EDITORIALS:

John Butterworth and John W. Hammon

Lidocaine for Neuroprotection: More Evidence of Efficacy
Anesth Analg 2002 95: 1131-1133. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Dongxin Wang, Xinmin Wu, Jun Li, Feng Xiao, Xiaoying Liu, and Meijin Meng

The Effect of Lidocaine on Early Postoperative Cognitive Dysfunction After Coronary Artery Bypass Surgery
Anesth Analg 2002 95: 1134-1141. [Abstract] [Full Text]  

IMPLICATIONS: Postoperative cognitive dysfunction is a commonly recognized complication after cardiac surgery. Intraoperative cerebral microembolism and hypoperfusion have been proposed to be the major mechanisms. The results of this study show that intraoperative administration of lidocaine decreased the occurrence of early postoperative cognitive dysfunction, perhaps because of its neuroprotective effects.

M. R. Sukernik, B. Mets, B. Kachulis, M. C. Oz, and E. Bennett-Guerrero

The Impact of Newly Diagnosed Patent Foramen Ovale in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: Case Series of Eleven Patients
Anesth Analg 2002 95: 1142-1146. [Abstract] [Full Text]  

IMPLICATIONS: This case series suggests that coronary artery bypass graft surgery can be safely performed in most patients with patent foramen ovale without the use of a cardiopulmonary bypass.

Avi A. Weinbroum, Aharon Glick, Yitzchak Copperman, Tamar Yashar, Valery Rudick, and Ron Flaishon

Halothane, Isoflurane, and Fentanyl Increase the Minimally Effective Defibrillation Threshold of an Implantable Cardioverter Defibrillator: First Report in Humans
Anesth Analg 2002 95: 1147-1153. [Abstract] [Full Text]  

IMPLICATIONS: Halothane, isoflurane, and IV fentanyl added to N2O/oxygen-based general anesthesia similarly increase minimal defibrillation threshold energy requirements (DFT) during cardioverter defibrillator implantation in humans. Subcutaneous lidocaine plus intermittent small-dose IV propofol minimizes DFT compared with these general anesthetics while providing equal patient satisfaction.

Rakesh Kumar, Indranil Chakraborty, and Raminder Sehgal

A Prospective Randomized Study Comparing Two Techniques of Perioperative Blood Conservation: Isovolemic Hemodilution and Hypervolemic Hemodilution
Anesth Analg 2002 95: 1154-1161. [Abstract] [Full Text]  

IMPLICATIONS: Both hypervolemic hemodilution (HVH) and isovolemic hemodilution (IVH) claim to reduce red blood cell loss during surgery by diluting the patient's blood. This study found both comparable in significantly reducing the exposure to bank blood in the perioperative period, the time needed, and the cost incurred. HVH, being simpler, because it does not involve blood withdrawal, appeared superior to IVH in the healthy adults studied. Larger studies are needed to substantiate the results.

Franz Kehl, Paul S. Pagel, John G. Krolikowski, Weidong Gu, Wolfgang Toller, David C. Warltier, and Judy R. Kersten

Isoflurane Does Not Produce a Second Window of Preconditioning Against Myocardial Infarction In Vivo
Anesth Analg 2002 95: 1162-1168. [Abstract] [Full Text]  

IMPLICATIONS: Isoflurane mimics the beneficial effects of ischemic preconditioning by protecting myocardium against infarction when it is administered shortly before a prolonged ischemic episode. However, unlike ischemic preconditioning, isoflurane does not produce a second window of protection 24 h after administration in dogs.

Bruno Jawan, Shigeru Goto, Chia-Yun Lai, Vanessa H. de Villa, Hsiang-Ning Luk, Hock-Liew Eng, Yaw-Sen Chen, Chi-Chih Wang, Yu-Fen Cheng, and Chao-Long Chen

The Effect of Hypernatremia on Liver Allografts in Rats
Anesth Analg 2002 95: 1169-1172. [Abstract] [Full Text]  

IMPLICATIONS: Hypernatremia in cadaveric donors may be detrimental to the graft in clinical liver transplantation, but acute donor hypernatremia induced by an IV infusion of 10% saline solution before graft procurement in nonbrain-dead rats did not affect the survival of the recipient rats in an experimental liver transplantation model.

Daniel Eyraud, Olivier Richard, Dominique C. Borie, Barbara Schaup, Alain Carayon, Corinne Vézinet, Marie Movschin, Jean-Christophe Vaillant, Pierre Coriat, and Laurent Hannoun

Hemodynamic and Hormonal Responses to the Sudden Interruption of Caval Flow: Insights from a Prospective Study of Hepatic Vascular Exclusion During Major Liver Resections
Anesth Analg 2002 95: 1173-1178. [Abstract] [Full Text]  

IMPLICATIONS: Hemodynamic and hormonal responses to the acute interruption of caval venous return to the heart were investigated in patients undergoing liver resection with hepatic vascular exclusion. A compensatory role for arginine vasopressin and sympathetic systems that provoked increased vascular resistance was demonstrated.

Idit Matot, Olga Scheinin, Ahmed Eid, and Oded Jurim

Epidural Anesthesia and Analgesia in Liver Resection (Brief Report)
Anesth Analg 2002 95: 1179-1181. [Abstract] [Full Text]  

IMPLICATIONS: In patients undergoing major liver resection, the decision to introduce an epidural catheter and the timing of its removal should be made with care because of the prolonged changes in platelet count and in prothrombin time that develop in some patients.

