EDITORIALS:

Paul F. White

Droperidol: A Cost-Effective Antiemetic for Over Thirty Years
Anesth Analg 2002 95: 789-790. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Paul Kessler, Gerd Neidhart, Dorothee H. Bremerich, Tayfun Aybek, Selami Dogan, Volker Lischke, and Christian Byhahn

High Thoracic Epidural Anesthesia for Coronary Artery Bypass Grafting Using Two Different Surgical Approaches in Conscious Patients
Anesth Analg 2002 95: 791-797. [Abstract] [Full Text]  

IMPLICATIONS. The sole use of high thoracic epidural anesthesia was studied in 20 patients who underwent beating-heart coronary artery bypass grafting using either median or partial lower sternotomy while awake.

H. Alex Leather, Patrick Segers, Yuan-Yuan Sun, Hendrik A. De Ruyter, Eugène Vandermeersch, and Patrick F. Wouters

The Limitations of Preload-Adjusted Maximal Power as an Index of Right Ventricular Contractility
Anesth Analg 2002 95: 798-804. [Abstract] [Full Text]  

IMPLICATIONS: Preload-adjusted maximal power (PAMP), a load-independent contractile index in the left ventricle, could offer a solution to the problem of measuring right ventricular (RV) contractility in clinical practice. However, this study in open-chest dogs suggests that PAMP is unreliable for assessment of RV contractility because of its sensitivity to afterload changes.

Paul S. Myles, Jennifer O. Hunt, Helen Fletcher, Jennifer Watts, David Bain, Andrew Silvers, and Mark R. Buckland

Remifentanil, Fentanyl, and Cardiac Surgery: A Double-Blinded, Randomized, Controlled Trial of Costs and Outcomes
Anesth Analg 2002 95: 805-812. [Abstract] [Full Text]  

IMPLICATIONS: Remifentanil did not significantly reduce the duration of tracheal intubation after cardiac surgery. Remifentanil, when compared with fentanyl (total doses of approximately 15 and 28 {micro}g/kg), blunts the hypertensive responses associated with cardiac surgery but is associated with more hypotension; when compared with fentanyl 15 {micro}g/kg, remifentanil reduces cortisol excretion. Larger-dose opioids (remifentanil 0.85 {micro}g {middle dot} kg-1 {middle dot} min-1 or fentanyl 28 {micro}g/kg) were associated with a decreased rate of myocardial infarction after cardiac surgery.

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

Propacetamol as Adjunctive Treatment for Postoperative Pain After Cardiac Surgery
Anesth Analg 2002 95: 813-819. [Abstract] [Full Text]  

IMPLICATIONS: This is the first placebo-controlled study to investigate the efficacy of propacetamol as a complementary analgesic to opioids after cardiac surgery. Propacetamol did not enhance analgesia, nor did it decrease cumulative opioid consumption or reduce adverse effects in a dose of 2 g given every sixth hour for 3 days after surgery.

Sue C. Ho, Colin F. Royse, Alistair G. Royse, Arthur Penberthy, and Roderick McRae

Persistent Pain After Cardiac Surgery: An Audit of High Thoracic Epidural and Primary Opioid Analgesia Therapies
Anesth Analg 2002 95: 820-823. [Abstract] [Full Text]  

IMPLICATIONS: Persistent wound pain after coronary artery bypass surgery is common, but it is usually is mild and infrequently interferes with daily living. An audit of two pain relief strategies (epidural analgesia or opiate analgesia) did not show any difference in the incidence of persistent pain.

Michael Fanshawe, Charles Ellis, Sally Habib, Steven N. Konstadt, and David L. Reich

A Retrospective Analysis of the Costs and Benefits Related to Alterations in Cardiac Surgery from Routine Intraoperative Transesophageal Echocardiography
Anesth Analg 2002 95: 824-827. [Abstract] [Full Text]  

IMPLICATIONS: A review of 430 adult cardiac surgical records indicates that routine transesophageal echocardiography during cardiac surgery, including coronary artery surgery, is beneficial and cost-effective.

Nicholas J. Wilkes, Susan V. Mallett, Tim Peachey, Carmelo Di Salvo, and Robin Walesby

Correction of Ionized Plasma Magnesium During Cardiopulmonary Bypass Reduces the Risk of Postoperative Cardiac Arrhythmia
Anesth Analg 2002 95: 828-834. [Abstract] [Full Text]  

IMPLICATIONS: In this study the correction of ionized plasma magnesium during cardiopulmonary bypass was guided by measurements from an ion-selective electrode. This intervention resulted in a reduction in the incidence of postoperative ventricular tachycardia and an increased frequency of continuous sinus rhythm. Ion-selective electrodes constitute a convenient near-patient test, providing a basis for the targeted replacement of ionized plasma magnesium.

