CARDIOVASCULAR ANESTHESIA:

Stefan Suttner, Swen N. Piper, Bernhard Kumle, Katrin Lang, Kerstin D. Röhm, Frank Isgro, and Joachim Boldt

The Influence of Allogeneic Red Blood Cell Transfusion Compared with 100% Oxygen Ventilation on Systemic Oxygen Transport and Skeletal Muscle Oxygen Tension After Cardiac Surgery
Anesth Analg 2004 99: 2-11. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We used systemic oxygen transport variables and skeletal muscle oxygen tension to assess the oxygenation status of moderately anemic, mechanically ventilated cardiac surgery patients in response to either allogeneic red blood cell transfusion or 100% oxygen ventilation. Transfusion of stored allogeneic blood was effective only in improving systemic oxygen delivery, whereas 100% oxygen ventilation improved systemic oxygenation and skeletal muscle oxygen tension.

Peter Rosenberger, Stanton K. Shernan, Simon C. Body, and Holger K. Eltzschig

Utility of Intraoperative Transesophageal Echocardiography for Diagnosis of Pulmonary Embolism
Anesth Analg 2004 99: 12-16. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Intraoperative pulmonary embolism is associated with frequent morbidity and mortality. A reliable diagnosis is crucial to initiate therapeutic intervention. Despite its practicality and utility for revealing indirect signs of pulmonary artery obstruction, intraoperative transesophageal echocardiography is limited in diagnosing pulmonary embolism via direct visualization.

Helge Schoenfeld, Manfred Muhm, Ulrich Doepfmer, Aristomenis Exadaktylos, and Hartmut Radtke

Platelet Activity in Washed Platelet Concentrates
Anesth Analg 2004 99: 17-20. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Washing of platelets may be indicated for thrombocytopenic patients with a history of allergic or febrile reactions after transfusion. We studied the spontaneous and adenosine diphosphate- and collagen-induced activation of platelets before and after washing of single-donor apheresis platelet concentrates. Washing procedure resulted in an impaired in vitro platelet function.

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

Peroxynitrite Decreases Hemostasis in Human Plasma In Vitro
Anesth Analg 2004 99: 21-26. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Coagulopathy has been associated with clinical scenarios involving reactive nitrogen species such as peroxynitrite. It was determined that exposure of human plasma to peroxynitrite generated by 3-morpholinosydnonimine resulted in hypocoagulability measured by prothrombin time, activated partial thromboplastin time, and thrombelastography. Peroxynitrite may play a significant role in hemorrhagic states.

David R. McIlroy and Andrew J. Silvers

Recombinant Factor VIIa for Life-Threatening Bleeding in High-Risk Cardiac Surgery Despite Full-Dose Aprotinin (Case Report)
Anesth Analg 2004 99: 27-30. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Despite full-dose prophylactic aprotinin and aggressive treatment of coagulopathy in a high-risk cardiac surgical case, life-threatening microvascular bleeding was controlled only after the administration of recombinant factor VIIa. There was no evidence of prothrombotic complications.

Matthias Hohlrieder, Rosmarie Oberhammer, Ingo H. Lorenz, Josef Margreiter, Gabriele Kühbacher, and Christian Keller

Life-Threatening Mediastinal Hematoma Caused by Extravascular Infusion Through a Triple-Lumen Central Venous Catheter (Case Report)
Anesth Analg 2004 99: 31-35. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This pediatric case report demonstrates a life-threatening intraoperative mediastinal hematoma caused by infusion of packed erythrocytes through the extravascular proximal lumen of a partially dislocated central venous catheter. Transesophageal echocardiography facilitated rapid intraoperative diagnosis.

Edward B. Braun, Christopher A. Palin, and Charles W. Hogue

Vasopressin During Spinal Anesthesia in a Patient with Primary Pulmonary Hypertension Treated with Intravenous Epoprostenol (Case Report)
Anesth Analg 2004 99: 36-37. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Primary pulmonary hypertension (PPH) is a progressively fatal disease that is associated with cardiovascular collapse and death with general anesthesia. We present a patient with PPH who underwent skin grafting under spinal anesthesia while receiving a continuous IV epoprostenol infusion. IV vasopressin was used to avoid systemic hypotension associated with spinal anesthesia.

Kathryn E. Glas, Jack S. Shanewise, and Robert A. Guyton

An Unusual Cause of Left Ventricular Outflow Tract Obstruction After Mitral Valve Repair (Case Report)
Anesth Analg 2004 99: 38-40. [Abstract] [Full Text] [PDF] [VIDEO]  [Request Permissions]  

IMPLICATIONS: The authors describe the intraoperative diagnosis of an unusual cause of left ventricular outflow obstruction in a patient with normal hemodynamic status after mitral valve repair.

