CARDIOVASCULAR ANESTHESIA:

Marc Rozner

Pacemaker Misinformation in the Perioperative Period: Programming Around the Problem (Editorial)
Anesth Analg 2004 99: 1582-1584. [Full Text]  

Deidre A. Sun, Lynn Martin, and Christopher R. Honey

Percutaneous Radiofrequency Trigeminal Rhizotomy in a Patient with an Implanted Cardiac Pacemaker (Case Report)
Anesth Analg 2004 99: 1585-1586. [Abstract] [Full Text]  

IMPLICATIONS: This case reports a patient with an implanted cardiac pacemaker who underwent an uneventful percutaneous radiofrequency trigeminal rhizotomy in which the radiofrequency was a source of electromagnetic interference, potentially disruptive to the cardiac pacemaker.

Vance G. Nielsen, Ralph T. Lyerly, III, and William Q. Gurley

The Effect of Dilution on Plasma Coagulation Kinetics Determined by Thrombelastography Is Dependent on Antithrombin Activity and Mode of Activation (Case Report)
Anesth Analg 2004 99: 1587-1592. [Abstract] [Full Text]  

IMPLICATIONS: Hemodilution-associated hypercoagulability is of clinical interest, given the morbidity and mortality associated with perioperative thrombophilia. We determined that decreased antithrombin activity is responsible for accelerated clot initiation via thrombelastography with in vitro plasma-based experiments. Celite activation of plasma resulted in a linear relationship between degree of dilution and thrombelastographic variables.

Michael F. James, Helét E. Potgieter, and P. Ellis

The Effect of Hemopure® on Coagulation in Clinically Relevant Concentrations (Case Report)
Anesth Analg 2004 99: 1593-1597. [Abstract] [Full Text]  

IMPLICATIONS: Hemopure(R), a polymerized bovine hemoglobin used as a blood substitute, might interfere with coagulation. At clinically relevant in vitro dilutions of whole blood, the effects of Hemopure(R) on whole-blood coagulation as measured by the thrombelastograph were not significantly different from those of the carrier substance, lactated Ringer's solution.

Brian S. Donahue

The Response to Activated Protein C After Cardiopulmonary Bypass: Impact of Factor V Leiden (Case Report)
Anesth Analg 2004 99: 1598-1603. [Abstract] [Full Text]  

IMPLICATIONS: Patients without factor V Leiden (FVL) have increased sensitivity to the activated protein C after cardiac surgery, whereas FVL carriers do not. These data provide mechanistic support for previous speculations that FVL subjects are at increased postoperative thrombotic risk relative to noncarriers.

G. Della Rocca, L. Pompei, M. G. Costa, C. Coccia, L. Scudeller, P. Di Marco, S. Monaco, and P. Pietropaoli

Fenoldopam Mesylate and Renal Function in Patients Undergoing Liver Transplantation: A Randomized, Controlled Pilot Trial (Case Report)
Anesth Analg 2004 99: 1604-1609. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated renal function comparing fenoldopam versus dopamine in liver transplantation recipients. In the fenoldopam-treated group, serum creatinine and BUN improved. There were more "interventions" of furosemide to maintain urine output >1 mL {middle dot} kg-1 {middle dot} h-1 in the dopamine group.

James E. Hillier, Tudor P. Toma, and Charles E. Gillbe

Bronchoscopic Lung Volume Reduction in Patients with Severe Emphysema: Anesthetic Management (Case Report)
Anesth Analg 2004 99: 1610-1614. [Abstract] [Full Text]  

IMPLICATIONS: Bronchoscopic lung volume reduction is a novel approach to the treatment of severe emphysema. We describe the anesthetic experience with this new procedure, highlighting the problems facing the anesthesiologist.

Amber Rithalia, Philip M. Hopkins, and Simon M. Harrison

The Effects of Halothane, Isoflurane, and Sevoflurane on Ca²⁺ Current and Transient Outward K⁺ Current in Subendocardial and Subepicardial Myocytes from the Rat Left Ventricle (Case Report)
Anesth Analg 2004 99: 1615-1622. [Abstract] [Full Text]  

IMPLICATIONS: Halothane, isoflurane, and sevoflurane reduce action potential duration (APD) by virtue of inhibitory effects on membrane currents, principally the calcium current. The differential effects of anesthetics on APD in the subepicardium and subendocardium appear to be due to their inhibitory action on the transient outward K+ current.

Pearl Toy and Ognjen Gajic

Transfusion-Related Acute Lung Injury (Brief Report)
Anesth Analg 2004 99: 1623-1624. [Abstract] [Full Text]  

IMPLICATIONS: Transfusion may rarely cause acute lung injury. Diagnosis is difficult because there is no single test for the condition. Diagnosis and management are described. Earlier recognition may lead to earlier diagnosis, treatment, and prevention.

