CARDIOVASCULAR ANESTHESIA:

Nanette M. Schwann, Jay C. Horrow, Michael D. Strong, III, Dmitri Chamchad, Albert Guerraty, and Andrew S. Wechsler

Does Off-Pump Coronary Artery Bypass Reduce the Incidence of Clinically Evident Renal Dysfunction After Multivessel Myocardial Revascularization?
Anesth Analg 2004 99: 959-964. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This prospective, observational trial suggests that patients who undergo complete coronary revascularization without cardiopulmonary bypass (off-pump) have similar incidences of postoperative creatinine increases when compared with patients undergoing traditional coronary artery bypass surgery with cardiopulmonary bypass.

Jianwen Wang, Miodrag Filipovic, Ainars Rudzitis, Isabelle Michaux, Karl Skarvan, Peter Buser, Atanas Todorov, Franziska Bernet, and Manfred D. Seeberger

Transesophageal Echocardiography for Monitoring Segmental Wall Motion During Off-Pump Coronary Artery Bypass Surgery
Anesth Analg 2004 99: 965-973. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Our study found that transesophageal echocardiography provided reliable visualization of left ventricular segmental wall motion during off-pump coronary artery bypass surgery in most patients--a prerequisite for echocardiographic monitoring for ischemia. Future studies are needed to evaluate whether such monitoring improves patient outcome.

H. Mayumi Homi, Hong Yang, Robert D. Pearlstein, and Hilary P. Grocott

Hemodilution During Cardiopulmonary Bypass Increases Cerebral Infarct Volume After Middle Cerebral Artery Occlusion in Rats
Anesth Analg 2004 99: 974-981. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Hemodilution (hemoglobin, 6 g/dL) increased cerebral infarct volume and worsened outcome after focal cerebral ischemia during cardiopulmonary bypass in rats; this suggests that excessive hemodilution may increase the risk of cardiac surgery-related stroke.

Jeremy A. Lieberman, Kayode A. Williams, and Andrew L. Rosenberg

Optimal Head Rotation for Internal Jugular Vein Cannulation When Relying on External Landmarks
Anesth Analg 2004 99: 982-988. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In a study of 49 volunteers, an ultrasound probe held in the manner of a syringe and needle demonstrated that the optimal head rotation to maximize internal jugular vein cannulation and minimize carotid artery puncture was 30{degrees} from midline for obese patients and as much as 60{degrees} for non-obese patients.

Andreas Koster, Derek Chew, Frank Merkle, Marcus Gruendel, Michael Jurmann, Hermann Kuppe, and Rainhard Oertel

Extracorporeal Elimination of Large Concentrations of Tirofiban by Zero-Balanced Ultrafiltration During Cardiopulmonary Bypass: An In Vitro Investigation
Anesth Analg 2004 99: 989-992. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Our data provide evidence that ultrafiltration is an effective method for extracorporeal elimination of high therapeutic levels of tirofiban. These results are of particular interest for the management of patients with impaired renal function or a high risk of developing perioperative renal failure who undergo cardiac surgery with the administration of tirofiban in the perioperative period.

Pengcheng Xu, Jun Wang, Ramesh Kodavatiganti, Yinming Zeng, and Ira S. Kass

Activation of Protein Kinase C Contributes to the Isoflurane-Induced Improvement of Functional and Metabolic Recovery in Isolated Ischemic Rat Hearts
Anesth Analg 2004 99: 993-1000. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Protein kinase C activation is part of the mechanism by which isoflurane improves functional and metabolic recovery after ischemia in isolated rat hearts.

Patrick Pasquina, Paolo Merlani, Jean Max Granier, and Bara Ricou

Continuous Positive Airway Pressure Versus Noninvasive Pressure Support Ventilation to Treat Atelectasis After Cardiac Surgery
Anesth Analg 2004 99: 1001-1008. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This prospective, randomized, controlled study analyzing the treatment for atelectasis after cardiac surgery showed that noninvasive pressure support ventilation was superior to continuous positive airway pressure for improving atelectasis based on radiological score but did not confer any additional benefit, thus raising the question of its clinical usefulness.