Drew A. MacGregor, David A. Zvara, R. Morris Treadway, Jr, Jamal A. Ibdah, James D. Maloney, Neal D. Kon, and Robert D. Riley

Late Presentation of Esophageal Injury After Transesophageal Echocardiography (Case Report)
Anesth Analg 2004 99: 41-44. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Esophageal injury due to transesophageal echocardiography is a serious complication that may not be evident for more than 2 days after cardiac surgery.

PEDIATRIC ANESTHESIA:

Pasquale De Negri, Giorgio Ivani, Tiziana Tirri, Pasqualina Modano, Cesare Reato, Staffan Eksborg, and Per-Arne Lonnqvist

A Comparison of Epidural Bupivacaine, Levobupivacaine, and Ropivacaine on Postoperative Analgesia and Motor Blockade
Anesth Analg 2004 99: 45-48. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The use of the newer local anesthetics levobupivacaine and ropivacaine was associated with similar postoperative analgesia but less unwanted muscle weakness of the lower extremities compared with the previous standard (bupivacaine) when administered as small-concentration (0.125%; 0.2 mg {middle dot} kg-1 {middle dot} h-1) postoperative epidural infusions in children.

Masanori Kashiwagi, Yasumasa Okada, Shun-ichi Kuwana, Shigeki Sakuraba, Ryoichi Ochiai, and Junzo Takeda

A Neuronal Mechanism of Propofol-Induced Central Respiratory Depression in Newborn Rats
Anesth Analg 2004 99: 49-55. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We analyzed the effects of propofol on medullary respiratory neurons in brainstem-spinal cord preparations from newborn rats in vitro using a perforated patch-clamp technique. Our findings suggest that the {gamma}-aminobutyric acid (GABA)A receptor-mediated hyperpolarization of preinspiratory neurons serves as the neuronal basis of propofol-induced respiratory depression.

Susan T. Verghese, Raafat S. Hannallah, Michael C. Slack, Russell R. Cross, and Kantilal M. Patel

Auscultation of Bilateral Breath Sounds Does Not Rule Out Endobronchial Intubation in Children
Anesth Analg 2004 99: 56-58. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Despite confirmation of correct endotracheal tube position by auscultation, fluoroscopy showed an endobronchial tube position in 11.8% of children positioned with their arms above their heads during cardiac catheterization procedures. This potential problem must be anticipated when deciding on the depth of tube insertion.

Kathleen H. Chaimberg and Joseph P. Cravero

Mucositis and Airway Obstruction in a Pediatric Patient (Case Report)
Anesth Analg 2004 99: 59-61. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report a case of airway obstruction resulting from mucositis and pseudomembrane formation in a 16-yr-old girl undergoing chemotherapy.

AMBULATORY ANESTHESIA:

Getúlio Rodrigues de Oliveira Filho and Leonardo Schonhorst

The Development and Application of an Instrument for Assessing Resident Competence During Preanesthesia Consultation
Anesth Analg 2004 99: 62-69. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A resident assessment score at outpatient preanesthesia consultation was constructed, validated, and applied. Quality assurance statistics were used for its interpretation. The instrument proved useful in scoring resident performance and in identifying different patterns of performance.

T. Andrew Bowdle

Nocturnal Arterial Oxygen Desaturation and Episodic Airway Obstruction After Ambulatory Surgery
Anesth Analg 2004 99: 70-76. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We studied nocturnal breathing before and after ambulatory surgery in 45 patients without a history of the sleep apnea syndrome. Nine patients had abnormal breathing that frequently resulted in hypoxemia. Oxygen desaturation occurred in the presence and absence of obvious upper airway obstruction. Five of the nine abnormally breathing patients had abnormal breathing before and after surgery.

ANESTHETIC PHARMACOLOGY:

Ashraf S. Habib, William D. White, Steve Eubanks, Theodore N. Pappas, and Tong J. Gan

A Randomized Comparison of a Multimodal Management Strategy Versus Combination Antiemetics for the Prevention of Postoperative Nausea and Vomiting
Anesth Analg 2004 99: 77-81. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A multimodal management strategy for postoperative nausea and vomiting was superior to combination antiemetic prophylaxis with inhaled anesthetic or total IV anesthesia with propofol.

