EDITORIALS:

Michael J. Cousins and Ronald D. Miller

Intrathecal Midazolam: An Ethical Editorial Dilemma
Anesth Analg 2004 98: 1507-1508. [Full Text]  

Tony L. Yaksh and Jeffrey W. Allen

Preclinical Insights into the Implementation of Intrathecal Midazolam: A Cautionary Tale
Anesth Analg 2004 98: 1509-1511. [Full Text]  

PAIN MEDICINE:

Adam P. Tucker, Cindy Lai, Raymond Nadeson, and Colin S. Goodchild

Intrathecal Midazolam I: A Cohort Study Investigating Safety
Anesth Analg 2004 98: 1512-1520. [Abstract] [Full Text]  

IMPLICATIONS: Intrathecal midazolam provides segmental analgesia, but conflicting animal studies have cast doubts on its safety. This investigation studied the effect of intrathecal midazolam by observing two cohorts of patients. In clinical practice, intrathecal midazolam (2 mg) did not increase adverse neurological symptoms compared with conventional therapies.

Adam P. Tucker, Joseph Mezzatesta, Raymond Nadeson, and Colin S. Goodchild

Intrathecal Midazolam II: Combination with Intrathecal Fentanyl for Labor Pain
Anesth Analg 2004 98: 1521-1527. [Abstract] [Full Text]  

IMPLICATIONS: Treatment of labor pain with epidural injections of local anesthetic is complicated by decreases in arterial blood pressure and leg weakness. This study showed that a mixture of two drugs, fentanyl and midazolam, could provide powerful pain relief when the drugs were given together spinally without such side effects.

Mary J. Johansen, Tamara Lee Gradert, William C. Satterfield, Wallace B. Baze, Keith Hildebrand, Lawrence Trissel, and Samuel J. Hassenbusch

Safety of Continuous Intrathecal Midazolam Infusion in the Sheep Model
Anesth Analg 2004 98: 1528-1535. [Abstract] [Full Text]  

IMPLICATIONS: We investigated the toxicity of preservative-free intrathecal midazolam delivered continuously via implanted infusion systems in sheep and pigs. Doses of 5-15 mg/d were well tolerated. The lack of neurotoxicity observed suggests that intrathecal midazolam may be an alternative for the treatment of intractable pain that is unresponsive to opioids.

Tony L. Yaksh and Jeffrey W. Allen

The Use of Intrathecal Midazolam in Humans: A Case Study of Process (Special Article)
Anesth Analg 2004 98: 1536-1545. [Abstract] [Full Text]  

IMPLICATIONS:The intrathecal use of midazolam has evolved over 20 years though a combination of preclinical and clinical investigations. We review the time course of this development to define critical elements that should be pursued in reducing the risk associated with the clinical use of a novel spinal drug.

Leiv A. Rosseland, Knut G. Helgesen, Harald Breivik, and Audun Stubhaug

Moderate-to-Severe Pain After Knee Arthroscopy Is Relieved by Intraarticular Saline: A Randomized Controlled Trial
Anesth Analg 2004 98: 1546-1551. [Abstract] [Full Text]  

IMPLICATIONS: In a randomized controlled trial we showed that pain after knee arthroscopy is modest and short-lived and can successfully be treated with intraarticular saline as placebo.

Masataka Yokoyama, Xiaohui Sun, Satoru Oku, Naoyuki Taga, Kenji Sato, Satoshi Mizobuchi, Toru Takahashi, and Kiyoshi Morita

Comparison of Percutaneous Electrical Nerve Stimulation with Transcutaneous Electrical Nerve Stimulation for Long-Term Pain Relief in Patients with Chronic Low Back Pain
Anesth Analg 2004 98: 1552-1556. [Abstract] [Full Text]  

IMPLICATIONS: A cumulative analgesic effect was observed in patients with chronic low back pain (LBP) after repeated percutaneous electrical nerve stimulation (PENS), but this effect gradually faded after the treatment was terminated. Results indicate that although PENS is effective for chronic LBP, treatments need to be continued to sustain analgesia.

Tony K. F. Chow, Elean To, Colin S. Goodchild, and John J. McNeil

A Simple, Fast, Easy Method to Identify the Evidence Base in Pain-Relief Research: Validation of a Computer Search Strategy Used Alone to Identify Quality Randomized Controlled Trials
Anesth Analg 2004 98: 1557-1565. [Abstract] [Full Text]  

IMPLICATIONS: Quality evidence about what is good clinical practice in pain treatment is buried in the medical literature among large quantities of other information. This article describes how any clinician with access to the Internet can identify those quality studies reliably, quickly, and inexpensively.

