CARDIOVASCULAR ANESTHESIA:

Greg Stratmann and Jonathan L. Benumof

Endobronchial Hemorrhage Due to Pulmonary Circulation Tear: Separating the Lungs and the Air from the Blood (Editorial)
Anesth Analg 2004 99: 1276-1279. [Full Text] [PDF] [Request Permissions]  

Ulrich R. Döpfmer, Jan-Peter Braun, Joachim Grosse, Holger Hotz, Katja Duveneck, and Martin B. Schneider

Treatment of Severe Pulmonary Hemorrhage After Cardiopulmonary Bypass by Selective, Temporary Balloon Occlusion (Case Report)
Anesth Analg 2004 99: 1280-1282. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report a case of lung bleeding and gas embolization during cardiac surgery that was successfully treated by temporary occlusion of the blood vessel feeding the affected lung lobe with a balloon dilating catheter and temporary selective ventilation of the contralateral lung without further surgical interventions.

Kenichi A. Tanaka, Fania Szlam, Nobuyuki Katori, Nobukazu Sato, J. David Vega, and Jerrold H. Levy

The Effects of Argatroban on Thrombin Generation and Hemostatic Activation In Vitro (Case Report)
Anesth Analg 2004 99: 1283-1289. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Argatroban can effectively reduce thrombin generation and prolong activated clotting in vitro. On the basis of its rapid binding to thrombin and its relatively short elimination half-life, argatroban may prove to be a useful adjunct for treating heparin resistance during cardiac surgery.

Jack J. Chavez, Donald E. Foley, Carolyn C. Snider, James C. Howell, Eli Cohen, Robert A. Muenchen, and Roger C. Carroll

A Novel Thrombelastograph® Tissue Factor/Kaolin Assay of Activated Clotting Times for Monitoring Heparin Anticoagulation During Cardiopulmonary Bypass (Case Report)
Anesth Analg 2004 99: 1290-1294. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This study evaluates the thrombelastograph as a new assay of blood clotting times; it is activated by the addition of tissue clotting factor and kaolin and used to monitor heparin anticoagulation during cardiopulmonary bypass. The thrombelastograph assay correlates with standard assays, is faster, is less sensitive to hemodilution, and can provide more information.

Pasi Lahtinen, Hannu Kokki, Tapio Hakala, and Markku Hynynen

S(+)-Ketamine as an Analgesic Adjunct Reduces Opioid Consumption After Cardiac Surgery (Case Report)
Anesth Analg 2004 99: 1295-1301. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This is the first placebo-controlled study to evaluate the efficacy and feasibility of S(+)-ketamine as a complementary analgesic to opioid after sternotomy in cardiac surgery patients. A small-dose S(+)-ketamine bolus followed by a continuous infusion for 48 h decreased cumulative opioid consumption and resulted in improved patient satisfaction with pain management. However, a few patients developed transient hallucinations.

Martin Dworschak, Dirk Breukelmann, and James D. Hannon

The Impact of Isoflurane During Simulated Ischemia/Reoxygenation on Intracellular Calcium, Contractile Function, and Arrhythmia in Ventricular Myocytes (Case Report)
Anesth Analg 2004 99: 1302-1307. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Isoflurane, a volatile anesthetic, administered during ischemia/reoxygenation, aggravated functional impairment in heart muscle cells. These alterations were probably caused by interference with intracellular Ca2+ handling proteins and by generation of oxygen radicals. Cardioprotection by isoflurane when given before ischemia should be reevaluated in situations of continuing ischemia and subsequent reperfusion.

Lynda M. Ludwig, Katsuya Tanaka, Janis T. Eells, Dorothee Weihrauch, Paul S. Pagel, Judy R. Kersten, and David C. Warltier

Preconditioning by Isoflurane Is Mediated by Reactive Oxygen Species Generated from Mitochondrial Electron Transport Chain Complex III (Case Report)
Anesth Analg 2004 99: 1308-1315. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The electron transport chain complex III inhibitor myxothiazol, but not the complex I inhibitor diphenyleneiodonium, abolished isoflurane-induced protection against ischemia-reperfusion injury and reactive oxygen species production in rabbits. Reactive oxygen species generated from electron transport chain complex III act in the signal transduction process mediating preconditioning by isoflurane in vivo.

