EDITORIALS:

William Splinter

Halothane: The End of an Era?
Anesth Analg 2002 95: 1471. [Full Text]  

Sten G.E. Lindahl and Margareta Mure

Dosing Oxygen: A Tricky Matter or a Piece of Cake?
Anesth Analg 2002 95: 1472-1473. [Full Text]  

Paul F. White

Need Information on "Off-Label" Uses of Anesthetic Drugs? Just Ask the Pharmaceutical Representative!
Anesth Analg 2002 95: 1474-1475. [Full Text]  

CARDIOVASCULAR ANESTHESIA:

Solomon Aronson, Aggie Butler, Raja Subhiyah, Richard E. Buckingham, Jr, Michael K. Cahalan, Steven Konstandt, Jonathan Mark, James Ramsay, Robert Savage, Joseph Savino, Jack S. Shanewise, John Smith, and Daniel Thys

Development and Analysis of a New Certifying Examination in Perioperative Transesophageal Echocardiography
Anesth Analg 2002 95: 1476-1482. [Abstract] [Full Text]  

IMPLICATIONS: This report describes the process involved in developing the certifying transesophageal echocardiography examination and identifies correlates with examination performance.

Mary P. Fillinger, Stephen D. Surgenor, Gregg S. Hartman, Cantwell Clark, Thomas M. Dodds, Athos J. Rassias, William C. Paganelli, Peter Marshall, David Johnson, Dennis Kelly, Dean Galatis, Elaine M. Olmstead, Cathy S. Ross, and Gerald T. O’Connor

The Association Between Heart Rate and In-Hospital Mortality After Coronary Artery Bypass Graft Surgery
Anesth Analg 2002 95: 1483-1488. [Abstract] [Full Text]  

IMPLICATIONS: We conducted an observational study to evaluate the association between heart rate upon arrival to the operating room (preinduction heart rate) and in-hospital mortality during coronary artery bypass graft surgery. After adjustment for baseline differences among patients, preinduction heart rate >=80 bpm was associated with an increased in-hospital mortality after coronary artery bypass graft surgery.

Weng Y. Thong, Andrew G. Strickler, Shu Li, Elester E. Stewart, Connie L. Collier, William K. Vaughn, and Nancy A. Nussmeier

Hyperthermia in the Forty-Eight Hours After Cardiopulmonary Bypass
Anesth Analg 2002 95: 1489-1495. [Abstract] [Full Text]  

IMPLICATIONS:Postoperative hyperthermia is common in cardiac surgery patients, with a bimodal distribution during the first 48 h. Jugular venous bulb temperature is slightly higher than bladder temperature for several hours. Postoperative cerebral hyperthermia may contribute to the severity of cerebral injury after cardiopulmonary bypass.

Claus Raedler, Wolfgang G. Voelckel, Volker Wenzel, Ludger Bahlmann, Wolfgang Baumeier, Christian A. Schmittinger, Holger Herff, Anette C. Krismer, Karl H. Lindner, and Keith G. Lurie

Vasopressor Response in a Porcine Model of Hypothermic Cardiac Arrest Is Improved with Active Compression-Decompression Cardiopulmonary Resuscitation Using the Inspiratory Impedance Threshold Valve
Anesth Analg 2002 95: 1496-1502. [Abstract] [Full Text]  

New strategies are needed to improve the efficiency of cardiopulmonary resuscitation (CPR) in hypothermic cardiac arrest. Active compression-decompression CPR with the inspiratory threshold valve improved carotid blood flow (and coronary perfusion pressure with vasopressin) compared with standard CPR.