M. Susan Mandell, Michael Wachs, Claus U. Niemann, and Thomas K. Henthorn

Elimination of Indocyanine Green in the Perioperative Evaluation of Donor Liver Function (Case Report)
Anesth Analg 2002 95: 1182-1184. [Abstract] [Full Text]  

IMPLICATIONS: The authors describe the intraoperative use of indocyanine green dye elimination to detect critical reductions in donor liver function.

Argyris S. Michalopoulos, Maria J. Tzoufi, George Theodorakis, and Spyros D. Mentzelopoulos

Acute Postoperative Pulmonary Thromboembolism as a Result of Intravascular Migration of a Pigtail Ureteral Stent (Case Report)
Anesth Analg 2002 95: 1185-1188. [Abstract] [Full Text]  

IMPLICATIONS: The symptomatic obstruction of a pulmonary arterial branch secondary to the intravascular migration of a pigtail ureteral stent is reported. This iatrogenic complication may cause dyspnea, chest pain, or both after uneventful urologic procedures involving ureteral stents.

Matthias Heringlake, Jan Schumacher, Beate Sedemund-Adib, Ludger Bahlmann, Sawas Eleftheriadis, Hans-Hinrich Sievers, Klaus Dalhoff, and Peter Schmucker

Bronchial Stenting and High-Frequency Percussive Ventilation Treatment of Descending Aortic Aneurysm-Induced Atelectasis of the Left Lung (Case Report)
Anesth Analg 2002 95: 1189-1191. [Abstract] [Full Text]  

IMPLICATIONS: This case report shows that atelectasis of the left lung—induced by extrinsic compression of the left main bronchus by an aortic aneurysm and persisting despite aggressive conservative treatment—may be effectively treated by bronchial stenting and high-frequency percussive ventilation.

Kimberly Skidmore, Joan Chen, and Lawrence Litt

Arterial Catheter Pressure Cable Corrosion Leading to Artifactual Diagnosis of Hypotension (Case Report)
Anesth Analg 2002 95: 1192-1195. [Abstract] [Full Text]  

IMPLICATIONS: Arterial pressure cable corrosion leads to artifactual hypotension despite a normally appearing waveform.

Kathleen H. Chaimberg and Kenneth W. Travis

Supine Hypertension During General Anesthesia in a Patient Taking Midodrine (Case Report)
Anesth Analg 2002 95: 1196-1197. [Abstract] [Full Text]  

IMPLICATIONS: Midodrine, a drug used to treat symptomatic orthostatic hypotension, may cause or exacerbate supine hypertension. We describe a case of a patient taking midodrine who exhibited severe hypertension during general anesthesia. Possible preventive measures to avoid this complication are discussed.

Edward Gologorsky and Angela Gologorsky

Aortic Valve Fibroelastomas as an Incidental Intraoperative Transesophageal Echocardiographic Finding (Case Report)
Anesth Analg 2002 95: 1198-1199. [Abstract] [Full Text] VIDEO LOOPS  

IMPLICATIONS. We report incidental findings of aortic valve fibroelastomas during routine intraoperative transesophageal echocardiography examination in cardiac surgery. Preoperative echocardiography failed to identify this potentially devastating pathology. The echocardiographic features of this lesion are reviewed, and the importance of diligence and complete examination are emphasized.

PEDIATRIC ANESTHESIA:

Tracy H. Laird, Stephen A. Stayer, Shannon M. Rivenes, Mark B. Lewin, E. Dean McKenzie, Charles D. Fraser, and Dean B. Andropoulos

Pulmonary-to-Systemic Blood Flow Ratio Effects of Sevoflurane, Isoflurane, Halothane, and Fentanyl/Midazolam with 100% Oxygen in Children with Congenital Heart Disease
Anesth Analg 2002 95: 1200-1206. [Abstract] [Full Text]  

IMPLICATIONS: Sevoflurane, halothane, isoflurane, and fentanyl/midazolam do not change pulmonary-to-systemic blood flow ratio in children with atrial and ventricular septal defects when administered at standard anesthetic doses with 100% oxygen.

Arash Pirat, Elif Akpek, and Gülnaz Arslan

Intrathecal Versus IV Fentanyl in Pediatric Cardiac Anesthesia
Anesth Analg 2002 95: 1207-1214. [Abstract] [Full Text]  

IMPLICATIONS: In this prospective, randomized study, we investigated the adequacy of a single intrathecal injection of fentanyl for intraoperative analgesia, compared the effects of IT and IV fentanyl on stress response, and assessed for an additive effect of IT and IV fentanyl administration in pediatric cardiac anesthesia. The results with these three different anesthetic regimens were similar regarding anesthesia depth and level of stress response. However, the combination of IT and IV routes may provide better hemodynamic stability and a less pronounced stress response, as reflected by 24-h urinary cortisol excretion.

Mohamed Abdulatif and Mohga El-Sanabary

Caudal Neostigmine, Bupivacaine, and Their Combination for Postoperative Pain Management After Hypospadias Surgery in Children
Anesth Analg 2002 95: 1215-1218. [Abstract] [Full Text]  

IMPLICATIONS: Caudal neostigmine 2 {micro}g/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery. Co-administration of the two drugs is associated with extended postoperative analgesia and reduced need for supplementary analgesics.