Shinji Kohro, Quinn H. Hogan, David C. Warltier, and Zeljko J. Bosnjak

Protein Kinase C Inhibitors Produce Mitochondrial Flavoprotein Oxidation in Cardiac Myocytes (Case Report)
Anesth Analg 2004 99: 1316-1322. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Inhibition of protein kinase C (PKC) blocks ischemic and anesthetic preconditioning of the myocardium. We observed that PKC inhibition produces intense oxidation of mitochondria by a pathway involving inositol triphosphate. This may indicate that PKC modulates adenosine triphosphate-sensitive K channels to prevent injurious mitochondrial oxidation.

W. Andrew Kofke, Patrick Konitzer, Qing Cheng Meng, Jia Guo, and Albert Cheung

The Effect of Apolipoprotein E Genotype on Neuron Specific Enolase and S-100ß Levels After Cardiac Surgery (Brief Report)
Anesth Analg 2004 99: 1323-1325. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Two blood tests thought to be biomarkers for brain injury were found to be increased after cardiac surgery with larger increases in patients with the apolipoprotein {epsilon}4 gene, a gene linked to Alzheimer's disease. There may be genetic differences in susceptibility to neurologic problems after surgery.

David A. Pybus

A Perioperative Echocardiographic Reporting and Recording System (Technical Communication)
Anesth Analg 2004 99: 1326-1329. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The development of inexpensive digital video transcoders and the incorporation of highly efficient video capture, compression, and streaming technology into the Windows(R) computer operating system has simplified the task of implementing a high-fidelity, real-time, digital, echocardiographic recording system. An application that uses these technologies and runs on a notebook computer is described.

G. Gueret, B. Rossignol, G. Kiss, J. P. Wargnier, A. Miossec, S. Spielman, and C. C. Arvieux

Is Muscle Relaxant Necessary for Cardiac Surgery? (Technical Communication)
Anesth Analg 2004 99: 1330-1333. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Residual paralysis as a result of repetitive doses or continuous administration of muscle relaxants is counterproductive for fast-track cardiac surgery which aims for early postoperative extubation and quick recovery. Perioperative patient movement, unwanted diaphragmatic contractions, difficult surgical conditions, and residual paralysis were prevented in 87 patients undergoing cardiac surgery by injecting a single dose of either atracurium or cisatracurium during induction of anesthesia. This practice has no negative impact on surgery and allows early and safe extubation of the trachea.

PEDIATRIC ANESTHESIA:

Anthony J. Clapcich, Ronald G. Emerson, David P. Roye, Jr., Hui Xie, Edward J. Gallo, Kathy C. Dowling, Brian Ramnath, and Eric J. Heyer

The Effects of Propofol, Small-Dose Isoflurane, and Nitrous Oxide on Cortical Somatosensory Evoked Potential and Bispectral Index Monitoring in Adolescents Undergoing Spinal Fusion
Anesth Analg 2004 99: 1334-1340. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In adolescent patients undergoing spinal fusion, propofol better preserves cortical somatosensory evoked potential amplitude measurement and provides a deeper level of hypnosis as measured by bispectral index values than combinations of small-dose isoflurane-N2O or small-dose isoflurane alone.

Bruce E. Miller, Steven R. Tosone, Nina A. Guzzetta, Jennifer L. Miller, and Keith K. Brosius

Fibrinogen in Children Undergoing Cardiac Surgery: Is It Effective?
Anesth Analg 2004 99: 1341-1346. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Fibrinogen appears to be dysfunctional in children <12 mo old with congenital heart disease based on evidence from modified thromboelastography. This may help explain the benefits of transfusing cryoprecipitate to infants after cardiopulmonary bypass and may limit the use of modified thromboelastography in transfusion algorithms for infants after cardiac surgery.