Magdalena Dorazil-Dudzik, Joanna Mika, Martin K.- H. Schafer, Yanzhang Li, Ilona Obara, Jerzy Wordliczek, and Barbara Przewlocka

The Effects of Local Pentoxifylline and Propentofylline Treatment on Formalin-Induced Pain and Tumor Necrosis Factor- Messenger RNA Levels in the Inflamed Tissue of the Rat Paw
Anesth Analg 2004 98: 1566-1573. [Abstract] [Full Text]  

IMPLICATIONS: This study demonstrates and provides biochemical evidence that preemptive inhibition of proinflammatory cytokine synthesis by local administration of pentoxifylline and propentofylline is useful in antagonizing hyperalgesia in formalin-induced pain. Moreover, local administration of pentoxifylline could be regarded as a valid approach to the treatment of inflammatory pain.

Helène Schulte, Alf Sollevi, and Märta Segerdahl

The Synergistic Effect of Combined Treatment with Systemic Ketamine and Morphine on Experimentally Induced Windup-Like Pain in Humans
Anesth Analg 2004 98: 1574-1580. [Abstract] [Full Text]  

IMPLICATIONS: This is the first experimental study in humans to find synergistic analgesic effects with coadministration of the N-methyl-D-aspartate receptor antagonist ketamine and morphine on pain involving central sensitization phenomena.

Alex Cahana, Antonio Carota, Marie-Louise Montadon, and Jean Marie Annoni

The Long-Term Effect of Repeated Intravenous Lidocaine on Central Pain and Possible Correlation in Positron Emission Tomography Measurements (Case Report)
Anesth Analg 2004 98: 1581-1584. [Abstract] [Full Text]  

IMPLICATIONS: We present a case of persistent central pain after encephalitis in a patient who had long-term pain relief after a series of IV lidocaine infusions. A positron emission tomography scan study, done before and after treatment, suggested that lidocaine for the diagnosis of chronic neuropathic pain may have a specific site of action in the brain.

CARDIOVASCULAR ANESTHESIA:

R. de Vroege, W. van Oeveren, J. van Klarenbosch, W. Stooker, M. A. J. M. Huybregts, C. E. Hack, L. van Barneveld, L. Eijsman, and C. R. H. Wildevuur

The Impact of Heparin-Coated Cardiopulmonary Bypass Circuits on Pulmonary Function and the Release of Inflammatory Mediators
Anesth Analg 2004 98: 1586-1594. [Abstract] [Full Text]  

IMPLICATIONS: Heparin coating of the extracorporeal circuit reduces the inflammatory response during cardiopulmonary bypass. Analysis of indices of pulmonary function indicates that use of heparin coating may result in less impaired gas exchange.

W. Nagels, R. Demeyere, J. Van Hemelrijck, E. Vandenbussche, K. Gijbels, and E. Vandermeersch

Evaluation of the Neuroprotective Effects of S(+)-Ketamine During Open-Heart Surgery
Anesth Analg 2004 98: 1595-1603. [Abstract] [Full Text]  

IMPLICATIONS: N-methyl-D-aspartic acid receptors play an important role during ischemic brain injury. We could not demonstrate that S(+)-ketamine resulted in greater neuroprotective effects compared with remifentanil during cardiopulmonary bypass procedures when both were combined with propofol.

Gerardo Tusman, Stephan H. Böhm, Fernando Suárez Sipmann, and Stefan Maisch

Lung Recruitment Improves the Efficiency of Ventilation and Gas Exchange During One-Lung Ventilation Anesthesia
Anesth Analg 2004 98: 1604-1609. [Abstract] [Full Text]  

IMPLICATIONS: In this article, we showed how a pulmonary ventilatory maneuver performed in the dependent lung during one-lung ventilation anesthesia improved arterial oxygenation and dead space.

Mary E. McSweeney, Susan Garwood, Jack Levin, Maria R. Marino, Shirley X. Wang, David Kardatzke, Dennis T. Mangano, and Richard L. Wolman

Adverse Gastrointestinal Complications After Cardiopulmonary Bypass: Can Outcome Be Predicted from Preoperative Risk Factors?
Anesth Analg 2004 98: 1610-1617. [Abstract] [Full Text]  

IMPLICATIONS: We identified the preoperative and intraoperative predictors associated with an increased incidence of postoperative gastrointestinal complications after cardiac surgery using cardiopulmonary bypass. Because these complications are associated with frequent morbidity and mortality, these predictors may be helpful in identifying patients at increased risk so that risk stratification can be modified and perioperative management can be appropriately adjusted.

