EDITORIALS:

Paul F. White

Electroanalgesia: Does It Have a Place in the Routine Management of Acute and Chronic Pain?
Anesth Analg 2004 98: 1197-1198. [Full Text]  

Charles W. Hogue, Jr., Kenneth J. Tuman, and Glen Gravlee

Cardiovascular Anesthesia: The Society of Cardiovascular Anesthesiologists, Its Journal, and New Opportunities
Anesth Analg 2004 98: 1200. [Full Text]  

Glenn S. Murphy, Joseph W. Szokol, Martin Nitsun, David A. Alspach, Michael J. Avram, Jeffery S. Vender, Timothy V. Votapka, and Todd K. Rosengart

The Failure of Retrograde Autologous Priming of the Cardiopulmonary Bypass Circuit to Reduce Blood Use After Cardiac Surgical Procedures
Anesth Analg 2004 98: 1201-1207. [Abstract] [Full Text]  

IMPLICATIONS: Priming of the cardiopulmonary bypass circuit with the patients' own blood (retrograde autologous priming) resulted in insignificant reductions in blood use in a large, unselected group of patients undergoing cardiac surgical procedures.

Michael J. Eisses, Kristy Seidel, Gabriel S. Aldea, and Wayne L. Chandler

Reducing Hemostatic Activation During Cardiopulmonary Bypass: A Combined Approach
Anesth Analg 2004 98: 1208-1216. [Abstract] [Full Text]  

IMPLICATIONS: A combined approach during cardiopulmonary bypass (CPB) that uses heparin-coated circuits, {epsilon}-aminocaproic acid, and limited reinfusion of shed pericardial blood is associated with reduced activation of the coagulation and fibrinolytic systems that typically occurs during conventional CPB.

Valter Casati, Stefano Benussi, Luca Sandrelli, Maria Antonietta Grasso, Salvatore Spagnolo, and Armando D’Angelo

Intraoperative Moderate Acute Normovolemic Hemodilution Associated with a Comprehensive Blood-Sparing Protocol in Off-Pump Coronary Surgery
Anesth Analg 2004 98: 1217-1223. [Abstract] [Full Text]  

IMPLICATIONS: We studied the blood-sparing effects of moderate acute normovolemic hemodilution (ANH) in 100 patients undergoing off-pump coronary surgery (OPCAB). Combined with tranexamic acid administration and shed blood reinfusion when the intraoperative bleeding exceeded 250 mL, ANH was effective in reducing the number of OPCAB patients who required allogeneic transfusions and the number of packed red blood cell units transfused.

John V. Booth, Erin E. Ward, Kelly C. Colgan, Bonita L. Funk, Habib El-Moalem, Michael P. Smith, Carmelo Milano, Peter K. Smith, Mark F. Newman, and Debra A. Schwinn

Metoprolol and Coronary Artery Bypass Grafting Surgery: Does Intraoperative Metoprolol Attenuate Acute ß-Adrenergic Receptor Desensitization During Cardiac Surgery?
Anesth Analg 2004 98: 1224-1231. [Abstract] [Full Text]  

IMPLICATIONS: We investigated whether IV metoprolol given during cardiac surgery attenuates myocardial ß-adrenergic receptor (ßAR) desensitization. Although metoprolol did not reduce ßAR desensitization, the incidence of supraventricular arrhythmias was reduced by 75% in patients receiving 20 mg or 30 mg metoprolol.

Shigeru Akamatsu, Akiyoshi Oda, Etsuji Terazawa, Takuji Yamamoto, Hiroto Ohata, Tomohiro Michino, and Shuji Dohi

Automated Cardiac Output Measurement by Transesophageal Color Doppler Echocardiography
Anesth Analg 2004 98: 1232-1238. [Abstract] [Full Text]  

IMPLICATIONS: Automated cardiac output measurement by transesophageal color Doppler echocardiography is a practical and rapid method to measure cardiac output. This technique is a promising new approach to echocardiographic quantification in the intraoperative setting.