Wolfram Schummer, Claudia Schummer, Don Bredle, and Rosemarie Fröber

The Anterior Jugular Venous System: Variability and Clinical Impact (Case Report)
Anesth Analg 2004 99: 1625-1629. [Abstract] [Full Text]  

IMPLICATIONS: The anterior jugular venous system provides an important collateral venous network with the subclavian and deep jugular veins, especially in unilateral occlusion of an innominate vein. In such cases, central venous catheters may be correctly placed via the anterior jugular venous system. However, central venous catheters malpositioned in the anterior jugular vein can increase the risk for complications and should be removed.

PEDIATRIC ANESTHESIA:

L. H. J. Eberhart, G. Geldner, P. Kranke, A. M. Morin, A. Schäuffelen, H. Treiber, and H. Wulf

The Development and Validation of a Risk Score to Predict the Probability of Postoperative Vomiting in Pediatric Patients
Anesth Analg 2004 99: 1630-1637. [Abstract] [Full Text]  

IMPLICATIONS: The incidence of postoperative vomiting might be predicted using duration of surgery >=30 min, age >=3 yr, strabismus surgery, and a positive history of postoperative vomiting/postoperative nausea and vomiting in the children or in their relatives. The predicted incidence of postoperative vomiting is 9%, 10%, 30%, 55%, and 70% for 0-4 of these risk factors present.

Young-Chang P. Arai, Kayo Fukunaga, Seiji Hirota, and Shoji Fujimoto

The Effects of Chin Lift and Jaw Thrust While in the Lateral Position on Stridor Score in Anesthetized Children with Adenotonsillar Hypertrophy
Anesth Analg 2004 99: 1638-1641. [Abstract] [Full Text]  

IMPLICATIONS: We investigated the effects of body position shifting and airway maneuvers on airway patency in anesthetized children scheduled for adenotonsillectomy. Lateral positioning not only improved airway patency but also enhanced the potential of airway maneuvers.

Richard J. Levy, Rosetta M. Chiavacci, Susan C. Nicolson, Jonathan J. Rome, Richard J. Lin, Mark A. Helfaer, and Vinay M. Nadkarni

An Evaluation of a Noninvasive Cardiac Output Measurement Using Partial Carbon Dioxide Rebreathing in Children
Anesth Analg 2004 99: 1642-1647. [Abstract] [Full Text]  

IMPLICATIONS: In this study, our aim was to evaluate the accuracy of a noninvasive technique of measuring cardiac output in children. Measures of cardiac output obtained via partial rebreathing were compared with measures obtained by thermodilution.

Zeev N. Kain, Alison A. Caldwell-Andrews, Inna Maranets, Brenda McClain, Dorothy Gaal, Linda C. Mayes, Rui Feng, and Heping Zhang

Preoperative Anxiety and Emergence Delirium and Postoperative Maladaptive Behaviors
Anesth Analg 2004 99: 1648-1654. [Abstract] [Full Text]  

IMPLICATIONS: A practicing clinician can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

Jane A. Goodwin, Willem L. van Meurs, Carla D. Sá Couto, Jan E. W. Beneken, and Shirley A. Graves

A Model for Educational Simulation of Infant Cardiovascular Physiology
Anesth Analg 2004 99: 1655-1664. [Abstract] [Full Text]  

IMPLICATIONS: We describe the adaptation of a cardiovascular model that reflects infant cardiovascular physiology and reacts appropriately to a set of interventions. This model can form the basis for a screen-based educational simulator. The ultimate goal is the simulation of a 6-mo-old infant in full-scale.

Edward R. Mariano, Louise Furukawa, Russell K. Woo, Craig T. Albanese, and John G. Brock-Utne

Anesthetic Concerns for Robot-Assisted Laparoscopy in an Infant (Case Report)
Anesth Analg 2004 99: 1665-1667. [Abstract] [Full Text]  

IMPLICATIONS: The robotic surgical system for pediatric laparoscopy severely limits the anesthesiologist's access to the patient and requires advance preparation to ensure patient safety. We present the anesthetic management of the first successful robot-assisted laparoscopic Kasai procedure in an infant.

AMBULATORY ANESTHESIA:

Anna-Maija Korhonen, Jukka V. Valanne, Ritva M. Jokela, Pirjo Ravaska, and Kari T. Korttila

A Comparison of Selective Spinal Anesthesia with Hyperbaric Bupivacaine and General Anesthesia with Desflurane for Outpatient Knee Arthroscopy
Anesth Analg 2004 99: 1668-1673. [Abstract] [Full Text]  

IMPLICATIONS: Patients undergoing ambulatory knee arthroscopy recover equally fast when using either selective spinal anesthesia with hyperbaric bupivacaine or general anesthesia with desflurane. Spinal anesthesia is associated with decreased pain scores and less postoperative nausea and vomiting in the hospital.