Rajiv Jhaveri, Soonyul Kim, A. Ron White, Sean Burke, Dan E. Berkowitz, and Daniel Nyhan

Enhanced Vasodilatory Responses to Milrinone in Catecholamine-Precontracted Small Pulmonary Arteries
Anesth Analg 2004 98: 1618-1622. [Abstract] [Full Text]  

IMPLICATIONS: This study demonstrated that milrinone had enhanced vasodilator effects when combined with drugs with ß-adrenoreceptor agonist activity in small pulmonary artery segments removed from pigs.

Brian S. Donahue

Factor V Leiden and Perioperative Risk (Review Article)
Anesth Analg 2004 98: 1623-1634. [Abstract] [Full Text]  

Greg Stratmann, Anil M. deSilva, Elaine E. Tseng, Julie Hambleton, Michel Balea, Anthony J. Romo, Michael J. Mann, Nancy L. Achorn, William F. Moskalik, and Charles W. Hoopes

Reversal of Direct Thrombin Inhibition After Cardiopulmonary Bypass in a Patient with Heparin-Induced Thrombocytopenia (Case Report)
Anesth Analg 2004 98: 1635-1639. [Abstract] [Full Text]  

IMPLICATIONS: A combination of modified ultrafiltration, hemodialysis, and the administration of recombinant factor VIIa, fresh frozen plasma, and cryoprecipitate may reverse the anticoagulant effect of bivalirudin.

Timothy S. J. Shine, Roy A. Greengrass, and Neil G. Feinglass

Use of Continuous Paravertebral Analgesia to Facilitate Neurologic Assessment and Enhance Recovery After Thoracoabdominal Aortic Aneurysm Repair (Case Report)
Anesth Analg 2004 98: 1640-1643. [Abstract] [Full Text]  

IMPLICATIONS: We provided postoperative continuous paravertebral analgesia in a patient after thoracoabdominal aneurysm repair requiring postoperative neurologic assessment. Paravertebral analgesia provides unilateral analgesia with fewer neurologic and hemodynamic side effects than central neuraxial blockade and should be considered for management of patients undergoing thoracic aortic aneurysm repair.

PEDIATRIC ANESTHESIA:

Simon D. Whyte and Peter D. Booker

Bispectral Index During Isoflurane Anesthesia in Pediatric Patients
Anesth Analg 2004 98: 1644-1649. [Abstract] [Full Text]  

IMPLICATIONS: This observational study of children undergoing cardiac catheterization characterizes the concentration-response relationship between bispectral index and isoflurane and demonstrates that bispectral index seems adequately calibrated for monitoring the depth of isoflurane anesthesia in pediatric patients.

Stephan C. Kettner, Arnold Pollak, Michael Zimpfer, Tanja Seybold, Andrea R. Prusa, Kurt Herkner, and Stefan Kuhle

Heparinase-Modified Thrombelastography in Term and Preterm Neonates
Anesth Analg 2004 98: 1650-1652. [Abstract] [Full Text]  

IMPLICATIONS: This study assessed the coagulation of preterm and term infants by thrombelastography and found functional integrity of coagulation despite, in part, decreased conventional coagulation variables.

Christophe Dadure, Cecilia Acosta, and Xavier Capdevila

Perioperative Pain Management of a Complex Orthopedic Surgical Procedure with Double Continuous Nerve Blocks in a Burned Child (Case Report)
Anesth Analg 2004 98: 1653-1655. [Abstract] [Full Text]  

IMPLICATIONS: Double continuous nerve blocks allow optimal analgesia in burned children after complex orthopedic surgery without major adverse events. Plasma concentrations of bupivacaine remained small during the study period.

Santhanam Suresh and Leah Templeton

Superficial Cervical Plexus Block for Vocal Cord Surgery in an Awake Pediatric Patient (Case Report)
Anesth Analg 2004 98: 1656-1657. [Abstract] [Full Text]  

IMPLICATIONS: Medialization thyroplasty is a surgical procedure that decreases the incidence of dysphagia and dysphonia in patients with vocal cord paralysis. This procedure is best performed in a patient who maintains the ability to phonate. We report a case of medialization thyroplasty in a pediatric patient after bilateral superficial cervical plexus blocks with minimal sedation.