Giorgio Della Rocca, Gabriella M. Costa, Cecilia Coccia, Livia Pompei, Pierangelo Di Marco, and Paolo Pietropaoli

Preload Index: Pulmonary Artery Occlusion Pressure Versus Intrathoracic Blood Volume Monitoring During Lung Transplantation
Anesth Analg 2002 95: 835-843. [Abstract] [Full Text]  

IMPLICATIONS: The assessment of intrathoracic blood volume index (ITBVI) by the transpulmonary single-indicator technique is a useful tool in lung transplant patients, providing a valid index of cardiac preload that may be superior to pulmonary artery occlusion pressure. However, more prospective, randomized studies are necessary to evaluate the role and limitations of this technique.

Andrew T. McCammon, Jonathan P. Wright, Mario Figueroa, and Vance G. Nielsen

Hemodilution with Albumin, but Not Hextend^®, Results in Hypercoagulability as Assessed by Thrombelastography® in Rabbits: Role of Heparin-Dependent Serpins and Factor VIII Complex
Anesth Analg 2002 95: 844-850. [Abstract] [Full Text]  

IMPLICATIONS: Isovolemic hemodilution (IVHD) is associated with hypercoagulability. Rabbits hemodiluted with albumin, but not Hextend(R), became hypercoagulable secondary to a loss of antithrombin activity with simultaneous maintenance of Factor VIII complex activity (VIII:C). Hextend(R)-treated animals had proportionate decreases in both antithrombin activity and VIII:C. IVHD-mediated hypercoagulability encountered clinically may be attenuated or exacerbated by the choice of colloid administered.

George J. Crystal and M. Ramez Salem

ß-Adrenergic Stimulation Restores Oxygen Extraction Reserve During Acute Normovolemic Hemodilution
Anesth Analg 2002 95: 851-857. [Abstract] [Full Text]  

IMPLICATIONS: By restoring the oxygen extraction reserve, isoproterenol and other inotropic drugs can enhance the margin of safety and extend the limit to which hematocrit can be reduced safely during acute normovolemic hemodilution. The use of this approach will depend on the degree of hemodilution, the extent of mixed venous oxygen desaturation, and whether increases in cardiac output are possible or desirable.

Petra Innerhofer, Dietmar Fries, Josef Margreiter, Anton Klingler, Gabriele Kühbacher, Bernhard Wachter, Elgar Oswald, Erwin Salner, Bernhard Frischhut, and Wolfgang Schobersberger

The Effects of Perioperatively Administered Colloids and Crystalloids on Primary Platelet-Mediated Hemostasis and Clot Formation
Anesth Analg 2002 95: 858-865. [Abstract] [Full Text]  

IMPLICATIONS: Our data suggest that during deliberate colloid administration, critically impaired fibrinogen polymerization and reduced fibrinogen concentrations might be reached earlier than expected. Therefore, maintaining fibrinogen concentrations seems essential when continuing blood loss is bridged by colloid infusion until transfusion triggers are reached, especially in patients already exhibiting borderline fibrinogen levels at baseline.

Thomas Gamsjäger, Burkhard Gustorff, and Sibylle A. Kozek-Langenecker

The Effects of Hydroxyethyl Starches on Intracellular Calcium in Platelets
Anesth Analg 2002 95: 866-869. [Abstract] [Full Text]  

IMPLICATIONS: Hydroxyethyl starch does not exert its known inhibitory effect on platelet function by interfering with intracellular activation processes.

Fedor Lurie, Jonathan S. Jahr, and Bernd Driessen

The Novel HemoCue^® Plasma/Low Hemoglobin System Accurately Measures Small Concentrations of Three Different Hemoglobin-Based Oxygen Carriers in Plasma: Hemoglobin Glutamer-200 (Bovine) (Oxyglobin^®), Hemoglobin Glutamer-250 (Bovine) (Hemopure^®), and Hemoglobin-Raffimer (Hemolink^TM)
Anesth Analg 2002 95: 870-873. [Abstract] [Full Text]  

IMPLICATIONS: This study evaluated a new bedside blood-measuring device for low levels and found that it rapidly measured low levels accurately for three blood substitutes.

Joseph W. Szokol, Mark Franklin, Glenn S. Murphy, Theodore M. Wynnychenko, and Stephen F. Sener

Left Ventricular Mass in a Patient with Carney’s Complex (Case Report)
Anesth Analg 2002 95: 874-875. [Abstract] [Full Text]  

IMPLICATIONS: Carney's complex is characterized by cardiac myxomas, adrenocortical disease, growth hormone-secreting adenomas, and other types of tumors. Its prevalence and incidence are unknown. The anesthesiologist must examine the patient or order tests to exclude cardiac tumors, signs of excess cortisol secretion, acromegaly, and possible peripheral nerve root involvement.

Marelise Kruger, Richard Bergstrom, and Barry A. Finegan

A Complication with the Use of a Centrifugal Pump During Thoraco-Abdominal Aortic Surgery (Case Report)
Anesth Analg 2002 95: 876-878. [Abstract] [Full Text]  

IMPLICATIONS: Centrifugal pumps used to enable atrio-femoral bypass may trigger a change in intra-cardiac shunt flow and increase the risk of morbidity and mortality.