ANESTHETIC PHARMACOLOGY:

Akira Kudoh, Hajime Takase, Yoko Takahira, and Tomoko Takazawa

Postoperative Confusion Increases in Elderly Long-Term Benzodiazepine Users
Anesth Analg 2004 99: 1674-1678. [Abstract] [Full Text]  

IMPLICATIONS: Some elderly patients are preoperatively treated with benzodiazepines for anxiety, insomnia, and depression. Although preoperative use of benzodiazepines is one of the risk factors for postoperative confusion, the relationship between postoperative confusion and preoperative psychiatric symptoms or duration of benzodiazepine exposure is unclear.

Edna Zohar, Martin Ellis, Nisim Ifrach, Avraham Stern, Oleg Sapir, and Brian Fredman

The Postoperative Blood-Sparing Efficacy of Oral Versus Intravenous Tranexamic Acid After Total Knee Replacement
Anesth Analg 2004 99: 1679-1683. [Abstract] [Full Text]  

IMPLICATIONS: To decrease complications related to blood transfusions, pharmacological manipulation of the clotting system may be performed. However, such strategies must be safe, reliable, and easy to administer. This study demonstrates that the blood-sparing efficacy of oral tranexamic acid is similar to that of IV tranexamic acid.

Anil Agarwal, Ravindra Pandey, Sanjay Dhiraaj, Prabhat K. Singh, Mehdi Raza, Chandra K. Pandey, Devendra Gupta, Arindam Choudhury, and Uttam Singh

The Effect of Epidural Bupivacaine on Induction and Maintenance Doses of Propofol (Evaluated by Bispectral Index) and Maintenance Doses of Fentanyl and Vecuronium
Anesth Analg 2004 99: 1684-1688. [Abstract] [Full Text]  

IMPLICATIONS: Epidural local anesthetics reduce the requirement of hypnotics, analgesics, and muscle relaxants. However, no study has evaluated the effect of local anesthetics on all three components of balanced anesthesia, i.e., hypnosis, analgesia, and muscle relaxation, in the clinical setting. We observed that epidural bupivacaine significantly reduces the requirement of all three during general anesthesia.

Jean-Luc Hanouz, Emmanuel Persehaye, Lan Zhu, Stéphane Lammens, Olivier Lepage, Massimo Massetti, Gérard Babatasi, André Khayat, Henri Bricard, and Jean-Louis Gérard

The Inotropic and Lusitropic Effects of Ketamine in Isolated Human Atrial Myocardium: The Effect of Adrenoceptor Blockade
Anesth Analg 2004 99: 1689-1695. [Abstract] [Full Text]  

IMPLICATIONS: In isolated human myocardium, racemic ketamine induced a moderate positive inotropic effect but a profound direct negative inotropic effect in the presence of ß-adrenoceptor blockade. Furthermore, ketamine hastened relaxation through stimulation of ß-adrenoceptor. This should be interpreted with the known various physiopathologic states and treatments interfering with {alpha}- and ß-adrenoceptors.

Chandra K. Pandey, Mehdi Raza, Rajeev Ranjan, Archana Lakra, Anil Agarwal, Uttam Singh, R. B. Singh, and Prabhat K. Singh

Intravenous Lidocaine Suppresses Fentanyl-Induced Coughing: A Double-Blind, Prospective, Randomized Placebo-Controlled Study
Anesth Analg 2004 99: 1696-1698. [Abstract] [Full Text]  

IMPLICATIONS: Fentanyl administration elicits cough. IV lidocaine 1.5 mg/kg suppresses fentanyl-induced coughing.

E. Schaub, C. Kern, and R. Landau

Pain on Injection: A Double-Blind Comparison of Propofol with Lidocaine Pretreatment Versus Propofol Formulated with Long- and Medium-Chain Triglycerides
Anesth Analg 2004 99: 1699-1702. [Abstract] [Full Text]  

IMPLICATIONS: Propofol-long- and medium-chain triglycerides resulted in a more frequent incidence of pain upon injection than propofol with 40 mg IV of lidocaine pretreatment as a Bier's block (47% versus 24%, respectively).

Annette Herweling, Federico Latorre, Andreas Herwig, Georg Horstick, Oliver Kempski, and Hendrik W. Gervais

The Hemodynamic Effects of Ephedrine on the Onset Time of Rocuronium in Pigs
Anesth Analg 2004 99: 1703-1707. [Abstract] [Full Text]  

IMPLICATIONS: In an animal study, the effect of ephedrine on onset time, cardiac index, and muscle blood flow was determined after administration of thiopental. A correlation between onset time of muscle relaxants and hemodynamic variables is discussed. Our results demonstrated that ephedrine did not shorten onset time of rocuronium in healthy pigs.