Timo T. Laitio, Heikki V. Huikuri, Timo H. Mäkikallio, Jouko Jalonen, Erkki S. H. Kentala, Hans Helenius, Olar Pullisaar, Jaakko Hartiala, and Harry Scheinin

The Breakdown of Fractal Heart Rate Dynamics Predicts Prolonged Postoperative Myocardial Ischemia
Anesth Analg 2004 98: 1239-1244. [Abstract] [Full Text]  

IMPLICATIONS: Night and daytime Holter recordings before surgical repair of traumatic hip fracture were analyzed with linear and nonlinear heart rate variability methods. Preoperatively increased randomness in heart rate variability was predictive for postoperative, silent prolonged myocardial ischemia. Prolonged myocardial ischemia increases the risk for adverse cardiac events.

Luc Massicotte, Marie-Pascale Sassine, Serge Lenis, and André Roy

Transfusion Predictors in Liver Transplant
Anesth Analg 2004 98: 1245-1251. [Abstract] [Full Text]  

IMPLICATIONS: This is a retrospective study of 206 liver transplants over 52 mo to identify the predictive factors of red blood cell transfusions and the anesthesiologists' transfusion strategies. We conclude that there is a wide difference in transfusion practices among anesthesiologists.

PEDIATRIC ANESTHESIA:

Zeev N. Kain, Alison A. Caldwell-Andrews, Dawn M. Krivutza, Megan E. Weinberg, Shu-Ming Wang, and Dorothy Gaal

Trends in the Practice of Parental Presence During Induction of Anesthesia and the Use of Preoperative Sedative Premedication in the United States, 1995–2002: Results of a Follow-Up National Survey
Anesth Analg 2004 98: 1252-1259. [Abstract] [Full Text]  

IMPLICATIONS: Over the past 7 yr there have been significant increases in the number of anesthesiologists who use preoperative sedative premedication and parental presence for children undergoing surgery.

Zeev N. Kain, Alison A. Caldwell-Andrews, Dawn M. Krivutza, Megan E. Weinberg, Dorothy Gaal, Shu-Ming Wang, and Linda C. Mayes

Interactive Music Therapy as a Treatment for Preoperative Anxiety in Children: A Randomized Controlled Trial
Anesth Analg 2004 98: 1260-1266. [Abstract] [Full Text]  

IMPLICATIONS: Depending on the music therapist, interactive music therapy may relieve anxiety on separation and entrance to the operating room but appears less effective during the induction of anesthesia.

Dean B. Andropoulos, Laura K. Diaz, Charles D. Fraser, Jr., E. Dean McKenzie, and Stephen A. Stayer

Is Bilateral Monitoring of Cerebral Oxygen Saturation Necessary During Neonatal Aortic Arch Reconstruction?
Anesth Analg 2004 98: 1267-1272. [Abstract] [Full Text]  

IMPLICATIONS: Left-sided cerebral hemisphere oxygen saturation, measured with near-infrared spectroscopy, was less than right-sided cerebral oxygen saturation during regional low-flow cerebral perfusion used for neonatal aortic arch reconstruction.

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

Intratracheal Application of Recombinant Surfactant Protein-C Surfactant to Rabbits Attenuates Acute Lung Injury Induced by Intratracheal Acidified Infant Formula
Anesth Analg 2004 98: 1273-1279. [Abstract] [Full Text]  

IMPLICATIONS: Small or large doses of recombinant surfactant protein-C surfactant given 30 min after intratracheal acidified infant formula attenuated physiological, biochemical, and morphological lung damage.

Marie-Pierre Bonnet, Eric Larousse, Karim Asehnoune, and Dan Benhamou

Spinal Anesthesia with Bupivacaine Decreases Cerebral Blood Flow in Former Preterm Infants
Anesth Analg 2004 98: 1280-1283. [Abstract] [Full Text]  

IMPLICATIONS: In former preterm infants having spinal anesthesia with bupivacaine, a decrease in cerebral blood flow velocity is displayed by middle cerebral artery transcranial Doppler examination.

Ravindra Bhat

Transient Vascular Insufficiency After Axillary Brachial Plexus Block in a Child (Case Report)
Anesth Analg 2004 98: 1284-1285. [Abstract] [Full Text]  

IMPLICATIONS: Transient vascular insufficiency of the upper limb may happen as a rare complication after axillary block. Knowledge of this complication can help the anesthesiologist in the management of this problem.