Jennifer A. Shumilla, Sarah M. Sweitzer, Edmond I Eger, II, Michael J. Laster, and Joan J. Kendig

Inhibition of Spinal Protein Kinase C- or - Isozymes Does Not Affect Halothane Minimum Alveolar Anesthetic Concentration in Rats
Anesth Analg 2004 99: 82-84. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Inhibition of two protein kinase C isozymes ({epsilon} and {gamma}) in the lower spinal cord (the site at which inhaled anesthetics act to produce immobility) did not affect the minimum alveolar anesthetic concentration (MAC) of halothane. These results produce no evidence that effects on receptor or ion channel phosphorylation underlie the capacity of inhaled anesthetics to produce immobility, a result consistent with the notion that direct actions on receptors or ion channels underlie MAC.

Yi Zhang, James M. Sonner, Edmond I Eger, II, Caroline R. Stabernack, Michael J. Laster, Douglas E. Raines, and R. Adron Harris

Gamma-Aminobutyric Acid_A Receptors Do Not Mediate the Immobility Produced by Isoflurane
Anesth Analg 2004 99: 85-90. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Although in vitro studies demonstrate that isoflurane enhances the effect of gamma aminobutyric acid (GABA) on GABAA receptors, results from the present in vivo work indicate that the GABAA receptor does not mediate the immobility produced by isoflurane.

Jörg Ahrens, Gertrud Haeseler, Martin Leuwer, Bahram Mohammadi, Klaus Krampfl, Reinhard Dengler, and Johannes Bufler

2,6 Di-tert-butylphenol, a Nonanesthetic Propofol Analog, Modulates ₁ß Glycine Receptor Function in a Manner Distinct from Propofol
Anesth Analg 2004 99: 91-96. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This in vitro study shows that, at the glycine receptor level, propofol does not differ from its nonanesthetic structural analog 2,6 di-tert-butylphenol in its ability to enhance the effect of small glycine concentrations but differs in its potential to directly activate chloride inward currents in the absence of the natural agonist.

Klaus Hahnenkamp, Joke Nollet, Danja Strümper, Tobias Halene, Pia Rathman, Eike Mortier, Hugo Van Aken, Joerg Knapp, Marcel E. Durieux, and Christian W. Hoenemann

Bupivacaine Inhibits Thromboxane A₂-Induced Vasoconstriction in Rat Thoracic Aorta
Anesth Analg 2004 99: 97-102. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Bupivacaine inhibits thromboxane A2-induced vasoconstriction in rat thoracic aorta rings in an endothelium-independent manner.

Lukas G. Weigl, Carmen Ludwig-Papst, and Hans G. Kress

4-Chloro-m-Cresol Cannot Detect Malignant Hyperthermia Equivocal Cells in an Alternative Minimally Invasive Diagnostic Test of Malignant Hyperthermia Susceptibility
Anesth Analg 2004 99: 103-107. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: For the diagnostic test of susceptibility to malignant hyperthermia (MH), 4-chloro-m-cresol (4-CmC) has been proposed. In our study with differentiated human skeletal muscle cells, however, 4-CmC, like caffeine, could not distinguish between cells from individuals tested in the in vitro contracture test as normal and MH equivocal.

Roger D. Knaggs, Isla M. Crighton, Timothy F. Cobby, Anthony J. P. Fletcher, and Gregory J. Hobbs

The Pupillary Effects of Intravenous Morphine, Codeine, and Tramadol in Volunteers
Anesth Analg 2004 99: 108-112. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The effect of several opioid analgesics on pupillary size has been studied. The results may be explained by differences in metabolism and pharmacokinetics of the drugs used. The data may be of use in defining a marker for the central effect of opioids and when assessing the degree of opioid toxicity.

Yoshitaka Fujii, Aki Uemura, and Hidenori Toyooka

The Recovery Profile of Reduced Diaphragmatic Contractility Induced by Propofol in Dogs
Anesth Analg 2004 99: 113-116. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Propofol at an anesthetic dose decreases diaphragmatic contractility in dogs, and its recovery is established within 20 min after the cessation of administration. This rapid recovery profile for diaphragm muscle dysfunction is widely accepted in anesthetic practice.

Anil Agarwal, Mehdi Raza, Sanjay Dhiraaj, Ravinder Pandey, Devendra Gupta, Chandra Kant Pandey, Prabhat K Singh, and Uttam Singh

Pain During Injection of Propofol: The Effect of Prior Administration of Butorphanol
Anesth Analg 2004 99: 117-119. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Pain associated with IV injection of propofol is seen in 28%-90% patients. Pretreatment with butorphanol 2 mg and lidocaine 40 mg attenuated the incidence and severity of pain associated with propofol injection. Butorphanol was the most effective and can be used routinely to prevent propofol pain.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Vance G. Nielsen, William Q. Gurley, Jr, and Thomas M. Burch

The Impact of Factor XIII on Coagulation Kinetics and Clot Strength Determined by Thrombelastography
Anesth Analg 2004 99: 120-123. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Changes in fibrinogen concentration have been implicated as the primary determinant of protein-mediated clot strength via thrombelastography. We determined that factor XIII (FXIII) activity significantly enhanced clot strength and speed of clot initiation and formation. Transfusion decision making with thrombelastography must account for the contribution of both fibrinogen and FXIII.