Joachim Boldt, Christian Brosch, Andreas Lehmann, Stephan Suttner, and Frank Isgro

The Prophylactic Use of the ß-Blocker Esmolol in Combination with Phosphodiesterase III Inhibitor Enoximone in Elderly Cardiac Surgery Patients
Anesth Analg 2004 99: 1009-1017. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Compared with an untreated control group, the prophylactic use of an IV combination of the ß-adrenergic blocker, esmolol, and the phosphodiesterase III inhibitor, enoximone, in elderly patients undergoing cardiac surgery with cardiopulmonary bypass resulted in beneficial effects on postbypass hemodynamic status, splanchnic perfusion, organ function, as well as inflammatory response and endothelial integrity.

Kethy Jules-Elysee, Thomas J. J. Blanck, John D. Catravas, George Chimento, Alexander Miric, Richard Kahn, Leonardo Paroli, and Thomas Sculco

Angiotensin-Converting Enzyme Activity: A Novel Way of Assessing Pulmonary Changes During Total Knee Arthroplasty
Anesth Analg 2004 99: 1018-1023. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The embolic phenomenon to the heart and lungs occurs in all patients undergoing total knee arthroplasty at the time of tourniquet release. This study investigates possible mechanisms that allow most patients to tolerate such insults to their lungs without clinical complications.

Abele Donati, Oriana Cornacchini, Silvia Loggi, Sandro Caporelli, Giovanna Conti, Stefano Falcetta, Francesco Alò, Gabriele Pagliariccio, Elisabetta Bruni, Jean-Charles Preiser, and Paolo Pelaia

A Comparison Among Portal Lactate, Intramucosal Sigmoid pH, and CO₂ (PaCO₂ – Regional PCO₂) as Indices of Complications in Patients Undergoing Abdominal Aortic Aneurysm Surgery
Anesth Analg 2004 99: 1024-1031. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Although older studies cannot correlate with outcome, this study is the first comparison of the values of three indirect markers of gut ischemia--portal venous lactate concentration, intramucosal intestinal pH, and gradient between regional and arterial PCO2--as predictors of organ failure after surgery for abdominal aortic aneurysm.

Ognjen Gajic, Juraj Sprung, Brian A. Hall, and Deborah J. Lightner

Fatal Acute Pulmonary Embolism in a Patient with Pelvic Lipomatosis After Surgery Performed After Transatlantic Airplane Travel (Case Report)
Anesth Analg 2004 99: 1032-1034. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Anesthesiologists and other perioperative physicians need to be aware of the prevalence of venous thromboembolism in patients with a history of recent long-haul air travel.

Toby N. Weingarten, Juraj Sprung, and James R. Munis

Peripheral Venous Pressure as a Measure of Venous Compliance During Pheochromocytoma Resection (Case Report)
Anesth Analg 2004 99: 1035-1037. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Both peripheral and central venous pressures reflect changes in venous tone during resection of a pheochromocytoma.

PEDIATRIC ANESTHESIA:

Deborah A. Schwengel, John McGready, Sean M. Berenholtz, Lori J. Kozlowski, David G. Nichols, and Myron Yaster

Peripherally Inserted Central Catheters: A Randomized, Controlled, Prospective Trial in Pediatric Surgical Patients
Anesth Analg 2004 99: 1038-1043. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this randomized, controlled trial, we found that peripherally inserted central catheters safely and effectively reduce needle punctures and improve patient satisfaction. The technique is cost-effective if anesthesiologists insert the catheters during surgical preparation time.

Giovanni Cucchiaro, Scott D. Markowitz, Robin Kaye, N. Scott Adzick, Ronald S. Litman, Charles A. Stanley, and Mehernoor F. Watcha

Blood Glucose Control During Selective Arterial Stimulation and Venous Sampling for Localization of Focal Hyperinsulinism Lesions in Anesthetized Children
Anesth Analg 2004 99: 1044-1048. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The use of a remifentanil infusion and delayed tracheal intubation decrease intraoperative glucose concentrations during arterial stimulation and hepatic venous sampling for localization of focal hyperinsulinism lesions in children.

Cengiz Karsli, Igor Luginbuehl, and Bruno Bissonnette

The Cerebrovascular Response to Hypocapnia in Children Receiving Propofol
Anesth Analg 2004 99: 1049-1052. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Cerebrovascular reactivity to CO2 is preserved above 30 mm Hg ETCO2 in children during propofol anesthesia but lost below 30 mm Hg. Reducing ETCO2 values to less than 30 mm Hg in children receiving propofol anesthesia may not result in any further reduction in cerebral blood flow velocity.