Ban C. H. Tsui and Kirsten Cunningham

Fiberoptic Endotracheal Intubation After Topicalization with In-Circuit Nebulized Lidocaine in a Child with a Difficult Airway (Case Report)
Anesth Analg 2004 98: 1286-1288. [Abstract] [Full Text]  

IMPLICATIONS: An in-circuit nebulization system to deliver topical lidocaine may facilitate fiberoptic-assisted intubation in anesthetized, spontaneously breathing children with compromised airways.

AMBULATORY ANESTHESIA:

Cliff K. S. Ong, Robin A. Seymour, and Juliana M.-H. Tan

Sedation with Midazolam Leads to Reduced Pain After Dental Surgery
Anesth Analg 2004 98: 1289-1293. [Abstract] [Full Text]  

IMPLICATIONS: In this observer blinded study, we found that IV midazolam treatment (0.09 mg/kg) has a pain-reducing effect after third molar surgery, thus improving postoperative pain management.

Sanjay M. Bhananker, Robert Paek, and Monica S. Vavilala

Water Intoxication and Symptomatic Hyponatremia After Outpatient Surgery (Case Report)
Anesth Analg 2004 98: 1294-1296. [Abstract] [Full Text]  

IMPLICATIONS: Water intoxication is an unusual but potentially lethal cause of perioperative hyponatremia. We report a patient with severe postoperative hyponatremia resulting from excess perioperative water consumption.

ANESTHETIC PHARMACOLOGY:

Adam C. Hall, Kathleen C. Rowan, Renna J. N. Stevens, Jill C. Kelley, and Neil L. Harrison

The Effects of Isoflurane on Desensitized Wild-Type and ₁(S270H) -Aminobutyric Acid Type A Receptors
Anesth Analg 2004 98: 1297-1304. [Abstract] [Full Text]  

IMPLICATIONS: Isoflurane enhances desensitized {gamma}-aminobutyric acid type A receptor (GABAA-R) currents, an effect that is subunit-dependent and attenuated by a mutation in an {alpha}1-subunit pore residue of the GABAA-R. As GABA release at inhibitory synapses is typically saturating, isoflurane modulation of desensitized receptors may be partly responsible for prolongation of inhibitory postsynaptic currents during anesthesia.

Noam N. Butterfield, Peter Graf, Craig R. Ries, and Bernard A. MacLeod

The Effect of Repeated Isoflurane Anesthesia on Spatial and Psychomotor Performance in Young and Aged Mice
Anesth Analg 2004 98: 1305-1311. [Abstract] [Full Text]  

IMPLICATIONS: This study demonstrates that repeated isoflurane general anesthesia impaired psychomotor performance in aged mice during the initial learning period; however, spatial learning improved and, overall, spatial memory and psychomotor performance were unimpaired. Thus, general anesthesia alone does not appear to result in prolonged cognitive deficits in aged mice.

Vance G. Nielsen, John P. Crow, Fen Zhou, and Dale A. Parks

Peroxynitrite Inactivates Tissue Plasminogen Activator
Anesth Analg 2004 98: 1312-1317. [Abstract] [Full Text]  

IMPLICATIONS: Tissue plasminogen activator (tPA) has a prominent role in fibrinolysis in vivo. Thrombosis has been associated with clinical scenarios involving decreases in tPA activity with concomitant formation of the oxidant peroxynitrite. We determined that peroxynitrite decreased tPA activity via thrombelastography(R). Peroxynitrite-mediated tPA inactivation may have a role in thrombotic states.

Chun-Ming Lin, Sharma Neeru, Anthony G. Doufas, Edwin Liem, Yunus Muneer Shah, Anupama Wadhwa, Rainer Lenhardt, Andrew Bjorksten, Akiko Taguchi, Barhara Kabon, Daniel I. Sessler, and Andrea Kurz

Dantrolene Reduces the Threshold and Gain for Shivering
Anesth Analg 2004 98: 1318-1324. [Abstract] [Full Text]  

IMPLICATIONS: Dantrolene substantially decreases the gain of shivering but produces relatively little central thermoregulatory inhibition. It thus seems unlikely to prove more effective than conventional muscle relaxants for treatment of life-threatening hyperthermia.