Lisa Wise-Faberowski, Mitsuo Aono, Robert D. Pearlstein, and David S. Warner

Apoptosis Is Not Enhanced in Primary Mixed Neuronal/Glial Cultures Protected by Isoflurane AgainstN-Methyl-D-Aspartate Excitotoxicity
Anesth Analg 2004 99: 1708-1714. [Abstract] [Full Text]  

IMPLICATIONS: Isoflurane inhibition of N-methyl-D-aspartate-induced necrotic cell death, evaluated in mixed neuronal/glial cell cultures, did not result in caspase-3-mediated apoptotic cell death. Our in vitro results failed to support the hypothesis that cells protected by isoflurane neuroprotection later deteriorate into an apoptotic state.

Canhui Liu, John D. Au, Hilary Liao Zou, Joseph F. Cotten, and C. Spencer Yost

Potent Activation of the Human Tandem Pore Domain K Channel TRESK with Clinical Concentrations of Volatile Anesthetics
Anesth Analg 2004 99: 1715-1722. [Abstract] [Full Text]  

IMPLICATIONS: Enhancement of background K channel currents by volatile anesthetics may contribute to neuronal depression during anesthesia. Currents passed by a newly discovered human background K channel, TWIK-related spinal cord K channel, are strongly enhanced by volatile anesthetics in the clinical range, suggesting a role for it in volatile anesthetic mechanisms.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Hildebrand S. Schwab, Manfred D. Seeberger, Edmond I Eger, II, Christoph H. Kindler, and Miodrag Filipovic

Sevoflurane Decreases Bispectral Index Values More than Does Halothane at Equal MAC Multiples
Anesth Analg 2004 99: 1723-1727. [Abstract] [Full Text]  

IMPLICATIONS: At equal multiples of the minimum alveolar concentration, sevoflurane produced lower bispectral index (BIS) values than did halothane. Such results indicate that BIS is drug specific.

Matthias Haenggi, Heidi Ypparila, Jukka Takala, Ilkka Korhonen, Martin Luginbühl, Steen Petersen-Felix, and Stephan M. Jakob

Measuring Depth of Sedation with Auditory Evoked Potentials During Controlled Infusion of Propofol and Remifentanil in Healthy Volunteers
Anesth Analg 2004 99: 1728-1736. [Abstract] [Full Text]  

IMPLICATIONS: Acoustic stimuli induce distinct changes in the electroencephalogram (EEG). We found that one component of these EEG modifications can be used to monitor the targeted light levels of sedation in critically ill patients nearly continuously, independent of adding remifentanil to a propofol-based sedation regime.

Paul Dalley, Brian Robinson, Jennifer Weller, and Catherine Caldwell

The Use of High-Fidelity Human Patient Simulation and the Introduction of New Anesthesia Delivery Systems
Anesth Analg 2004 99: 1737-1741. [Abstract] [Full Text]  

IMPLICATIONS: A human patient simulator may reduce the risk of learning-curve error in anesthesiologists using new, complex equipment without subjecting patients to risk. It can be used to highlight potential design errors in new equipment through usability testing or certify practitioners before they use new equipment.

Anselm Bräuer, Larissa Pacholik, Thorsten Perl, Michael John Murray English, Wolfgang Weyland, and Ulrich Braun

Conductive Heat Exchange with a Gel-Coated Circulating Water Mattress
Anesth Analg 2004 99: 1742-1746. [Abstract] [Full Text]  

IMPLICATIONS: Conductive warming with a gel-coated circulating water mattress was studied as a new method to prevent perioperative hypothermia. The physical properties of heat exchange were determined, and possibilities and limitations of the method are described.

PAIN MEDICINE:

Jacek B. Cywinski, Brian M. Parker, Meng Xu, and Samuel A. Irefin

A Comparison of Postoperative Pain Control in Patients After Right Lobe Donor Hepatectomy and Major Hepatic Resection for Tumor
Anesth Analg 2004 99: 1747-1752. [Abstract] [Full Text]  

IMPLICATIONS: Patients who underwent right lobe donor hepatectomy (RLDH) experienced more postoperative pain as compared with patients after major hepatic resection for tumor. This may be partially explained by the longer surgical duration observed in the RLDH group. Better perioperative teaching for patient-controlled epidural analgesia use may improve early postoperative pain control in RLDH patients.

Steven P. Cohen, Audrey S. Chang, Thomas Larkin, and Jianren Mao

The Intravenous Ketamine Test: A Predictive Response Tool for Oral Dextromethorphan Treatment in Neuropathic Pain
Anesth Analg 2004 99: 1753-1759. [Abstract] [Full Text]  

IMPLICATIONS: In this study, an IV infusion of ketamine, a parenteral N-methyl-D-aspartate receptor antagonist, was found to predict the analgesic response to an oral treatment regimen of dextromethorphan, an oral N-methyl-D-aspartate antagonist, in 84% of patients with neuropathic pain. A fine-tuned IV ketamine test may enhance patient care by saving time and conserving valuable resources.