Barry D. Kussman, Robert V. Mulkern, and Robert S. Holzman

Iatrogenic Hyperthermia During Cardiac Magnetic Resonance Imaging (Case Report)
Anesth Analg 2004 99: 1053-1055. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Radiofrequency energy absorbed during magnetic resonance imaging (MRI) is added to metabolic energy and must be balanced by appropriate heat loss to maintain normothermia. Although hypothermia is more likely during anesthesia for MRI, this report of hyperthermia stresses the importance of temperature monitoring, particularly for long scans with high-energy sequences.

Anita V. Delgado and John C. Sanders

A Simple Technique to Reduce Epistaxis and Nasopharyngeal Trauma During Nasotracheal Intubation in a Child with Factor IX Deficiency Having Dental Restoration (Case Report)
Anesth Analg 2004 99: 1056-1057. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Nasal trauma and bleeding may be reduced during nasotracheal intubation by using a rapid, inexpensive technique that avoids potentially problematic topical medications.

Lynne R. Ferrari

Preoperative Evaluation of Pediatric Surgical Patients with Multisystem Considerations (Review Article)
Anesth Analg 2004 99: 1058-1069. [Abstract] [Full Text] [PDF] [Request Permissions]  

AMBULATORY ANESTHESIA:

Tong J. Gan, Kui Ran Jiao, Michael Zenn, and Gregory Georgiade

A Randomized Controlled Comparison of Electro-Acupoint Stimulation or Ondansetron Versus Placebo for the Prevention of Postoperative Nausea and Vomiting
Anesth Analg 2004 99: 1070-1075. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Electro-acupoint stimulation or ondansetron is more effective than placebo for the prevention of postoperative nausea and vomiting but electro-acupoint stimulation is more effective in controlling nausea. Stimulation at P6 has analgesic effects.

Sigrid Adam, Jasper van Bommel, Michal Pelka, Maaike Dirckx, David Jonsson, and Jan Klein

Propofol-Induced Injection Pain: Comparison of a Modified Propofol Emulsion to Standard Propofol with Premixed Lidocaine
Anesth Analg 2004 99: 1076-1079. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Premixing of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of standard propofol containing long-chain triglycerides (LCT) causes less pain on injection than propofol containing both medium-chain triglycerides (MCT) and LCT and thus increases patient comfort.

ANESTHETIC PHARMACOLOGY:

Kyo S. Kim, Mi A. Cheong, Hee J. Lee, and Jae M. Lee

Tactile Assessment for the Reversibility of Rocuronium-Induced Neuromuscular Blockade During Propofol or Sevoflurane Anesthesia
Anesth Analg 2004 99: 1080-1085. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Even in the presence of train-of-four responses, the clinician should be aware that reversal may be inadequate.

Yigal Leykin, Tommaso Pellis, Mariella Lucca, Giacomina Lomangino, Bernardo Marzano, and Antonino Gullo

The Pharmacodynamic Effects of Rocuronium When Dosed According to Real Body Weight or Ideal Body Weight in Morbidly Obese Patients
Anesth Analg 2004 99: 1086-1089. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The adaptation of drug dosages in obese patients is a matter of concern. We investigated the onset time and duration of action of rocuronium, a neuromuscular blocking drug, in morbidly obese patients. For clinical proposes, in the morbidly obese, rocuronium should be dosed on the basis of ideal body weight rather than real body weight.

Yigal Leykin, Tommaso Pellis, Mariella Lucca, Giacomina Lomangino, Bernardo Marzano, and Antonino Gullo

The Effects of Cisatracurium on Morbidly Obese Women
Anesth Analg 2004 99: 1090-1094. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We investigated the effects of cisatracurium, one of the stereoisomers of atracurium, on morbidly obese patients, prompted by the conflicting evidence reported for atracurium. We concluded that the duration of action of cisatracurium is prolonged when dosed according to real body weight in morbidly obese patients.

Hideya Ohmori, Yasumitsu Sato, and Akiyoshi Namiki

The Anticonvulsant Action of Propofol on Epileptiform Activity in Rat Hippocampal Slices
Anesth Analg 2004 99: 1095-1101. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We have demonstrated that propofol depressed epileptiform activity in rat hippocampal slices. Adenosine neuromodulation through the A1 receptor may contribute to the anticonvulsant action of propofol.