Julia C. Finkel and Ahmed Elrefai

The Use of Dexmedetomidine to Facilitate Opioid and Benzodiazepine Detoxification in an Infant (Case Report)
Anesth Analg 2004 98: 1658-1659. [Abstract] [Full Text]  

IMPLICATIONS: Dexmedetomidine was used to facilitate opioid and benzodiazepine withdrawal in an 8-mo-old infant. A processed electroencephalogram (Bispectral Index) was used to guide the titration of dexmedetomidine in this neurologically impaired infant. This is the first report of dexmedetomidine use in an infant to manage chemical dependence withdrawal.

AMBULATORY ANESTHESIA:

Kim E. Turner, Joel L. Parlow, Nicole D. Avery, Deborah A. Tod, and Andrew G. Day

Prophylaxis of Postoperative Nausea and Vomiting with Oral, Long-Acting Dimenhydrinate in Gynecologic Outpatient Laparoscopy
Anesth Analg 2004 98: 1660-1664. [Abstract] [Full Text]  

IMPLICATIONS: Dimenhydrinate is an inexpensive antiemetic with few side effects available as a long-acting oral formulation. Women undergoing outpatient gynecologic laparoscopy were given droperidol, an effective antiemetic, dimenhydrinate alone, or the combination of the two drugs. Dimenhydrinate plus droperidol significantly reduced the overall incidence of vomiting, but not nausea, when compared with droperidol alone.

Tong J. Gan, Girish P. Joshi, Eugene Viscusi, Raymond Y. Cheung, William Dodge, John G. Fort, and Connie Chen

Preoperative Parenteral Parecoxib and Follow-Up Oral Valdecoxib Reduce Length of Stay and Improve Quality of Patient Recovery After Laparoscopic Cholecystectomy Surgery
Anesth Analg 2004 98: 1665-1673. [Abstract] [Full Text]  

IMPLICATIONS: The administration of preoperative IV parecoxib followed by oral valdecoxib after surgery resulted in a shorter length of stay in the postoperative anesthesia care unit, a better quality of postoperative recovery, and a faster return to normal activity, with greater patient satisfaction, after laparoscopic cholecystectomy.

ANESTHETIC PHARMACOLOGY:

Ronald Miller

Will Succinylcholine Ever Disappear? (Editorial)
Anesth Analg 2004 98: 1674-1675. [Full Text]  

Thewarug Werawatganon, Oranuch Kyokong, Somrat Charuluxananan, and Sahadol Punyatavorn

Muscular Injury After Succinylcholine and Electroconvulsive Therapy
Anesth Analg 2004 98: 1676-1679. [Abstract] [Full Text]  

IMPLICATIONS: Both succinylcholine and electroconvulsive therapy cause muscular injury. However, we unexpectedly found that psychiatric patients who received succinylcholine and electroconvulsive therapy had less muscular damage than surgical patients who received succinylcholine for intubation. Therefore, appropriate use of succinylcholine can attenuate the muscular damaging effect from the therapy.

Mohammad I. El-Orbany, Ninos J. Joseph, M. Ramez Salem, and Arthur J. Klowden

The Neuromuscular Effects and Tracheal Intubation Conditions After Small Doses of Succinylcholine
Anesth Analg 2004 98: 1680-1685. [Abstract] [Full Text]  

IMPLICATIONS: In normal healthy patients, succinylcholine 0.6 mg/kg produces clinical intubation conditions identical to the traditional 1.0-mg/kg dose but is associated with a shorter recovery time.

Mohamed Naguib, Cynthia A. Lien, John Aker, and Rudolfo Eliazo

Posttetanic Potentiation and Fade in the Response to Tetanic and Train-of-Four Stimulation During Succinylcholine-Induced Block
Anesth Analg 2004 98: 1686-1691. [Abstract] [Full Text]  

IMPLICATIONS: Posttetanic potentiation and fade in response to train-of-four and tetanic stimuli are characteristics of neuromuscular block after bolus administration of different doses of succinylcholine. We also conclude that some characteristics of a Phase II block are evident from an initial dose (i.e., as small as 0.3 mg/kg) of succinylcholine.