Vance G. Nielsen

The Detection of Changes in Heparin Activity in the Rabbit: A Comparison of Anti-Xa Activity, Thrombelastography^®, Activated Partial Thromboplastin Time, and Activated Coagulation Time
Anesth Analg 2002 95: 1503-1506. [Abstract] [Full Text]  

IMPLICATIONS: Changes in thrombelastography (TEG(R)) variables more sensitively reflect changes in circulating heparin activity than activated partial thromboplastin time (aPTT) and activated coagulation time (ACT) after small-dose heparin administration in rabbits. Thus, TEG(R) may be more helpful than aPTT and ACT in the detection of heparin in both laboratory and clinical settings wherein heparin may play a role in coagulopathy.

Andrew D. Maslow, Meredith M. Regan, Peter Panzica, Stephanie Heindel, John Mashikian, and Mark E. Comunale

Precardiopulmonary Bypass Right Ventricular Function Is Associated with Poor Outcome After Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Systolic Dysfunction
Anesth Analg 2002 95: 1507-1518. [Abstract] [Full Text]  

IMPLICATIONS: Right ventricular function before cardiopulmonary bypass is associated with poor outcome after coronary artery surgery in patients with poor left ventricular function.

Thomas Suarez, Jeffrey P. Baerwald, and Chadd Kraus

Central Venous Access: The Effects of Approach, Position, and Head Rotation on Internal Jugular Vein Cross-Sectional Area
Anesth Analg 2002 95: 1519-1524. [Abstract] [Full Text]  

IMPLICATIONS: Central venous catheter insertion is commonly performed in the neck by using the right internal jugular vein. This study assesses factors affecting the cross-sectional area of this vein during central venous catheterization.

Marc Licker, Gregory Khatchatourian, Alexandre Schweizer, Marek Bednarkiewicz, Didier Tassaux, and Catherine Chevalley

The Impact of a Cardioprotective Protocol on the Incidence of Cardiac Complications After Aortic Abdominal Surgery
Anesth Analg 2002 95: 1525-1533. [Abstract] [Full Text]  

IMPLICATIONS: Implementation of American College of Cardiology/American Heart Association guidelines and use of antiadrenergic drugs were associated with better cardiac outcomes after major vascular surgery.

Glenn S. Murphy, Joseph W. Szokol, Jeffery S. Vender, Jesse H. Marymont, and Michael J. Avram

The Use of Neuromuscular Blocking Drugs in Adult Cardiac Surgery: Results of a National Postal Survey
Anesth Analg 2002 95: 1534-1539. [Abstract] [Full Text]  

IMPLICATIONS:This postal survey of cardiac anesthesiologists demonstrates that long-acting muscle relaxants are frequently administered to fast-track cardiac surgical patients. Neuromuscular blockade is rarely monitored or reversed in this patient population.

Matthias L. Riess, Amadou K. S. Camara, Enis Novalija, Qun Chen, Samhita S. Rhodes, and David F. Stowe

Anesthetic Preconditioning Attenuates Mitochondrial Ca²⁺ Overload During Ischemia in Guinea Pig Intact Hearts: Reversal by 5-Hydroxydecanoic Acid
Anesth Analg 2002 95: 1540-1546. [Abstract] [Full Text]  

IMPLICATIONS:Myocardial ischemia/reperfusion injury is associated with mitochondrial Ca2+ overload. Mitochondrial [Ca2+] and function were measured in guinea pig isolated hearts. Anesthetic preconditioning attenuated mitochondrial Ca2+ overload during ischemia, improved function, and reduced infarct size. Reversal by 5-hydroxydecanoate suggests that anesthetic preconditioning may be triggered by mitochondrial adenosine triphosphate-sensitive K channel opening.

Lance P. Brauer, Christer H. Svensén, Robert G. Hahn, Sadik Kilicturgay, George C. Kramer, and Donald S. Prough

Influence of Rate and Volume of Infusion on the Kinetics of 0.9% Saline and 7.5% Saline/6.0% Dextran 70 in Sheep
Anesth Analg 2002 95: 1547-1556. [Abstract] [Full Text]  

IMPLICATIONS: Kinetic analysis of a short infusion of 7.5% saline/6% dextran or 0.9% saline accurately predicts the effects of a longer infusion of the same volume (7.5% saline/6% dextran) or of a larger volume (0.9% saline).