Melissa Wheeler, Patrick K. Birmingham, Ralph A. Lugo, Corri L. Heffner, and Charles J. Coté

The Pharmacokinetics of the Intravenous Formulation of Fentanyl Citrate Administered Orally in Children Undergoing General Anesthesia
Anesth Analg 2004 99: 1347-1351. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this pilot study of 10 children undergoing general anesthesia, we found pharmacokinetic variables and plasma concentrations with the IV formulation of fentanyl given by mouth to be similar to those described for oral transmucosal fentanyl. Further studies of efficacy and safety are required before this method of fentanyl administration can be safely recommended.

V. Ravindra Bhat and G. Venkateshwaran

A Secure Method of Nasotracheal Tube Fixation Using an Infant Feeding Tube (Brief Report)
Anesth Analg 2004 99: 1352-1354. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This article describes a method of fixing the nasotracheal tube for anesthesia for maxillofacial surgeries using an infant feeding tube.

Joseph P. Cravero and George T. Blike

Review of Pediatric Sedation (Review Article)
Anesth Analg 2004 99: 1355-1364. [Abstract] [Full Text] [PDF] [Request Permissions]  

Dean B. Andropoulos, Stephen A. Stayer, Laura K. Diaz, and Chandra Ramamoorthy

Neurological Monitoring for Congenital Heart Surgery (Review Article)
Anesth Analg 2004 99: 1365-1375. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Brain monitoring for pediatric cardiac surgery (near infrared cerebral oximetry, transcranial Doppler ultrasound, and processed electroencephalogram) is now readily available and has the potential to improve neurological outcomes.

Peter J. Kulka, Hakki Toker, Jörg Heim, Alexander Joist, and Jens Jakschik

Suspected Central Anticholinergic Syndrome in a 6-Week-Old Infant (Case Report)
Anesth Analg 2004 99: 1376-1378. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A 6-wk-old boy was unarousable after an uneventful general anesthetic. After eliminating other causes, a central anticholinergic syndrome seemed possible. IV physostigmine successfully reversed the comatose state and confirmed the diagnosis.

AMBULATORY ANESTHESIA:

Anita C. Rudy, Barbara A. Coda, Sanford M. Archer, and Daniel P. Wermeling

A Multiple-Dose Phase I Study of Intranasal Hydromorphone Hydrochloride in Healthy Volunteers
Anesth Analg 2004 99: 1379-1386. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Pharmacokinetics were determined for multiple doses of intranasal hydromorphone hydrochloride in healthy volunteers. Rapid absorption and predictable accumulation and pharmacokinetics support the investigation of hydromorphone hydrochloride nasal spray as a therapeutic alternative to oral and IM administration.

Andrea Casati, Elena Moizo, Chiara Marchetti, and Federico Vinciguerra

A Prospective, Randomized, Double-Blind Comparison of Unilateral Spinal Anesthesia with Hyperbaric Bupivacaine, Ropivacaine, or Levobupivacaine for Inguinal Herniorrhaphy
Anesth Analg 2004 99: 1387-1392. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Comparing spinal block produced with 8 mg of hyperbaric bupivacaine 0.5%, 8 mg of hyperbaric levobupivacaine 0.5%, and 12 mg of hyperbaric ropivacaine 0.5%, this prospective, randomized, double-blind study demonstrated that all 3 local anesthetics have similarly short clinical profiles.

ANESTHETIC PHARMACOLOGY:

Deborah J. Culley, Mark G. Baxter, Catherine A. Crosby, Rustam Yukhananov, and Gregory Crosby

Impaired Acquisition of Spatial Memory 2 Weeks After Isoflurane and Isoflurane-Nitrous Oxide Anesthesia in Aged Rats
Anesth Analg 2004 99: 1393-1397. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Two hours of isoflurane anesthesia with or without nitrous oxide impairs the ability of aged rats to acquire a novel spatial memory task 2 wk later.