David P. Martin, Bradley D. Bergman, and Ines H. Berger

Epidural Blood Patch and Acute Varicella (Case Report)
Anesth Analg 2004 99: 1760-1762. [Abstract] [Full Text]  

IMPLICATIONS: Epidural blood patch may be a safe therapeutic option for patients with postdural puncture headache in the context of acute varicella (chickenpox). In these circumstances, patients should first receive adequate antiviral coverage.

Marc A. Huntoon, Mark-Friedrich B. Hurdle, Richard W. Marsh, and Ronald K. Reeves

Intrinsic Spinal Cord Catheter Placement: Implications of New Intractable Pain in a Patient with a Spinal Cord Injury (Case Report)
Anesth Analg 2004 99: 1763-1765. [Abstract] [Full Text]  

IMPLICATIONS: A case is presented of new intractable flank pain after intrathecal infusion system placement in a man with a T12 spinal cord injury. Pain after intrathecal infusion system placement was evaluated by magnetic resonance imaging and the catheter was found to be intraparenchymal. Increased vigilance is warranted when caring for paraplegic patients.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

David O. Warner, Michael G. Sarr, Kenneth P. Offord, and Lowell C. Dale

Anesthesiologists, General Surgeons, and Tobacco Interventions in the Perioperative Period
Anesth Analg 2004 99: 1766-1773. [Abstract] [Full Text]  

IMPLICATIONS: Although most surgeons and anesthesiologists believe that it is important for their patients to stop smoking at the time of surgery, most do not have the knowledge or experience to help them achieve this goal.

D. Cattano, E. Panicucci, A. Paolicchi, F. Forfori, F. Giunta, and C. Hagberg

Risk Factors Assessment of the Difficult Airway: An Italian Survey of 1956 Patients
Anesth Analg 2004 99: 1774-1779. [Abstract] [Full Text]  

IMPLICATIONS: We collected data to correlate anatomical indexes and the difficult airway. The Mallampati score correlates with the laryngoscopic view (Cormack-Lehane score), but it is not useful in the prediction of difficult intubation as a single risk factor.

CRITICAL CARE AND TRAUMA:

Yoshihisa Fujita, Tokunori Yamamoto, Itsuro Sano, Naoki Yoshioka, and Hajime Hinenoya

A Comparison of Changes in Cardiac Preload Variables During Graded Hypovolemia and Hypervolemia in Mechanically Ventilated Dogs
Anesth Analg 2004 99: 1780-1786. [Abstract] [Full Text]  

IMPLICATIONS: We simultaneously monitored dynamic preload variables—such as systolic blood pressure variation, its down component, pulse pressure variation, stroke volume variation, and esophageal Doppler-derived corrected flow time—during induced hypovolemia and hypervolemia. The results demonstrated that these variables, with the exception of corrected flow time, are useful indicators of hypovolemia, but not of hypervolemia.

Michael Holzer, Wilhelm Behringer, Fritz Sterz, Julia Kofler, Elisabeth Oschatz, Ernst Schuster, and Anton N. Laggner

Ventricular Fibrillation Median Frequency May Not Be Useful for Monitoring During Cardiac Arrest Treated with Endothelin-1 or Epinephrine
Anesth Analg 2004 99: 1787-1793. [Abstract] [Full Text]  

IMPLICATIONS: Median fibrillation frequency (MF) has been suggested as an online monitoring tool during resuscitation. In a pig model, during prolonged resuscitation, we compared the individual curves of MF, mean fibrillation amplitude, and coronary perfusion pressure and found that MF was not useful for monitoring resuscitation efforts.

Nobuyuki Katori, Fania Szlam, Jerrold H. Levy, and Kenichi A. Tanaka

A Novel Method to Assess Platelet Inhibition by Eptifibatide with Thrombelastograph®
Anesth Analg 2004 99: 1794-1799. [Abstract] [Full Text]  

IMPLICATIONS: We examined a novel batroxobin-based activator for detecting platelet inhibition induced by eptifibatide on thrombelastography (TEG(R)). We concluded that batroxobin-modified TEG(R) was more sensitive than kaolin TEG(R) for detecting eptifibatide-induced platelet inhibition at clinical concentrations.

Patrick Ziemann-Gimmel and David E. Schwartz

Increased Carboxyhemoglobin in a Patient with a Large Retroperitoneal Hematoma (Case Report)
Anesth Analg 2004 99: 1800-1802. [Abstract] [Full Text]  

IMPLICATIONS: We report the development of significant carboxyhemoglobinemia in a critically ill, mechanically ventilated patient who required massive transfusion because of retroperitoneal hemorrhage secondary to pheochromocytoma.

Jordi Serrat, Julio J. Roza, and Teresa Planella

Hepatic Hydrothorax in the Absence of Ascites: Respiratory Failure in a Cirrhotic Patient (Case Report)
Anesth Analg 2004 99: 1803-1804. [Abstract] [Full Text]  

IMPLICATIONS: Hydrothorax is a pleural space fluid accumulation. Most pleural effusions are rarely observed. Although unusual, these effusions associated with hepatic cirrhosis and ascites have been well described. However, the case we present here showed no clinical signs of ascites before surgery. Therefore, the patient developed a right-sided hydrothorax as a result of residual motor blockade during anesthesia recovery.