Jochen Sticher, Stefan Scholz, Olav Böning, Ralph Theo Schermuly, Claudia Schumacher, Dieter Walmrath, and Gunter Hempelmann

Small-Dose Nitric Oxide Improves Oxygenation During One-Lung Ventilation: An Experimental Study
Anesth Analg 2002 95: 1557-1562. [Abstract] [Full Text]  

IMPLICATIONS: Inhaled nitric oxide at 4 ppm improves arterial oxygenation during one-lung ventilation to a greater extent than larger doses, and this effect is caused by a reduction in intrapulmonary shunt.

Lawrence C. Tsen, Scott Segal, Margaret Pothier, L. Howard Hartley, and Angela M. Bader

The Effect of Alterations in a Preoperative Assessment Clinic on Reducing the Number and Improving the Yield of Cardiology Consultations
Anesth Analg 2002 95: 1563-1568. [Abstract] [Full Text]  

IMPLICATIONS: Alterations in preoperative assessment testing clinic consultation algorithms, education, and staffing can significantly reduce the use of preoperative cardiology consultations while improving their overall yield.

Edwin G. Avery and Thomas E. MacGillivray

Arrested Paradoxical Emboli in Transit Diagnosed by Intraoperative Transesophageal Echocardiography (Case Report)
Anesth Analg 2002 95: 1569-1571. [Abstract] [Full Text] VIDEO FILES  

IMPLICATIONS:We describe a patient who developed a deep venous thrombosis that subsequently embolized to both the pulmonary and systemic arterial circulations. The diagnosis of arrested paradoxical embolus in transit at two separate and unique anatomic locations was made with intraoperative transesophageal echocardiography, and the patient did not suffer organ damage as a result of the paradoxical emboli.

PEDIATRIC ANESTHESIA:

Robert H. Friesen, Jonathan L. Wurl, and Richard M. Friesen

Duration of Preoperative Fast Correlates with Arterial Blood Pressure Response to Halothane in Infants
Anesth Analg 2002 95: 1572-1576. [Abstract] [Full Text]  

IMPLICATIONS: We studied changes in blood pressure during halothane anesthesia in infants and children and found that blood pressure decreased to a greater extent in infants who fasted for longer than 8 h before surgery. This exacerbation of the already significant hemodynamic depression observed in infants during halothane anesthesia underscores the importance of adherence to published fasting guidelines.

Thomas O. Erb, Janet M. Hall, Richard J. Ing, Ronald J. Kanter, Frank H. Kern, Scott R. Schulman, and Tong J. Gan

Postoperative Nausea and Vomiting in Children and Adolescents Undergoing Radiofrequency Catheter Ablation: A Randomized Comparison of Propofol- and Isoflurane-Based Anesthetics
Anesth Analg 2002 95: 1577-1581. [Abstract] [Full Text]  

IMPLICATIONS: In children undergoing radiofrequency catheter ablation and receiving prophylactic ondansetron, a frequent incidence (60%) of postoperative vomiting was observed under an isoflurane-based anesthetic, whereas the incidence was significantly reduced to a very low level (5%) under a propofol-based anesthetic.

Dinesh K. Choudhry and B. Randall Brenn

Bispectral Index Monitoring: A Comparison Between Normal Children and Children with Quadriplegic Cerebral Palsy
Anesth Analg 2002 95: 1582-1585. [Abstract] [Full Text]  

IMPLICATIONS: We compared bispectral (BIS) values with different sevoflurane concentrations between normal children and children with cerebral palsy. We observed that, in children with cerebral palsy, BIS values exhibited a similar pattern of change as is observed in normal children. However, absolute BIS values obtained in such children are lower than those in normal children while awake and at different sevoflurane concentrations.