Sonia J. Vaida, Diana Gaitini, Bruce Ben-David, Mostafa Somri, Carin A. Hagberg, and Luis A. Gaitini

A New Supraglottic Airway, the Elisha Airway Device: A Preliminary Study (Technical Communication)
Anesth Analg 2004 99: 124-127. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The ability of the Elisha Airway Device to perform three functions—ventilation, blind and/or fiberoptic-aided intubation without interruption of ventilation, and gastric tube insertion—was studied for the first time in patients receiving general anesthesia with mechanical ventilation.

Amir Baker, Walter Klimscha, James C. Eisenach, Xin-Hui Li, Eckart Wildling, Wolfgang A. Menth-Chiari, and Astrid I. Chiari

Intrathecal Clonidine for Postoperative Analgesia in Elderly Patients: The Influence of Baricity on Hemodynamic and Analgesic Effects
Anesth Analg 2004 99: 128-134. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In elderly patients after surgical repair of traumatic hip fracture, intrathecal hyperbaric clonidine reduces hemodynamic side effects but also the quality and duration of postoperative analgesia compared with isobaric clonidine.

Gastón Schechtmann, Johan Wallin, Björn A. Meyerson, and Bengt Linderoth

Intrathecal Clonidine Potentiates Suppression of Tactile Hypersensitivity by Spinal Cord Stimulation in a Model of Neuropathy
Anesth Analg 2004 99: 135-139. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Pain after nerve injury is often difficult to manage, but some patients may respond to electrical stimulation of the spinal cord (SCS) with satisfactory pain relief. This study in the rat suggests that spinal delivery of a drug (clonidine) in combination with SCS for pain relief warrants clinical investigation.

Douglas G. Ririe, David Barclay, Heather Prout, Chuanyo Tong, Joseph R. Tobin, and James C. Eisenach

Preoperative Sciatic Nerve Block Decreases Mechanical Allodynia More in Young Rats: Is Preemptive Analgesia Developmentally Modulated?
Anesth Analg 2004 99: 140-145. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: With a model of postoperative pain, younger animals demonstrated preemptive analgesic effects from sciatic nerve block, whereas older animals did not. These data in rats suggest that preemptive analgesia in the postoperative model may be more effective in the young.

Trine Mikkelsen, Mads U. Werner, Birgit Lassen, and Henrik Kehlet

Pain and Sensory Dysfunction 6 to 12 Months After Inguinal Herniotomy
Anesth Analg 2004 99: 146-151. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Inguinal hernia repair is associated with a 5%-30% incidence of chronic pain. In this study, sensory testing of the surgical area did not show clinical significant differences between the pain and nonpain groups. These results suggest that factors other than cutaneous nerve damage are involved in the development of chronic pain after hernia repair.

Guo Hua Zhang, Sun Seek Min, Kyu Sang Lee, Seung Keun Back, Seong Jun Yoon, Young Wook Yoon, Yang In Kim, Heung Sik Na, Seung Kil Hong, and Hee Chul Han

Intraarticular Pretreatment with Ketamine and Memantine Could Prevent Arthritic Pain: Relevance to the Decrease of Spinal c-Fos Expression in Rats
Anesth Analg 2004 99: 152-158. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study demonstrated that peripheral pretreatment with ketamine and memantine suppressed both arthritic pain-related behavior and spinal c-Fos expression. These results indicate that both ketamine and memantine have prophylactic analgesia and provide support for their potential use as peripheral analgesics for joint pain.

Lin Shi, Philippe Lebrun, Frederic Camu, and Martin Zizi

Intrathecal Catheterization and Solvents Interfere with Cortical Somatosensory Evoked Potentials Used in Assessing Nociception in Awake Rats
Anesth Analg 2004 99: 159-165. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Variability is the main limitation of cortical somatosensory evoked potential (CSEP) measurements. This study validated CSEPs to examine central sensitization induced by formalin. Testing conditions were found in which CSEP signals could be reliably used to evaluate central sensitization processes, as well as the antinociceptive effect of the drug, in a dose-dependent manner.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Gilles Lebuffe, Benoît Vallet, Jukka Takala, Gary Hartstein, Maurice Lamy, Monty Mythen, Jan Bakker, David Bennett, Owen Boyd, and Andrew Webb

A European, Multicenter, Observational Study to Assess the Value of Gastric-to-End Tidal PCO₂ Difference in Predicting Postoperative Complications
Anesth Analg 2004 99: 166-172. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Gastric-to-end tidal partial pressure difference of carbon dioxide (Pr-etCO2) is recognized as an index of gastrointestinal perfusion during surgery. In a high-risk surgical population with an expected duration of surgery of more than 2 h, this European, multicenter observational study suggests that automated semi-continuous monitoring of Pr-etCO2 can be used as an intraoperative predictor of poor outcome.

