CARDIOVASCULAR ANESTHESIA:

Douglas B. Coursin and Richard C. Prielipp

The New Anesthesia Diet Plan: Keeping Perioperative Carbs in Check (Editorial)
Anesth Analg 2004 99: 316-318. [Full Text]  

George Carvalho, Anne Moore, Baqir Qizilbash, Kevin Lachapelle, and Thomas Schricker

Maintenance of Normoglycemia During Cardiac Surgery
Anesth Analg 2004 99: 319-324. [Abstract] [Full Text]  

IMPLICATIONS: The hyperinsulinemic normoglycemic clamp can be used to preserve normoglycemia during open heart surgery. This technique in combination with a continuous intravenous glucose monitoring system may be applied in future studies to investigate the effect of aggressive intraoperative glucose control on outcome after cardiac surgery.

Yuji Kadoi, Shigeru Saito, Fumio Goto, and Nao Fujita

The Effect of Diabetes on the Interrelationship Between Jugular Venous Oxygen Saturation Responsiveness to Phenylephrine Infusion and Cerebrovascular Carbon Dioxide Reactivity
Anesth Analg 2004 99: 325-331. [Abstract] [Full Text]  

IMPLICATIONS: We examined whether the interrelationship between jugular venous oxygen saturation responsiveness to phenylephrine infusion and cerebrovascular CO2 reactivity, as well as impaired cerebrovascular autoregulation, were associated with previous hyperglycemia.

Ruggero Amà, Patrick Segers, Carl Roosens, Tom Claessens, Pascal Verdonck, and Jan Poelaert

The Effects of Load on Systolic Mitral Annular Velocity by Tissue Doppler Imaging
Anesth Analg 2004 99: 332-338. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated the effects of load changes on systolic mitral annular velocity (Sm) by Tissue Doppler Imaging velocity. Our results show that Sm is dependent on increases in preload and cannot be recommended as a variable of ventricular contractile performance in critically ill patients where significant changes in ventricular filling occur.

Orathy Patangi Sanjay and Deepak Ivan Tauro

Midazolam: An Effective Antiemetic After Cardiac Surgery—A Clinical Trial
Anesth Analg 2004 99: 339-343. [Abstract] [Full Text]  

IMPLICATIONS: Midazolam is a more effective antiemetic than ondansetron for preventing postoperative nausea and vomiting after cardiac surgery.

Jens Plachky, Stefan Hofer, Martin Volkmann, Eike Martin, Hubert J. Bardenheuer, and Markus A. Weigand

Regional Cerebral Oxygen Saturation Is a Sensitive Marker of Cerebral Hypoperfusion During Orthotopic Liver Transplantation
Anesth Analg 2004 99: 344-349. [Abstract] [Full Text]  

IMPLICATIONS: Neurologic complications contribute significantly to morbidity and mortality of patients after orthotopic liver transplantation (OLT). We investigated whether monitoring regional cerebral oxygen saturation (rSO2) by near-infrared spectroscopy correlates with postoperative increases in neuron-specific enolase and S-100, two variables of cerebral tissue injury. The rSO2 sensitively reflected transient cerebral hypoperfusion during OLT.

Khay-Wee Toh, Kasinathan Nadesan, Ming Yao Sie, Raja Vijeyasingam, and Patrick Seow Koon Tan

Postoperative Death in a Patient with Unrecognized Arrhythmogenic Right Ventricular Dysplasia Syndrome (Case Report)
Anesth Analg 2004 99: 350-352. [Abstract] [Full Text]  

IMPLICATIONS: Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited disease of the heart resulting in life-threatening arrhythmias and heart failure. The authors describe the case of a 59-yr-old female patient with undiagnosed ARVD. During general anesthesia, cardiovascular collapse unresponsive to resuscitation occurred in the absence of arrhythmias.

Raymond M. Planinsic, Ramona Nicolau-Raducu, Bijan Eghtesad, and Amadeo Marcos

Diagnosis and Treatment of Intracardiac Thrombosis During Orthotopic Liver Transplantation (Case Report)
Anesth Analg 2004 99: 353-356. [Abstract] [Full Text]  

IMPLICATIONS: Intracardiac thrombosis occurring during liver transplantation can be a catastrophic event leading to death. Understanding the causes and treatment of hypercoagulability during liver transplantation is important to reduce the risk of this complication.