Susan T. Verghese, Raafat S. Hannallah, Linda Jo Rice, A. Barry Belman, and Kantilal M. Patel

Caudal Anesthesia in Children: Effect of Volume Versus Concentration of Bupivacaine on Blocking Spermatic Cord Traction Response During Orchidopexy
Anesth Analg 2002 95: 1219-1223. [Abstract] [Full Text]  

IMPLICATIONS: In children undergoing orchidopexy, a caudal block with a larger volume of dilute bupivacaine is more effective than a smaller volume of the more concentrated solution in blocking the peritoneal response during spermatic cord traction, with no change in the quality of postoperative analgesia.

Terri Voepel-Lewis, Sandy Merkel, Alan R. Tait, Agnieszka Trzcinka, and Shobha Malviya

The Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Observational Tool as a Measure of Pain in Children with Cognitive Impairment
Anesth Analg 2002 95: 1224-1229. [Abstract] [Full Text]  

IMPLICATIONS: The FLACC pain assessment tool may facilitate reliable and valid observational pain assessment in children with cognitive impairment who cannot self-report their pain. Objective pain assessment is important to facilitate effective postoperative pain management in these vulnerable children.

Radha Sukhani, Ana Lucia Pappas, Jordan Lurie, Andrew J. Hotaling, Albert Park, and Elaine Fluder

Ondansetron and Dolasetron Provide Equivalent Postoperative Vomiting Control After Ambulatory Tonsillectomy in Dexamethasone-Pretreated Children
Anesth Analg 2002 95: 1230-1235. [Abstract] [Full Text]  

IMPLICATIONS: The efficacy of a single dose of prophylactic ondansetron versus dolasetron in conjunction with dexamethasone was studied on posttonsillectomy retching/vomiting and 48-h recovery in children 2-12 yr old. Compared with placebo, ondansetron and dolasetron produced comparable reductions in the incidence of retching/vomiting and the need for rescue antiemetics.

Pervin Bozkurt, Guner Kaya, Yuksel Yeker, Nuvit Sarimurat, Ebru Yesildag, Gonca Tekant, Haluk Emir, and Osman Faruk Senyuz

Arterial Carbon Dioxide Markedly Increases During Diagnostic Laparoscopy in Portal Hypertensive Children
Anesth Analg 2002 95: 1236-1240. [Abstract] [Full Text]  

IMPLICATIONS: We compared children with portal hypertension with systemically healthy children during laparoscopy. The increase in arterial and end-tidal CO2 was remarkable in children with portal hypertension, regardless of bicarbonate changes. Managing ventilation to accommodate hypercarbia is of the utmost importance for such cases.

Virender K. Mohan, Vanlal M. Darlong, Lokesh Kashyap, Sailesh K. Mishra, and Kalpana Gupta

Fiberoptic-Guided Fogarty Catheter Placement Using the Same Diaphragm of an Adapter Within the Single-Lumen Tube in Children (Case Report)
Anesth Analg 2002 95: 1241-1242. [Abstract] [Full Text]  

IMPLICATIONS: We describe successful placement of a Fogarty catheter for one-lung ventilation through a single-lumen tube using a single diaphragm of an adapter for both the fiberoptic bronchoscope and the Fogarty catheter.

Toshitaka Minami, Takehiko Adachi, and Kazuhiko Fukuda

An Effective Use of Magnesium Sulfate for Intraoperative Management of Laparoscopic Adrenalectomy for Pheochromocytoma in a Pediatric Patient (Case Report)
Anesth Analg 2002 95: 1243-1244. [Abstract] [Full Text]  

IMPLICATIONS: This report concerns a case for which the intraoperative use of magnesium sulfate as an adjunct to the conventional use of nicardipine was effective for managing a pediatric patient with pheochromocytoma who was undergoing a laparoscopic operation.

Steve M. Auden, Sanford L. Lapin, and Ann Marie Joseph-Reynolds

Cardiac Arrest from Tension Pneumopericardium in a Premature Infant (Case Report)
Anesth Analg 2002 95: 1245-1247. [Abstract] [Full Text]  

IMPLICATIONS: This case report describes a rare and potentially fatal anesthetic complication. It occurred during the care of a small premature infant as a result of improper use of medical equipment.

Ka Shun Cheng, Ju-Mei Ng, Hsueh-Yu Li, and Philip M. Hartigan

Vallecular Cyst and Laryngomalacia in Infants: Report of Six Cases and Airway Management (Case Report)
Anesth Analg 2002 95: 1248-1250. [Abstract] [Full Text]  

IMPLICATIONS: This report describes difficulties encountered in the airway management of six infants with concurrent vallecular cyst and laryngomalacia. It is hoped that our experience will assist others in the management of such patients.

G. Brent Shulman and Neil Roy Connelly

Bilateral Pneumothoraces in a Pediatric Patient Undergoing Hickman Catheter Placement (Case Report)
Anesth Analg 2002 95: 1251-1252. [Abstract] [Full Text]  

IMPLICATIONS: The laryngeal mask airway (LMA) is often used for airway management in pediatric patients. We report bilateral pneumothoraces in a patient who underwent neck surgery whose airway was managed with a LMA. We recommend that the LMA be used with caution in small children undergoing deep-neck dissection.

