it was inhibited by aspirin, diclofenac, and lornoxicam. Rofecoxib may be safer than classic NSAIDs with respect to platelet function during the perioperative period.

Thomas Volk, Michael Schenk, Kristina Voigt, Stefan Tohtz, Michael Putzier, and Wolfgang J. Kox

Postoperative Epidural Anesthesia Preserves Lymphocyte, but Not Monocyte, Immune Function After Major Spine Surgery
Anesth Analg 2004 98: 1086-1092. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS:Epidural analgesia affects the immune system. Postoperative epidural analgesia, compared with conventional IV opioid therapy, preserves lymphocyte rather than monocyte functions. An improvement of postoperative immune function by epidural analgesia therefore may improve postoperative resistance to infectious complications or to chronic pain states.

Xiaohui Sun, Masataka Yokoyama, Satoshi Mizobuchi, Ryuji Kaku, Hideki Nakatsuka, Toru Takahashi, and Kiyoshi Morita

The Effects of Pretreatment with Lidocaine or Bupivacaine on the Spatial and Temporal Expression of c-Fos Protein in the Spinal Cord Caused by Plantar Incision in the Rat
Anesth Analg 2004 98: 1093-1098. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Prevention of early pain by pretreatment with local anesthetics provides little benefit for postoperative pain relief in the plantar incision model, although c-Fos expression is suppressed. The number of c-Fos-expressing neurons is not necessarily correlated with pain behavior.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

David L. Hepner, Angela M. Bader, Shelley Hurwitz, Michael Gustafson, and Lawrence C. Tsen

Patient Satisfaction with Preoperative Assessment in a Preoperative Assessment Testing Clinic
Anesth Analg 2004 98: 1099-1105. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Patient satisfaction can serve as an important indicator of the quality of preoperative care delivered in Preoperative Assessment Testing Clinics (PATC). Information and communication, both from clinical and nonclinical service providers, remain the most important positive components, and the total duration of the clinic visit represents the most negative component, of patient satisfaction in a PATC.

Richard Brull, Colin J. L. McCartney, Vincent W. S. Chan, Frances Chung, and Regan Rawson

Are Patients Comfortable Consenting to Clinical Anesthesia Research Trials on the Day of Surgery? (Brief Report)
Anesth Analg 2004 98: 1106-1110. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This retrospective survey suggests that patient recruitment and consent for negligible- or minimal-risk clinical anesthesia research trials is appropriate when performed on the day of surgery.

Jonathan D. Katz

Do Anesthesiologists Die at a Younger Age Than Other Physicians? Age-Adjusted Death Rates (Brief Report)
Anesth Analg 2004 98: 1111-1113. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: It has been suggested that one of the potential occupational hazards of the practice of anesthesiology is premature death. This study disproves the notion that anesthesiologists die at a younger age than other physicians.

CRITICAL CARE AND TRAUMA:

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

The Antiinflammatory Effects of Ketamine in Endotoxemic Rats During Moderate and Mild Hypothermia
Anesth Analg 2004 98: 1114-1120. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Although ketamine administration decreased the severity of hypotension and acidosis in endotoxemic rats, ketamine administration may not have additive beneficial antiinflammatory effects during hypothermia.

Mark D. Price, Pranay Kanake, and Daniel Talmor

Paradoxical Embolus After Multiple Trauma Resulting in a Cerebrovascular Accident (Case Report)
Anesth Analg 2004 98: 1121-1123. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Paradoxical embolism after multiple traumas is described. Delay in diagnosis may occur given the need for near continuous sedation in the patient with injuries undergoing multiple surgeries and diagnostic tests.

James R. Hebl, Brian A. Hall, and Juraj Sprung

Prolonged Cardiovascular Collapse Due to Unrecognized Latex Anaphylaxis (Case Report)
Anesth Analg 2004 98: 1124-1126. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We describe a patient who experienced latex-induced intraoperative anaphylaxis. The event coincided with antibiotic administration, which prompted us to erroneously assume that the causative allergen was medication related. Allergy to latex must always be considered as a potential culprit of perioperative cardiovascular collapse.

NEUROSURGICAL ANESTHESIA:

Alan Kaye, Ian J. Kucera, James Heavner, Adrian Gelb, Muhamed Anwar, Marilyn Duban, A. Salam Arif, Rosemary Craen, Cheng-Tao Chang, Raul Trillo, and Marc Hoffman

The Comparative Effects of Desflurane and Isoflurane on Lumbar Cerebrospinal Fluid Pressure in Patients Undergoing Craniotomy for Supratentorial Tumors
Anesth Analg 2004 98: 1127-32. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This is the largest study to date comparing the effects of desflurane and isoflurane on patients undergoing craniotomy for supratentorial mass lesion with evidence of midline shift or edema. Neither desflurane nor isoflurane significantly altered lumbar cerebrospinal fluid pressure when moderate hypocapnia was maintained.