Oliver Kunitz, Jan-Hinrich Baumert, Klaus Hecker, Thorben Beeker, Mark Coburn, André Zühlsdorff, and Rolf Rossaint

Xenon Does Not Prolong Neuromuscular Block of Rocuronium
Anesth Analg 2004 99: 1398-1401. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Except for xenon, the interactions of inhaled anesthetics with neuromuscular blocking drugs are known. Therefore, the influence of xenon on the onset time, duration, recovery index, and recovery time of rocuronium during propofol and xenon anesthesia was compared. No differences were found.

Michael H. Dueck, Matthias Paul, Philipp Sagawe, Aloys Oberthuer, Christoph Wedekind, and Ulf Boerner

Different F-Wave Recovery After Neuromuscular Blockade with Pancuronium and Mivacurium
Anesth Analg 2004 99: 1402-1407. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Our findings using F-wave monitoring indicate a differential recovery of the whole motor system after administration of two different neuromuscular blocking drugs that was not detected by peripheral mechanomyography. This result may have been caused by different spinal effects of pancuronium compared with mivacurium.

Yousuke Shiga, Kouichiro Minami, Kayoko Segawa, Yasuhito Uezono, Munehiro Shiraishi, Takeyoshi Sata, Chieko Yamamoto, and Kim Sung-Teh

The Inhibition of Aortic Smooth Muscle Cell Proliferation by the Intravenous Anesthetic Ketamine
Anesth Analg 2004 99: 1408-1412. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Vascular smooth muscle cell (SMC) proliferation has been recognized as central to the pathology of major forms of vascular disease. Ketamine inhibited SMCs at clinical concentrations via the protein kinase C pathway. Our present results indicate that ketamine might prevent the proliferation of SMCs clinically.

Steven L. Jinks, Joseph F. Antognini, Robert C. Dutton, Earl Carstens, and Edmond I Eger, II

Isoflurane Depresses Windup of C Fiber-Evoked Limb Withdrawal with Variable Effects on Nociceptive Lumbar Spinal Neurons in Rats
Anesth Analg 2004 99: 1413-1419. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Isoflurane may exert part of its antinociceptive action by depressing spinal cord neuronal excitability and windup, an action that might occur at least partly at the N-methyl-D-aspartate receptor.

Elina Salmi, Kaike K. Kaisti, Liisa Metsähonkala, Vesa Oikonen, Sargo Aalto, Kjell Någren, Susanna Hinkka, Jarmo Hietala, Esa R. Korpi, and Harry Scheinin

Sevoflurane and Propofol Increase ¹¹C-Flumazenil Binding to Gamma-Aminobutyric Acid_A Receptors in Humans
Anesth Analg 2004 99: 1420-1426. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Both sevoflurane and propofol enhanced gamma-aminobutyric acid (GABA)A receptor binding in the living human brain as assessed with 11C-labeled flumazenil and positron emission tomography, thus supporting the involvement of GABAA receptors in the mechanism of action of both volatile anesthetics and propofol.

Daniel R. Brown and Michael J. Brown

Hypoglycemia Associated with Preoperative Metoprolol Administration (Case Report)
Anesth Analg 2004 99: 1427-1428. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In patients with abnormal energy metabolism, which may occur with cancer, or a history of unexplained hypoglycemia, care must be taken to ensure that hypoglycemia does not occur when ß-adrenergic antagonists are administered.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Paul F. White, Jun Tang, Hong Ma, Ronald H. Wender, Alexander Sloninsky, and Robert Kariger

Is the Patient State Analyzer with the PSArray² a Cost-Effective Alternative to the Bispectral Index Monitor During the Perioperative Period?
Anesth Analg 2004 99: 1429-1435. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The new disposable electrode configuration, PSArray2, for the patient state analyzer would appear to be a cost-effective alternative to the electroencephalogram-based bispectral index monitor for assessing the level of consciousness during the induction of and emergence from anesthesia, as well as for titrating intravenous (propofol) and volatile (desflurane) anesthetics during the maintenance period.