Kristy Beal, Juliette Dean, James Chen, Elena Dragaon, Ann Saulino, and Charles D. Collard

Budget Negotiation for Industry-Sponsored Clinical Trials (Special Article)
Anesth Analg 2004 99: 173-176. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Industry-sponsored clinical research over the past decade has been significantly altered by the rapid growth of commercially oriented networks of contract-research organizations and site-management organizations. Successful budgeting for the performance of an industry-sponsored clinical trial thus requires a thorough understanding of the direct and indirect costs associated with performing clinical research.

CRITICAL CARE AND TRAUMA:

Mathias Zürcher, Martin R. Tramèr, and Bernhard Walder

Colonization and Bloodstream Infection with Single- Versus Multi-Lumen Central Venous Catheters: A Quantitative Systematic Review
Anesth Analg 2004 99: 177-182. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Each catheter that is placed into a central vein may induce some morbidity: complications are mechanical, thrombotic, and infectious. Catheter-related bloodstream infection is the most important complication. This systematic review of randomized controlled trials suggests that for every 20 single-lumen catheters inserted, one bloodstream infection would be avoided that would have occurred had multi-lumen catheters been used.

NavParkash S. Sandhu

Transpectoral Ultrasound-Guided Catheterization of the Axillary Vein: An Alternative to Standard Catheterization of the Subclavian Vein
Anesth Analg 2004 99: 183-187. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Axillary vein catheterization using real-time sonography provides an image of a puncturing needle and axillary vein simultaneously, preventing lung, arterial, and nerve injury.

Neel Sengupta, Keng Leong Ang, Doraiswamy Prakash, Vivien Ng, and Shane J. George

Twenty Months’ Routine Use of a New Percutaneous Tracheostomy Set Using Controlled Rotating Dilation
Anesth Analg 2004 99: 188-192. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Routine use of a controlled rotating dilation percutaneous tracheostomy technique can be safely performed over a long period by doctors with different levels of experience under close bedside supervision and represents a viable alternative percutaneous tracheostomy technique.

Nicola Petrucci and Walter Iacovelli

Ventilation with Smaller Tidal Volumes: A Quantitative Systematic Review of Randomized Controlled Trials
Anesth Analg 2004 99: 193-200. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Mechanical breathing can cause lung damage and bleeding in patients affected by severe lung failure. This systematic review summarizes clinical trials testing a lung-protective method of mechanical ventilation. Protective ventilation can decrease deaths in the short term but the effects in the long term are unknown.

Martin W. Dünser, Dietmar R. Fries, Wolfgang Schobersberger, Hanno Ulmer, Volker Wenzel, Barbara Friesenecker, Walter R. Hasibeder, and Andreas J. Mayr

Does Arginine Vasopressin Influence the Coagulation System in Advanced Vasodilatory Shock with Severe Multiorgan Dysfunction Syndrome?
Anesth Analg 2004 99: 201-206. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This randomized, controlled study examined the effects of arginine vasopressin (AVP) infusion on the coagulation system in advanced vasodilatory shock with severe multiorgan dysfunction syndrome. AVP does not increase Factor VIII, von Willebrand Factor antigen, and ristocetin Co-Factor but may induce thrombocytopenia. Global coagulation is not different from norepinephrine therapy alone.

Jebadurai Ratnaraj, Barbara Kabon, Michael R. Talcott, Daniel I. Sessler, and Andrea Kurz

Supplemental Oxygen and Carbon Dioxide Each Increase Subcutaneous and Intestinal Intramural Oxygenation
Anesth Analg 2004 99: 207-211. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Tissue oxygenation is the primary determinant of oxidative killing rate by neutrophils. Increasing inspired oxygen concentration from 30% to 100% or increasing end-tidal PCO2 from 30 mm Hg to 50 mm Hg increased both subcutaneous or intestinal intramural tissue oxygenation, with supplemental oxygen being most effective. Either treatment is thus likely to reduce the risk of infection.

Yuji Kadoi and Fumio Goto

Selective Inducible Nitric Oxide Inhibition Can Restore Hemodynamics, but Does Not Improve Neurological Dysfunction in Experimentally-Induced Septic Shock in Rats
Anesth Analg 2004 99: 212-220. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We examined whether selective inducible nitric oxide synthase inhibition can prevent the neurological changes induced by sepsis and found that it could not improve neurological dysfunction.