Masataka Saito, Osamu Shibata, Masakazu Yamaguchi, Maki Yoshimura, Tetsuji Makita, Noboru Harada, Masami Niwa, and Koji Sumikawa

Metoclopramide Causes Airway Smooth Muscle Relaxation Through Inhibition of Muscarinic M₃ Receptor in the Rat Trachea
Anesth Analg 2004 98: 1325-1329. [Abstract] [Full Text]  

IMPLICATIONS: We investigated the effect of metoclopramide on the contraction, phosphatidylinositol response, and binding affinity of muscarinic M3 receptors in rat trachea preparations. Our findings suggest that the attenuation by metoclopramide of carbachol-induced contraction and phosphatidylinositol response may be mediated through the muscarinic M3 receptors.

Yongfeng Zhang, Ziping Luo, and Paul F. White

A Model for Evaluating Droperidol’s Effect on the Median QT_c Interval (Special Article)
Anesth Analg 2004 98: 1330-1335. [Abstract] [Full Text]  

IMPLICATIONS: Using a square-root curve fit model to evaluate the relationship between the dose of droperidol and QTc prolongation, small-dose droperidol (0.625-1.25 mg IV) would be expected to produce <30-ms prolongation of the QTc interval. Therefore, small "antiemetic" doses of droperidol would not be expected to produce proarrhythmogenic effects when used for prophylaxis in surgical patients.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Yasuhiro Morimoto, Satoshi Hagihira, Yumika Koizumi, Kazuyoshi Ishida, Mishiya Matsumoto, and Takefumi Sakabe

The Relationship Between Bispectral Index and Electroencephalographic Parameters During Isoflurane Anesthesia
Anesth Analg 2004 98: 1336-1340. [Abstract] [Full Text]  

IMPLICATIONS: The relationship between bispectral index (BIS) and electroencephalographic parameters was evaluated during nitrous oxide/isoflurane anesthesia. At surgical levels of anesthesia, BIS and the relative synchrony of fast and slow wave (a parameter derived from bispectral analysis) or burst-compensated spectral edge frequency 95% (a parameter derived from power spectral analysis) are well correlated.

Tomoki Nishiyama, Takashi Matsukawa, and Kazuo Hanaoka

A Comparison of the Clinical Usefulness of Three Different Electroencephalogram Monitors: Bispectral Index, Processed Electroencephalogram, and Alaris Auditory Evoked Potentials
Anesth Analg 2004 98: 1341-1345. [Abstract] [Full Text]  

IMPLICATIONS: We compared the usefulness of three electroencephalogram monitors. The Bispectral Index was the easiest for obtaining low impedance, the auditory evoked potential index had the least inappropriateness rate for general anesthesia and had the largest responsiveness, and the spectral edge frequency was the fastest in stabilizing measurement after electric cautery.

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

Comparative Evaluation of Narcotrend^TM, Bispectral Index^TM, and Classical Electroencephalographic Variables During Induction, Maintenance, and Emergence of a Propofol/Remifentanil Anesthesia
Anesth Analg 2004 98: 1346-1353. [Abstract] [Full Text]  

IMPLICATIONS: The modern electroencephalographic monitoring systems NarcotrendTM and Bispectral IndexTM are more reliable indicators for the assessment of anesthetic states than classical electroencephalographic and hemodynamic variables to predict anesthetic conditions from before induction of anesthesia until extubation during a standardized anesthetic regime with propofol and remifentanil. The analgesic potency of depth of anesthesia could not be detected by NarcotrendTM and Bispectral IndexTM.

Johannes H. van Oostrom and Richard J. Melker

Comparative Testing of Pulse Oximeter Probes
Anesth Analg 2004 98: 1354-1358. [Abstract] [Full Text]  

IMPLICATIONS: We studied the performance of pulse oximeter probes in a simulated environment. Our results show significant differences between some probes that affect the accuracy of measurement.

PAIN MEDICINE:

Sabine M. Sator-Katzenschlager, Gisela Scharbert, Sibylle A. Kozek-Langenecker, Jozef C. Szeles, Gabriele Finster, Andreas W. Schiesser, Georg Heinze, and Hans Georg Kress

The Short- and Long-Term Benefit in Chronic Low Back Pain Through Adjuvant Electrical Versus Manual Auricular Acupuncture
Anesth Analg 2004 98: 1359-1364. [Abstract] [Full Text]  

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

Sang-Wook Shin, James C. Eisenach, Srinias G. Rao, and Chuanyao Tong

The Monoamine Reuptake Inhibitor Milnacipran Does Not Affect Nociception to Acute Visceral Distension in Rats
Anesth Analg 2004 98: 1365-1369. [Abstract] [Full Text]  

IMPLICATIONS: Neither intrathecal nor IV milnacipran, a monoamine reuptake inhibitor, inhibits an acute visceral pain response induced by colorectal or uterine cervical distension.