Rosaleen Chun, Beverley A. Orser, and Mina Madan

Platelet Glycoprotein IIb/IIIa Inhibitors: Overview and Implications for the Anesthesiologist (Review Article)
Anesth Analg 2002 95: 879-888. [Full Text]  

PEDIATRIC ANESTHESIA:

Paula M. Bokesch, Elumalai Appachi, Marco Cavaglia, Emad Mossad, and Roger B.B. Mee

A Glial-Derived Protein, S100B, in Neonates and Infants with Congenital Heart Disease: Evidence for Preexisting Neurologic Injury
Anesth Analg 2002 95: 889-892. [Abstract] [Full Text]  

IMPLICATIONS: Neonates with hypoplastic left heart syndrome and no forward flow in the ascending aorta may have brain injury at birth before heart surgery.

ANESTHETIC PHARMACOLOGY:

Saira K. Shahani, Ratnakumari Lingamaneni, and Hugh C. Hemmings, Jr

General Anesthetic Actions on Norepinephrine, Dopamine, and -Aminobutyric Acid Transporters in Stably Transfected Cells
Anesth Analg 2002 95: 893-899. [Abstract] [Full Text]  

IMPLICATIONS: Previous studies have implicated neurotransmitter transporters as targets for general anesthetic effects on synaptic transmission. Recombinant transporters for norepinephrine and dopamine were sensitive to certain volatile and IV anesthetics, whereas {gamma}-aminobutyric acid transporters were insensitive. These anesthetic- and neurotransmitter-specific effects may underlie some of the secondary effects of general anesthetics.

Munehiro Shiraishi, Izumi Shibuya, Kouichiro Minami, Yasuhito Uezono, Takashi Okamoto, Nobuyuki Yanagihara, Susumu Ueno, Yoichi Ueta, and Akio Shigematsu

A Neurosteroid Anesthetic, Alphaxalone, Inhibits Nicotinic Acetylcholine Receptors in Cultured Bovine Adrenal Chromaffin Cells
Anesth Analg 2002 95: 900-906. [Abstract] [Full Text]  

IMPLICATIONS: Alphaxalone inhibits the function of nAChRs at clinically relevant concentrations in adrenal chromaffin cells. Thus, the present findings may provide some information for understanding the anesthetic mechanism of alphaxalone.

Xian-Ping Dong and Tian-Le Xu

The Actions of Propofol on -Aminobutyric Acid-A and Glycine Receptors in Acutely Dissociated Spinal Dorsal Horn Neurons of the Rat
Anesth Analg 2002 95: 907-914. [Abstract] [Full Text]  

IMPLICATIONS: The actions of propofol on the {gamma}-aminobutyric acid-A receptor (GABAAR) and the glycine receptor (GlyR) were investigated in acutely dissociated rat spinal dorsal horn neurons by using whole-cell patch-clamp electrophysiology. Propofol was found to potentiate the functions of GABAAR and GlyR at the spinal level, which might contribute to propofol-induced analgesia and anesthesia.

Laure Pain, Serge Gobaille, Carmen Schleef, Dominique Aunis, and Philippe Oberling

In Vivo Dopamine Measurements in the Nucleus Accumbens After Nonanesthetic and Anesthetic Doses of Propofol in Rats
Anesth Analg 2002 95: 915-919. [Abstract] [Full Text]  

IMPLICATIONS: Depending on the dose, propofol either increased or decreased the concentration of dopamine in the nucleus accumbens, as assessed during microdialysis in freely moving rats. Only large doses which display a pharmacological profile, such as propofol, may show promise.

Christian Grasshoff and Thomas Gillessen

The Effect of Propofol on Increased Superoxide Concentration in Cultured Rat Cerebrocortical Neurons After Stimulation of N-Methyl-D-Aspartate Receptors (Brief Report)
Anesth Analg 2002 95: 920-922. [Abstract] [Full Text]  

IMPLICATIONS: The neuroprotective properties of propofol may be because of its action as an antioxidant. To investigate whether propofol reduces the N-methyl-D-aspartate-induced increase in superoxide anion levels, the fluorescence of dihydroethidium acetoxymethylester, as an indicator for cellular superoxide concentration, was measured in cultured rat forebrain neurons.

Hermann J. Theilen, Sigrid Adam, Michael D. Albrecht, and Maximilian Ragaller

Propofol in a Medium- and Long-Chain Triglyceride Emulsion: Pharmacological Characteristics and Potential Beneficial Effects (Brief Report)
Anesth Analg 2002 95: 923-929. [Abstract] [Full Text]  

IMPLICATIONS: Propofol diluted in an emulsion of medium- and long chain-triglycerides shows equivalent pharmacological properties during long-term sedation compared with its hitherto well known formulation containing long-chain triglycerides only. In addition, potential favorable effects on the plasma triglyceride profile could be found.

Claus U. Niemann, Caroline Stabernack, Natalie Serkova, Wolfgang Jacobsen, Uwe Christians, and Edmond I Eger, II

Cyclosporine Can Increase Isoflurane MAC (Brief Report)
Anesth Analg 2002 95: 930-934. [Abstract] [Full Text]  

IMPLICATIONS: The immunosuppressive drug, cyclosporine, which is frequently used after organ transplantation, increases the amount of a commonly used anesthetic (isoflurane) necessary to avoid movement to painful stimuli in the rat.