Hsiupei Chen, Victor Ng, Christopher J. Kane, and Isobel A. Russell

The Role of Transesophageal Echocardiography in Rapid Diagnosis and Treatment of Migratory Tumor Embolus (Case Report)
Anesth Analg 2004 99: 357-359. [Abstract] [Full Text] [VIDEOS]   

IMPLICATIONS: Transesophageal echocardiography (TEE) helped characterize, monitor, and facilitate excision of a renal cell carcinoma extending into the inferior vena cava. After the tumor unexpectedly embolized, TEE played a life-saving role in the diagnosis and treatment of the tumor embolus. We provide Internet-accessible videos of the tumor thrombus in transit and propose routine TEE use during excision of renal cell carcinomas extending into the inferior vena cava.

PEDIATRIC ANESTHESIA:

Isabelle Constant, Dominique Laude, Elizabeth Hentzgen, and Isabelle Murat

Does Halothane Really Preserve Cardiac Baroreflex Better Than Sevoflurane? A Noninvasive Study of Spontaneous Baroreflex in Children Anesthetized with Sevoflurane Versus Halothane
Anesth Analg 2004 99: 360-369. [Abstract] [Full Text]  

IMPLICATIONS: Using noninvasive methods of cardiac baroreflex investigation, we have demonstrated that despite the relative preservation of vagal activity during halothane anesthesia, halothane and sevoflurane have a similar depressor effect on cardiac baroreflex activity during the induction of anesthesia in children.

Alexander Reich, Anne Schulze Everding, Monika Bulla, Olaf Anselm Brinkmann, and Hugo Van Aken

Hepatitis After Sevoflurane Exposure in an Infant Suffering from Primary Hyperoxaluria Type 1 (Case Report)
Anesth Analg 2004 99: 370-372. [Abstract] [Full Text]  

IMPLICATIONS: Sevoflurane is a frequently used inhaled anesthetic in pediatric anesthesia and is regarded as a drug with low organ toxicity. This case report demonstrates a possible connection of the use of this drug and hepatic injury.

Tae W. Kim and Mark Harbott

The Use of Caudal Morphine for Pediatric Liver Transplantation (Case Report)
Anesth Analg 2004 99: 373-374. [Abstract] [Full Text]  

IMPLICATIONS: We describe the first use of caudal morphine for pediatric liver transplantation. A caudal block was performed in a 3-yr-old child at the beginning of the operation. The benefits of a supplemental regional technique were demonstrated without evidence of any neurologic or respiratory complications.

AMBULATORY ANESTHESIA:

Alparslan Turan, Dilek Memis, Beyhan Karamanlioglu, Recep Yagiz, Zafer Pamukçu, and Ebru Yavuz

The Analgesic Effects of Gabapentin in Monitored Anesthesia Care for Ear-Nose-Throat Surgery
Anesth Analg 2004 99: 375-378. [Abstract] [Full Text]  

IMPLICATIONS: Gabapentin has been demonstrated to be effective in different pain models. This study demonstrated that gabapentin decreases intraoperative and postoperative pain scores and analgesic requirements in rhinoplasty or endoscopic sinus surgery patients; however, dizziness may be a handicap for use in ambulatory patients.

Roy G. Soto, Eugene S. Fu, Hector Vila, Jr., and Rafael V. Miguel

Capnography Accurately Detects Apnea During Monitored Anesthesia Care
Anesth Analg 2004 99: 379-382. [Abstract] [Full Text]  

IMPLICATIONS: Capnography is not a mandatory monitor for monitored anesthesia care procedures, nor is it required for sedation performed outside of the operating room, although there are practice guidelines that suggest that monitoring of ventilatory function be used to reduce the risk of adverse outcomes. Use of capnography can enhance detection of apnea during sedation procedures and potentially improve patient safety.

Robert H. Small, Steven I. Ganzberg, and Andreas W. Schuster

Unsuspected Temporomandibular Joint Pathology Leading to a Difficult Endotracheal Intubation (Case Report)
Anesth Analg 2004 99: 383-385. [Abstract] [Full Text]  

IMPLICATIONS: The result of failing to secure the airway of a patient undergoing general anesthesia can be catastrophic. It is ominous when there is a condition that makes airway management difficult and that is not easily diagnosed in advance. This report discusses one such condition and describes a technique to overcome the difficulty.

ANESTHETIC PHARMACOLOGY:

TaeHyung Han, HyeongSeok Kim, JiYoung Bae, KwangMin Kim, and J. A. Jeevendra Martyn

Neuromuscular Pharmacodynamics of Rocuronium in Patients with Major Burns
Anesth Analg 2004 99: 386-392. [Abstract] [Full Text]  

IMPLICATIONS: After major burn injury, the response to nondepolarizing neuromuscular blocking drugs is unpredictable but usually demonstrates resistance. This study documents that a 1.2 mg/kg dose of rocuronium provides good intubating conditions with a faster onset time compared with a dose of 0.9 mg/kg.