Gregg K. Motonaga, Keith K. Lee, and Jeffrey R. Kirsch

The Efficacy of the Arrow Staple Device for Securing Central Venous Catheters to Human Skin
Anesth Analg 2004 99: 1436-1439. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Suturing central venous catheters to the skin exposes health care workers to unnecessary risks of needlestick injury. We compared the efficacy of an alternative attachment method using staples with the widely accepted suture method. Determining the anchoring strength of staples is important because there may be substantial risk and difficulty reinserting inadvertently dislodged catheters.

Jun Kawasaki, Nobuyuki Katori, Mitsuharu Kodaka, Hideki Miyao, and Kenichi A. Tanaka

Electron Microscopic Evaluations of Clot Morphology During Thrombelastography®
Anesth Analg 2004 99: 1440-1444. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We have shown structural changes of the forming clot in relation to thrombelastography variables using scanning electron microscopy. Clot structure was examined in the whole blood and platelet-rich plasma in the presence and the absence of abciximab.

Stanley D. Mac Murdo and Charles W. Buffington

Brand and Size Matter When Choosing a Syringe to Relieve Pressure in a Tracheal Tube Cuff (Technical Communication)
Anesth Analg 2004 99: 1445-1449. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: An inline syringe can be used as a pressure relief valve for tracheal tube cuffs. The brand of syringe and size are important determinants of cuff pressure. No syringe works automatically, so cuff pressure should be adjusted intermittently.

Barry A. Finegan

Access Denied; Care Impaired: The Benefits of Having Online Medical Information Available at the Point-of-Care (Case Report)
Anesth Analg 2004 99: 1450-1452. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Two cases are described in which immediate access to a medical information database and other Internet available resources altered physician decision making intraoperatively. The potential benefits, limitations, and difficulties encountered using such resources in the operating room are discussed.

PAIN MEDICINE:

Asokumar Buvanendran, Jeffrey S. Kroin, James M. Kerns, Subhash N. K. Nagalla, and Kenneth J. Tuman

Characterization of a New Animal Model for Evaluation of Persistent Postthoracotomy Pain
Anesth Analg 2004 99: 1453-1460. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: A new model of persistent postthoracotomy pain has been developed using thoracotomy and rib-retraction for 60 min in rats. Pathologic changes in nerves can be demonstrated, persistent mechanical and cold allodynia evolve, and responses to systemic and intrathecal analgesic drugs can be quantified.

Hanife Altunkaya, Yetkin Ozer, Eksal Kargi, Isil Ozkocak, Mübin Hosnuter, Cengiz Bekir Demirel, and Orhan Babuccu

The Postoperative Analgesic Effect of Tramadol When Used as Subcutaneous Local Anesthetic
Anesth Analg 2004 99: 1461-1464. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The local anesthetic and postoperative analgesic effect of tramadol were compared with that of lidocaine for minor surgery performed using local anesthesia. Tramadol may be a good choice for minor surgery because of its sufficient local anesthetic and analgesic effects.

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

Preincisional Intravenous Pentoxifylline Attenuating Perioperative Cytokine Response, Reducing Morphine Consumption, and Improving Recovery of Bowel Function in Patients Undergoing Colorectal Cancer Surgery
Anesth Analg 2004 99: 1465-1471. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Preoperative IV pentoxifylline improved postoperative pain, resulting in diminished morphine consumption, faster return of bowel function, and attenuated production of interleukin (IL)-6, IL-8, and IL-1 receptor antagonist in the perioperative period, but it did not increase the risk of complications in this small patient group.

Joseph Gimbel and Harry Ahdieh

The Efficacy and Safety of Oral Immediate-Release Oxymorphone for Postsurgical Pain
Anesth Analg 2004 99: 1472-1477. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Oxymorphone immediate-release provides effective pain relief in patients experiencing moderate-to-severe pain after major orthopedic surgery.