Kimberley E. Culp, John G. Augoustides, Andrew E. Ochroch, and Bonnie L. Milas

Clinical Management of Cardiogenic Shock Associated with Prolonged Propofol Infusion (Case Report)
Anesth Analg 2004 99: 221-226. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This case report details survival of a patient who developed postoperative cardiogenic shock associated with a prolonged propofol infusion. The pivotal role of mechanical circulatory support is emphasized. The management of circulatory collapse in a patient sedated with propofol should include prompt discontinuation of propofol and early institution of mechanical circulatory support.

Juan Santiago-Palma, E. Daniela Hord, Ricardo Vallejo, Jason Trella, and Shihab U Ahmed

Respiratory Distress After Intrathecal Baclofen Withdrawal (Case Report)
Anesth Analg 2004 99: 227-229. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A 19-yr-old woman with dystonia developed adductor spasms of the vocal cords after the interruption of intrathecal baclofen. Her symptoms resolved after intrathecal baclofen was restored. In patients with dystonia receiving intrathecal baclofen, the onset of dyspnea should prompt the investigation of baclofen withdrawl.

NEUROSURGICAL ANESTHESIA:

Nino Stocchetti, Katia Canavesi, Sandra Magnoni, Valerio Valeriani, Valeria Conte, Sandra Rossi, Luca Longhi, Elisa Roncati Zanier, and Angelo Colombo

Arterio-Jugular Difference of Oxygen Content and Outcome After Head Injury
Anesth Analg 2004 99: 230-234. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In a series of 229 severely head-injured patients, the cases with a favorable outcome had a higher mean arterio-jugular difference of oxygen content than the ones with an unfavorable outcome.

Toshinori Horiuchi, Masahiko Kawaguchi, Takanori Sakamoto, Naoko Kurita, Satoki Inoue, Mitsutoshi Nakamura, Noboru Konishi, and Hitoshi Furuya

The Effects of the -Opioid Agonist SNC80 on Hind-Limb Motor Function and Neuronal Injury After Spinal Cord Ischemia in Rats
Anesth Analg 2004 99: 235-240. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Although recent evidence suggested neuroprotective efficacy of a {delta}-opioid agonist in the brain, there have been no data regarding its efficacy in the spinal cord. The results in this study showed that the {delta}-opioid agonist SNC80 attenuated neuronal injury after spinal cord ischemia in rats.

OBSTETRIC ANESTHESIA:

Hsiao Lun Sun, Qing Dong Ling, Wei Zen Sun, Rick Sai-Chuen Wu, Tzong Jeng Wu, Shih Chieh Wang, and Chih Cheng Chien

Lower Limb Wrapping Prevents Hypotension, but Not Hypothermia or Shivering, After the Introduction of Epidural Anesthesia for Cesarean Delivery
Anesth Analg 2004 99: 241-244. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We examined the effect of leg wrapping on the incidence of hypotension and hypothermia after epidural anesthesia. Although this maneuver prevents maternal hypotension after epidural anesthesia, it does not decrease the magnitude of sublingual temperature change, nor does it prevent the occurrence of shivering.

REGIONAL ANESTHESIA:

Samuel Evron, Daniel Sessler, Oscar Sadan, Mona Boaz, Marek Glezerman, and Tiberiu Ezri

Identification of the Epidural Space: Loss of Resistance with Air, Lidocaine, or the Combination of Air and Lidocaine
Anesth Analg 2004 99: 245-250. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In laboring women receiving epidural analgesia, identifying the epidural space by loss-of-resistance with lidocaine was more effective and caused fewer complications than identifying the epidural space by loss of resistance with air.

D. Macalou, S. Trueck, P. Meuret, M. Heck, F. Vial, S. Ouologuem, X. Capdevila, J. -M. Virion, and H. Bouaziz

Postoperative Analgesia After Total Knee Replacement: The Effect of an Obturator Nerve Block Added to the Femoral 3-in-1 Nerve Block
Anesth Analg 2004 99: 251-254. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Femoral 3-in-1 nerve block alone is frequently used for pain control after total knee replacement but does not provide complete postoperative analgesia. This study showed that the addition of an obturator nerve block to femoral 3-in-1 nerve block improves the quality of postoperative analgesia after total knee replacement.

Martin Jetzek-Zader, Guido Peterschulte, Ulrich Ludwig, and Peter Lipfert

Muscle Weakness and Paresthesia Associated with Epidural Analgesia in a Patient with an Intrathecal Neurofibrolipoma as Part of a Tethered Cord Syndrome (Case Report)
Anesth Analg 2004 99: 255-258. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report a case of acute aggravation of a previously undiagnosed tethered cord syndrome during lumbar epidural anesthesia, which demonstrates the need of anesthesiologists to be aware of this syndrome.