Olivier Fourcade, Marie-Françoise Simon, Lawrence Litt, Kamran Samii, and Hugues Chap

Propofol Inhibits Human Platelet Aggregation Induced by Proinflammatory Lipid Mediators
Anesth Analg 2004 99: 393-398. [Abstract] [Full Text]  

IMPLICATIONS: Propofol inhibited the platelet aggregation induced by three proinflammatory lipid mediators (lysophosphatidic acid, platelet-activating factor, and thromboxane A2). The absence of inhibition of intracellular calcium increase induced by these agonists suggests that propofol acts distal to platelet receptors.

Robert A. Veselis, Vladimir A. Feshchenko, Ruth A. Reinsel, Ann M. Dnistrian, Bradley Beattie, and Timothy J. Akhurst

Thiopental and Propofol Affect Different Regions of the Brain at Similar Pharmacologic Effects
Anesth Analg 2004 99: 399-408. [Abstract] [Full Text]  

IMPLICATIONS: Despite very similar sedative and hypnotic effects, propofol and thiopental affect regional cerebral blood flow differently during drug effects. These differing patterns may provide clues as to how the drugs produce different behavioral effects, such as sedation and amnesia.

Akira Kitamura, Ryoichi Sato, William Marszalec, Jay Z. Yeh, Ryo Ogawa, and Toshio Narahashi

Halothane and Propofol Modulation of -Aminobutyric Acid_A Receptor Single-Channel Currents
Anesth Analg 2004 99: 409-415. [Abstract] [Full Text]  

IMPLICATIONS: Although both halothane and propofol increase {gamma}-aminobutyric acid (GABA)-mediated synaptic inhibition, thereby causing anesthesia, the underlying mechanisms at the single GABA receptor channels have been shown to be different by using the patch-clamp technique.

Klaus Hahnenkamp, Marcel E. Durieux, Hugo van Aken, Sascha Berning, Thomas J. Heyse, Christian W. Hönemann, and Bettina Linck

Modulation of Xenopus laevis Ca-Activated Cl Currents by Protein Kinase C and Protein Phosphatases: Implications for Studies of Anesthetic Mechanisms
Anesth Analg 2004 99: 416-422. [Abstract] [Full Text]  

IMPLICATIONS: The Xenopus ICl(Ca), commonly used as a reporter current in studies of anesthetic effects on G protein-coupled signaling, is modulated by phosphorylation. Anesthetic effects on channel phosphorylation state can therefore be misinterpreted as effects on receptor signaling.

Karin Thorlacius and Mikael Bodelsson

Sevoflurane Promotes Endothelium-Dependent Smooth Muscle Relaxation in Isolated Human Omental Arteries and Veins
Anesth Analg 2004 99: 423-428. [Abstract] [Full Text]  

IMPLICATIONS: Anesthesia with sevoflurane is accompanied by vasodilatation. We studied the effects of sevoflurane on isolated human arteries and veins. In contrast to previous animal studies, our results show that sevoflurane at larger concentrations promotes endothelium-dependent vasodilatation via an enhancement of the vascular smooth muscle response to relaxing second messengers.

Jakob Walldén, Sven-Egron Thörn, and Magnus Wattwil

The Delay of Gastric Emptying Induced by Remifentanil Is Not Influenced by Posture
Anesth Analg 2004 99: 429-434. [Abstract] [Full Text]  

IMPLICATIONS: In healthy volunteers, remifentanil 0.2 {micro}g {middle dot} kg-1 {middle dot} min-1 delayed gastric emptying, and there were no differences in this delay between 2 extreme postures (right lateral head-up and left lateral head-down position). Our results indicate that the remifentanil-induced delay in gastric emptying is not influenced by posture.

Heikki Swan, Päivi J. Laitinen, and Lauri Toivonen

Volatile Anesthetics and Succinylcholine in Cardiac Ryanodine Receptor Defects
Anesth Analg 2004 99: 435-437. [Abstract] [Full Text]  

IMPLICATIONS: We report a series of patients with cardiac ryanodine receptor (RyR) defects who had general anesthesia. Succinylcholine and volatile anesthetics do not seem to have a clinically significant effect on cardiac RyR2. This suggests an isoform-specific effect of these compounds on the RyR1 calcium channel, the mutations of which are associated with malignant hyperthermia.