Marie-Agnes Docquier, Patricia Lavand’homme, Valerie Collet, and Marc De Kock

Spinal ₂-Adrenoceptors Are Involved in the MACbar-Sparing Effect of Systemic Clonidine In Rats (Brief Report)
Anesth Analg 2002 95: 935-939. [Abstract] [Full Text]  

IMPLICATIONS: Using intrathecal {alpha}-adrenergic antagonist administration, we demonstrated that a spinal mechanism is involved in the MACbar-sparing effect of systemic clonidine in rats.

Thomas M. Hemmerling, Joachim Schmidt, Christian Schurr, Georg Breuer, and Klaus E. Jacobi

A Comparison Between Anterior and Posterior Monitoring of Neuromuscular Blockade at the Diaphragm: Both Sites Can Be Used Interchangeably (Brief Report)
Anesth Analg 2002 95: 940-943. [Abstract] [Full Text]  

IMPLICATIONS: We present a novel site of monitoring neuromuscular blockade of the diaphragm at the patient's back, which shows good agreement with the conventional anterior site at the seventh or eighth intercostal space.

Yoshitaka Fujii, Aki Uemura, and Hidenori Toyooka

Flumazenil Recovers Diaphragm Muscle Dysfunction Caused by Midazolam in Dogs (Brief Report)
Anesth Analg 2002 95: 944-947. [Abstract] [Full Text]  

IMPLICATIONS: In dogs, flumazenil recovers diaphragm muscle dysfunction (reduced contractility and inhibited electrical activity) caused by midazolam in a dose-related manner.

Shung-Tai Ho, Jhi-Joung Wang, Jeng-Chai Huang, Mao-Tsun Lin, and Wen-Jinn Liaw

The Magnitude of Acute Tolerance to Morphine Analgesia: Concentration-Dependent or Time-Dependent? (Brief Report)
Anesth Analg 2002 95: 948-951. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated the relationship of either the infusion time or the plasma morphine concentrations on the magnitude of acute tolerance to morphine analgesia in rabbits. We found that the magnitude of morphine tolerance is significantly correlated to the duration of infusion but not to the different steady-state plasma morphine concentrations.

Tadanobu Yasuda, Satoshi Takahashi, and Akitomo Matsuki

Tumor Necrosis Factor- Reduces Ketamine- and Propofol-Induced Anesthesia Time in Rats (Brief Report)
Anesth Analg 2002 95: 952-955. [Abstract] [Full Text]  

IMPLICATIONS: Tumor necrosis factor alpha (TNF{alpha}) regulates many physiological events in the brain. We investigated the effects of TNF{alpha} on anesthesia time in rats. Both central and peripheral administration of TNF{alpha} decreased anesthesia time induced by ketamine and propofol.

Giampiero Patriarca, Eleonora Nucera, Emanuela Pollastrini, Chiara Roncallo, Alessandro Buonomo, Francesco Bartolozzi, Tiziana De Pasquale, Giovanni Gasbarrini, and Domenico Schiavino

Sublingual Desensitization: A New Approach to Latex Allergy Problem (Brief Report)
Anesth Analg 2002 95: 956-960. [Abstract] [Full Text]  

IMPLICATIONS: We present 12 cases of latex allergy in patients who underwent desensitization by a sublingual exposure protocol. This study provides evidence that a safe therapeutic approach to latex allergy is possible.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Alexander Kober, Thomas Scheck, Frank Lieba, Renate Barker, Wolfgang Vlach, Wolfgang Schramm, and Klaus Hoerauf

The Influence of Active Warming on Signal Quality of Pulse Oximetry in Prehospital Trauma Care
Anesth Analg 2002 95: 961-966. [Abstract] [Full Text]  

IMPLICATIONS: Clinical trials show that pulse oximeter signal quality is limited by hypothermia. In this study we show that active whole-body warming of trauma victims improves monitoring quality during transport to the hospital.

Steven J. Barker

"Motion-Resistant" Pulse Oximetry: A Comparison of New and Old Models
Anesth Analg 2002 95: 967-972. [Abstract] [Full Text]  

IMPLICATIONS. New improvements in pulse oximeter technology have resulted in significantly better accuracy and reliability during patient motion. The Masimo pulse oximeter demonstrated the best performance of the 20 instruments tested.

PAIN MEDICINE:

Mark S. Wallace, Danielle Barger, and Gery Schulteis

The Effect of Chronic Oral Desipramine on Capsaicin-Induced Allodynia and Hyperalgesia: A Double-Blinded, Placebo-Controlled, Crossover Study
Anesth Analg 2002 95: 973-978. [Abstract] [Full Text]  

IMPLICATIONS: Human experimental pain models have recently been developed; however, the efficacy of the tricyclic antidepressants (TCA) in these models has not been systematically studied. This investigation provides further validation of human experimental pain models and demonstrates that the chronic delivery of a TCA has no effect on human experimental pain.