NEUROSURGICAL ANESTHESIA:

Hiroshi Saeki, Mishiya Matsumoto, Shuichi Kaneko, Shunsuke Tsuruta, Ying Jun Cui, Kazunobu Ohtake, Kazuyoshi Ishida, and Takefumi Sakabe

Is Intrathecal Magnesium Sulfate Safe and Protective Against Ischemic Spinal Cord Injury in Rabbits?
Anesth Analg 2004 99: 1805-1812. [Abstract] [Full Text]  

IMPLICATIONS: Intrathecal administration of magnesium sulfate has a risk of neurotoxicity and shows no evidence of protective effects against ischemic spinal cord injury. Although the intrathecal use of magnesium sulfate has been reported in humans, further evaluations of its safety are warranted.

Harish S. Lecamwasam, Hemanth A. Baboolal, and Peter F. Dunn

Acute Adrenal Insufficiency After Large-Dose Glucocorticoids for Spinal Cord Injury (Case Report)
Anesth Analg 2004 99: 1813-1814. [Abstract] [Full Text]  

IMPLICATIONS: We describe a patient who developed adrenal insufficiency (AI) after glucocorticoid therapy for spinal cord injury. Their temporal association and the exclusion of other possible etiologies led us to postulate that AI was a complication of the glucocorticoids. Clinicians should, therefore, consider AI in patients with SCI receiving glucocorticoids.

Senthilkumar Sadhasivam and A. Murat Kaynar

Iatrogenic Arteriovenous Fistula During Lumbar Microdiscectomy (Case Report)
Anesth Analg 2004 99: 1815-1817. [Abstract] [Full Text]  

IMPLICATIONS: Iatrogenic vascular injuries after lumbar disk surgery are rare but potentially life threatening. Such injuries may perioperatively present in a diverse array of manifestations, and often the diagnosis is delayed or overlooked, which may increase morbidity and mortality. Early diagnosis and surgical repair of these vascular injuries can be life saving.

OBSTETRIC ANESTHESIA:

Dmitri Chamchad, Valerie A. Arkoosh, Jay C. Horrow, Jodie L. Buxbaum, Igor Izrailtyan, Lev Nakhamchik, Dirk Hoyer, and J. Yasha Kresh

Using Heart Rate Variability to Stratify Risk of Obstetric Patients Undergoing Spinal Anesthesia
Anesth Analg 2004 99: 1818-1821. [Abstract] [Full Text]  

IMPLICATIONS: The heart rate variability statistic peak point correlation dimension (PD2) successfully predicted hypotension within 20 min of spinal anesthesia in all 22 pregnant women undergoing cesarean delivery. If further research supports this finding, real-time electrocardiograph analysis of peak PD2 might prevent adverse circulatory events in these women.

Avner Leon, Olga Mayzler, Mony Benifla, Michael Semionov, Yulia Fuxman, Israel Eilig, Vadim Passuga, Maryana K. Doitchinova, Boris Gurevich, Alan A. Artru, and Yoram Shapira

Determining Minimum Alveolar Anesthetic Concentration of Halothane in Rats: The Effect of Incremental Change in Halothane Concentration and Number of Crossovers
Anesth Analg 2004 99: 1822-1828. [Abstract] [Full Text]  

IMPLICATIONS: We determined the minimum alveolar anesthetic concentration (MAC) of halothane in rats by using the bracketing technique. The size of the incremental change in halothane affected the estimation of MAC. Increment size should be considered when MAC estimates are compared between studies or when the accuracy of MAC is assessed.

REGIONAL ANESTHESIA:

Subrata Podder, Neeraj Kumar, L. N. Yaddanapudi, and Pramila Chari

Paramedian Lumbar Epidural Catheter Insertion with Patients in the Sitting Position Is Equally Successful in the Flexed and Unflexed Spine
Anesth Analg 2004 99: 1829-1832. [Abstract] [Full Text]  

IMPLICATIONS: Positioning for lumbar epidural block involves flexing the spine, which can be difficult and painful in patients with lower limb injury. With the paramedian approach, it was possible to perform the block in most sitting patients without flexing the spine. The median approach required spinal flexion in most patients.

Pavel Michalek, Ivan David, Milos Adamec, and Libor Janousek

Cervical Epidural Anesthesia for Combined Neck and Upper Extremity Procedure: A Pilot Study
Anesth Analg 2004 99: 1833-1836. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated the efficacy and acceptability of cervical epidural anesthesia using ropivacaine for total parathyroidectomy with subsequent partial implantation of the gland into the forearm muscles (combined neck and upper extremity procedure). There were no complications or vital sign deterioration in 15 cases. Epidural anesthesia allowed the monitoring of vocal cord function.