Takefumi Inada, Takashi Asai, Makiko Yamada, and Koh Shingu

Propofol and Midazolam Inhibit Gastric Emptying and Gastrointestinal Transit in Mice
Anesth Analg 2004 99: 1102-1106. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: For patients whose lungs are mechanically ventilated, propofol or midazolam may be used to produce sedation. At a light level of sedation, propofol may be preferable to midazolam because of its weaker inhibitory effect on gastrointestinal transit. With an increasing depth of sedation, such an advantage may be reduced.

Claudia Praetel, Michael J. Banner, Terri Monk, and Andrea Gabrielli

Isoflurane Inhalation Enhances Increased Physiologic Deadspace Volume Associated with Positive Pressure Ventilation and Compromises Arterial Oxygenation
Anesth Analg 2004 99: 1107-1113. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The effects of positive pressure ventilation in combination with inhaled isoflurane or total IV anesthesia on physiologic deadspace volume (VDphys) were investigated in a crossover study. Inhaled isoflurane resulted in a significantly larger increase in VDphys and an associated decrease in arterial oxygenation. This result may be important in patients with preexisting severe ventilation/perfusion abnormalities and impaired gas exchange.

Paul J. Borgdorff, Traian I. Ionescu, Peter L. Houweling, and Johannes T. A. Knape

Large-Dose Intrathecal Sufentanil Prevents the Hormonal Stress Response During Major Abdominal Surgery: A Comparison with Intravenous Sufentanil in a Prospective Randomized Trial
Anesth Analg 2004 99: 1114-1120. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This prospective, randomized trial demonstrates that large-dose intrathecal sufentanil (150 {micro}g) as part of combined general and regional anesthesia prevents activation of the hormonal stress response during major abdominal surgery and improves postoperative analgesia in comparison with IV balanced anesthesia.

Go-Shine Huang, Chi-Yuan Li, Ping-Ching Hsu, Chien-Sung Tsai, Tso-Chou Lin, and Chih-Shung Wong

Sevoflurane Anesthesia Attenuates Adenosine Diphosphate-Induced P-Selectin Expression and Platelet-Leukocyte Conjugate Formation
Anesth Analg 2004 99: 1121-1126. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Sevoflurane inhibited P-selectin expression of platelets in platelet rich plasma and whole blood, and reduced platelet-leukocyte conjugate formation ex vivo via flow cytometry analysis, which suggests modulation of platelet activation and platelet-leukocyte interaction.

Engelbert Deusch, Hans Georg Kress, Birgit Kraft, and Sibylle A. Kozek-Langenecker

The Procoagulatory Effects of Delta-9-Tetrahydrocannabinol in Human Platelets
Anesth Analg 2004 99: 1127-1130. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Delta-9-tetrahydrocannabinol activated human platelets in vitro in a concentration-dependent manner. The two known cannabinoid receptors (CB1 and CB2) were both detected on the cell membrane of human platelets.

Shin Nakayama, Masayuki Miyabe, Yoshihiro Kakiuchi, Shinichi Inomata, Yoshiko Osaka, Taeko Fukuda, Yukinao Kohda, and Hidenori Toyooka

Propofol Does Not Inhibit Lidocaine Metabolism During Epidural Anesthesia
Anesth Analg 2004 99: 1131-1135. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The potential for a drug interaction between propofol and epidurally administered lidocaine was tested. Propofol does not alter the metabolism of lidocaine in a clinical setting compared with sevoflurane. This finding implies that propofol can be used safely for general anesthesia combined with continuous epidural anesthesia with lidocaine.

Andrey B. Petrenko, Tomohiro Yamakura, Naoshi Fujiwara, Ahmed R. Askalany, Hiroshi Baba, and Kenji Sakimura

Reduced Sensitivity to Ketamine and Pentobarbital in Mice Lacking the N-Methyl-D-Aspartate Receptor GluR1 Subunit
Anesth Analg 2004 99: 1136-1140. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Mice deficient in the N-methyl-D-aspartate (NMDA) receptor GluR{epsilon}1 subunit showed reduced sensitivity to the anesthetic/hypnotic actions of ketamine. Sensitivity to pentobarbital, which, unlike ketamine, does not interact with NMDA receptors at clinically relevant concentrations, was also reduced. Our results illustrate the difficulties with interpreting altered anesthetic sensitivity in knockout animal models.