R. Norman Harden, Nathan J. Rudin, Stephen Bruehl, William Kee, Devang K. Parikh, Jason Kooch, Thomas Duc, and Richard H. Gracely

Increased Systemic Catecholamines in Complex Regional Pain Syndrome and Relationship to Psychological Factors: A Pilot Study
Anesth Analg 2004 99: 1478-1485. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This pilot study explored systemic venous plasma catecholamine levels in complex regional pain syndrome and the correlation with scores on psychometric measures. Our results suggest that increased catecholamine levels may result from pain or may reflect premorbid adrenergic hyperactivity, which could predispose these individuals to develop the syndrome.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Jakob Lauritsen and Ann M. Moller

Publications in Anesthesia Journals: Quality and Clinical Relevance
Anesth Analg 2004 99: 1486-1491. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We analyzed the proportion of clinically relevant articles in five major anesthesia journals. Using predetermined criteria, 20% of the articles in 5 journals were found to be clinically relevant.

Franklin Dexter and Liam O’Neill

Data Envelopment Analysis to Determine by How Much Hospitals Can Increase Elective Inpatient Surgical Workload for Each Specialty
Anesth Analg 2004 99: 1492-1500. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We apply data envelopment analysis to measure market capture of elective inpatient surgery for all hospitals in a state. We evaluate the usefulness of the data envelopment analysis by focusing on one hospital and its competitors.

CRITICAL CARE AND TRAUMA:

Semra Demirbilek, M. Ozcan Ersoy, Savas Demirbilek, Abdurrahman Karaman, Necla Gürbüz, Nihayet Bayraktar, and Mehmet Bayraktar

Small-Dose Capsaicin Reduces Systemic Inflammatory Responses in Septic Rats
Anesth Analg 2004 99: 1501-1507. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The influence of small- and large-dose capsaicin on systemic inflammatory responses, nitrite/nitrate (NOx), tissue superoxide dismutase, and malondialdehyde (MDA) levels was investigated in the rat model of sepsis. Small-dose capsaicin treatment attenuated the increases in proinflammatory cytokines and decreased NOx and tissue MDA in septic rats.

Torsten Loop, Tobias Bross, Matjaz Humar, Alexander Hoetzel, Rene Schmidt, Heike L. Pahl, Klaus K. Geiger, and Benedikt H. J. Pannen

Dobutamine Inhibits Phorbol-Myristate-Acetate-Induced Activation of Nuclear Factor-B in Human T Lymphocytes In Vitro
Anesth Analg 2004 99: 1508-1515. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Dobutamine is a specific inhibitor of nuclear factor-{kappa}B, which may provide a molecular mechanism for the immunomodulation associated with ß-adrenergic therapy.

Achim von Goedecke, Christian Keller, Horst G. Wagner-Berger, Wolfgang G. Voelckel, Christoph Hörmann, Angelika Zecha-Stallinger, and Volker Wenzel

Developing a Strategy to Improve Ventilation in an Unprotected Airway with a Modified Mouth-to-Bag Resuscitator in Apneic Patients (Technical Communication)
Anesth Analg 2004 99: 1516-1520. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Using a modified mouth-to-bag resuscitator or automatic pressure-controlled ventilation during ventilation of an unprotected airway resulted in an approximately 25% reduction in peak flow rate and peak airway pressure when compared with a pediatric self-inflating bag.

NEUROSURGICAL ANESTHESIA:

Oliver Grottke, Peter Johannes Dietrich, Stefanie Wiegels, and Frank Wappler

Intraoperative Wake-Up Test and Postoperative Emergence in Patients Undergoing Spinal Surgery: A Comparison of Intravenous and Inhaled Anesthetic Techniques Using Short-Acting Anesthetics
Anesth Analg 2004 99: 1521-1527. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The balanced anesthetic regimen with desflurane and remifentanil allows a more rapid initial awakening during and after surgery combined with an immediate neurological examination of good quality during spinal surgery compared with propofol and remifentanil.