Martin Soehle, Marek Czosnyka, John D. Pickard, and Peter J. Kirkpatrick

Continuous Assessment of Cerebral Autoregulation in Subarachnoid Hemorrhage
Anesth Analg 2004 98: 1133-1139. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The moving correlation coefficients between slow changes of arterial blood pressure and mean or systolic flow velocity, termed "Mx" and "Sx," respectively, characterize cerebral autoregulation but have not been applied to subarachnoid hemorrhage. A study in 15 patients revealed that Mx and Sx were significantly increased, indicating impaired autoregulation during vasospasm as compared with baseline, as well as on the side of vasospasm in comparison with the contralateral side.

OBSTETRIC ANESTHESIA:

Ki Jinn Chin and Seow Woon Yeo

Bispectral Index Values at Sevoflurane Concentrations of 1% and 1.5% in Lower Segment Cesarean Delivery
Anesth Analg 2004 98: 1140-1144. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Bispectral index (BIS) values <60 are consistent with a high probability of unconsciousness. An end-tidal concentration of 1.5% sevoflurane maintained BIS values <60 during cesarean delivery, whereas 1% did not. Adverse effects were not seen with the use of larger concentrations of sevoflurane.

Bee B. Lee, Warwick D. Ngan Kee, Floria F. Ng, Tze K. Lau, and Eliza L. Y. Wong

Epidural Infusions of Ropivacaine and Bupivacaine for Labor Analgesia: A Randomized, Double-Blind Study of Obstetric Outcome
Anesth Analg 2004 98: 1145-1152. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In a randomized-controlled study, we found no major outcome advantage of continuous epidural infusion of ropivacaine 0.1% with fentanyl 0.0002% over bupivacaine 0.1% with fentanyl 0.0002% for labor analgesia. Although ropivacaine was associated with a shorter first stage of labor, the relative difference is probably of limited clinical importance, and there was no difference in the mode of delivery.

M. Van de Velde, A. Teunkens, M. Hanssens, E. Vandermeersch, and J. Verhaeghe

Intrathecal Sufentanil and Fetal Heart Rate Abnormalities: A Double-Blind, Double Placebo-Controlled Trial Comparing Two Forms of Combined Spinal Epidural Analgesia with Epidural Analgesia in Labor
Anesth Analg 2004 98: 1153-1159. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Combined spinal epidural analgesia (CSE) produces pain relief during labor. Fetal heart rate changes after CSE using intrathecal sufentanil have been reported. We performed a randomized, blinded trial confirming that fetal heart rate changes are more frequent after CSE using 7.5 {micro}g of intrathecal sufentanil as compared with other forms of neuraxial labor analgesia.

Asokumar Buvanendran, Pouya Mohajer, Xavier Pombar, and Kenneth J. Tuman

Perioperative Management with Epidural Anesthesia for a Parturient with Superior Vena Caval Obstruction (Case Report)
Anesth Analg 2004 98: 1160-1163. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Perioperative management of patients with superior vena caval obstruction presents an anesthetic challenge because of the severe cardiopulmonary compromise. This case report describes a parturient who presented for cesarean delivery with superior vena caval obstruction resulting from metastasis from breast cancer.

Fouad N. Atallah, Béatrice M. Riu, Luc B. Nguyen, Philippe O. Seguin, and Olivier A. Fourcade

Boerhaave’s Syndrome After Postoperative Vomiting (Case Report)
Anesth Analg 2004 98: 1164-1166. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report a case of postoperative vomiting complicated by esophageal rupture (Boerhaave's syndrome). As this complication is quite rare, anesthesiologists may fail to consider this diagnosis.

REGIONAL ANESTHESIA:

Carlo D. Franco, Vitaliy Domashevich, Gennadiy Voronov, Amir B. Rafizad, and Tanyu J. Jelev

The Supraclavicular Block with a Nerve Stimulator: To Decrease or Not to Decrease, That Is the Question
Anesth Analg 2004 98: 1167-1171. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: When nerve blocks are performed with a nerve stimulator, it is customary to reduce the nerve stimulator output to <= 0.5 mA before injecting. Apparently this is not necessary with a supraclavicular block.

Sébastien Robaux, Cornelia Blunt, Eric Viel, Philippe Cuvillon, Philippe Nouguier, Gilles Dautel, Sylvie Boileau, Florence Girard, and Hervé Bouaziz

Tramadol Added to 1.5% Mepivacaine for Axillary Brachial Plexus Block Improves Postoperative Analgesia Dose-Dependently
Anesth Analg 2004 98: 1172-1177. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.