Takafumi Horishita, Kouichiro Minami, Junichi Ogata, and Takeyoshi Sata

Anesthetic Management of Patients with Severe Peripheral Ischemia Due to Calciphylaxis (Case Report)
Anesth Analg 2004 99: 438-439. [Abstract] [Full Text]  

IMPLICATIONS: We managed a patient with calciphylaxis during anesthesia by using laser Doppler blood flowmetry and infusion of prostaglandin E1. This management procedure is useful for patients with calciphylaxis and severely impaired peripheral circulation.

Pierre Albaladejo, Thomas Geeraerts, Fady Francis, Yves Castier, Guy Lesèche, and Jean Marty

Aspirin Withdrawal and Acute Lower Limb Ischemia (Brief Report)
Anesth Analg 2004 99: 440-443. [Abstract] [Full Text]  

IMPLICATIONS: Among a retrospective cohort of 181 patients presenting with acute lower limb ischemia, we studied 11 patients who had recently stopped taking aspirin. This study should alert clinicians to the risk of discontinuing chronic aspirin therapy in patients with severe peripheral vascular disease.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Masao Hayashi, Toru Takahashi, Hiroshi Morimatsu, Hiromi Fujii, Naoyuki Taga, Satoshi Mizobuchi, Masaki Matsumi, Hiroshi Katayama, Masataka Yokoyama, Masahiro Taniguchi, and Kiyoshi Morita

Increased Carbon Monoxide Concentration in Exhaled Air After Surgery and Anesthesia
Anesth Analg 2004 99: 444-448. [Abstract] [Full Text]  

IMPLICATIONS: We measured exhaled carbon monoxide (CO) concentrations and arterial carboxyhemoglobin concentrations in patients who underwent surgery under general or spinal anesthesia. Both indices were significantly larger than the preoperative value on the day after surgery and in the recovery room, regardless of anesthesia, suggesting that endogenous CO production is increased by generalized oxidative stress.

Kwok F. J. Ng

Changes in Thrombelastograph^TM Variables Associated with Aging (Technical Communication)
Anesth Analg 2004 99: 449-454. [Abstract] [Full Text]  

IMPLICATIONS: Aging is associated with changes in thrombelastography (TEG(R)) variables. They change by approximately 20%-40% in the hypercoagulable direction in an 80-yr-old compared with a 20-yr-old. These difference may be important when TEG(R) interpretation involves patients of different ages, such as in clinical trials or when TEG(R)-based transfusion algorithms are applied.

PAIN MEDICINE:

Philip J. Siddall and Arthur W. Duggan

Towards a Mechanisms-Based Approach to Pain Medicine (Editorial)
Anesth Analg 2004 99: 455-456. [Full Text]  

Isabelle Decosterd, Andrew Allchorne, and Clifford J. Woolf

Differential Analgesic Sensitivity of Two Distinct Neuropathic Pain Models
Anesth Analg 2004 99: 457-463. [Abstract] [Full Text]  

IMPLICATIONS: Analgesic effects of drugs often used for the treatment of neuropathic pain were evaluated in two independent animal models of neuropathic pain. The differential analgesic response between models suggests that different mechanisms are involved and that multiple models are required to study mechanisms and predict drug efficacy for neuropathic pain.

Yoko Osawa, Akiyoshi Oda, Hiroki Iida, Shigeaki Tanahashi, and Shuji Dohi

The Effects of Class Ic Antiarrhythmics on Tetrodotoxin-Resistant Na⁺ Currents in Rat Sensory Neurons
Anesth Analg 2004 99: 464-471. [Abstract] [Full Text]  

IMPLICATIONS: We examined the effect of class Ic antiarrhythmics on tetrodotoxin-resistant Na+ channels that are important in nociception. They blocked these channels in a concentration- and use-dependent manner, with a minor difference from those of lidocaine, a Ib antiarrhythmic.

Leonardo Kapural, Nagy Mekhail, Zdenko Korunda, and Ayman Basali

Intradiscal Thermal Annuloplasty for the Treatment of Lumbar Discogenic Pain in Patients with Multilevel Degenerative Disc Disease
Anesth Analg 2004 99: 472-476. [Abstract] [Full Text]  

IMPLICATIONS: We found significant improvement in pain scores and functional capacity in both multilevel and one or two level degenerative disk disease (DDD) patients after intradiscal thermal annuloplasty (IDTA). However, the group with 1-2 Level DDD did much better after IDTA, suggesting that the number of discs affected is an important determining factor for long-term outcome.