Jae-Hyon Bahk, Joohon Sung, and In-Jin Jang

A Comparison of Ketamine and Lidocaine Spray with Propofol for the Insertion of Laryngeal Mask Airway in Children: A Double-Blinded Randomized Trial
Anesth Analg 2002 95: 1586-1589. [Abstract] [Full Text]  

IMPLICATIONS: Ketamine and lidocaine spray appear to be appropriate for laryngeal mask airway (LMA) insertion in children. Thus, apnea and airway obstruction, the two most serious and frequent complications of propofol, can be avoided during LMA insertion.

AMBULATORY ANESTHESIA:

M. J. Sanchez-Ledesma, L. López-Olaondo, F. J. Pueyo, F. Carrascosa, and A. Ortega

A Comparison of Three Antiemetic Combinations for the Prevention of Postoperative Nausea and Vomiting
Anesth Analg 2002 95: 1590-1595. [Abstract] [Full Text]  

IMPLICATIONS: The combination of ondansetron plus dexamethasone or droperidol was significantly better than the combination of dexamethasone plus droperidol in the prophylaxis of postoperative nausea and vomiting in women undergoing general anesthesia for major gynecological surgery, with intrathecal and IV morphine (patient-controlled analgesia) for management of postoperative pain.

Bruce Ben-David, Patrick J. DeMeo, Christen Lucyk, and David Solosko

Minidose Lidocaine-Fentanyl Spinal Anesthesia in Ambulatory Surgery: Prophylactic Nalbuphine Versus Nalbuphine Plus Droperidol
Anesth Analg 2002 95: 1596-1600. [Abstract] [Full Text]  

IMPLICATIONS: Droperidol in combination with nalbuphine enhances analgesia and is more effective than nalbuphine alone in preventing pruritus, nausea, and vomiting after minidose lidocaine-fentanyl spinal anesthesia.

Jan L. De Witte, Carmen Alegret, Daniel I. Sessler, and Guy Cammu

Preoperative Alprazolam Reduces Anxiety in Ambulatory Surgery Patients: A Comparison with Oral Midazolam
Anesth Analg 2002 95: 1601-1606. [Abstract] [Full Text]  

IMPLICATIONS: Oral alprazolam 0.5 mg and midazolam 7.5 mg comparably reduce anxiety in ambulatory surgery patients. Despite early psychomotor impairment, neither drug delays postanesthetic extubation nor prolongs discharge from the postanesthesia care unit.

ANESTHETIC PHARMACOLOGY:

Kazuyoshi Hirota, Yoshio Hashimoto, and David G. Lambert

Interaction of Intravenous Anesthetics with Recombinant Human M1-M3 Muscarinic Receptors Expressed in Chinese Hamster Ovary Cells
Anesth Analg 2002 95: 1607-1610. [Abstract] [Full Text]  

IMPLICATIONS: In this study using recombinant human M1-M3 muscarinic receptors, we show that for agonist-stimulated increases in intracellular Ca2+ thiopental acts as a M3 antagonist.

Edmond I Eger, II, Diane Gong, Yilei Xing, Douglas E. Raines, and Pamela Flood

Acetylcholine Receptors and Thresholds for Convulsions from Flurothyl and 1,2-Dichlorohexafluorocyclobutane
Anesth Analg 2002 95: 1611-1615. [Abstract] [Full Text]  

IMPLICATIONS: The results from the present study provide conflicting data concerning the notion that acetylcholine receptors mediate the capacity of nonimmobilizers to produce convulsions.

R. Ross Kennedy, Richard A. French, and Christopher Spencer

Predictive Accuracy of a Model of Volatile Anesthetic Uptake
Anesth Analg 2002 95: 1616-1621. [Abstract] [Full Text]  

IMPLICATIONS: We compared measured inhaled anesthetic concentrations with those predicted by a model. The method used for comparison has been used to study models of propofol administration. Our model predicts expired isoflurane and sevoflurane concentrations at least as well as common propofol models predict arterial propofol concentrations.