Seiya Nakamura, Manabu Kakinohana, Kazuhiro Sugahara, Sakura Kinjo, and Yuji Miyata

Intrathecal Morphine, but Not Buprenorphine or Pentazocine, Can Induce Spastic Paraparesis After a Noninjurious Interval of Spinal Cord Ischemia in the Rat (Brief Report)
Anesth Analg 2004 99: 1528-1531. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATION: The present study shows that neither intrathecal pentazocine nor intrathecal buprenorphine can increase spasticity of hindlimbs after a noninjurious interval of spinal cord ischemia in rats. These results indicate that the effect of various opioids on motor function after a noninjurious interval of spinal cord ischemia might be opioid-specific.

OBSTETRIC ANESTHESIA:

Stephen H. Halpern, Holly Muir, Terrance W. Breen, David C. Campbell, Jon Barrett, Robert Liston, and J. Wade Blanchard

A Multicenter Randomized Controlled Trial Comparing Patient-Controlled Epidural with Intravenous Analgesia for Pain Relief in Labor
Anesth Analg 2004 99: 1532-1538. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Two-hundred forty-two healthy, term, nulliparous patients in spontaneous labor were randomized to receive either patient-controlled IV or patient-controlled epidural labor analgesia. No difference in the incidence of cesarean delivery was observed between groups. The data support the hypothesis that epidural analgesia does not increase the incidence of cesarean delivery compared with IV analgesia.

REGIONAL ANESTHESIA:

Brian D. Sites, Michael Beach, John D. Gallagher, Robert A. Jarrett, Michael B. Sparks, and C. Johan F. Lundberg

A Single Injection Ultrasound-Assisted Femoral Nerve Block Provides Side Effect-Sparing Analgesia When Compared with Intrathecal Morphine in Patients Undergoing Total Knee Arthroplasty
Anesth Analg 2004 99: 1539-1543. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: In this prospective, randomized, and single-blinded trial we identify a side effect-sparing postoperative analgesic approach for total knee replacement surgery. A single injection femoral nerve block provides equivalent analgesia with a reduction in side effects when compared with intrathecal morphine.

Denis Jochum, Gabriella Iohom, Olivier Choquet, Dioukamady Macalou, Samba Ouologuem, Pascal Meuret, Freddy Kayembe, Michel Heck, Paul-Michel Mertes, and Hervé Bouaziz

Adding a Selective Obturator Nerve Block to the Parasacral Sciatic Nerve Block: An Evaluation
Anesth Analg 2004 99: 1544-1549. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The aim of this study was to objectively evaluate the efficacy of obturator nerve anesthesia after a parasacral block. These findings demonstrate the unreliability of parasacral block to achieve obturator nerve anesthesia. A selective obturator nerve block should be considered in the clinical setting when such a block is desirable.

Matthew R. Offerdahl, Robert L. Lennon, and Terese T. Horlocker

Successful Removal of a Knotted Fascia Iliaca Catheter: Principles of Patient Positioning for Peripheral Nerve Catheter Extraction (Case Report)
Anesth Analg 2004 99: 1550-1552. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We describe successful removal of a knotted fascia iliaca catheter. The principles for removal of knotted or broken peripheral catheters are not well known and may differ from those for spinal or epidural catheters. Altering patient positioning to minimize pressure and tension on the soft tissues surrounding the catheter may facilitate catheter removal.

GENERAL ARTICLES:

Donald M. Miller

A Proposed Classification and Scoring System for Supraglottic Sealing Airways: A Brief Review (Medical Intelligence)
Anesth Analg 2004 99: 1553-1559. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: This brief preliminary review of supraglottic sealing airways provides a rational systematic approach to understanding airway devices and a suggested scoring method to enhance appreciation of their merits and differences.

Joseph Brimacombe, Achim von Goedecke, Christian Keller, Lawrence Brimacombe, and Moira Brimacombe

The Laryngeal Mask Airway Unique^TM versus the Soft Seal^TM Laryngeal Mask: A Randomized, Crossover Study in Paralyzed, Anesthetized Patients (Medical Intelligence)
Anesth Analg 2004 99: 1560-1563. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: The laryngeal mask airway Unique TM is superior to the Soft Seal TM laryngeal mask in terms of ease of insertion, fiberoptic position, and mucosal trauma but similar in terms of oropharyngeal leak pressure and ease of ventilation.