AMBULATORY ANESTHESIA:

Chester C. Buckenmaier, III, Karen C. Nielsen, Ricardo Pietrobon, Stephen M. Klein, Aliki H. Martin, Roy A. Greengrass, and Susan M. Steele

Small-Dose Intrathecal Lidocaine Versus Ropivacaine for Anorectal Surgery in an Ambulatory Setting
Anesth Analg 2002 95: 1253-1257. [Abstract] [Full Text]  

IMPLICATIONS: In this prospective trial, small-dose ropivacaine with fentanyl was as effective as small-dose lidocaine with fentanyl for anorectal procedures in the ambulatory setting.

S. Robaux, H. Bouaziz, C. Cornet, J. M. Boivin, N. Lefèvre, and M. C. Laxenaire

Acute Postoperative Pain Management at Home After Ambulatory Surgery: A French Pilot Survey of General Practitioners’ Views (Special Article)
Anesth Analg 2002 95: 1258-1262. [Abstract] [Full Text]  

IMPLICATIONS: We assessed the views of French general practitioners concerning pain relief at home after ambulatory surgery in a cross-sectional prospective survey. The results revealed that there is need for improvement, mainly in prescribing more suitable analgesic protocols and optimizing postdischarge relationships between physicians.

ANESTHETIC PHARMACOLOGY:

Sang-Hwan Do, Hong-yu Fang, Byung-Moon Ham, and Zhiyi Zuo

The Effects of Lidocaine on the Activity of Glutamate Transporter EAAT3: The Role of Protein Kinase C and Phosphatidylinositol 3-Kinase
Anesth Analg 2002 95: 1263-1268. [Abstract] [Full Text]  

IMPLICATIONS: By using the Xenopus oocyte expression system, we investigated the effects of lidocaine on a glutamate transporter (EAAT3). Our findings suggest that lidocaine enhances EAAT3 activity at certain concentrations and that protein kinase C and phosphatidylinositol 3-kinase may mediate these lidocaine effects.

Yousuke Shiga, Kouichiro Minami, Munehiro Shiraishi, Yasuhito Uezono, Osamu Murasaki, Muneshige Kaibara, and Akio Shigematsu

The Inhibitory Effects of Tramadol on Muscarinic Receptor-Induced Responses in Xenopus Oocytes Expressing Cloned M₃ Receptors
Anesth Analg 2002 95: 1269-1273. [Abstract] [Full Text]  

IMPLICATION. Muscarinic receptors are involved in neuronal function and are targets of analgesic drugs. We here report that tramadol inhibits type-3 muscarinic receptors function via quinuclidinyl benzilate-binding sites at clinically relevant concentrations. These findings may explain the modulation of neuronal function and the anticholinergic effects of tramadol.

Victor N. Pashkov and Hugh C. Hemmings, Jr.

The Effects of General Anesthetics on Norepinephrine Release from Isolated Rat Cortical Nerve Terminals
Anesth Analg 2002 95: 1274-1281. [Abstract] [Full Text]  

IMPLICATIONS. General anesthetics affect synaptic transmission both by altering neurotransmitter release and by modulating postsynaptic responses to transmitter. Anesthetics exert both drug-specific and transmitter-specific effects on transmitter release: therapeutic concentrations of some anesthetics stimulate basal, but not evoked, norepinephrine release, in contrast to evoked glutamate release, which is inhibited.

Andrzej L. Dawidowicz, Rafal Kalitynski, Andrzej Nestorowicz, and Anna Fijalkowska

Changes of Propofol Concentration in Cerebrospinal Fluid During Continuous Infusion
Anesth Analg 2002 95: 1282-1284. [Abstract] [Full Text]  

IMPLICATIONS: Propofol concentrations in the cerebrospinal fluid in neurosurgical patients Propofol concentration in cerebrospinal fluid of investigated patients decreased significantly after starting intraventricular drainage, despite relatively steady blood propofol concentrations. These results supplement the limited information about propofol pharmacokinetics in the human central nervous system.

Mariusz G. Banaszczyk, Alison T. Carlo, Violeta Millan, Adam Lindsey, Ronald Moss, Dennis J. Carlo, and Sheldon S. Hendler

Propofol Phosphate, a Water-Soluble Propofol Prodrug: In Vivo Evaluation
Anesth Analg 2002 95: 1285-1292. [Abstract] [Full Text]  

IMPLICATIONS. Propofol phosphate, a water-soluble prodrug of the widely used IV anesthetic propofol, was developed and evaluated in mice, rats, rabbits, and pigs after IV injection. The results of the study clearly demonstrate the feasibility of the prodrug approach to achieve sedative and anesthetic levels of propofol in laboratory animals; this warrants further evaluation in humans.

Mi A. Cheong, Kyo S. Kim, and Won J. Choi

Ephedrine Reduces the Pain from Propofol Injection
Anesth Analg 2002 95: 1293-1296. [Abstract] [Full Text]  

IMPLICATIONS. Propofol is a widely used IV anesthetic for the induction of anesthesia, but it often causes local pain when administered into peripheral veins. A small dose of ephedrine reduces the incidence and intensity of the pain without significant adverse hemodynamic effects during induction.

Hossein Majedi, Mozaffar Rabiee, Zahid Hussain Khan, and Bahman Hassannasab

A Comparison of Metoclopramide and Lidocaine for Preventing Pain on Injection of Diazepam
Anesth Analg 2002 95: 1297-1299. [Abstract] [Full Text]  

IMPLICATIONS: Metoclopramide, rather than lidocaine pretreatment, may be a reasonable analgesic alternative to decrease pain from a diazepam injection, especially when there is a medical condition in which lidocaine should be used very cautiously.