TECHNOLOGY, COMPUTING, AND SIMULATION:

A. Ekman, L. Brudin, and R. Sandin

A Comparison of Bispectral Index and Rapidly Extracted Auditory Evoked Potentials Index Responses to Noxious Stimulation During Sevoflurane Anesthesia
Anesth Analg 2004 99: 1141-1146. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: At a hypnotic level associated with surgical sevoflurane anesthesia, the data in this study suggest that Bispectral Index (BIS) better displays drug-related alterations in the level of hypnosis than auditory evoked potentials index (AAI) or hemodynamic variables and that there is no difference between BIS and AAI in the response time to a noxious stimulus.

Alexander Dullenkopf, Achim Schmitz, Goran Lamesic, Markus Weiss, and Anette Lang

The Influence of Acupressure on the Monitoring of Acoustic Evoked Potentials in Unsedated Adult Volunteers
Anesth Analg 2004 99: 1147-1151. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study shows that the A-line autoregressive index, a tool for monitoring depth of anesthesia, can be influenced by acupressure. Ten minutes of acupressure on the Extra 1 point but not on a control point significantly reduced stress levels in unsedated adult volunteers.

Mehmet S. Ozcan, Claudia Praetel, M. Tariq Bhatti, Nikolaus Gravenstein, Michael E. Mahla, and Christoph N. Seubert

The Effect of Body Inclination During Prone Positioning on Intraocular Pressure in Awake Volunteers: A Comparison of Two Operating Tables
Anesth Analg 2004 99: 1152-1158. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study investigated whether body inclination can improve the increase in intraocular pressure (IOP) caused by prone positioning in healthy awake volunteers. We conclude that the increase in IOP caused by prone positioning is ameliorated by the reverse Trendelenburg position and aggravated by the Trendelenburg position.

R. Ross Kennedy, Richard A. French, and Sandra Gilles

The Effect of a Model-Based Predictive Display on the Control of End-Tidal Sevoflurane Concentrations During Low-Flow Anesthesia
Anesth Analg 2004 99: 1159-1163. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A model-based system that uses anesthesia machine settings to predict and display future end-tidal (ET) sevoflurane concentrations was tested. Anesthesiologists made step changes in ET sevoflurane 1.5-2.3 times faster when using the system. This display may simplify the administration of volatile anesthesia, especially at low gas flows.

Surinder Singh and Robert G. Loeb

Fatal Connection: Death Caused by Direct Connection of Oxygen Tubing into a Tracheal Tube Connector (Case Report)
Anesth Analg 2004 99: 1164-1165. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A patient died of pulmonary barotrauma after oxygen extension tubing was mistakenly connected to her tracheal tube during cardiopulmonary resuscitation. We call for worldwide equipment standards to prevent future occurrences and describe examples of connectors that would prevent such misconnections.

PAIN MEDICINE:

Paul A. Leonard, Radha Arunkumar, and Timothy J. Brennan

Bradykinin Antagonists Have No Analgesic Effect on Incisional Pain
Anesth Analg 2004 99: 1166-1172. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Bradykinin antagonists reduce pain behaviors and inflammation in animal models of persistent nociception. We studied the effects of bradykinin antagonists in a rat model of postoperative pain.

Anil Gupta, Andrea Perniola, Kjell Axelsson, Sven E. Thörn, Kristina Crafoord, and Narinder Rawal

Postoperative Pain After Abdominal Hysterectomy: A Double-Blind Comparison Between Placebo and Local Anesthetic Infused Intraperitoneally
Anesth Analg 2004 99: 1173-1179. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A double-blind study was performed to assess postoperative pain and analgesic requirements after abdominal hysterectomy. Postoperative intraperitoneal local anesthetic infusions (levobupivacaine 12.5 mg/h) had a significant opioid-sparing effect compared with placebo and had a less frequent incidence of postoperative nausea during 4-24 h.

C. Hansen, I. Gilron, and M. Hong

The Effects of Intrathecal Gabapentin on Spinal Morphine Tolerance in the Rat Tail-Flick and Paw Pressure Tests
Anesth Analg 2004 99: 1180-1184. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Analgesic opioid tolerance may limit the efficacy of opioids, such as morphine, and has underlying mechanisms that are also important in the development of neuropathic pain. This study supports previous evidence that gabapentin prevents opioid tolerance and more specifically indicates that intrathecal gabapentin prevents the development of spinal opioid tolerance.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Kevin K. Tremper, Amy Shanks, Michelle Sliwinski, Steven J. Barker, Roberta Hines, and Alan R. Tait

Faculty and Finances of United States Anesthesiology Training Programs: 2002–2003
Anesth Analg 2004 99: 1185-1192. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Open faculty positions in United States training programs have remained fairly constant at 8% to 10% from 2000 to 2003. Institutional support for training departments has more than doubled since 2000, reaching approximately $85,000/faculty in 2003.