Steven L. Jinks, Joseph F. Antognini, John T. Martin, S.- W. Jung, Earl Carstens, and Richard Atherley

Isoflurane, but Not Halothane, Depresses C-Fos Expression in Rat Spinal Cord at Concentrations that Suppress Reflex Movement After Supramaximal Noxious Stimulation
Anesth Analg 2002 95: 1622-1628. [Abstract] [Full Text]  

IMPLICATIONS: Isoflurane depressed neuronal activity in the spinal cord as measured with fos-like immunoreactivity (FLI), but this occurred only when reflex withdrawal responses were abolished. Halothane, however, did not depress FLI, even at concentrations sufficient to block reflex withdrawal. These two anesthetics may have differing effects on neuronal function and responses.

Cornelius Keyl, Annette Schneider, Jonny Hobbhahn, and Luciano Bernardi

Sinusoidal Neck Suction for Evaluation of Baroreflex Sensitivity During Desflurane and Sevoflurane Anesthesia
Anesth Analg 2002 95: 1629-1636. [Abstract] [Full Text]  

IMPLICATIONS: Despite exhibiting different effects on autonomic activity, sevoflurane and desflurane depress the baroreflex-mediated short-term control of heart rate and blood pressure in a similar manner.

Noriaki Kanaya, Paul A. Murray, and Derek S. Damron

The Differential Effects of Midazolam and Diazepam on Intracellular Ca²⁺ Transients and Contraction in Adult Rat Ventricular Myocytes
Anesth Analg 2002 95: 1637-1644. [Abstract] [Full Text]  

IMPLICATIONS: Midazolam and diazepam differentially alter the cardiac excitation-contraction coupling at the cellular level, which is mediated by altering the availability of intracellular free Ca2+ in adult rat ventricular myocytes. In addition, diazepam, but not midazolam, decreases myofilament Ca2+ sensitivity. However, the benzodiazepines have no direct influence on excitation-contraction coupling, except at very large doses.

Neil M. Agnew, Jonathan B. Kendall, Maria Akrofi, Jane Tran, Ajaib S. Soorae, Richard Page, Glenn N. Russell, and Stephen H. Pennefather

Gastroesophageal Reflux and Tracheal Aspiration in the Thoracotomy Position: Should Ranitidine Premedication be Routine?
Anesth Analg 2002 95: 1645-1649. [Abstract] [Full Text]  

IMPLICATIONS: Gastroesophageal reflux (GER) and tracheal aspiration of acid may increase morbidity and mortality in patients undergoing thoracotomy. This randomized, double-blinded, placebo-controlled study demonstrates frequent incidences of both acid GER and tracheal acid aspiration during surgery that are significantly reduced by premedication with ranitidine.

C.U. Wiklund, U. Lindsten, S. Lim, and S.G.E. Lindahl

Interactions of Volatile Anesthetics with Cholinergic, Tachykinin, and Leukotriene Mechanisms in Isolated Guinea Pig Bronchial Smooth Muscle
Anesth Analg 2002 95: 1650-1655. [Abstract] [Full Text]  

IMPLICATIONS: Halothane, sevoflurane, and desflurane attenuated airway smooth muscle tone via inhibition of cholinergic and nonadrenergic noncholinergic neurotransmission. Sevoflurane and desflurane reduced leukotriene C4-induced bronchoconstriction, whereas halothane did not. This indicates a beneficial role for sevoflurane and desflurane in asthmatics.

Kyo S. Kim, Se H. Lew, Hee Y. Cho, and Mi A. Cheong

Residual Paralysis Induced by Either Vecuronium or Rocuronium After Reversal with Pyridostigmine
Anesth Analg 2002 95: 1656-1660. [Abstract] [Full Text]  

IMPLICATIONS: Without monitoring, the significant residual neuromuscular block after vecuronium or rocuronium is not eliminated even by reversal with a large dose of pyridostigmine and can still be a problem in the recovery room.