Taeko Fukuda, Chikako Nishimoto, Setsuji Hisano, Masayuki Miyabe, and Hidenori Toyooka

The Analgesic Effect of Xenon on the Formalin Test in Rats: A Comparison with Nitrous Oxide
Anesth Analg 2002 95: 1300-1304. [Abstract] [Full Text]  

IMPLICATIONS: Inhaled xenon suppressed nociceptive behaviors, c-fos expression, and activation of the N-methyl-D-aspartate receptor during the formalin test in rats. Xenon's analgesic effect was speculated to result from the inhibition of the N-methyl-D-aspartate receptor in vivo.

Peter J. Davis, Richard L. Stiller, Annette S. Wilson, Francis X. McGowan, Talmage D. Egan, and Keith T. Muir

In Vitro Remifentanil Metabolism: The Effects of Whole Blood Constituents and Plasma Butyrylcholinesterase
Anesth Analg 2002 95: 1305-1307. [Abstract] [Full Text]  

IMPLICATIONS: This was a test-tube-designed study to determine whether an enzyme deficiency (butyrylcholinesterase deficiency) changes the way remifentanil is metabolized. It seems that remifentanil dosage does not need to be changed in patients with butyrylcholinesterase deficiency.

A. Turan, S. Emet, B. Karamanlioglu, D. Memis, N. Turan, and Z. Pamukcu

Analgesic Effects of Rofecoxib in Ear-Nose-Throat Surgery
Anesth Analg 2002 95: 1308-1311. [Abstract] [Full Text]  

IMPLICATIONS. The aim of this study was to evaluate the analgesic efficacy and opioid-sparing effect of rofecoxib, a new selective cyclooxygenase-2 inhibitor drug, in ear-nose-throat surgery patients. Preoperative administration of oral rofecoxib provided a significant analgesic benefit and decreased the need for opioids in patients undergoing nasal septal and nasal sinus surgery.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Jonathan H. Waters, Julia ShinJung Lee, and Matthew T. Karafa

A Mathematical Model of Cell Salvage Efficiency
Anesth Analg 2002 95: 1312-1317. [Abstract] [Full Text]  

IMPLICATIONS: In this study, a mathematical model of cell salvage was developed. The model was then matched against real clinical cases to gain an understanding of the variables that modify cell salvage efficiency. The model illustrates that cell salvage can be a highly effective method of avoiding blood transfusion.

S. Pockett and S. M. Tan

The Auditory Steady-State Response Is Not a Suitable Monitor of Anesthesia
Anesth Analg 2002 95: 1318-1323. [Abstract] [Full Text]  

IMPLICATIONS. Auditory steady-state responses (ASSRs) are brain waves evoked by auditory stimuli. Because they reportedly disappear under general anesthesia, they have been suggested as potential indicators of anesthetic depth. However, in this study, we show that about half our normal adult subjects did not produce measurable ASSRs when awake. This suggests that ASSRs are not good candidates for use in monitoring anesthetic depth during surgery.

Gunter N. Schmidt, Petra Bischoff, Thomas Standl, Moritz Voigt, Luca Papavero, and Jochen Schulte am Esch

Narcotrend, Bispectral Index, and Classical Electroencephalogram Variables During Emergence from Propofol/Remifentanil Anesthesia
Anesth Analg 2002 95: 1324-1330. [Abstract] [Full Text]  

IMPLICATIONS: We investigated modern and classical electroencephalographic (EEG) variables during emergence from propofol/remifentanil anesthesia. Modern EEG variables indicate changes of infusion in propofol, but not in remifentanil. Thus, modern EEG variables did not provide an adequate assessment of depth of anesthesia when remifentanil was used.

Brian M. Ilfeld, Timothy E. Morey, and F. Kayser Enneking

The Delivery Rate Accuracy of Portable Infusion Pumps Used for Continuous Regional Analgesia
Anesth Analg 2002 95: 1331-1336. [Abstract] [Full Text]  

IMPLICATIONS: Portable pumps often used for local anesthetic infusion during continuous regional analgesia exhibit varying degrees of delivery rate accuracy and consistency. Furthermore, increases in temperature result in an increased infusion rate for various pumps investigated. These factors should be taken into consideration when choosing and using a portable infusion pump.

Robert M. Pousman, William A. Eilers, III, Bruce Johns, and Harry Jung

Irritant Contact Dermatitis After Use of Bispectral Index^® Sensor in Prone Position (Case Report)
Anesth Analg 2002 95: 1337-1338. [Abstract] [Full Text]  

IMPLICATIONS: Because the Bispectral Index(R) monitor is placed on the forehead, skin reactions such as dermatitis have more than cosmetic implications for the physician and patient.

PAIN MEDICINE:

Philip I. Joyce, Daniela Rizzi, Girolamo Caló, David J. Rowbotham, and David G. Lambert

The Effect of Guanethidine and Local Anesthetics on the Electrically Stimulated Mouse Vas Deferens
Anesth Analg 2002 95: 1339-1343. [Abstract] [Full Text]  

IMPLICATIONS: In this study, with a sympathetically innervated vas deferens preparation, local anesthetics reduced the efficacy of the sympatholytic guanethidine, questioning its co-administration in the pain clinic.