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

The Analgesic Effects of Gabapentin After Total Abdominal Hysterectomy
Anesth Analg 2004 98: 1370-1373. [Abstract] [Full Text]  

IMPLICATIONS: This randomized, controlled trial examined the effects of preoperative oral gabapentin 1200 mg on postoperative pain and tramadol consumptions. We conclude that preoperative oral gabapentin is effective in reducing postoperative pain scores and tramadol consumption in patients after abdominal hysterectomy.

Myung Ha Yoon, Jeong Il Choi, and Sang Hyun Kwak

Characteristic of Interactions Between Intrathecal Gabapentin and Either Clonidine or Neostigmine in the Formalin Test
Anesth Analg 2004 98: 1374-1379. [Abstract] [Full Text]  

IMPLICATIONS: We determined the pharmacological properties of gabapentin combined with either clonidine or neostigmine in the formalin test. Spinal gabapentin reinforced the effects of clonidine and neostigmine in the formalin test. The hitherto unreported action of gabapentin on acute nociceptive stimulus could be of considerable significance.

Kaoru Hara, Yoji Saito, Yumiko Kirihara, and Shinichi Sakura

The Interaction Between Gamma-Aminobutyric Acid Agonists and Diltiazem in Visceral Antinociception in Rats
Anesth Analg 2004 98: 1380-1384. [Abstract] [Full Text]  

IMPLICATIONS: Intrathecal administration of diltiazem in combination with a {gamma}-aminobutyric acid (GABA) agonist, muscimol or baclofen, potentiated the GABA agonists-induced visceral antinociception but did not affect motor paralysis. The present results indicate that the coadministration of the two types of drugs may be clinically useful.

Colin J. L. McCartney, Avinash Sinha, and Joel Katz

A Qualitative Systematic Review of the Role of N-Methyl-D-Aspartate Receptor Antagonists in Preventive Analgesia
Anesth Analg 2004 98: 1385-1400. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated, in a qualitative systematic review, the effect of N-methyl D-aspartate antagonists on reducing postoperative pain and analgesic consumption beyond the clinical duration of action of the target drug (preventive analgesia). Dextromethorphan and ketamine were found to have significant immediate and preventive analgesic benefit in 67% and 58% of studies, respectively.

Junichi Ogata, Kouichiro Minami, Yasuhito Uezono, Takashi Okamoto, Munehiro Shiraishi, Akio Shigematsu, and Yoichi Ueta

The Inhibitory Effects of Tramadol on 5-Hydroxytryptamine Type 2C Receptors Expressed in Xenopus Oocytes
Anesth Analg 2004 98: 1401-1406. [Abstract] [Full Text]  

IMPLICATIONS: We examined the effects of tramadol on 5-hydroxytryptamine type 2C receptor (5-HT2CR) expressed in Xenopus oocytes. Tramadol inhibited 5-HT2CR function and the specific binding of [3H]5-HT to 5-HT2CR in a competitive manner. From these data, the mechanism of the inhibitory effect on 5-HT2CR might involve the competitive displacement of 5-HT binding to the 5-HT2CR.

M. I. Arévalo, E. Escribano, A. Calpena, J. Domenech, and J. Queralt

Rapid Skin Anesthesia Using a New Topical Amethocaine Formulation: A Preclinical Study
Anesth Analg 2004 98: 1407-1412. [Abstract] [Full Text]  

IMPLICATIONS: Topical anesthetics are used in several painful clinical procedures, but they tend to have a slow onset time. A new amethocaine microemulsion with a faster onset of analgesia than commercial formulations was developed and its activity tested in pain states induced by heat or mechanical stimulus in inflamed and healthy rat paws.