Takafumi Horishita, Kouichiro Minami, Nobuyuki Yanagihara, Munehiro Shiraishi, Takashi Okamoto, Yousuke Shiga, Susumu Ueno, and Akio Shigematsu

Alphaxalone, a Neurosteroid Anesthetic, Inhibits Norepinephrine Transporter Function in Cultured Bovine Adrenal Medullary Cells
Anesth Analg 2002 95: 1661-1666. [Abstract] [Full Text]  

IMPLICATIONS: Alphaxalone inhibited the desipramine-sensitive uptake of [3H]-norepinephrine (NE) by interfering with desipramine binding in bovine adrenal medullary cells. A bolus IV administration of alphaxalone slightly and significantly increased the serum NE levels in anesthetized rats. These findings suggest that alphaxalone competitively inhibits NE transporter function probably in sympathetic neurons.

Avery Tung, BobbieJean Sweitzer, and Thomas Cutter

Cardiac Arrest After Labetalol and Metoclopramide Administration in a Patient with Scleroderma (Case Report)
Anesth Analg 2002 95: 1667-1668. [Abstract] [Full Text]  

IMPLICATIONS: Although recent Food and Drug Administration warnings have noted proarrhythmic effects of droperidol, other antiemetic drugs may have similar effects. We report a case of cardiac arrest after uncomplicated regional anesthesia in a patient with scleroderma who received labetalol and metoclopramide after surgery. Metoclopramide should be used with caution when risk factors for dysrhythmia are present.

TECHNOLOGY, COMPUTING, AND SIMULATION:

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

A Comparison of Patient State Index and Bispectral Index Values During the Perioperative Period
Anesth Analg 2002 95: 1669-1674. [Abstract] [Full Text]  

IMPLICATIONS: The patient state index could be a useful alternative to the bispectral index for assessing level of consciousness during the induction of and emergence from anesthesia, as well as for titrating IV and volatile anesthetics during surgery.

Thomas M. Hemmerling, Claudia Coimbra, Pierre Harvey, and Manon Choinière

Needle Electrodes Can Be Used for Bispectral Index Monitoring of Sedation in Burn Patients (Technical Communication)
Anesth Analg 2002 95: 1675-1677. [Abstract] [Full Text]  

IMPLICATIONS: We present the results of a study examining the agreement of bispectral index values obtained using original sensor and subdermal needle electrodes in burn patients. Both types of electrodes can be used interchangeably to monitor depth of sedation.

Thomas M. Hemmerling and Brigitte Migneault

Falsely Increased Bispectral Index During Endoscopic Shoulder Surgery Attributed to Interferences with the Endoscopic Shaver Device (Case Report)
Anesth Analg 2002 95: 1678-1679. [Abstract] [Full Text]  

IMPLICATIONS: Endoscopic shaver activity can cause falsely increased bispectral index (BIS) readings. Close observation of BIS during periods with no shaver activity will reveal the true BIS and can be used to titrate depth of anesthesia. The reason for these interferences remain unclear.

Marie-Paule L. A. Bouche, Linda F. M. Versichelen, Michel M. R. F. Struys, Jan F. P. Van Bocxlaer, André P. De Leenheer, Eric P. Mortier, and Georges Rolly

No Compound A Formation with Superia^® During Minimal-Flow Sevoflurane Anesthesia: A Comparison with Sofnolime^® (Case Report)
Anesth Analg 2002 95: 1680-1685. [Abstract] [Full Text]  

IMPLICATIONS: During minimal-flow 2.3%-2.5% end-tidal sevoflurane, no compound A (Co A) is formed with the NaOH- and KOH-free CO2 absorbent Superia. Although Co A values with KOH-free Sofnolime are still within reported safe limits, Superia is definitely an alternative for safe clinical practice.