Pekka M. Kairaluoma, Martina S. Bachmann, Aulikki K. Korpinen, Per H. Rosenberg, and Pertti J. Pere

Single-Injection Paravertebral Block Before General Anesthesia Enhances Analgesia After Breast Cancer Surgery With and Without Associated Lymph Node Biopsy
Anesth Analg 2004 99: 1837-1843. [Abstract] [Full Text]  

IMPLICATIONS: Preoperative single-injection paravertebral block proved a suitable adjunct to a multimodal analgesic regimen: it improved postoperative analgesia and prevented postoperative nausea and vomiting after breast resection or mastectomy with and without associated axillary dissection.

Engelbert Deusch, Justus Benrath, Lukas Weigl, Konrad Neumann, and Sibylle A. Kozek-Langenecker

The Mechanical Properties of Continuous Spinal Small-Bore Catheters
Anesth Analg 2004 99: 1844-1847. [Abstract] [Full Text]  

IMPLICATIONS: Material characteristics of continuous spinal anesthesia small-bore catheters are very different. Although extrapolation from experimental studies to clinical routine should be made with care, our data suggest that catheters with higher strength characteristics may reduce the risk of catheter breakage in patients.

GENERAL ARTICLES:

Earl M. Strum, Janos Szenohradszki, Wayne A. Kaufman, Gary J. Anthone, Ingrid L. Manz, and Philip D. Lumb

Emergence and Recovery Characteristics of Desflurane Versus Sevoflurane in Morbidly Obese Adult Surgical Patients: A Prospective, Randomized Study
Anesth Analg 2004 99: 1848-1853. [Abstract] [Full Text]  

IMPLICATIONS: Morbidly obese adult patients who underwent major abdominal surgery in a prospective, randomized study awoke significantly faster after desflurane than after sevoflurane anesthesia, and the patients anesthetized with desflurane had higher oxygen saturations on entry to the postanesthesia care unit.

Joel Olsson, Christer H. Svensén, and Robert G. Hahn

The Volume Kinetics of Acetated Ringer’s Solution During Laparoscopic Cholecystectomy
Anesth Analg 2004 99: 1854-1860. [Abstract] [Full Text]  

IMPLICATIONS: A weak diuretic effect that slightly enhanced the hemodilution occurred on infusing acetated Ringer's solution during laparoscopic cholecystectomy. A nomogram facilitates the choice of infusion rate.

Philip M. Jones, Steven H. Segal, and Adrian W. Gelb

Venous Oxygen Embolism Produced by Injection of Hydrogen Peroxide into an Enterocutaneous Fistula (Case Report)
Anesth Analg 2004 99: 1861-1863. [Abstract] [Full Text]  

IMPLICATIONS: Hydrogen peroxide is used intraoperatively and perioperatively for the identification of fistula tracts. A venous oxygen embolism occurred in a 66-yr-old man after the intraoperative injection of 60 mL 3% hydrogen peroxide into an enterocutaneous fistula. The relevant aspects of the diagnosis and treatment of oxygen embolism are discussed.

Peter E. Frasco, Renee E. Caswell, and Donald Novicki

Venous Air Embolism During Transurethral Resection of the Prostate (Case Report)
Anesth Analg 2004 99: 1864-1866. [Abstract] [Full Text]  

IMPLICATIONS: The incorrect assembly of a bladder irrigation system caused air to be pumped from an open drain through the resectoscope into the bladder, which led to a near fatal cardiac arrest caused by venous air embolism. Anesthesiologists and urologists should be aware of this potential complication.

Eduardo N. Chini, Michael J. Brown, Michael A. Farrell, and J. William Charboneau

Hypertensive Crisis in a Patient Undergoing Percutaneous Radiofrequency Ablation of an Adrenal Mass Under General Anesthesia (Case Report)
Anesth Analg 2004 99: 1867-1869. [Abstract] [Full Text]  

IMPLICATIONS: Anesthesiologists are often asked to provide care for patients undergoing radiofrequency ablation of neoplastic lesions. It is important that they be aware of and be prepared to treat complications such as severe hypertension, tachycardia, and arrhythmias, which can occur during these procedures.