Helena Argiriadou, Sabine Himmelseher, Pinelopi Papagiannopoulou, Mary Georgiou, Fotios Kanakoudis, Maria Giala, and Eberhard Kochs

Improvement of Pain Treatment After Major Abdominal Surgery by Intravenous S(+)-Ketamine
Anesth Analg 2004 98: 1413-1418. [Abstract] [Full Text]  

IMPLICATIONS: After major visceral surgery, preincisional and repeated intraoperative small-dose S(+)-ketamine added to general and epidural anesthesia causes better postoperative pain relief than general and epidural anesthesia alone.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Matthew B. Weinger, Swapna B. Reddy, and Jason M. Slagle

Multiple Measures of Anesthesia Workload During Teaching and Nonteaching Cases
Anesth Analg 2004 98: 1419-1425. [Abstract] [Full Text]  

IMPLICATIONS: Psychological, physiological, and procedural workload measures during routine general anesthesia cases documented the increased work demands of induction and emergence. Intraoperative teaching increased workload and decreased vigilance, suggesting the need for caution when educating during patient care.

CRITICAL CARE AND TRAUMA:

Viktoria D. Mayr, Claus Raedler, Volker Wenzel, Karl H. Lindner, and Hans-Ulrich Strohmenger

A Comparison of Epinephrine and Vasopressin in a Porcine Model of Cardiac Arrest After Rapid Intravenous Injection of Bupivacaine
Anesth Analg 2004 98: 1426-1431. [Abstract] [Full Text]  

IMPLICATIONS: Although cardiovascular collapse occurs mostly immediately after rapid injection of a local anesthetic in the presence of anesthesiologists, resuscitation may be difficult, and the outcome is usually poor. In this model of bupivacaine-induced cardiac arrest, cardiopulmonary resuscitation with a combination of vasopressin and epinephrine resulted in significantly better survival rates than in the placebo group.

Silvia Nunes, Hans Ulrich Rothen, Lukas Brander, Jukka Takala, and Stephan M. Jakob

Changes in Splanchnic Circulation During an Alveolar Recruitment Maneuver in Healthy Porcine Lungs
Anesth Analg 2004 98: 1432-1438. [Abstract] [Full Text]  

IMPLICATIONS: Recruitment maneuvers (RM) produce high intrathoracic pressures and volumes that may compromise hemodynamics. We found a marked transient impairment of hemodynamics during a RM in 10 anesthetized pigs. At 8 min after RM, blood flow remained reduced in the celiac trunk, superior mesenteric, and renal arteries, as well as in the portal vein. This residual decrease may present a risk in conditions with markedly compromised circulatory reserves.

Raul Coimbra, Alvaro Razuk-Filho, Margareth M. Yada-Langui, and Mauricio Rocha-e-Silva

Intraarterial Pulmonary Pentoxifylline Improves Cardiac Performance and Oxygen Utilization After Hemorrhagic Shock: A Novel Resuscitation Strategy
Anesth Analg 2004 98: 1439-1446. [Abstract] [Full Text]  

IMPLICATIONS: This study shows that a novel route (via the pulmonary circulation) used to administer pentoxifylline after hemorrhagic shock leads to superior cardiac performance in comparison with administration via lactated Ringer's solution or IV systemic pentoxifylline.

Ricard Valero, Silvia Serrano, Ramón Adalia, Javier Tercero, Annabel Blasi, Gerard Sánchez-Etayo, Gloria Martínez, Lluis Caral, and Guillermo Ibáñez

Anesthetic Management of a Patient in Prone Position with a Drill Bit Penetrating the Spinal Canal at C1-C2, Using a Laryngeal Mask (Case Report)
Anesth Analg 2004 98: 1447-1450. [Abstract] [Full Text]  

IMPLICATIONS: Management of patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. Anesthesia may be induced and the airway can be managed with the patient already in the prone position for surgery.

Emmanuel Scherrer, Loic Tual, and Gilles Dhonneur

Tracheal Ring Fracture During a PercuTwist Tracheostomy Procedure (Case Report)
Anesth Analg 2004 98: 1451-1453. [Abstract] [Full Text]  

IMPLICATIONS: Like other antegrade single-step techniques, the PercuTwist tracheostomy presents the risk of anterior tracheal wall damage during the initial stage of the dilation process. Antegrade forces applied to the trachea should be minimized by sufficiently deep skin incision and both slow and smooth initial rotation of the dilator.