CRITICAL CARE AND TRAUMA:

Marc Leone, Jacques Albanèse, Xavier Viviand, Franck Garnier, Aurelie Bourgoin, Karine Barrau, and Claude Martin

The Effects of Remifentanil on Endotracheal Suctioning-Induced Increases in Intracranial Pressure in Head-Injured Patients
Anesth Analg 2004 99: 1193-1198. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Remifentanil bolus in severe head trauma patients in the intensive care unit induces an increase in intracranial pressure related to a decrease in mean arterial blood pressure, suggesting the preservation of autoregulation. Only large doses of this opioid requiring hemodynamic support can block coughing induced by an endotracheal suction.

Robert Apsner, Diego Gruber, Walter H. Hörl, and Gere Sunder-Plassmann

Parathyroid Hormone Secretion During Citrate Anticoagulated Hemodialysis in Acutely Ill Maintenance Hemodialysis Patients
Anesth Analg 2004 99: 1199-1204. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Bleeding complications during extracorporeal detoxification procedures can be reduced if regional citrate anticoagulation is used instead of heparin. Citrate anticoagulation can induce important changes in the secretion of parathyroid hormone.

Hiroshi Morimatsu, Keiji Goto, Takashi Matsusaki, Hiroshi Katayama, Hiromi Matsubara, Tohru Ohe, and Kiyoshi Morita

Rapid Development of Severe Interstitial Pneumonia Caused by Epoprostenol in a Patient with Primary Pulmonary Hypertension (Case Report)
Anesth Analg 2004 99: 1205-1207. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Epoprostenol infusion can cause a rapid, severe interstitial pneumonia (IP), even soon after the induction of therapy. Clinicians should keep this syndrome in mind, especially when treating a severe case of IP.

NEUROSURGICAL ANESTHESIA:

David S. Warner and Cecil O. Borel

Treatment of Traumatic Brain Injury: One Size Does Not Fit All (Editorial)
Anesth Analg 2004 99: 1208-1210. [Full Text] [PDF] [Request Permissions]  

Olaf L. Cremer, Gert W. van Dijk, Gerrit J. Amelink, Anne Marie G. A. de Smet, Karel G. M. Moons, and Cornelis J. Kalkman

Cerebral Hemodynamic Responses to Blood Pressure Manipulation in Severely Head-Injured Patients in the Presence or Absence of Intracranial Hypertension
Anesth Analg 2004 99: 1211-1217. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: To determine optimal cerebral perfusion pressure (CPP) after severe head injury, we pharmacologically manipulated CPP between 51 and 108 mm Hg. We found that the brain was within autoregulation limits when intracranial pressure was normal, whereas it was operating at the lower threshold of autoregulation when intracranial hypertension was present.

OBSTETRIC ANESTHESIA:

Natàlia Aragonès, Antoni Arxer, María Vieito, Josefina Ros, Antonio Villalonga, and Xavier Ustrell

The Diagnosis and Treatment of a Patient with Puerperal Infection and Subdural Hygromas (Case Report)
Anesth Analg 2004 99: 1218-1220. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We describe a puerperal patient with persistent postural headache after accidental lumbar puncture in which magnetic resonance imaging showed subdural hygromas. The condition was successfully treated with an epidural patch using dextran 40.

REGIONAL ANESTHESIA:

Salvatore Sia, Francesco Pelusio, Remo Barbagli, and Calogero Rivituso

Analgesia Before Performing a Spinal Block in the Sitting Position in Patients with Femoral Shaft Fracture: A Comparison Between Femoral Nerve Block and Intravenous Fentanyl
Anesth Analg 2004 99: 1221-1224. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Femoral nerve block produces a more intense analgesic effect than IV administration of fentanyl when given to facilitate the sitting position for spinal anesthesia in patients undergoing surgery for femoral shaft fractures.

Jaime Rodríguez, M. Bárcena, M. Taboada-Muñiz, J. Lagunilla, and J. Álvarez

A Comparison of Single Versus Multiple Injections on the Extent of Anesthesia with Coracoid Infraclavicular Brachial Plexus Block
Anesth Analg 2004 99: 1225-1230. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Both dual- and triple-injection infraclavicular coracoid block had better efficacy than a single-injection technique in providing anesthesia of the upper limb. Triple injection was not better than dual injection; therefore, the authors recommend dual-injection coracoid block.