Ban C. H. Tsui and Stephan Malherbe

Inadvertent Cervical Epidural Catheter Placement via the Caudal Route Using Electrical Stimulation (Case Report)
Anesth Analg 2004 99: 259-261. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: To avoid misinterpretation of the stimulation level with the Tsui test, the epidural catheter should be continuously stimulated while it is advanced. The length of epidural catheter required should be predetermined before insertion, and the position of the catheter should also be radiographically confirmed after surgery.

GENERAL ARTICLES:

Claude Couvret, Marc Laffon, Annick Baud, Valérie Payen, Philippe Burdin, and Jacques Fusciardi

A Restrictive Use of Both Autologous Donation and Recombinant Human Erythropoietin Is an Efficient Policy for Primary Total Hip or Knee Arthroplasty
Anesth Analg 2004 99: 262-271. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: During primary total hip or knee arthroplasty, the limitation of erythropoietin to patients with hematocrit <=37%, the restrictive use of autologous donation to patients with 37% < hematocrit <= 39% and no autologous donation in the nonanemics may allow savings both in blood requirements and financial cost.

Ozan Akça, Anupama Wadhwa, Papiya Sengupta, Jaleel Durrani, Keith Hanni, Mary Wenke, Yüksel Yücel, Rainer Lenhardt, Anthony G. Doufas, and Daniel I. Sessler

The New Perilaryngeal Airway (CobraPLA^TM) Is as Efficient as the Laryngeal Mask Airway (LMA^TM) but Provides Better Airway Sealing Pressures
Anesth Analg 2004 99: 272-278. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The perilaryngeal airway (CobraPLA) has insertion characteristics similar to those of the laryngeal mask airway but better airway sealing capabilities. This better sealing might improve the ability to provide mechanical ventilation.

Kuang-I Cheng, Koung-Shing Chu, Siu-Wah Chau, Soo-Lee Ying, Hong-Te Hsu, Yin-Lung Chang, and Chao-Shun Tang

Lightwand-Assisted Intubation of Patients in the Lateral Decubitus Position
Anesth Analg 2004 99: 279-283. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The skilled anesthesiologist can easily and effectively perform a lightwand-assisted intubation for patients in a lateral position. This alternative technique should be practiced before attempting it for the first time, and it is recommended for patients who must remain in a lateral position.

Dieter Fröhlich, Sigrid Wittmann, Gregor Rothe, Daniel I. Sessler, Peter Vogel, and Kai Taeger

Mild Hyperthermia Down-Regulates Receptor-Dependent Neutrophil Function
Anesth Analg 2004 99: 284-292. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In contrast to nonreceptor-dependent phagocytosis and oxidative killing, several crucial receptor-dependent functions of neutrophils have a temperature-dependent regulation, with increased function during hypothermia and reduced function during hyperthermia.

Anthony M.-H. Ho, Manoj K. Karmakar, Wynnie W. M. Lam, Freda O. Lam, T. W. Lee, S. K. Ng, and David C. Chung

Does the Presence of a Tracheal Bronchus Affect the Margin of Safety of Double-Lumen Tube Placement? (Brief Report)
Anesth Analg 2004 99: 293-295. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: An orifice arising on the right tracheal wall to supply all or part of the right upper lobe occurs with a frequency of {approx}0.5%. Because tracheal bronchi usually arise at within 2 cm of the carina, they should only rarely reduce the intrinsic margin of safety of left-sided double-lumen tubes.

MEETING REPORT:

Etsuro K. Motoyama and Shoichi Uezono

The Society for Pediatric Anesthesia: The First Joint Meeting of the Society for Pediatric Anesthesia and the Japanese Society of Pediatric Anesthesiology
Anesth Analg 2004 99: 296-300. [Full Text] [PDF] [Request Permissions]  

LETTERS TO THE EDITOR:

Laurie Schechter, Sandra L. Barcelona, Michael P. Eaton, and Anahat K. Dhillon

Comparisons Between Level 1® and Other Fast Flow Fluid Warming Systems • Response • Response
Anesth Analg 2004 99: 301-302. [Full Text] [PDF] [Request Permissions]  

Jean-Pol Depoix, Jean-Michel Julliard, Pierre Aubry, Jean-Marie Desmonts, Alec Vahanian, and Jean Mantz

Propofol-Remifentanil Target-Controlled Anesthesia in a Patient with Hyperkalemic Familial Periodic Paralysis
Anesth Analg 2004 99: 302. [Full Text] [PDF] [Request Permissions]  