COCHRANE CORNER:

COCHRANE CORNER
Anesth Analg 2004 99: 1870. [Full Text]  

LETTERS TO THE EDITOR:

Paul D. Mannheimer, Paul B. Batchelder, Mike Larsen, Hartmut Gehring, Ewald Konecny, Johannes H. van Oostrom, and Richard J. Melker

The Use of Pulse Oximeter Functional Testers in Evaluating SpO₂ Accuracy • Response
Anesth Analg 2004 99: 1871. [Full Text]  

Ulrich Jaschinski, Michael Ried, Michael Lichtwarck-Aschoff, and Helmuth Forst

Bleeding Diathesis Due to Failed Antagonism of Heparin: Successful Treatment with Recombinant Factor VIIa
Anesth Analg 2004 99: 1872. [Full Text]  

Elif Bengi Sener and Ethem Güneren

Can Organophosphates Facilitate Acute Tongue Necrosis?
Anesth Analg 2004 99: 1872-1873. [Full Text]  

Carlo L. Romanò and Emanuela Cecca

Pin-Pricks and Pins’ Tricks: A New Method to Reduce Pin-Prick Pain of Intramuscular and Subcutaneous Injections
Anesth Analg 2004 99: 1873. [Full Text]  

Vincent Minville, Luc N’Guyen, Bernard Coustet, Olivier Fourcade, and Kamran Samii

Difficult Airway in Obstetric Using Ilma-Fastrach®
Anesth Analg 2004 99: 1873. [Full Text]  

Krzysztof M. Kuczkowski and Ulrike B. Eisenmann

Hypertensive Encephalopathy Mimicking Postdural Puncture Headache in a Parturient Beyond the Edge of Reproductive Age
Anesth Analg 2004 99: 1873-1874. [Full Text]  

Gaku Inagawa, Takaaki Miwa, and Koichi Hiroki

The Change of Difficult Intubation with Growth in a Patient with Treacher Collins Syndrome
Anesth Analg 2004 99: 1874. [Full Text]  

Stephan Blumenthal, Marco Nadig, Alain Borgeat, and Carlo D. Franco

The Supraclavicular Block with a Nerve Stimulator: Where Is the Needle Tip, That Is the Question • Response
Anesth Analg 2004 99: 1874-1875. [Full Text]  

Guy Weinberg, Paul Hertz, Janet Newman, Viktoria D. Mayr, Claus Raedler, Volker Wenzel, Karl H. Lindner, and Hans-Ulrich Strohmenger

Lipid, Not Propofol, Treats Bupivacaine Overdose • Response
Anesth Analg 2004 99: 1875-1876. [Full Text]  

Keith E. Frazer, Jose Valle, Henry L. Bennett, Ghassem E. Larijani, and Michael E. Goldberg

Does Modafinil Improve Recovery? • Response
Anesth Analg 2004 99: 1876-1877. [Full Text]  

V. Dimitriou, C. Iatrou, J. Brimacombe, G. S. Voyagis, Ryu Komatsu, Osamu Nagata, Daniel I. Sessler, and Makoto Ozaki

Intubating Laryngeal Mask Airway in Lateral Position • Response
Anesth Analg 2004 99: 1877. [Full Text]  

E. Guasch, M. J. Millan, F. Gilsanz, and A. González

Omentum Through the Vulva as First Sign of a Uterine Rupture
Anesth Analg 2004 99: 1877-1878. [Full Text]  

Vincent Minville, Clément Chassery, Delphine Kern, Olivier Fourcade, and Christophe Dadure

Hyperbaric Oxygen Therapy and Pain Management in a Child with Continuous Infraclavicular Brachial Plexus Block
Anesth Analg 2004 99: 1878. [Full Text]  

Fouad Atallah, M. Khedis, P. Seguin, O. Fourcade, and K. Samii

Postoperative Analgesia and Recovery After Open and Laparoscopic Prostatectomy
Anesth Analg 2004 99: 1878-1879. [Full Text]  

Spyros D. Mentzelopoulos, Apostolos Armaganidis, Dimitra Niokou, Paraskevi Matsota, Maria Tzoufi, Nikos Kelekis, Kostantinos Soultanis, Nikos Oikonomopoulos, and Georgia Kostopanagiotou

MRI of the Upper Airway and McCoy-Balloon Laryngoscopy with Left Molar Approach in a Patient with Arthrogryposis Multiplex Congenita and Previous Unsuccessful Endotracheal Intubation
Anesth Analg 2004 99: 1879-1880. [Full Text]  

Malcolm Fisher and Gilles Dhonneur

Prick Testing for Neuromuscular Blocking Drugs • Response
Anesth Analg 2004 99: 1880-1881. [Full Text]  

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

Should CO₂ Laser Jet Ventilation Be Abandoned? • Response
Anesth Analg 2004 99: 1882. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

David A. Zvara and Ludwig H. Lin

Lippincott’s Interactive Cardiac Anesthesia Library • Clinical Monitoring and Transesophageal Echocardiography: Part II. Vol. 42, No. 2, International Anesthesiology Clinics.
Anesth Analg 2004 99: 1883. [Full Text]  

GUEST REVIEWERS, AUTHOR AND SUBJECT INDEXES:

GUEST REVIEWERS, AUTHOR AND SUBJECT INDEXES
Anesth Analg 2004 99: 1884-1888. [Full Text]  

Author Index
Anesth Analg 2004 99: 1889-1910. [Full Text]  

Subject Index
Anesth Analg 2004 99: 1911-1934. [Full Text]  

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