Stephan Strebel, Jürg A. Gurzeler, Markus C. Schneider, Armin Aeschbach, and Christoph H. Kindler

Small-Dose Intrathecal Clonidine and Isobaric Bupivacaine for Orthopedic Surgery: A Dose-Response Study
Anesth Analg 2004 99: 1231-1238. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Small doses of intrathecal clonidine (<=150 {micro}g) coadministered to isobaric bupivacaine provide dose-dependent and clinically significant prolongation of spinal anesthesia and pain relief while preserving hemodynamic stability and causing no sedation. In contrast to other approaches to prolong spinal anesthesia (combined spinal-epidural technique) or to relieve postoperative pain (intrathecal opioids), intrathecal clonidine <=150 {micro}g does not cause an additional technical challenge or unpredictable pharmacological risk.

GENERAL ARTICLES:

Saifudin Rashiq, Meera Shah, Ava K. Chow, Paul J. O’Connor, and Barry A. Finegan

Predicting Allogeneic Blood Transfusion Use in Total Joint Arthroplasty
Anesth Analg 2004 99: 1239-1244. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The use of allogeneic blood in patients undergoing joint replacement surgery was modeled statistically. A prediction rule was created from this model. It estimates a given patient's risk of transfusion during total joint arthroplasty and can be used to target transfusion risk reduction measures more effectively.

G. Iohom, S. Szarvas, V. Larney, J. O’Brien, E. Buckley, M. Butler, and G. Shorten

Perioperative Plasma Concentrations of Stable Nitric Oxide Products Are Predictive of Cognitive Dysfunction After Laparoscopic Cholecystectomy
Anesth Analg 2004 99: 1245-1252. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The results of this prospective observational study suggest that preoperative (and postoperative) plasma concentrations of stable nitric oxide products (but not S-100ß) are associated with early postoperative cognitive dysfunction. The former represents a potential biochemical predictor of postoperative cognitive dysfunction.

Sean C. Minogue, James Ralph, and Martin J. Lampa

Laryngotracheal Topicalization with Lidocaine Before Intubation Decreases the Incidence of Coughing on Emergence from General Anesthesia
Anesth Analg 2004 99: 1253-1257. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We studied the effect of laryngotracheal spraying with lidocaine before intubation on the incidence of coughing on emergence from general anesthesia in cases <2 h duration and found its use to be associated with a significantly decreased incidence of coughing on emergence.

Halil Ibrahim Uzunlar, Ahmet Eroglu, Ahmet Can Senel, Habib Bostan, and Nesrin Erciyes

A Patient with Glanzmann’s Thrombasthenia for Emergent Abdominal Surgery (Case Report)
Anesth Analg 2004 99: 1258-1260. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We describe the management of an emergent surgical patient with Glanzmann's thrombasthenia and nasopharyngeal bleeding requiring platelets and recombinant activated factor VII infusions. These patients may need postoperative intensive care.

LETTERS TO THE EDITOR:

James P. Dilger and Jonathan D. Katz

Lines of Miscommunication • Response
Anesth Analg 2004 99: 1261. [Full Text] [PDF] [Request Permissions]  

Selim Candan, Gülnaz Arslan, Yehuda Ginosar, Ed Riley, and Martin Angst

The Site of Action of Epidural Fentanyl • Response
Anesth Analg 2004 99: 1261-1262. [Full Text] [PDF] [Request Permissions]  

Frans B. Plötz and Ingrid Prins

Small-Dose Dopamine in Critically Ill Infants and Children
Anesth Analg 2004 99: 1262-1263. [Full Text] [PDF] [Request Permissions]  

Seung Z. Yoon and Franklin Dexter

The Necessity of Guidelines for Any Workday or Four Weeks Systems for Allocating OR Times • Response
Anesth Analg 2004 99: 1263. [Full Text] [PDF] [Request Permissions]  

Kaew Supbornsug and Irene P. Osborn

Topicalization of the Airway Using the GlideScope
Anesth Analg 2004 99: 1263-1264. [Full Text] [PDF] [Request Permissions]  

Thomas M. Hemmerling, Stéphane Deschamps, Guillaume Michaud, and Guillaume Trager