Shashi Kiran and Bhatia Upma

Use of Small-Dose Bupivacaine (3 mg vs 4 mg) for Unilateral Spinal Anesthesia in the Outpatient Setting
Anesth Analg 2004 99: 302-303. [Full Text] [PDF] [Request Permissions]  

W. Brinkert, M. Steegers, and A. Hensens

Continuous Inflation of a Punctured Cuff During Pulmonary Surgery
Anesth Analg 2004 99: 303. [Full Text] [PDF] [Request Permissions]  

Krzysztof M. Kuczkowski, Steven P. Cohen, and Grzegorz P. Kozikowski

Pneumocephalus Following an Uneventful Lumbar Puncture: Does the Gauge of a Spinal Needle Matter? • Response
Anesth Analg 2004 99: 303-304. [Full Text] [PDF] [Request Permissions]  

Laxmaiah Manchikanti, Mark V. Boswell, Vijay Singh, Nathaniel Katz, Gilbert Fanciullo, and Janet E. Vielguth

Monitoring of Patients Receiving Long-Term Opioid Therapy • Response
Anesth Analg 2004 99: 304-305. [Full Text] [PDF] [Request Permissions]  

Luc G. Morris, Jennifer L. Marti, David J. Ziff, Peter Lierz, and Peter Felleiter

Termination of Idiopathic Persistent Singultus (Hiccup) with Supra-Supramaximal Inspiration. • Response
Anesth Analg 2004 99: 305-306. [Full Text] [PDF] [Request Permissions]  

Thomas Schricker and Ban C. H. Tsui

Postoperative Intrathecal Morphine for Analgesia after Major Orthopedic Surgery? • Response
Anesth Analg 2004 99: 306. [Full Text] [PDF] [Request Permissions]  

Jan Hofland, Robert Tenbrinck, Antonio González-Arévalo, Juan I. Gómez-Arnau, and Santiago García-del-Valle

Oxygen Consumption: Validation of the Closed-Circuit PhysioFlex® Anaesthesia Machine • Response
Anesth Analg 2004 99: 306. [Full Text] [PDF] [Request Permissions]  

Daryl J. Kor, Mark T. Keegan, Kenyon W. Kruse, and C. Mark Bazzell

Malposition of a Pulmonary Artery Catheter in a Patient with an Inferior Vena Cava Filter
Anesth Analg 2004 99: 307. [Full Text] [PDF] [Request Permissions]  

Y. M. Shouman

More Information from the Pressure Gauge of Oxygen Cylinders
Anesth Analg 2004 99: 307-308. [Full Text] [PDF] [Request Permissions]  

Tiberiu Ezri, Marian Weissenberg, Ofer Yanai, Michael Sullam-Muggia, Zion Houri, and Peter Szmuk

Internal or External Diameter?
Anesth Analg 2004 99: 308. [Full Text] [PDF] [Request Permissions]  

Aimé Limoge and Florence Dixmerias-Iskandar

A Personal Experience Using Limoge’s Current During a Major Surgery
Anesth Analg 2004 99: 309. [Full Text] [PDF] [Request Permissions]  

Ilhan Celik, Joachim Boldt, and Hans-Joachim Priebe

Renal Dysfunction After Hydroxyethyl Starch • Response
Anesth Analg 2004 99: 309-310. [Full Text] [PDF] [Request Permissions]  

Steven M. Dunn, Larry Robbins, Neil Roy Connelly, and William H. Rosenblatt

The LMA ProSeal ^TM May Not Be the Best Option for Difficult to Intubate/Ventilate Patients • Response
Anesth Analg 2004 99: 310-311. [Full Text] [PDF] [Request Permissions]  

Stefan G. de Hert, Philippe J. Van der Linden, Sven A. F. Tulner, Robert J. M. Klautz, Gerda L. van Rijk-Zwikker, Frank H. M. Engbers, Jeroen J. Bax, Jan Baan, Ernst E. van der Wall, Robert A. Dion, and Paul Steendijk

Left Ventricular Function After Cardiopulmonary Bypass Is Related to the Length-Dependent Regulation of Myocardial Function • Response
Anesth Analg 2004 99: 311-312. [Full Text] [PDF] [Request Permissions]  

Chris Christodoulou, J. Brimacombe, and C. Keller

ProSeal Laryngeal Mask Airway Foldover Detection • Response
Anesth Analg 2004 99: 312-313. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Bryant A. Murphy

Anesthesiologist’s Manual of Surgical Procedures, 3rd ed. • Books and Multimedia Received
Anesth Analg 2004 99: 314. [Full Text] [PDF] [Request Permissions]  

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