T. Andrew Bowdle, Aaron Even, Danny D. Shen, and Meghan Swardstrom

Methadone for the Induction of Anesthesia: Plasma Histamine Concentration, Arterial Blood Pressure, and Heart Rate
Anesth Analg 2004 98: 1692-1697. [Abstract] [Full Text]  

IMPLICATIONS: The same dose of IV methadone (20 mg) that is effective for postoperative pain is also suitable for the induction of anesthesia in combination with etomidate. The plasma histamine concentration was notably increased in two patients, without obvious hemodynamic sequelae. Therefore, methadone appears to have the potential for producing histamine release.

Tania B. Mahinda, Blaise M. Lovell, and Bradley K. Taylor

Morphine-Induced Analgesia, Hypotension, and Bradycardia Are Enhanced in Hypertensive Rats
Anesth Analg 2004 98: 1698-1704. [Abstract] [Full Text]  

IMPLICATIONS: Presentation of essential hypertension should be considered when opioid regimens are planned both during surgery (to minimize cardiovascular complications) and during the postoperative period (to optimize analgesic effects).

Shantadurga Rajaram and Howard A. Nash

A Specific Alteration in the Electroretinogram of Drosophila melanogaster Is Induced by Halothane and Other Volatile General Anesthetics
Anesth Analg 2004 98: 1705-1711. [Abstract] [Full Text]  

IMPLICATIONS: Electroretinography (ERG) provides a useful monitor of anesthetic effects on the fruit fly. The effects of volatile anesthetics on the ERG are recapitulated by inactivation of potassium channels.

Yilei Xing, Jim Sonner, Michael J. Laster, Wella Abaigar, Valerie B. Caraiscos, Beverley Orser, and Edmond I Eger, II

Insulin Decreases Isoflurane Minimum Alveolar Anesthetic Concentration in Rats Independently of an Effect on the Spinal Cord
Anesth Analg 2004 98: 1712-1717. [Abstract] [Full Text]  

IMPLICATIONS: Intrathecal and IV insulin administration equally decrease isoflurane MAC in rats, regardless of the concentration of blood sugar. These findings indicate that although insulin decreases MAC, the decrease is not mediated by actions on the spinal cord.

Rainer Haseneder, Jörge Kurz, Hans-Ulrich U. Dodt, Eberhard Kochs, Walter Zieglgänsberger, Michaela Scheller, Gerhard Rammes, and Gerhard Hapfelmeier

Isoflurane Reduces Glutamatergic Transmission in Neurons in the Spinal Cord Superficial Dorsal Horn: Evidence for a Presynaptic Site of an Analgesic Action
Anesth Analg 2004 98: 1718-1723. [Abstract] [Full Text]  

IMPLICATIONS: The present electrophysiological in vitro experiments provide evidence that the volatile anesthetic isoflurane reduces excitatory transmitter release at the first site of synaptic integration of nociceptive inputs, the spinal cord superficial dorsal horn. This effect may contribute to the anesthetic action of volatile anesthetics at the spinal cord level.

Ho-Kyung Song and Dae Chul Jeong

The Effect of Propofol on Cytotoxicity and Apoptosis of Lipopolysaccharide-Treated Mononuclear Cells and Lymphocytes
Anesth Analg 2004 98: 1724-1728. [Abstract] [Full Text]  

IMPLICATIONS: Propofol at acceptable therapeutic concentrations, and under experimentally contrived septic conditions, did not affect the cytotoxic activity of mononuclear cells or the apoptosis level of mononuclear cells, lymphocytes, and monocytes from peripheral blood.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Thomas M. Hemmerling, Guillaume Michaud, Guillaume Trager, and François Donati

Simultaneous Determination of Neuromuscular Blockade at the Adducting and Abducting Laryngeal Muscles Using Phonomyography
Anesth Analg 2004 98: 1729-1733. [Abstract] [Full Text]  

IMPLICATIONS: After neuromuscular blockade in humans, the recovery of the ability to open the vocal cords takes longer than the ability to close the vocal cords.