Antonio Macias, Pablo Monedero, María Adame, Wenceslao Torre, Isabel Fidalgo, and Francisco Hidalgo

A Randomized, Double-Blinded Comparison of Thoracic Epidural Ropivacaine, Ropivacaine/Fentanyl, or Bupivacaine/Fentanyl for Postthoracotomy Analgesia
Anesth Analg 2002 95: 1344-1350. [Abstract] [Full Text]  

IMPLICATIONS: Thoracic epidural ropivacaine/fentanyl provided adequate pain relief and similar analgesia to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. Plain 0.2% ropivacaine was associated with worse pain control and an increased incidence of postoperative nausea and vomiting. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia.

Sharon M. Gordon, Jaime S. Brahim, Ronald Dubner, Linda M. McCullagh, Christine Sang, and Raymond A. Dionne

Attenuation of Pain in a Randomized Trial by Suppression of Peripheral Nociceptive Activity in the Immediate Postoperative Period
Anesth Analg 2002 95: 1351-1357. [Abstract] [Full Text]  

IMPLICATIONS: Suppression of postoperative pain immediately after surgery attenuates the pain experienced 1 to 2 days after surgery. These findings suggest that pain after minor surgery can be prevented by blocking the development of pain processes that amplify pain for days after surgery.

Steven P. Cohen and Salahadin Abdi

Venous Malformations Associated with Central Pain: Report of a Case (Case Report)
Anesth Analg 2002 95: 1358-1360. [Abstract] [Full Text]  

IMPLICATIONS: The authors describe an unusual case of central pain (CP) that resulted from giant venous hemangiomas. The patient was treated with a variety of medications, including the N-methyl-D-aspartate antagonist dextromethorphan. We report the first known association between venous malformations and CP and briefly describe why the use of dextromethorphan in this disorder requires further evaluation.

Mads U. Werner, Lykke Søholm, Per Rotbøll-Nielsen, and Henrik Kehlet

Does an Acute Pain Service Improve Postoperative Outcome? (Review Article)
Anesth Analg 2002 95: 1361-1372. [Full Text]  

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Nava Klein and Charles Weissman

Evaluating Intraoperative Therapeutic and Diagnostic Interventions
Anesth Analg 2002 95: 1373-1380. [Abstract] [Full Text]  

IMPLICATIONS: A scoring system to quantify the extent of nonsurgical intraoperative care was developed. The scoring system was validated and correlated well with surgical complexity; it was able to differentiate between the intensity of care provided during various surgical procedures.

T. Kasai, M. Hirose, K. Yaegashi, T. Matsukawa, A. Takamata, and Y. Tanaka

Preoperative Risk Factors of Intraoperative Hypothermia in Major Surgery Under General Anesthesia
Anesth Analg 2002 95: 1381-1383. [Abstract] [Full Text]  

IMPLICATIONS: Increases in age and height and decreases in weight systolic blood pressure and heart rate are major preoperative risk factors of intraoperative hypothermia during major surgery.

NEUROSURGICAL ANESTHESIA:

Alain Gauthier, Francois Girard, Daniel Boudreault, Monique Ruel, and Alexandre Todorov

Sevoflurane Provides Faster Recovery and Postoperative Neurological Assessment Than Isoflurane in Long-Duration Neurosurgical Cases
Anesth Analg 2002 95: 1384-1388. [Abstract] [Full Text]  

IMPLICATIONS: The low-solubility anesthetic, sevoflurane, provides faster recovery and postoperative neurological assessment than isoflurane after long-duration (4.7 MAC-h) intracranial surgery.

Seiya Nakamura, Manabu Kakinohana, Yutaka Taira, Hiroshi Iha, and Kazuhiro Sugahara

The Effect of Gamma-Aminobutyric Acid (GABA) Receptor Drugs on Morphine-Induced Spastic Paraparesis After a Noninjurious Interval of Spinal Cord Ischemia in Rats
Anesth Analg 2002 95: 1389-1395. [Abstract] [Full Text]  

IMPLICATIONS: The purpose of this study was to investigate interactions between morphine and GABAergic agonists or antagonists on motor function after spinal cord ischemia and then clarify the mechanism of the spastic paraparesis induced by intrathecal morphine. The spastic paraparesis induced by intrathecal morphine may be mediated in part by GABA receptors.

OBSTETRIC ANESTHESIA:

Michael J. Paech, Samantha L. Banks, Lyle C. Gurrin, Seng T. Yeo, and Timothy J. G. Pavy

A Randomized, Double-Blinded Trial of Subarachnoid Bupivacaine and Fentanyl, With or Without Clonidine, for Combined Spinal/Epidural Analgesia During Labor
Anesth Analg 2002 95: 1396-1401. [Abstract] [Full Text]  

IMPLICATIONS: The addition of 15-45 {micro}g of clonidine to subarachnoid fentanyl plus bupivacaine did not significantly increase the duration of spinal analgesia but did decrease maternal blood pressure. The results of this study do not support the use of subarachnoid clonidine to prolong the action of spinal labor analgesia when fentanyl plus bupivacaine are administered.