Xiangqi Li and J. David Clark

Hyperalgesia During Opioid Abstinence: Mediation by Glutamate and Substance P
Anesth Analg 2002 95: 979-984. [Abstract] [Full Text]  

IMPLICATIONS: Opioids are a mainstay of treatment for many types of chronic pain. These studies provide evidence that the hyperalgesia induced by chronic opioid administration may be in part to spinal neuroplastic changes.

Argyro Fassoulaki, Konstantinos Patris, Costantine Sarantopoulos, and Quinn Hogan

The Analgesic Effect of Gabapentin and Mexiletine After Breast Surgery for Cancer
Anesth Analg 2002 95: 985-991. [Abstract] [Full Text]  

IMPLICATIONS: Patients undergoing breast surgery for cancer may develop chronic pain. We evaluated the effect of mexiletine and gabapentin on the acute and chronic pain after breast surgery for cancer. Both drugs reduced the postoperative analgesic requirements, and particularly, gabapentin reduced pain after movement. The overall incidence of chronic pain was unaffected except for burning pain.

Christine Leduc, Marc E. Gentili, Jean-Pierre Estèbe, Pascal Le Corre, Jacques-Philippe Moulinoux, and Claude Ecoffey

The Effect of Local Anesthetics and Amitriptyline on Peroxidation In Vivo in an Inflammatory Rat Model: Preliminary Reports
Anesth Analg 2002 95: 992-996. [Abstract] [Full Text]  

IMPLICATIONS. We investigated the antioxidant effects of local anesthetics and amitriptyline in an inflammatory rat model. Amitriptyline exhibits antioxidant properties per se, whereas lidocaine and bupivacaine (plain or encapsulated) seem to inhibit the peroxidation process. This may have future application in limiting toxic oxygen metabolite production during the inflammatory process.

Vesa K. Kontinen and Theo F. Meert

Vocalization Responses After Intrathecal Administration of Ionotropic Glutamate Receptor Agonists in Rats
Anesth Analg 2002 95: 997-1001. [Abstract] [Full Text]  

IMPLICATIONS: Vocalization responses evoked by spinal administration of ionotropic glutamate receptor agonists can be used for experimental analgesic studies. However, pathological pain models did not substantially alter vocalization responses, possibly indicating that this test is not suitable for studying the role of spinal excitatory amino acids in central sensitization.

Halina Machelska and Christoph Stein

Immune Mechanisms in Pain Control (Review Article)
Anesth Analg 2002 95: 1002-1008. [Full Text]  

John P.R. Loughrey and Srdjan S. Nedeljkovic

Dissociative Mental State in a Patient with an Intrathecal Drug Administration System (Case Report)
Anesth Analg 2002 95: 1009-1011. [Abstract] [Full Text]  

IMPLICATIONS: We describe a patient with acute mental status changes, which resolved on removal of medication from the reservoir of a Synchromed(R) intrathecal pump. This report highlights the potential adverse mental affects of chronic spinal infusions for pain therapy and discusses pitfalls in toxicology analysis using immunoassay.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Tom Pedersen, Ann M. Møller, and Jane Cracknell

The Mission of the Cochrane Anesthesia Review Group: Preparing and Disseminating Systematic Reviews of the Effect of Health Care in Anesthesiology (Special Article)
Anesth Analg 2002 95: 1012-1018. [Abstract] [Full Text]  

IMPLICATIONS: This article illustrates the basic principles of evidence-based medicine and the work within the Cochrane Collaboration and the Cochrane Anesthesia Review Group. It describes how important randomized controlled trials and systematic reviews are in providing the best evidence to answer clinically relevant questions.

R. David Warters, Jeffrey Katz, Peter Szmuk, Susan L. Luehr, Evan G. Pivalizza, Stephen M. Koch, Marilu Price, and Tiberiu Ezri

Development Criteria for Academic Leadership in Anesthesiology: Have They Changed? (Special Article)
Anesth Analg 2002 95: 1019-1023. [Full Text]  

John V. Booth, Davida Grossman, Jill Moore, Catherine Lineberger, James D. Reynolds, J. G. Reves, and David Sheffield

Substance Abuse Among Physicians: A Survey of Academic Anesthesiology Programs (Special Article)
Anesth Analg 2002 95: 1024-1030. [Abstract] [Full Text]  

IMPLICATIONS: This survey indicates that the frequency of controlled substance abuse among anesthesiologists has changed little in the past few years, despite an increase in the control and accounting procedures for controlled substances as well as increased mandatory education.

CRITICAL CARE AND TRAUMA:

Heiner Krieter, Christof Denz, Christoph Janke, Thomas Bertsch, Thomas Luiz, Klaus Ellinger, and Klaus van Ackern

Hypertonic-Hyperoncotic Solutions Reduce the Release of Cardiac Troponin I and S-100 After Successful Cardiopulmonary Resuscitation in Pigs
Anesth Analg 2002 95: 1031-1036. [Abstract] [Full Text]  

IMPLICATIONS: Infusion of hypertonic-hyperoncotic solutions (HHS) after successful cardiopulmonary resuscitation in pigs significantly reduced the release of cardiac troponin I and cerebral protein S-100, which are sensitive and specific markers of cell damage. Treatment with HHS may provide a new option to improve the outcome of cardiopulmonary resuscitation.