Philipp Lirk, Bernhard Moriggl, Joshua Colvin, Christian Keller, Lukas Kirchmair, Josef Rieder, and Christian Kolbitsch

The Incidence of Lumbar Ligamentum Flavum Midline Gaps (Brief Report)
Anesth Analg 2004 98: 1178-1180. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The ligamentum flavum is a crucial anatomical landmark for the safe performance of epidural anesthesia. However, the present study demonstrates some failure of the lumbar ligamentum flavum as a landmark. This may mean that, using a midline approach, one cannot always rely on the ligamentum flavum as a perceptible barrier to epidural needle advancement.

André Gottschalk, Petra Bischoff, Katrin Lamszus, and Thomas Standl

Epidural Hematoma After Spinal Anesthesia in a Patient with Undiagnosed Epidural Lymphoma (Case Report)
Anesth Analg 2004 98: 1181-1183. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report a case of a women developing epidural bleeding 3 wk after performing an uneventful spinal anesthesia for removal of a wire loop in her left knee. Pathological examination of the neurosurgically removed hematoma revealed a highly vascularized epidural centroblastic non-Hodgkin lymphoma.

GENERAL ARTICLES:

Kay Stricker, Rene Orler, Katrin Yen, Jukka Takala, and Martin Luginbühl

Severe Hypercapnia Due to Pulmonary Embolism of Polymethylmethacrylate During Vertebroplasty (Case Report)
Anesth Analg 2004 98: 1184-1186. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Osteoporotic spine fractures are increasingly treated by injection of bone cement into the vertebral body. Polymethylmethacrylate embolism is a rare but potentially fatal complication. We report on a case of polymethylmethacrylate embolism that was at first unrecognized because of uncharacteristic signs and symptoms.

Chen-Wei Lu, Yi-Sharng Chen, and Ming-Jiuh Wang

Massive Pulmonary Embolism After Application of an Esmarch Bandage (Case Report)
Anesth Analg 2004 98: 1187-1189. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Transesophageal echocardiography was highly valuable in finding the cause of sudden intraoperative cardiovascular collapse. The use of extracorporeal membrane oxygenation to support the failing right ventricle after emergent pulmonary embolectomy could help to rescue patients with massive pulmonary embolism.

LETTERS TO THE EDITOR:

Glen Atlas

A Method to Quickly Estimate Remaining Time for an Oxygen E-Cylinder
Anesth Analg 2004 98: 1190. [Full Text] [PDF] [Request Permissions]  

Zafer Salim Tabboush

Tumescent Anesthesia: A Concern of Anesthesiologists
Anesth Analg 2004 98: 1190. [Full Text] [PDF] [Request Permissions]  

William T. McBride, Nadia Khalil, Peter Elliott, and Marilyn Armstrong

Clomethiazole Alters Immune Function Within an Isolated Cardiopulmonary Bypass Circuit
Anesth Analg 2004 98: 1191. [Full Text] [PDF] [Request Permissions]  

Peter E. Horowitz, Tariq Chaudhry, and Mark E. Comunale

Con: The FMS 2000 Blood/Fluid Warmer Is Not Better than the Level 1 H1025 • Response
Anesth Analg 2004 98: 1191. [Full Text] [PDF] [Request Permissions]  

Tricia Meyer and Frank Villamaria

Abbreviations
Anesth Analg 2004 98: 1191-1192. [Full Text] [PDF] [Request Permissions]  

Eugene R. Worth and Jonathan L. Benumof

Haeckel’s Recapitulation Theory Should Not Be Used as a Defense of the ASA Difficult Airway Algorithm • Response
Anesth Analg 2004 98: 1192. [Full Text] [PDF] [Request Permissions]  

D. John Doyle

Phonocardiographic Recording from the Trachea: Use of a Special Endotracheal Tube
Anesth Analg 2004 98: 1192-1193. [Full Text] [PDF] [Request Permissions]  

Eric L. Bloomfield, Bruce J. Leone, and Armin Schubert

The Safety of Hemoglobin Blood Substitutes • Response
Anesth Analg 2004 98: 1193. [Full Text] [PDF] [Request Permissions]  

G. D. Puri and Kawal Preet Singh

Damage to the Three-Way Valves by a Clear Propofol Formulation
Anesth Analg 2004 98: 1193-1194. [Full Text] [PDF] [Request Permissions]  

Greg Gordon and Lisa A. Muraika

Remember the Simple Digital Alternative • Response
Anesth Analg 2004 98: 1194. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Keith A. Minnich

Clinical Transesophageal Echocardiography: A Problem-Oriented Approach, 2nd edition
Anesth Analg 2004 98: 1195. [Full Text] [PDF] [Request Permissions]  

ERRATA:

Michael S. Stix and Cornelius J. O’Connor, Jr.

Correction
Anesth Analg 2004 98: 902. [Full Text] [PDF] [Request Permissions]  

Correction
Anesth Analg 2004 98: 955. [Full Text] [PDF] [Request Permissions]  

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