NEUROSURGICAL ANESTHESIA:

Shailendra Joshi, Mei Wang, Ervant V. Nishanian, and Ronald G. Emerson

Electrocerebral Silence by Intracarotid Anesthetics Does Not Affect Early Hyperemia After Transient Cerebral Ischemia in Rabbits
Anesth Analg 2004 98: 1454-1459. [Abstract] [Full Text]  

IMPLICATIONS: Intracarotid injection of anesthetic drugs in doses that are sufficient to produce electrocerebral silence do not obtund early cerebral hyperemia after transient cerebral ischemia. This suggests that vascular, not neuronal mechanisms, are primarily responsible for early postischemic cerebral hyperperfusion.

OBSTETRIC ANESTHESIA:

Michael J. Paech, Timothy J. G. Pavy, Christopher E. P. Orlikowski, Seng T. Yeo, Samantha L. Banks, Sharon F. Evans, and Jennifer Henderson

Postcesarean Analgesia with Spinal Morphine, Clonidine, or Their Combination
Anesth Analg 2004 98: 1460-1466. [Abstract] [Full Text]  

IMPLICATIONS: A multimodal approach to postcesarean analgesia, using subarachnoid bupivacaine, fentanyl, morphine 100 {micro}g, and clonidine 60 {micro}g, improves pain relief compared with morphine 100 {micro}g or clonidine 150 {micro}g alone, but increases intraoperative sedation and may increase perioperative vomiting.

Christian Keller, Joseph Brimacombe, Philipp Lirk, and Fritz Pühringer

Failed Obstetric Tracheal Intubation and Postoperative Respiratory Support with the ProSeal^TM Laryngeal Mask Airway (Case Report)
Anesth Analg 2004 98: 1467-1470. [Abstract] [Full Text]  

IMPLICATIONS: We report the successful use of the ProSealTM laryngeal mask airway for failed obstetric intubation and postoperative respiratory support in a patient with HELLP syndrome.

Klaus Kjaer, Michele Comerford, and Farida Gadalla

General Anesthesia for Cesarean Delivery in a Patient with Paroxysmal Nocturnal Hemoglobinuria and Thrombocytopenia (Case Report)
Anesth Analg 2004 98: 1471-1472. [Abstract] [Full Text]  

IMPLICATIONS:Pregnancy in patients with paroxysmal nocturnal hemoglobinuria increases the risk of hemolysis, thrombosis, anemia, and thrombocytopenia. We describe the anesthetic management of a patient with paroxysmal nocturnal hemoglobinuria and thrombocytopenia who underwent general anesthesia for cesarean delivery.

REGIONAL ANESTHESIA:

Battista Borghi, Vanni Agnoletti, Alessandro Ricci, Hanna van Oven, Nicoletta Montone, and Andrea Casati

A Prospective, Randomized Evaluation of the Effects of Epidural Needle Rotation on the Distribution of Epidural Block
Anesth Analg 2004 98: 1473-1478. [Abstract] [Full Text]  

IMPLICATIONS: Turning the Tuohy introducer needle 45 degrees toward the operative side before threading the epidural catheter is a simple maneuver that produces a preferential distribution of epidural anesthesia and analgesia toward the operative side, minimizing the volume of local anesthetic required to provide adequate pain relief after total hip arthroplasty.

Miguel Angel Reina, Oscar De León Casasola, M. C. Villanueva, Andrés López, Fabiola Machés, and José Antonio De Andrés

Ultrastructural Findings in Human Spinal Pia Mater in Relation to Subarachnoid Anesthesia
Anesth Analg 2004 98: 1479-1485. [Abstract] [Full Text]  

IMPLICATIONS: The ultrastructural anatomy of the human pia mater, such as pial cells, membrane thickness, and subpial tissue at different levels of the thoracic and lumbar spinal cord and nerve roots, was studied by special staining techniques, immunohistochemistry, and transmission and scanning electron microscopy. Fenestrations were found in samples at the thoracic-lumbar junction, conus medullaris, and nerve root levels. No fenestrations were found in samples at the thoracic level. At present, we cannot determine the significance of these findings.

Matthew Oldman, Colin J. L. McCartney, Andrea Leung, Regan Rawson, Anahi Perlas, Jeff Gadsden, and Vincent W. S. Chan

A Survey of Orthopedic Surgeons’ Attitudes and Knowledge Regarding Regional Anesthesia
Anesth Analg 2004 98: 1486-1490. [Abstract] [Full Text]  

IMPLICATIONS: Orthopedic surgeons understand the benefits of and are supportive of the use of regional anesthesia in their practices. Barriers to increased popularity include perceived operating room delays and lack of reliability.