REGIONAL ANESTHESIA:

Bee B. Lee, Warwick D. Ngan Kee, John L. Plummer, Manoj K. Karmakar, and April S.Y. Wong

The Effect of the Addition of Epinephrine on Early Systemic Absorption of Epidural Ropivacaine in Humans
Anesth Analg 2002 95: 1402-1407. [Abstract] [Full Text]  

IMPLICATIONS: The addition of epinephrine 5 {micro}g/mL to epidural ropivacaine reduced the systemic arterial and venous plasma concentrations of ropivacaine in the first hour and the maximum plasma concentration of ropivacaine. Epinephrine may be a useful additive for reducing the risk of systemic toxicity when large doses of ropivacaine are given epidurally.

Makoto Tanaka and Toshiaki Nishikawa

Does the Choice of Electrocardiography Lead Affect the Efficacy of the T-Wave Criterion for Detecting Intravascular Injection of an Epinephrine Test Dose?
Anesth Analg 2002 95: 1408-1411. [Abstract] [Full Text]  

IMPLICATIONS: To determine whether an epidural catheter is in a blood vessel, an epidural test dose containing 15 {micro}g of epinephrine is used. We found that decreases in the T-wave amplitude of Leads I, II, III, and V5 of the electrocardiogram were equally sensitive and specific for detecting intravascular injection of the test dose in sevoflurane-anesthetized adult patients.

Andrew P. Morley, James Derrick, Paul T. Seed, Perpetua E. Tan, David C. Chung, and Timothy G. Short

Isoflurane Dosage for Equivalent Intraoperative Electroencephalographic Suppression in Patients With and Without Epidural Blockade
Anesth Analg 2002 95: 1412-1418. [Abstract] [Full Text]  

IMPLICATIONS: The dose of general anesthetic required to maintain similar intraoperative suppression of brain electrical activity is 21% less in patients with nerve blockade than in those without. This dose reduction results in faster waking times in patients with nerve blockade, which may reflect lighter intraoperative anesthesia. The dose of general anesthetic required to maintain similar intraoperative suppression of brain electrical activity is 21% less in patients with nerve blockade than in those without. This dose reduction results in faster waking times in patients with nerve blockade, which may reflect lighter intraoperative anesthesia.

A. Turan, B. Karamanlyoglu, D. Memis, G. Kaya, and Z. Pamukçu

Intravenous Regional Anesthesia Using Prilocaine and Neostigmine
Anesth Analg 2002 95: 1419-1422. [Abstract] [Full Text]  

IMPLICATIONS: Neostigmine has been added to local anesthetics for central and peripheral nerve blocks. This study was conducted to evaluate the effects of neostigmine when added to prilocaine for IV regional anesthesia (IVRA). Neostigmine as an adjunct to prilocaine improves quality of anesthesia and is beneficial in IVRA.

Gavin Martin, Catherine K. Lineberger, David B. MacLeod, Habib E. El-Moalem, Dara S. Breslin, David Hardman, and Francine D’Ercole

A New Teaching Model for Resident Training in Regional Anesthesia
Anesth Analg 2002 95: 1423-1427. [Abstract] [Full Text]  

IMPLICATIONS. Inadequate exposure to peripheral nerve blocks has been a national problem. A teaching model instituted at Duke University Health System has resulted in a fourfold increase in exposure to peripheral nerve blocks compared with the national averages.

Pierre C. Pandin, Arlette Vandesteene, and Alain A. d’Hollander

Lumbar Plexus Posterior Approach: A Catheter Placement Description Using Electrical Nerve Stimulation (Brief Report)
Anesth Analg 2002 95: 1428-1431. [Abstract] [Full Text]  

IMPLICATIONS: The authors describe a modified technique of posterior approach to the lumbar plexus in the psoas compartment which allows nerve stimulation for the location of the plexus and catheter placement for extended-duration surgery and postoperative patient-controlled regional analgesia. A frequent incidence of total lumbar plexus block was observed.

GENERAL ARTICLES:

Dietmar Enk, Anne M. Palmes, Hugo Van Aken, and Martin Westphal

Nasotracheal Intubation: A Simple and Effective Technique to Reduce Nasopharyngeal Trauma and Tube Contamination
Anesth Analg 2002 95: 1432-1436. [Abstract] [Full Text]  

IMPLICATIONS. Nasopharyngeal passage of an endotracheal tube can be facilitated by a flexible Wendl tube (nasopharyngeal airway) covering and guiding the rigid tube tip. This technique is helpful in reducing the incidence and severity of nosebleeds and in minimizing contamination of the tip of the endotracheal tube with blood and mucus.

Yasunari Urakami, Ichiro Takenaka, Motohiro Nakamura, Hiroshi Fukuyama, Kazuyoshi Aoyama, and Tatsuo Kadoya

The Reliability of the Bellhouse Test for Evaluating Extension Capacity of the Occipitoatlantoaxial Complex
Anesth Analg 2002 95: 1437-1441. [Abstract] [Full Text]  

IMPLICATIONS. The Bellhouse test was not always accurate to evaluate the actual occipitoatlantoaxial extension capacity because of the inevitable occurrence of the subaxial extension. This may mean that some difficult endotracheal intubations will be unpredictable.

Tsutomu Oshima, Yoshiko Kasuya, Yasuhisa Okumura, Etsuji Terazawa, and Shuji Dohi

Prevention of Nausea and Vomiting with Tandospirone in Adults After Tympanoplasty
Anesth Analg 2002 95: 1442-1445. [Abstract] [Full Text]  

IMPLICATIONS: Oral tandospirone reduced the incidence of postoperative nausea and vomiting without significant adverse effects in adults undergoing tympanoplasty under general anesthesia.