An Unusual Site for BIS Monitoring
Anesth Analg 2004 99: 1264-1265. [Full Text] [PDF] [Request Permissions]  

Rudolph H. de Jong, Mary E. Kouri, and Dan J. Kopacz

Troubling Incidence of Lidocaine Radiculotoxicity (TNS) in Volunteers • Response
Anesth Analg 2004 99: 1265-1266. [Full Text] [PDF] [Request Permissions]  

Jeffrey Katz

Treatment of Persistent Cerebrospinal Fluid Leak with an Epidural Blood Patch
Anesth Analg 2004 99: 1266. [Full Text] [PDF] [Request Permissions]  

Krzysztof M. Kuczkowski

Does an Epidural Catheter Impede or Stimulate Dural Inflammatory Response and Normal Dural Closure After Dural Puncture?
Anesth Analg 2004 99: 1266. [Full Text] [PDF] [Request Permissions]  

A. G. Steel, B. J. Watson, S. Abdy, and J. G. Allen

Persistent Cerebrospinal Fluid Leak
Anesth Analg 2004 99: 1266-1267. [Full Text] [PDF] [Request Permissions]  

Jeffrey S. Lee and Marc Van de Velde

Does Intrathecal Sufentanil Really Cause More Episodes of Fetal Bradycardia? • Response
Anesth Analg 2004 99: 1267. [Full Text] [PDF] [Request Permissions]  

Thomas M. Hemmerling, Jean-François Olivier, Fadi Basile, Ignatio Prieto, David A. Rosen, and Denzil W. Hawkinberry

Epidural Hematoma After Anticoagulation with a Thoracic Epidural Catheter in Place: A Mere Coincidence? • Response
Anesth Analg 2004 99: 1267-1268. [Full Text] [PDF] [Request Permissions]  

Barry L. Friedberg and Paul F. White

Paradoxical Increase in Pain Requirements with Midazolam Premedication • Response
Anesth Analg 2004 99: 1268-1269. [Full Text] [PDF] [Request Permissions]  

Lewis S. Coleman, Guy Weinberg, William Hoffman, Douglas Feinstein, and Chanannait Paisanthasan

Bupivacaine and Ventricular Fibrillation • Response
Anesth Analg 2004 99: 1269. [Full Text] [PDF] [Request Permissions]  

M. El-Orbany, M. R. Salem, Vladimir Nekhendzy, and Paul Simmonds

The Eschmann Tracheal Tube Introducer Is Not an Airway Exchange Device • Response
Anesth Analg 2004 99: 1269-1270. [Full Text] [PDF] [Request Permissions]  

Rudolph H. de Jong and Pekka Tarkkila

Overnight Stay Lowers Incidence of Lidocaine Radiculotoxicity ("TNS") • Response
Anesth Analg 2004 99: 1270-1271. [Full Text] [PDF] [Request Permissions]  

Mark D. Weber and Michael J. Romano

A Quick and Simple Method to Provide Transtracheal Jet Ventilation
Anesth Analg 2004 99: 1271-1272. [Full Text] [PDF] [Request Permissions]  

Mitchel B. Sosis, Colin J. L. McCartney, Richard Brull, Vincent Chan, and Frances Chung

Proper Consent for Clinical Anesthesia Research May Be Difficult to Obtain on the Day of Surgery • Response
Anesth Analg 2004 99: 1272. [Full Text] [PDF] [Request Permissions]  

Jeffrey S. Lee, Andrea Casati, and Battista Borghi

The Effects of Epidural Needle Rotation • Response
Anesth Analg 2004 99: 1272. [Full Text] [PDF] [Request Permissions]  

Sui-Cheung Yu, Warwick D. Ngan Kee, Anne S. K. Kwan, Jean-Denis Roy, Michel Girard, and Pierre Drolet

Intrathecal Meperidine and Shivering in Obstetric Anesthesia • Response
Anesth Analg 2004 99: 1272-1273. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Jonathan R. Gavrin

Handbook of Pain Relief in Older Adults: An Evidence-Based Approach • Books and Multimedia Received
Anesth Analg 2004 99: 1274. [Full Text] [PDF] [Request Permissions]  

ERRATA:

Correction
Anesth Analg 2004 99: 1031. [Full Text] [PDF] [Request Permissions]  

Correction
Anesth Analg 2004 99: 1055. [Full Text] [PDF] [Request Permissions]  

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