Yossi Manisterski, Zvi Vaknin, Ron Ben-Abraham, Ori Efrati, Danny Lotan, Mati Berkovitch, Asher Barak, Zohar Barzilay, and Gideon Paret

Endotracheal Epinephrine: A Call for Larger Doses
Anesth Analg 2002 95: 1037-1041. [Abstract] [Full Text]  

IMPLICATIONS: We conducted a prospective, randomized, laboratory comparison of increasing doses of endotracheal epinephrine to ascertain the yet undetermined optimal dose of endotracheal epinephrine that would increase arterial blood pressure (BP). A decrease in BP was obviated only at a dose equivalent to 10-fold the currently recommended one. Clinical studies using larger doses of endotracheal epinephrine and their use as first-line therapy in cardiac arrest are warranted.

NEUROSURGICAL ANESTHESIA:

Kai-Michael Scheufler, Hans-Joachim Röhrborn, and Josef Zentner

Does Tissue Oxygen-Tension Reliably Reflect Cerebral Oxygen Delivery and Consumption?
Anesth Analg 2002 95: 1042-1048. [Abstract] [Full Text]  

IMPLICATIONS. The relationship between brain oxygen partial pressure and several variables of energy metabolism was investigated during variable degrees of cerebral ischemia and hypoxia in a rabbit model. Correct interpretation of individual brain oxygen partial pressure values, especially with respect to definition of energetic thresholds, requires complementary information from assessment of cerebral blood flow and tissue oxygen extraction.

Christian Kolbitsch, Ingo H. Lorenz, Christoph Hörmann, Michael F. Schocke, Christian Kremser, Patrizia L. Moser, Karl P. Pfeiffer, and Arnulf Benzer

The Impact of Hypercapnia on Systolic Cerebrospinal Fluid Peak Velocity in the Aqueduct of Sylvius
Anesth Analg 2002 95: 1049-1051. [Abstract] [Full Text]  

IMPLICATIONS: Magnetic resonance imaging measurements of systolic cerebrospinal fluid peak velocity (CSFVPeak) in the aqueduct of Sylvius are sensitive enough to detect even minor changes in cerebral compliance. We investigated the effect of hypercapnia-induced changes in cerebral blood volume on systolic CSFVPeak in anesthetized patients. Hypercapnia (end-tidal carbon dioxide concentration = 60 mm Hg) increased systolic CSFVPeak.

Richard C. Prielipp, Michael H. Wall, Joseph R. Tobin, Leanne Groban, Mark A. Cannon, Frederic H. Fahey, H. Donald Gage, David A. Stump, Robert L. James, Judy Bennett, and John Butterworth

Dexmedetomidine-Induced Sedation in Volunteers Decreases Regional and Global Cerebral Blood Flow
Anesth Analg 2002 95: 1052-1059. [Abstract] [Full Text] Data Supplement  

IMPLICATIONS: Dexmedetomidine-induced sedation decreased cerebral blood flow (CBF) by {cong}33%, which could be due to direct {alpha}2-receptor cerebral smooth muscle vasoconstriction or to compensatory CBF changes caused by dexmedetomidine-induced decreases in the cerebral metabolic rate.

Hsueh-Lin Chen, Chih-Shung Wong, Shung-Tai Ho, Fang-Lin Chang, Che-Hao Hsu, and Ching-Tang Wu

A Lethal Pulmonary Embolism During Percutaneous Vertebroplasty (Case Report)
Anesth Analg 2002 95: 1060-1062. [Abstract] [Full Text]  

IMPLICATIONS: This case report describes a fatal cardiac arrest during percutaneous vertebroplasty. This serves to remind us that life threatening intraoperative pulmonary embolism may occur in this minimal invasive procedure. Surgical precautions and invasive cardiovascular monitoring may be required in high-risk patients.

OBSTETRIC ANESTHESIA:

Miriam J. P. Harnett, Kodali Bhavani-Shankar, Sanjay Datta, and Lawrence C. Tsen

In Vitro Fertilization-Induced Alterations in Coagulation and Fibrinolysis as Measured by Thromboelastography
Anesth Analg 2002 95: 1063-1066. [Abstract] [Full Text]  

IMPLICATIONS. The dramatic changes in estrogen produced by in vitro fertilization therapies result in hemostatic marker alterations. Thrombelastograph(R) coagulation analysis, which provides a global assessment of these changes, demonstrated significant alterations in two coagulation indices (clot formation time, coagulation index), although all variables remained within normal limits. The relative importance of fibrinogen versus platelets in determining clot strength was observed. No significant alterations in fibrinolysis were detected.