Patrick Wettstein, André Haeberli, Monika Stutz, Miriam Rohner, Cinzia Corbetta, Konrad Gabi, Thomas Schnider, and Wolfgang Korte

Decreased Factor XIII Availability for Thrombin and Early Loss of Clot Firmness in Patients with Unexplained Intraoperative Bleeding (Medical Intelligence)
Anesth Analg 2004 99: 1564-1569. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: From a prospective study of 226 patients undergoing elective surgery, we suggest that unexplained intraoperative bleeding might occur secondary to a preexisting, nonovert coagulopathy with decreased Factor XIII availability and a consecutive reduction of clot firmness during surgical stress.

Daniel d’Hulst, John Butterworth, Sebron Dale, Timothy Oaks, and Brian Matthews

Polypoid Hyperplasia of the Larynx Misdiagnosed as a Malpositioned Laryngeal Mask Airway (Case Report)
Anesth Analg 2004 99: 1570-1572. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: Polypoid hyperplasia of the larynx, the most common benign lesion of this organ, may cause partial obstruction of inspiration during positive pressure ventilation through a (laryngeal) mask airway.

Kevin K. Bach, Fred W. Lindsay, Lamont S. Berg, and Red S. Howard

Prolonged Postoperative Disorientation After Methylene Blue Infusion During Parathyroidectomy (Case Report)
Anesth Analg 2004 99: 1573-1574. [Abstract] [Full Text] [PDF] [Request Permissions]  

IMPLICATIONS: We report the case of a patient who, after a large dose of methylene blue, had a postoperative course that was unusual because of slowly resolving altered mental status.

LETTERS TO THE EDITOR:

Shahzad G. Raja, Isao Tsuneyoshi, Rumi Katai, Junichirou Hamasaki, Masanori Onomoto, and Yuichi Kanmura

Dopamine and Radial Artery: Implications for Clinical Practice • Response
Anesth Analg 2004 99: 1575. [Full Text] [PDF] [Request Permissions]  

Alain C. Van Elstraete, Thierry Lebrun, Ignace Sandefo, Bruno Polin, Rebecca K. F. Kwok, Matthew T. V. Chan, and Tony Gin

Are Preemptive Analgesic Effects of Ketamine Linked to Inadequate Perioperative Analgesia? • Response
Anesth Analg 2004 99: 1576. [Full Text] [PDF] [Request Permissions]  

Jeffrey J. Pasternak, Susan L. Ryan, and William L. Lanier

Incidental Radiologic Discovery of a Large Posterior Pharyngeal Mass in a Tracheally Intubated Child With Facial Anomalies
Anesth Analg 2004 99: 1576-1577. [Full Text] [PDF] [Request Permissions]  

Sujesh Bansal and Brian Chan

Fluid Leak from Epidural Puncture Site: A Diagnostic Dilemma • Response
Anesth Analg 2004 99: 1577. [Full Text] [PDF] [Request Permissions]  

Eric Goldszmidt, Joseph Brimacombe, and Christian Keller

Awake Intubation Is Indicated in Pregnant Women with Difficult Airways • Response
Anesth Analg 2004 99: 1577-1578. [Full Text] [PDF] [Request Permissions]  

Marilyn Weis, J. P. Abenstein, Kirsten Hall Long, Brian P. McGlinch, and Niki M. Dietz

Study Regarding Anesthesia Outcomes Cites Outdated Studies • Response
Anesth Analg 2004 99: 1578-1579. [Full Text] [PDF] [Request Permissions]  

BOOK AND MULTIMEDIA REVIEWS:

Jon D. Samuels and John J. Savarese

Anesthetic Pharmacology: Physiologic Principles and Clinical Practice • Books and Multimedia Received
Anesth Analg 2004 99: 1580. [Full Text] [PDF] [Request Permissions]  

ERRATA:

Correction
Anesth Analg 2004 99: 1333. [Full Text] [PDF] [Request Permissions]  

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