GENERAL ARTICLES:

Marta Coussa, Stefania Proietti, Pierre Schnyder, Philippe Frascarolo, Michel Suter, Donat R. Spahn, and Lennart Magnusson

Prevention of Atelectasis Formation During the Induction of General Anesthesia in Morbidly Obese Patients
Anesth Analg 2004 98: 1491-1495. [Abstract] [Full Text]  

IMPLICATIONS: Application of positive end-expiratory pressure during induction of general anesthesia in morbidly obese patients prevents atelectasis formation and improves oxygenation. Therefore, this technique should be considered for anesthesia induction in morbidly obese patients.

Charles E. Reier and Allan R. Reier

Radiologic-Assisted Endotracheal Intubation (Case Report)
Anesth Analg 2004 98: 1496-1498. [Abstract] [Full Text]  

IMPLICATIONS: Radiologic-assisted intubation facilitated endotracheal intubation without sedation, instrumentation, or significant movement of the occiput, cervical spine, or mandible. The procedure was accomplished in <12 min and with only 22 s of fluoroscopy. This approach provides the ultimate adjunct to the preoperative airway physical evaluation while providing for immediate (or delayed) atraumatic endotracheal intubation. The diagnostic information and procedure can be recorded on a compact disk.

LETTERS TO THE EDITOR:

W. John Russell

Cross-Reactivity Documented for Hemaccel and Gelofusin
Anesth Analg 2004 98: 1499. [Full Text]  

Jonathan V. Roth and Anastasia Shields

A Dilemma: How Does One Treat Anaphylaxis in the Sulfite Allergic Patient Since Epinephrine Contains Sodium Metabisulfite?
Anesth Analg 2004 98: 1499. [Full Text]  

Dara S. Breslin, Michael E. McBrien, and David L. Hepner

Management of Severe Anaphylactic Reactions Should Include Administration of Alpha Adrenergic Agonists • Response
Anesth Analg 2004 98: 1499-1500. [Full Text]  

Prakash K. Dubey

An Unusual Cause of Intraoperative Shivering
Anesth Analg 2004 98: 1500-1501. [Full Text]  

Vincent Souron, Christopher J. Jankowski, and Terese T. Horlocker

A Complete Block of the Knee Combines Both Sacral and Lumbar Plexus Blocks • Response
Anesth Analg 2004 98: 1501. [Full Text]  

David W. Cooper, Yehuda Ginosar, Edward T. Riley, and Martin S. Angst

Evidence of Clinical Benefits from the Predominant Spinal Action of Bolus-Dose Epidural Fentanyl • Response
Anesth Analg 2004 98: 1501-1502. [Full Text]  

A. Bogdanov, A. Kapila, Chakib M. Ayoub, Marwan S. Rizk, Chadi I. Yaacoub, Anis S. Baraka, and Antoine M. Lteif

Aintree Intubating Bougie • Response
Anesth Analg 2004 98: 1502. [Full Text]  

Sebastiano Mercadante, Hans Juha Exner, Jürgen Peters, and Matthias Eikermann

Epidural Treatment in Advanced Cancer Patients • Response
Anesth Analg 2004 98: 1503-1504. [Full Text]  

Vankatesh Srinivasa, Bhavani Shanker Kodali, and Philip M. Hartigan

Evolving Capnograms After Single Lung Transplant
Anesth Analg 2004 98: 1504. [Full Text]  

Elemer K. Zsigmond, Christopher Lysakowski, Lionel Dumont, Martin Tramèr, and Edömer Tassonyi

Findings of Study of Needle-Free Jet-Injection System with Lidocaine Are Contrary To Published Reports • Response
Anesth Analg 2004 98: 1504-1505. [Full Text]  

Toinette Fontrier

Lithium for Fibromyalgia
Anesth Analg 2004 98: 1505. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Richard W. Rosenquist and Noor M. Gajraj

Atlas of Common Pain Syndromes • Interventional Pain Management. Anesthesiology Clinics of North America, Vol. 21, No. 4 • Books and Multimedia Received
Anesth Analg 2004 98: 1506. [Full Text]  

ERRATA:

Correction
Anesth Analg 2004 98: 1223. [Full Text]  

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