John J. Liszka-Hackzell and David P. Martin

An Analysis of the Relationship Between Activity and Pain in Chronic and Acute Low Back Pain
Anesth Analg 2004 99: 477-481. [Abstract] [Full Text]  

IMPLICATIONS: We studied 15 patients with acute low back pain and 15 patients with chronic low back pain and found that there is a relationship between activity and pain in the patients with acute low back pain but not in the patients with chronic low back pain.

Kathirvel Subramaniam, Balachundhar Subramaniam, and Richard A. Steinbrook

Ketamine as Adjuvant Analgesic to Opioids: A Quantitative and Qualitative Systematic Review
Anesth Analg 2004 99: 482-495. [Abstract] [Full Text]  

IMPLICATIONS: Narcotics alone are not effective in all postoperative patients for adequate pain relief. They may also be associated with unacceptable side effects. Thus, there remains a need for additional pain medications. We found ketamine, an IV anesthetic drug, in small doses helped reduce narcotic use after surgery.

André P. Wolff, Oliver H. G. Wilder Smith, Ben J. P. Crul, Marc P. van de Heijden, and Gerbrand J. Groen

Lumbar Segmental Nerve Blocks with Local Anesthetics, Pain Relief, and Motor Function: A Prospective Double-Blind Study Between Lidocaine and Ropivacaine
Anesth Analg 2004 99: 496-501. [Abstract] [Full Text]  

IMPLICATIONS: This study is the first to report on the relationship between a segmental nerve block, pain relief, and its effect on motor function in patients with chronic back pain radiating into the leg.

Ching-Tang Wu, Shu-Wen Jao, Cecil O. Borel, Chun-Chang Yeh, Chi-Yuan Li, Chueng-He Lu, and Chih-Shung Wong

The Effect of Epidural Clonidine on Perioperative Cytokine Response, Postoperative Pain, and Bowel Function in Patients Undergoing Colorectal Surgery
Anesth Analg 2004 99: 502-509. [Abstract] [Full Text]  

IMPLICATIONS: The combination of preoperative epidural clonidine with postoperative patient-controlled analgesia morphine, ropivacaine, and clonidine provides preemptive analgesia and results in reduced pain intensity, diminished opioid consumption, a faster return of bowel function, and attenuated production of interleukin (IL)-6, IL-8, and IL-1 receptor antagonist (RA) in the perioperative period, without any complications. The lower levels of IL-6, IL-8, and IL-1RA could diminish pain transmission and central nervous system sensitization, thus improving postoperative pain and allowing a faster return of bowel function.

Philip J. Siddall and Michael J. Cousins

Persistent Pain as a Disease Entity: Implications for Clinical Management (Review Article)
Anesth Analg 2004 99: 510-520. [Abstract] [Full Text]  

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Jeffrey M. Taekman, Gene Hobbs, Linda Barber, Barbara G. Phillips-Bute, Melanie C. Wright, Mark F. Newman, and Mark Stafford-Smith

Preliminary Report on the Use of High-Fidelity Simulation in the Training of Study Coordinators Conducting a Clinical Research Protocol
Anesth Analg 2004 99: 521-527. [Abstract] [Full Text]  

IMPLICATIONS: A complex clinical research protocol was replicated in the Duke University Human Simulation and Patient Safety Center. Clinical research coordinators trained in simulation showed significantly greater confidence in their ability to perform the research protocol. We conclude that simulation training should be considered as a training method of research coordinators.

CRITICAL CARE AND TRAUMA:

Gregory M. T. Hare, Kathryn M. Hum, Steve Y. Kim, Aiala Barr, Andrew J. Baker, and C. David Mazer

Increased Cerebral Tissue Oxygen Tension After Extensive Hemodilution with a Hemoglobin-Based Oxygen Carrier
Anesth Analg 2004 99: 528-535. [Abstract] [Full Text]  

IMPLICATIONS: This study demonstrates that cerebral tissue oxygen tension is increased after exchange transfusion with a hemoglobin-based oxygen carrier (hemoglobin raffimer), despite evidence of cerebral vasoconstriction and an increase in methemoglobin concentration in isoflurane-anesthetized rats.

José Reinaldo Cerqueira Braz, Paulo do Nascimento, Jr., Odilar Paiva Filho, Leandro Gobbo Braz, Luiz Antonio Vane, Pedro Thadeu Galvão Vianna, and Geraldo Rolim Rodrigues, Jr.

The Early Systemic and Gastrointestinal Oxygenation Effects of Hemorrhagic Shock Resuscitation with Hypertonic Saline and Hypertonic Saline 6% Dextran-70: A Comparative Study in Dogs
Anesth Analg 2004 99: 536-546. [Abstract] [Full Text]  

IMPLICATIONS: Resuscitation with hypertonic saline and hypertonic saline with dextran solutions during hemorrhagic shock in dogs may not improve the splanchnic circulation, as indicated by lower intramucosal pH values during resuscitation.