REGIONAL ANESTHESIA:

Tomoki Nishiyama, Kazuo Hanaoka, and Youji Ochiai

The Median Approach to Transsacral Epidural Block
Anesth Analg 2002 95: 1067-1070. [Abstract] [Full Text]  

IMPLICATIONS: The median approach to transsacral epidural block has been described in children. We found that it is technically feasible in adults and presents an alternative to caudal block for procedures on the rectal, anal, or urethral region.

Marty L. Ericksen, Jeffrey D. Swenson, and Nathan L. Pace

The Anatomic Relationship of the Sciatic Nerve to the Lesser Trochanter: Implications for Anterior Sciatic Nerve Block
Anesth Analg 2002 95: 1071-1074. [Abstract] [Full Text]  

IMPLICATIONS: Magnetic resonance images suggest that in the majority of supine subjects, the sciatic nerve is lateral to the lesser trochanter of the femur and therefore not accessible using the classic anterior approach. By contrast, 4 cm below the lesser trochanter, the sciatic nerve is consistently medial to the femoral shaft and therefore may be more accessible using an anterior approach.

Salvatore Sia, Antonella Lepri, Maria Consolata Campolo, and Rossana Fiaschi

Four-Injection Brachial Plexus Block Using Peripheral Nerve Stimulator: A Comparison Between Axillary and Humeral Approaches
Anesth Analg 2002 95: 1075-1079. [Abstract] [Full Text]  

IMPLICATIONS: Two methods of brachial plexus block using a nerve-stimulator were compared in a prospective study. A four-injection technique was performed at the axillary or at the humeral level. Both approaches provided a fast onset and a high success rate. The differences found between the groups could be considered clinically unimportant.

Greta M. Palmer, Brian E. Cairns, Steven L. Berkes, Patricia S. Dunning, George A. Taylor, and Charles B. Berde

The Effects of Lidocaine and Adrenergic Agonists on Rat Sciatic Nerve and Skeletal Muscle Blood Flow In Vivo
Anesth Analg 2002 95: 1080-1086. [Abstract] [Full Text]  

IMPLICATIONS: Accepting that the microsphere technique may be limited in its sensitivity to detect small but clinically relevant changes in tissue blood flow, our findings suggest that mechanisms other than local vasoconstriction may contribute to the prolongation of lidocaine nerve blocks by epinephrine.

Stella Ugboma, Xuan Au-Truong, Leonard I. Kranzler, Saleh H. Rifai, Ninos J. Joseph, and M. Ramez Salem

The Breaking of an Intrathecally-Placed Epidural Catheter During Extraction (Case Report)
Anesth Analg 2002 95: 1087-1089. [Abstract] [Full Text]  

IMPLICATIONS: Misplacement of an epidural catheter into the subarachnoid space is a recognized complication. However, breakage of an intrathecal epidural catheter during removal presents a dilemma. Appropriate imaging, a neurosurgical consultation, and aggressive surgical exploration and extraction of the retained piece are warranted, even in the asymptomatic patient.

GENERAL ARTICLES:

Marian Weisenberg, R. David Warters, Benjamin Medalion, Peter Szmuk, Yehuda Roth, and Tiberiu Ezri

Endotracheal Intubation with a Gum-Elastic Bougie in Unanticipated Difficult Direct Laryngoscopy: Comparison of a Blind Technique Versus Indirect Laryngoscopy with a Laryngeal Mirror
Anesth Analg 2002 95: 1090-1093. [Abstract] [Full Text]  

IMPLICATIONS: We evaluated the efficacy of intubation over a gum-elastic bougie by using either a blind technique or a laryngeal mirror. Intubation with a gum-elastic bougie had a lower failure rate using indirect laryngoscopy with a laryngeal mirror (P < 0.05) than a traditional blind technique.

Hartmut Ocker, Volker Wenzel, Peter Schmucker, Markus Steinfath, and Volker Dörges

A Comparison of the Laryngeal Tube with the Laryngeal Mask Airway During Routine Surgical Procedures
Anesth Analg 2002 95: 1094-1097. [Abstract] [Full Text]  

IMPLICATIONS: The laryngeal tube, a newly developed airway device, and the laryngeal mask airway were used to ventilate patients in the operating room. Both airway devices proved to be effective and safe; however, the laryngeal tube allowed greater airway pressure during ventilation.

Mohammad A. Siyam and Dan Benhamou

Difficult Endotracheal Intubation in Patients with Sleep Apnea Syndrome
Anesth Analg 2002 95: 1098-1102. [Abstract] [Full Text]  

IMPLICATIONS: Because patients with sleep apnea syndrome have an increased risk of difficult endotracheal intubation and may present with cardiovascular disease, preoperative preventive measures should be undertaken to avoid untoward events.

Kyo S. Kim, Min S. Koo, Jeong W. Jeon, Hahck S. Park, and Ik S. Seung

Capsicum Plaster at the Korean Hand Acupuncture Point Reduces Postoperative Nausea and Vomiting After Abdominal Hysterectomy
Anesth Analg 2002 95: 1103-1107. [Abstract] [Full Text]  

IMPLICATIONS: Capsicum plaster at either the Korean hand acupuncture point K-D2 or the Pericardium 6 acupoint reduces postoperative nausea and vomiting in patients undergoing abdominal hysterectomy.