Mieko Chinzei, Shigehito Sawamura, Masakazu Hayashida, Takayuki Kitamura, Hisayoshi Tamai, and Kazuo Hanaoka

Change in Bispectral Index During Epileptiform Electrical Activity Under Sevoflurane Anesthesia in a Patient with Epilepsy (Case Report)
Anesth Analg 2004 98: 1734-1736. [Abstract] [Full Text]  

IMPLICATIONS: During epileptiform electroencephalographic activity (EEG), the Bispectral Index shows an abnormal fluctuation caused by repeated abrupt alterations between normal EEG and abnormal epileptiform EEG patterns.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Amr E. Abouleish, Donald S. Prough, Charles W. Whitten, and Lydia A. Conlay

Increasing the Value of Time Reduces the Lost Economic Opportunity of Caring for Surgeries of Longer-Than-Average Times
Anesth Analg 2004 98: 1737-1742. [Abstract] [Full Text]  

IMPLICATIONS: Longer-than-average surgical durations result in less potential revenue per hour under current billing methodology. This study quantifies the increase in billing productivity when the value of time is increased, when evaluating the billing productivity of four academic anesthesiology groups.

Gisli H. Sigurdsson

Anesthesiologists Should Be Familiar with the Management of Victims of Terrorist Attacks (Editorial)
Anesth Analg 2004 98: 1743-1745. [Full Text]  

Micha Y. Shamir, Yoram G. Weiss, Dafna Willner, Yoav Mintz, Allan I. Bloom, Yuval Weiss, Charles L. Sprung, and Charles Weissman

Multiple Casualty Terror Events: The Anesthesiologist’s Perspective
Anesth Analg 2004 98: 1746-1752. [Abstract] [Full Text]  

IMPLICATIONS: Anesthesiologists provide essential care to patients injured in terror events, from the initial resuscitation through therapeutic/diagnostic procedures and surgeries. Operational issues faced by a department of anesthesiology during the initial 8 h after terrorist actions were examined. Multiple, and often parallel, efforts were required of the department.

Amir Vardi, Haim Berkenstadt, Inbal Levin, Ariel Bentencur, and Amitai Ziv

Intraosseous Vascular Access in the Treatment of Chemical Warfare Casualties Assessed by Advanced Simulation: Proposed Alteration of Treatment Protocol
Anesth Analg 2004 98: 1753-1758. [Abstract] [Full Text]  

IMPLICATIONS: In a chemical warfare mass casualty scenario, the protective gear worn by medical personnel, the time constraints, and the casualties' medical condition impose limitations on the establishment of IV access during early treatment of the victims. A spring-driven, trigger-operated intraosseous infusion delivery system may offer an effective solution.

Claus Raedler, Wolfgang G. Voelckel, Volker Wenzel, Anette C. Krismer, Christian A. Schmittinger, Holger Herff, Viktoria D. Mayr, Karl H. Stadlbauer, Karl H. Lindner, and Alfred Königsrainer

Treatment of Uncontrolled Hemorrhagic Shock After Liver Trauma: Fatal Effects of Fluid Resuscitation Versus Improved Outcome After Vasopressin
Anesth Analg 2004 98: 1759-1766. [Abstract] [Full Text]  

IMPLICATIONS: Although IV fluid administration is the mainstay of nonsurgical management of trauma patients with uncontrolled hemorrhagic shock, the efficacy of this strategy has been discussed controversially. In this animal model of severe liver trauma with uncontrolled hemorrhagic shock, vasopressin, but not saline placebo or fluid resuscitation, improved short-term survival.

Masanori Ogata, Koichiroh Nandate, Takashi Kawasaki, Chika Kawasaki, Masayuki Ozaki, and Akio Shigematsu

A Platelet Activating Factor Receptor Antagonist Inhibits Cytokine Production in Human Whole Blood by Bacterial Toxins and Live Bacteria
Anesth Analg 2004 98: 1767-1772. [Abstract] [Full Text]  

IMPLICATIONS: The platelet-activating factor receptor plays an important role in producing proinflammatory cytokines induced by bacterial toxins, such as lipopolysaccharide,Staphylococcus enterotoxin B, and live Gram-positive and Gram-negative bacteria.

NEUROSURGICAL ANESTHESIA:

Toshie Shiraishi, Hiroyuki Uchino, Takeshi Sagara, and Nagao Ishii

A Comparison of Frontal and Occipital Bispectral Index Values Obtained During Neurosurgical Procedures (Brief Report)
Anesth Analg 2004 98: 1773-1775. [Abstract] [Full Text]  

IMPLICATIONS: Bispectral values were positively correlated when recorded from frontal and occipital sensors in patients undergoing clipping of unruptured cerebral aneurysms while anesthetized with propofol and fentanyl.