George M. Hall and Peter Salmon

Physiological and Psychological Influences on Postoperative Fatigue
Anesth Analg 2002 95: 1446-1450. [Abstract] [Full Text]  

IMPLICATIONS. Fatigue is common after major surgery and delays recovery. It is usually attributed to the physiological response to surgery. We studied patients undergoing hip arthroplasty and found that the severity of postoperative fatigue was not predicted by physiological changes. Instead, it was predicted by the preoperative level of fatigue.

Ya-Chun Chu, Shen-Kou Tsai, Kwok-Hon Chan, Sheng-Chin Kao, Ching-Huang Liang, and Su-Man Lin

Lateral Medullary Syndrome After Prone Position for General Surgery (Case Report)
Anesth Analg 2002 95: 1451-1453. [Abstract] [Full Text]  

IMPLICATIONS: We describe postoperative lateral medullary syndrome with myoclonic spasm. Improper head rotation during positioning in the anesthetized patient might obstruct the flow of the vertebral artery at the neck and result in diminished perfusion of the associated regions in patients with a history of cervical spinal trauma.

Rakesh Kumar, Prashast, Anupriya Wadhwa, and S. Akhtar

The Upside-Down Intubating Laryngeal Mask Airway: A Technique for Cases of Fixed Flexed Neck Deformity (Case Report)
Anesth Analg 2002 95: 1454-1458. [Abstract] [Full Text]  

IMPLICATIONS: When the neck is fixed in extreme flexion, access to the windpipe becomes very difficult. The intubating laryngeal mask airway (ILMA) appears unsuitable for guiding the breathing tube into the windpipe in such cases because of its rigid, preformed shape. However, the ILMA introduced upside down may provide the answer, even if the mouth opening is smaller than normal.

LETTERS TO THE EDITOR:

Vladimir Nigrovic, Matthias Paul, Christoph H. Kindler, and C. Spencer Yost

The Potency of New Muscle Relaxants on Recombinant Muscle-Type Acetylcholine Receptors • Response
Anesth Analg 2002 95: 1459. [Full Text]  

Lutz Schaffranietz, Christian Rudolph, Wolfgang Heinke, Hernán R. Muñoz, and José E. De la Fuente

Propofol, Nitrous Oxide, and Jugular Bulb Oxygen Saturation • Response
Anesth Analg 2002 95: 1459-1460. [Full Text]  

Narendra Dhingra

The Effect of Clonidine on Peribulbar Block
Anesth Analg 2002 95: 1460. [Full Text]  

Masayuki Ozaki, Kouichiro Minami, and Akio Shigematsu

A Rapid Infusion System Using a Three-Way Stopcock with Two No-Return Valves
Anesth Analg 2002 95: 1461. [Full Text]  

John Pollard and Wilton A. van Klei

Optimizing the Benefits of Outpatient Preoperative Anesthesia Evaluation • Response
Anesth Analg 2002 95: 1461. [Full Text]  

Junichi Ikegaki and Hiromi Katoh

A Single Lobal Inflation Technique Using Bronchofiberoptic Jet Ventilation During Video-Assisted Thoracoscopic Surgery for Bullae
Anesth Analg 2002 95: 1462. [Full Text]  

Mitchel B. Sosis, Brian Cohen, Claude Lentschener, Abdelmalek Ghimouz, Philippe Bonnichon, Christine Parc, and Yves Ozier

Diagnosis of Acute Glaucoma in the Postoperative Period • Response
Anesth Analg 2002 95: 1462-1463. [Full Text]  

Luzius A. Steiner, Marek Czosnyka, and Hiroshi Endoh

Assessing Drug Effects on Cerebral Autoregulation Using the Static Rate of Autoregulation • Response
Anesth Analg 2002 95: 1463. [Full Text]  

Mark E. Bruley, Albert L. de Richemond, and Steven J. Barker

Supplemental Oxygen Versus Latent Alcohol Vapors as Surgical Fire Precursors • Response
Anesth Analg 2002 95: 1464. [Full Text]  

Daniel Freymond, Jean-Pierre Mustaki, Donat R. Spahn, and Bertrand Jaques

Droperidol-Treated PONV and Bilateral Mandibular Fracture After Maxillofacial Surgery
Anesth Analg 2002 95: 1465. [Full Text]  

Julian Stone and William Fawcett

A Case of Frozen Succinylcholine Encountered During Emergency Cesarean Delivery
Anesth Analg 2002 95: 1465. [Full Text]  

C. N. Seubert, N. Gravenstein, Thomas M. Hemmerling, and Hubert Schmitt

Venous Air Embolism During Changes in Patient Position or Ventilation: An Etiology for Postoperative Cardiovascular Collapse? • Response
Anesth Analg 2002 95: 1465-1466. [Full Text]  

Philip R. Belcher, Elijah W. Muriithi, Paul Wajon, and John Gibson

Postoperative Bleeding After Coronary Artery Bypass Surgery with Cardiopulmonary Bypass • Response
Anesth Analg 2002 95: 1466-1467. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

Andrew J. Mannes, Bobbie Jean Sweitzer, and Lee A. Fleisher

Methods in Pain Research • Preoperative Evaluation and Cost Containment • Anesthesia for the Cardiac Patient • Books and Multimedia Received
Anesth Analg 2002 95: 1468-1469. [Full Text]  

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