François Kerbaul, Philippe Van der Linden, Sébastien Pierre, Benoît Rondelet, Christian Melot, Serge Brimioulle, and Robert Naeije

Prevention of Hemodilution-Induced Inhibition of Hypoxic Pulmonary Vasoconstriction by N-Acetylcysteine in Dogs
Anesth Analg 2004 99: 547-551. [Abstract] [Full Text]  

IMPLICATIONS: Hemodilution inhibits hypoxic pulmonary vasoconstriction. This study showed that this potential cause of altered gas exchange is partly explained by viscosity changes and is completely preventable by the administration of the reactive oxygen species scavenger N-acetylcysteine.

Smita Prakash, Tazeen Fatima, and Mridula Pawar

Patient-Controlled Analgesia with Fentanyl for Burn Dressing Changes
Anesth Analg 2004 99: 552-555. [Abstract] [Full Text]  

IMPLICATIONS: Pain during burn dressing changes is severe and is often undertreated. Patient-controlled analgesia with fentanyl provides adequate pain relief and patient satisfaction and avoids over- and undermedication.

Roman V. Plachinta, Manuela J. M. de Klaver, John K. Hayes, and George F. Rich

The Protective Effect of Protein Kinase C and Adenosine Triphosphate-Sensitive Potassium Channel Agonists Against Inflammation in Rat Endothelium and Vascular Smooth Muscle In Vitro and In Vivo
Anesth Analg 2004 99: 556-561. [Abstract] [Full Text]  

IMPLICATIONS: Volatile anesthetics protect the vasculature via mechanisms involving protein kinase C (PKC) and adenosine triphosphate-sensitive potassium (KATP) channels. In this study, we showed that PKC and KATP agonists attenuate lipopolysaccharide-induced injury of endothelial and vascular smooth muscle cells in vitro, whereas this protection is minimal in vivo after systemic administration. Protection of the vasculature from endotoxemia-associated injury may preserve important physiological endothelial and vascular smooth muscle functions.

NavParkash S. Sandhu

The Use of Ultrasound for Axillary Artery Catheterization Through Pectoral Muscles: A New Anterior Approach (Case Report)
Anesth Analg 2004 99: 562-565. [Abstract] [Full Text]  

IMPLICATIONS: Axillary artery catheterization through the armpit is associated with nerve injuries and frequent infection. Our technique of introducing the catheter through the pectoral muscles by using real-time sonography allows imaging of the artery, the surrounding nerves, and the needle. This may increase both success and safety by decreasing nerve injuries and infection.

Michael A. Gropper

Evidence-Based Management of Critically Ill Patients: Analysis and Implementation (Review Article)
Anesth Analg 2004 99: 566-572. [Abstract] [Full Text]  

NEUROSURGICAL ANESTHESIA:

François Girard, Robert Moumdjian, Daniel Boudreault, Philippe Chouinard, Alain Bouthilier, Éric Sauvageau, Monique Ruel, and Dominique C. Girard

The Effect of Propofol Sedation on the Intracranial Pressure of Patients with an Intracranial Space-Occupying Lesion
Anesth Analg 2004 99: 573-577. [Abstract] [Full Text]  

IMPLICATIONS: The use of propofol sedation does not result in a higher intracranial pressure than no sedation in patients with a brain tumor undergoing stereotactic biopsy under regional anesthesia.

REGIONAL ANESTHESIA:

Kenneth Drasner

Thoracic Epidural Anesthesia: Asleep at the Wheal? (Editorial)
Anesth Analg 2004 99: 578-579. [Full Text]  

Ming-Chang Kao, Shen-Kou Tsai, Mei-Yung Tsou, Hsien-Kuang Lee, Wan-Yuo Guo, and Jenkin S. Hu

Paraplegia After Delayed Detection of Inadvertent Spinal Cord Injury During Thoracic Epidural Catheterization in an Anesthetized Elderly Patient (Case Report)
Anesth Analg 2004 99: 580-583. [Abstract] [Full Text]  

IMPLICATIONS: We report a case of permanent paraplegia after an intracord catheterization during attempted thoracic epidural anesthesia in an anesthetized elderly patient. Subsequent injection of local anesthetic into the misplaced catheter and delayed detection of the postoperative neurologic deficits resulted in this tragic complication.