Mohammad Golparvar, Hossein Naddafnia, and Mahmood Saghaei

Evaluating the Relationship Between Arterial Blood Pressure Changes and Indices of Pulse Oximetric Plethysmography (Case Report)
Anesth Analg 2002 95: 1686-1690. [Abstract] [Full Text]  

IMPLICATIONS: The cyclical respiratory-induced changes in the amplitude of the pulse oximeter waveform can be used to detect normotensive hypovolemia. This study shows that hypotension produces the same effect. Therefore, in hypotensive conditions, we cannot determine the presence of hypovolemia.

PAIN MEDICINE:

Terese T. Horlocker, Zahid H. Bajwa, Zubaira Ashraf, Sajid Khan, Jack L. Wilson, Naveed Sami, Christine Peeters-Asdourian, Christopher A. Powers, Darrell R. Schroeder, Paul A. Decker, and Carol A. Warfield

Risk Assessment of Hemorrhagic Complications Associated with Nonsteroidal Antiinflammatory Medications in Ambulatory Pain Clinic Patients Undergoing Epidural Steroid Injection
Anesth Analg 2002 95: 1691-1697. [Abstract] [Full Text]  

IMPLICATIONS: Previous studies performed in obstetric and surgical populations have demonstrated that antiplatelet therapy does not increase the risk of spinal hematoma associated with spinal or epidural anesthesia and analgesia. We confirm the safety of epidural steroid injection in patients receiving aspirin-like medications.

Maruãn Omais, Gabriela R. Lauretti, and Cleber A.J. Paccola

Epidural Morphine and Neostigmine for Postoperative Analgesia After Orthopedic Surgery
Anesth Analg 2002 95: 1698-1701. [Abstract] [Full Text]  

IMPLICATIONS: The combination of epidural morphine and epidural neostigmine resulted in postoperative analgesia (11 h) devoid of side effects, being an alternative analgesic technique in the population studied.

Ian Gilron, Debbie Tod, David H. Goldstein, Joel L. Parlow, and Elizabeth Orr

The Relationship Between Movement-Evoked Versus Spontaneous Pain and Peak Expiratory Flow After Abdominal Hysterectomy
Anesth Analg 2002 95: 1702-1707. [Abstract] [Full Text]  

IMPLICATIONS:Movement-evoked pain may be an important contributor to postoperative complications, but its mechanisms are poorly understood. This study provides the first evidence that postoperative evoked pain correlates with lung function and highlights the need for future research on mechanisms and implications of this phenomenon.

Keiichi Omote, Hiroki Yamamoto, Tomoyuki Kawamata, Yoshito Nakayama, and Akiyoshi Namiki

The Effects of Intrathecal Administration of an Antagonist for Prostaglandin E Receptor Subtype EP₁ on Mechanical and Thermal Hyperalgesia in a Rat Model of Postoperative Pain
Anesth Analg 2002 95: 1708-1712. [Abstract] [Full Text]  

IMPLICATIONS: We examined the effects of an intrathecally administered selective EP1 receptor antagonist on mechanical and thermal hyperalgesia in a postoperative pain model. The intrathecal EP1 receptor antagonist inhibited the mechanical, but not thermal, hyperalgesia, indicating the potential for an EP1 receptor antagonist to be used as an analgesic for postoperative pain, especially incident pain.

Ashley R. Webb, Samuel Leong, Paul S. Myles, and Sara J. Burn

The Addition of a Tramadol Infusion to Morphine Patient-Controlled Analgesia After Abdominal Surgery: A Double-Blinded, Placebo-Controlled Randomized Trial
Anesth Analg 2002 95: 1713-1718. [Abstract] [Full Text]  

IMPLICATIONS: In this study, we determined whether adding a second pain-killing drug, tramadol, could improve pain relief after major surgery in patients receiving morphine patient-controlled analgesia. We found that patients receiving tramadol had significantly better opinions of their pain relief and used significantly less morphine with no increase in side effects.