Peter A. Southorn, Mary Ellen Warner, Alan D. Sessler, and Kai Rehder

The Legacy of Albert Faulconer Jr (Special Article)
Anesth Analg 2002 95: 1108-1111. [Full Text]  

Mazen A. Maktabi, Henry Hoffman, Gery Funk, and Robert P. From

Laryngeal Trauma During Awake Fiberoptic Intubation (Case Report)
Anesth Analg 2002 95: 1112-1114. [Abstract] [Full Text]  

IMPLICATIONS: We describe three patients with difficult airways in which fiberoptic endotracheal intubation was used to insert breathing tubes into the patients' windpipes. Airway injury occurred during the use of this technique. Although largely a safe technique, care should be exercised when anesthesiologists choose equipment and when they perform this technique.

MEETING REPORT:

David M. Polaner and Jennifer Krupp

The 8th Joint Conference on Pediatric Anesthesiology of the Society of Pediatric Anesthesia and the American Academy of Pediatrics Section on Anesthesiology and Pain Management, Miami Beach, Florida, March 7, 2002
Anesth Analg 2002 95: 1115-1118. [Full Text]  

LETTERS TO THE EDITOR:

David Amar and Nick Scott

Beta-Adrenergic Blocker Withdrawal Confounds the Benefits of Epidural Analgesia With Sympathectomy on Supraventricular Arrhythmias After Cardiac Surgery • Response
Anesth Analg 2002 95: 1119. [Full Text]  

Greg Stratmann, Uli R. Jahn, Hans-G. Bone, Hugo Van Aken, Christoph Schmidt, and Michael Booke

Sympathectomy for Acute Pulmonary Embolism • Response
Anesth Analg 2002 95: 1119-1120. [Full Text]  

Alex Macario and Minal Vasanawala

Technology and Computing in the Surgical Suite: Key Features of an OR Management Information System and Opportunities for the Future
Anesth Analg 2002 95: 1120-1121. [Full Text]  

H. T. G. Bergendahl, P. A. Lonnqvist, P. De Negri, G. Ivani, and S. Eksborg

Increased Postoperative Arterial Blood Pressure Stability with Continuous Epidural Infusion of Clonidine in Children
Anesth Analg 2002 95: 1121-1122. [Full Text]  

Yoo J. Kondo, Toshiyuki Okutomi, and Sumio Hoka

Beware of Gastric Tube!
Anesth Analg 2002 95: 1122. [Full Text]  

André Mulot, Sergio Sepulveda, Jean-Pierre Haberer, and Marco Alifano

Diagnosis of Postpneumonectomy Bronchopleural Fistula Using Inhalation of Oxygen or Nitrous Oxide
Anesth Analg 2002 95: 1122-1123. [Full Text]  

R. Badaoui, C. El Kettani, M. Fikri, M. Ouendo, P. Canova-Bartoli, and M. Ossart

Spontaneous Cervical and Mediastinal Air Emphysema After Ecstasy Abuse
Anesth Analg 2002 95: 1123. [Full Text]  

Prasad V. Akole

Caution! Another Potential Source of Trouble: A Skin Staple Falling into the Trachea During Laryngectomy
Anesth Analg 2002 95: 1123-1124. [Full Text]  

Vandana Chugh and Baljit Singh

Per Oral Removal of Tapeworm Following Vomiting After Surgery
Anesth Analg 2002 95: 1124. [Full Text]  

Thomas Heidegger, Hansjörg Gerig, Virendra K. Arya, and Amitabh Dutta

Anticipated Difficult Airway: The Role of Fiberoptics • Response
Anesth Analg 2002 95: 1124-1125. [Full Text]  

Wonsik Ahn, Jae-Hyon Bahk, and Young-Jin Lim

The "Gauge" System for the Medical Use
Anesth Analg 2002 95: 1125. [Full Text]  

Federico Bilotta, Giovanni Rosa, Swen N. Piper, Wolfgang H. Maleck, and Joachim Boldt

Pharmacological Prevention of Postanesthetic Shivering • Response
Anesth Analg 2002 95: 1125-1126. [Full Text]  

Mitchel B. Sosis

Further Comments on the Withdrawal of Rapacuronium
Anesth Analg 2002 95: 1126-1127. [Full Text]  

Elif A. Akpek, Demet S. Sulemanji, and Gülnaz Arslan

Effects of Anesthesia on Linguistic Skills: Can Anesthesia Cause Language Switches?
Anesth Analg 2002 95: 1127. [Full Text]  

Kiyoshi Nagase, Kaori Ando-Nagase, and Hiroshi Endoh

To Cite or Not to Cite • Response
Anesth Analg 2002 95: 1127-1128. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Hans-Joachim Priebe

Problems in Anesthesia: Cardiothoracic Surgery • Books and Multimedia Received
Anesth Analg 2002 95: 1129. [Full Text]  

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