Radha Sukhani, Antoun Nader, Kenneth D. Candido, Robert Doty, Jr., Honorio T. Benzon, Edward Yaghmour, Mark Kendall, and Robert McCarthy

Nerve Stimulator-Assisted Evoked Motor Response Predicts the Latency and Success of a Single-Injection Sciatic Block
Anesth Analg 2004 99: 584-588. [Abstract] [Full Text]  

IMPLICATIONS: The type of evoked motor response (EMR) during nerve stimulator-assisted single-injection sciatic nerve block impacts the latency and success of complete block. Compared with EMRs plantar flexion, dorsiflexion, or eversion, EMR inversion is associated with the shortest latency to a complete block of the sciatic nerve.

François J. Singelyn, Laurence Lhotel, and Bertrand Fabre

Pain Relief After Arthroscopic Shoulder Surgery: A Comparison of Intraarticular Analgesia, Suprascapular Nerve Block, and Interscalene Brachial Plexus Block
Anesth Analg 2004 99: 589-592. [Abstract] [Full Text]  

IMPLICATIONS: The authors demonstrate that single-dose interscalene brachial plexus block is the most efficient analgesic technique after arthroscopic shoulder surgery. A suprascapular nerve block is a clinically appropriate alternative, but single-dose intraarticular local anesthetic has no beneficial effect.

Shihab U. Ahmed, Ricardo Vallejo, and E. Daniela Hord

Seizures After a Bier Block with Clonidine and Lidocaine (Case Report)
Anesth Analg 2004 99: 593-594. [Abstract] [Full Text]  

IMPLICATIONS: Clonidine is being used increasingly as an adjuvant medication for neuropathic pain and to improve the duration of regional anesthesia. Four cases of seizures associated with the use of clonidine have been reported. We present a case of seizure after a Bier block with lidocaine and clonidine in a patient with complex regional pain syndrome type I.

Tamas Szabo, Syed Ali, and Enrico M. Camporesi

Intraoperative Recombinant Activated Factor VII for Emergent Epidural Hematoma Evacuation (Case Report)
Anesth Analg 2004 99: 595-597. [Abstract] [Full Text]  

IMPLICATIONS: We report a case of a chronically anticoagulated patient who developed an epidural hematoma after an epidural injection. Recombinant activated factor VII (rFVIIa) was administered during surgery to achieve hemostasis and to enable the hematoma evacuation. We also review additional cases in the literature in which rFVIIa was used.

GENERAL ARTICLES:

Ann Miriam and Grace Korula

A Simple Glucose Insulin Regimen for Perioperative Blood Glucose Control: The Vellore Regimen
Anesth Analg 2004 99: 598-602. [Abstract] [Full Text]  

IMPLICATIONS: Intraoperative blood glucose control with 1 U of insulin for every 1-50 mg of blood glucose value more than 100 mg/dL added to 100 mL of 5% dextrose in a measured volume set was tested hourly. It is a simple and effective method and combines the advantages of combined glucose insulin and variable rate insulin infusion.

Abderrahmane Bouaggad, Sif Eddine Nejmi, Moulay Ahmed Bouderka, and Omar Abbassi

Prediction of Difficult Tracheal Intubation in Thyroid Surgery
Anesth Analg 2004 99: 603-606. [Abstract] [Full Text]  

IMPLICATIONS: We studied 320 patients with goiter who were scheduled for thyroidectomy, to investigate the incidence of difficult tracheal intubation and to evaluate factors linked to difficult intubation. The presence of cancerous goiter is a major factor for predicting difficult intubation and may lead to better anticipation of difficult airway management.

Thomas C. Mort

Emergency Tracheal Intubation: Complications Associated with Repeated Laryngoscopic Attempts
Anesth Analg 2004 99: 607-613. [Abstract] [Full Text]  

IMPLICATIONS: Intraoperative blood glucose control with 1 U of insulin for every 1-50 mg of blood glucose value more than 100 mg/dL added to 100 mL of 5% dextrose in a measured volume set was tested hourly. It is a simple and effective method and combines the advantages of combined glucose insulin and variable rate insulin infusion.

Wendy Laupu and Joseph Brimacombe

Potassium Permanganate Reduces Protein Contamination of Reusable Laryngeal Mask Airways (Brief Report)
Anesth Analg 2004 99: 614-616. [Abstract] [Full Text]  

IMPLICATIONS: Supplementary cleaning with potassium permanganate 2 mg/L does not eliminate protein deposits from all laryngeal mask airways, but it does reduce the number of devices contaminated from 100% to 20%.