Rao N. Gundamraj and Kathryn K. Lauer

Diagnosis of Intracranial Arterial Stenosis Using Transcranial Doppler Flowmetry (Case Report)
Anesth Analg 2004 98: 1776-1778. [Abstract] [Full Text]  

Transcranial Doppler detected critical blood flow reduction in response to anesthesia induction and onset of hyperventilation in a brain tumor patient.

OBSTETRIC ANESTHESIA:

Michela Camorcia, Giorgio Capogna, Gordon Lyons, and Malachy O. Columb

The Relative Motor Blocking Potencies of Intrathecal Ropivacaine: Effects of Concentration
Anesth Analg 2004 98: 1779-1782. [Abstract] [Full Text]  

IMPLICATIONS: The minimum local anesthetic dose for motor block with 0.1% ropivacaine is 50% larger than the 1% concentration with a relative efficacy ratio of 1.5. Our findings suggest that more diluted local anesthetic solutions determine less motor block, and this may be considered in ambulant laboring parturients.

Andrej Alfirevic, Maged Argalious, and John E. Tetzlaff

Pressure Sore as a Complication of Labor Epidural Analgesia (Case Report)
Anesth Analg 2004 98: 1783-1784. [Abstract] [Full Text]  

IMPLICATIONS: We report a pressure sore that resulted from lumbar epidural analgesia for labor.

REGIONAL ANESTHESIA:

Carole Barbero, Régis Fuzier, and Kamran Samii

Anterior Approach to the Sciatic Nerve Block: Adaptation to the Patient’s Height
Anesth Analg 2004 98: 1785-1788. [Abstract] [Full Text]  

IMPLICATIONS: This prospective but noncomparative work was performed to evaluate a new anterior technique of sciatic block, an adaptation of the anatomic landmarks described by Chelly and Delaunay, to patient height.

Stephan C. Marsch, Mathias Sluga, Wolfgang Studer, Jonas Barandun, Domenic Scharplatz, and Wolfgang Ummenhofer

0.5% Versus 1.0% 2-Chloroprocaine for Intravenous Regional Anesthesia: A Prospective, Randomized, Double-Blind Trial
Anesth Analg 2004 98: 1789-1793. [Abstract] [Full Text]  

IMPLICATIONS: Compared to a standard dose of 40 mL 0.5% chloroprocaine, 40 mL 1% chloroprocaine resulted in an earlier onset of analgesia duration and improved distal tourniquet tolerance during IV regional anesthesia. These beneficial effects must be weighed against a fourfold increase in signs of systemic local anesthetic toxicity.

Michael J. Cousins, David Brazier, and Raymond Cook

Intracranial Hypotension Caused by Cervical Cerebrospinal Fluid Leak: Treatment with Epidural Blood Patch (Case Report)
Anesth Analg 2004 98: 1794-1797. [Abstract] [Full Text]  

IMPLICATIONS:Low cerebrospinal fluid (CSF) pressure may cause severe posturally-related headache. In the patient, a vertebral disc protrusion in the neck seems to have contributed to a CSF leak. An injection of blood into the epidural space at the precise site of the CSF leak was followed by complete and lasting resolution of the headache.

GENERAL ARTICLES:

Khwaja Zakriya, Frederick E. Sieber, Colleen Christmas, James F. Wenz, Sr., and Shawn Franckowiak

Brief Postoperative Delirium in Hip Fracture Patients Affects Functional Outcome at Three Months
Anesth Analg 2004 98: 1798-1802. [Abstract] [Full Text]  

IMPLICATIONS: Brief postoperative delirium lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently.

Takashi Asai and Koh Shingu

Time-Related Cuff Pressures of the Laryngeal Tube With and Without the Use of Nitrous Oxide
Anesth Analg 2004 98: 1803-1806. [Abstract] [Full Text]  

IMPLICATIONS: Nitrous oxide may increase pharyngeal pressure by the cuffs of the laryngeal tube, and thus it is advisable to monitor and adjust the intracuff pressure of the laryngeal tube during anesthesia to minimize possible ischemic changes to the oropharynx.

Bettina Leemann, Thomas Heidegger, Rudolf Grossenbacher, Thomas Schnider, and Hans J. Gerig

A Severe Complication After Laser-Induced Damage to a Transtracheal Catheter During Endoscopic Laryngeal Microsurgery (Case Report)
Anesth Analg 2004 98: 1807-1808. [Abstract] [Full Text]  

IMPLICATIONS: The percutaneous transtracheal jet ventilation for elective laryngeal laser surgery reduces the risk of airway fires and gives a free endoscopic operative field. This case report suggests that, even when using a teflon catheter, laser-induced damage with severe complications might occur.