Chang-Po Kuo, Chih-Shung Wong, Cecil O. Borel, Chih-Ping Yang, Chun-Chang Yeh, Chueng-He Lu, and Ching-Tang Wu

Cerebrospinal Fluid Rhinorrhea After Thermometer Insertion Through the Nose (Case Report)
Anesth Analg 2004 99: 617-619. [Abstract] [Full Text]  

IMPLICATIONS: For patients in the prone position, axillary or rectal placement of a temperature probe may be preferable when oral thermometer placement fails. Cerebrospinal fluid rhinorrhea is a potential complication after any nasopharyngeal instrumentation.

LETTERS TO THE EDITOR:

Gary R. Haynes, Thomas A. Neff, Reto Stocker, and Donat R. Spahn

Is Hydroxyethyl Starch Safe in Brain Injury? • Response
Anesth Analg 2004 99: 620-622. [Full Text]  

Timothy E. Smith, Daniel d’Hulst, and Douglas G. Ririe

A Well-Fertilized Bulb Should Blossom
Anesth Analg 2004 99: 622. [Full Text]  

Michael Paige and Philip E. Bickler

Falsely Low Pulse Oximetry Values in Patients Receiving Docetaxel (Taxotere®)
Anesth Analg 2004 99: 622-623. [Full Text]  

Barry Smiler

Risperidol and Asystole
Anesth Analg 2004 99: 623. [Full Text]  

M. A. E. Marcus, M. Van Kleef, E. A. J. Joosten, and Jacques E. Chelly

The Quest for New Devices to Improve Postoperative Pain Control • Response
Anesth Analg 2004 99: 623-624. [Full Text]  

Sonia Wadhawan, Vibha, and Rakesh Kumar

An Uncommon Reason for Damage to the Intubating Laryngeal Mask Airway (ILMA) Endotracheal Tube Cuff-Inflation System
Anesth Analg 2004 99: 624. [Full Text]  

Beny Charbit, Emmanuel Samain, Pierre Albaladejo, Younes El Houari, Frédérique Le Corre, Aimée Redondo, Bruno Deval, and Jean Marty

Peripartum Management of a Suspected Spinal Hematoma After Epidural Puncture
Anesth Analg 2004 99: 624-625. [Full Text]  

John J. Henderson, Virendra K. Arya, and Arun Kumar

Failure to Advance the Guidewire When the Seldinger Technique Is Used for Central Venous Cannulation: Safe and Reliable Recovery • Response
Anesth Analg 2004 99: 625-626. [Full Text]  

Evan J. Goodman and Adam J. Haas

The Natural Half Life of a Large Stock of Reusable Laryngeal Mask Airways at a Teaching Hospital
Anesth Analg 2004 99: 626-627. [Full Text]  

Michael F. Mulroy, Joseph M. Neal, and Julia E. Pollock

What Is Wrong with This Picture of Pain Management?
Anesth Analg 2004 99: 627. [Full Text]  

Ingeborg Schafhalter-Zoppoth, Ivan D. Zeitz, and Andrew T. Gray

Inadvertent Femoral Nerve Impalement and Intraneural Injection Visualized by Ultrasound
Anesth Analg 2004 99: 627-628. [Full Text] [VIDEOS]   

Felice Agrò, Massimiliano Carassiti, and Caterina Magnani

Percutaneous Dilatational Cricothyroidotomy: Airway Control via CobraPLA^TM
Anesth Analg 2004 99: 628. [Full Text]  

Krzysztof M. Kuczkowski

Lifestyle Changes in U.S. Academic Anesthesia: Quo Vadis?
Anesth Analg 2004 99: 628-629. [Full Text]  

Paul Eckinger, Emily Ratner, and John Brock-Utne

Latex Allergy: Oh, What a Surprise! Another Reason Why All Anesthesia Equipment Should Be Latex-Free
Anesth Analg 2004 99: 629. [Full Text]  

Mark D. Weber and Tina Slusher

A Nasal Bridle for Securing Nasotracheal Tubes
Anesth Analg 2004 99: 629. [Full Text]  

Süreyya Gültekin

Bilateral Brachial Plexus Block Versus Segmental Epidural Anesthesia
Anesth Analg 2004 99: 630. [Full Text]  

Jennifer M. Sarjeant, Jeannie L. Callum, and Abdulmohsin Abdulla Al-Ghamdi

The Use of Tourniquets in Patients with Sickle Cell Disease • Response
Anesth Analg 2004 99: 630. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Warren J. Levy and F. Kayser Enneking

The Manual of Anesthetic Practice. • Peripheral Nerve Blocks: Principles and Practice. • Books and Multimedia Received
Anesth Analg 2004 99: 631. [Full Text]  

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