LETTERS TO THE EDITOR:

Tong J. Gan

"Black Box" Warning on Droperidol: Report of the FDA Convened Expert Panel
Anesth Analg 2004 98: 1809. [Full Text]  

Meg A. Rosenblatt, David L. Reich, Ram Roth, Babatunde O. Ogunnaike, Charles W. Whitten, and Kyle Jones

Bariatric Surgery and the Prevention of Postoperative Respiratory Complications • Response • Response
Anesth Analg 2004 98: 1810-1811. [Full Text]  

Franklin Dexter and David L. Brown

Financial Disclosure
Anesth Analg 2004 98: 1811. [Full Text]  

Thomas M. Hemmerling

BIS Sensor Electrodes Can Cause Skin Lesions: Case Report
Anesth Analg 2004 98: 1811-1812. [Full Text]  

Lukas Kirchmair, Bernhard Moriggl, Manfred Greher, Vincent W. S. Chan, and Anahi Perlas

One View Is No View • Response
Anesth Analg 2004 98: 1812-1813. [Full Text]  

Jeffrey S. Lee, Ralph E. Harding, Antoine G. M. Aya, Nathalie Vialles, and Jacques Ripart

Spinal Anesthesia in Severe Preeclampsia • Response
Anesth Analg 2004 98: 1813. [Full Text]  

B. Çelebioglu, E. Özer, and V. Çeliker

Unsuspected Mechanical Airway Obstruction in Obstructive Sleep Apnea Syndrome
Anesth Analg 2004 98: 1813-1814. [Full Text]  

Steve Serlin

Dexmedetomidine in Pediatrics: Controlled Studies Needed
Anesth Analg 2004 98: 1814. [Full Text]  

James F. Mayhew and Lisa A. Muraika

Continuous Monitoring of the End Tidal CO₂ Ensures that the Endotracheal Tube Remains in Place During the Removal of the LMA • Response
Anesth Analg 2004 98: 1814-1815. [Full Text]  

Leo I. Stemp and Lisa A. Muraika

"Quick Look" Direct Laryngoscopy to Avoid Cannot Intubate/Cannot Ventilate Inductions • Response
Anesth Analg 2004 98: 1815. [Full Text]  

Judith Harea and Lisa A. Muraika

Bullard Laryngoscope Proven Useful in Difficult Intubations in Children with Treacher Collins • Response
Anesth Analg 2004 98: 1815-1816. [Full Text]  

Steve M. Auden, Walter M. Rose, Kenneth R. Velleman, Shin Nakayama, Shinji Takahashi, and Hidenori Toyooka

A Tale of Two Wires • Response
Anesth Analg 2004 98: 1816. [Full Text]  

Vicente Martínez-Pons, Valentín Madrid, J. Brimacombe, S. Irving, and C. Keller

Ease Placement of LMA ProSeal with a Gastric Tube Inserted • Response
Anesth Analg 2004 98: 1816-1817. [Full Text]  

G. J. Coetzee, J. Brimacombe, W. Laupu, and C. Keller

Proteinaceous Material on Routinely Cleaned Laryngeal Mask Airways • Response
Anesth Analg 2004 98: 1817-1818. [Full Text]  

Russell B. P. Stasiuk

Should the Conventional Method for Routine Tracheal Intubation Be Questioned?
Anesth Analg 2004 98: 1818. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Brett R. Stacey and Christina Mora Mangano

Peripheral Nerve Blocks: A Color Atlas, 2nd ed. • Anesthesia and the Cardiac Patient. Anesthesiology Clinics of North America, Vol. 21, No. 5. • Books and Multimedia Received
Anesth Analg 2004 98: 1819-1820. [Full Text]  

GUEST REVIEWERS, AUTHOR AND SUBJECT INDEXES:

GUEST REVIEWER LIST OCTOBER 1, 2003 THRU MARCH 31, 2004
Anesth Analg 2004 98: 1821-1825. [Full Text]  

Author Index
Anesth Analg 2004 98: 1826-1846. [Full Text]  

Subject Index
Anesth Analg 2004 98: 1847-1872. [Full Text]  

ERRATA:

Correction
Anesth Analg 2004 98: 1565. [Full Text]  

Correction
Anesth Analg 2004 98: 1673. [Full Text]  

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