Chandra K. Pandey, Neeta Bose, Garima Garg, Namita Singh, Arvind Baronia, Anil Agarwal, Prabhat K. Singh, and Uttam Singh

Gabapentin for the Treatment of Pain in Guillain-Barré Syndrome: A Double-Blinded, Placebo-Controlled, Crossover Study
Anesth Analg 2002 95: 1719-1723. [Abstract] [Full Text]  

IMPLICATIONS: Gabapentin, an antiepileptic drug, has been used effectively for different types of pain management. This study demonstrates that gabapentin has minimal side effects and is an alternative to opioids and nonsteroidal antiinflammatory drugs for management of the bimodal nature of pain of Guillain-Barre Syndrome patients.

Jan H. Vranken, Marinus H. van der Vegt, Leon H. Ubags, Aarnout J. Pijl, and Misa Dzoljic

Continuous Sacral Nerve Root Block in the Management of Neuropathic Cancer Pain (Case Report)
Anesth Analg 2002 95: 1724-1725. [Abstract] [Full Text]  

IMPLICATIONS: Neuropathic cancer pain caused by tumor infiltration in the sacral plexus is primarily treated by nonsteroidal antiinflammatory drugs, antidepressants, anticonvulsants, and opioids. In one patient with severe pain despite pharmacotherapy, a catheter for the continuous administration of local anesthetics was inserted along the first sacral root, resulting in markedly improved analgesia.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

Richard H. Epstein and Franklin Dexter

Uncertainty in Knowing the Operating Rooms in Which Cases Were Performed Has Little Effect on Operating Room Allocations or Efficiency
Anesth Analg 2002 95: 1726-1730. [Abstract] [Full Text]  

IMPLICATIONS: Up to a 30% uncertainty in knowing the actual operating room (OR) in which cases were performed had a minor effect on OR allocations to maximize OR efficiency and on the resulting staffing costs. Thus, facilities with this common error in their OR information systems data will generally be able to use their existing data for accurate OR allocations.

MEDICAL INTELLIGENCE:

Alex M. Zbinden

Introducing a Balanced Scorecard Management System in a University Anesthesiology Department
Anesth Analg 2002 95: 1731-1738. [Abstract] [Full Text]  

IMPLICATIONS: The study goal was to show how Balanced Scorecard, a modern management tool based on score numbers, can efficiently be applied to a university anesthesiology department. Nineteen score numbers were established in four perspectives. Meaningful results were obtained with limited resources to support a process of innovation and improvement.

CRITICAL CARE AND TRAUMA:

Sushil P. Ambesh, Chandra K. Pandey, Shashi Srivastava, Anil Agarwal, and Dinesh K. Singh

Percutaneous Tracheostomy with Single Dilatation Technique: A Prospective, Randomized Comparison of Ciaglia Blue Rhino Versus Griggs’ Guidewire Dilating Forceps
Anesth Analg 2002 95: 1739-1745. [Abstract] [Full Text]  

IMPLICATIONS: The tracheas of 60 patients were cannulated through an artificial opening by using a single-step dilation technique with Ciaglia Blue Rhino or Griggs' dilation forceps. The techniques were equally effective for cannulation of the trachea. However, Ciaglia Blue Rhino was associated with rupture of tracheal rings in one-third of patients and increased airway pressure in all, whereas the Griggs' technique was associated with under- or over-formation of the tracheal opening, each in one-third of patients.

NEUROSURGICAL ANESTHESIA:

Christophe Broux, Irène Tropres, Olivier Montigon, Cécile Julien, Michel Decorps, and Jean-François Payen

The Effects of Sustained Hyperventilation on Regional Cerebral Blood Volume in Thiopental-Anesthetized Rats
Anesth Analg 2002 95: 1746-1751. [Abstract] [Full Text]  

IMPLICATIONS: Sustained hyperventilation has a transient effect in decreasing cerebral blood volume (CBV). Using susceptibility contrast magnetic resonance imaging in thiopental-anesthetized rats, we found differences between brain regions in their transient CBV response to sustained hyperventilation.

Anthony G. Doufas, Ozan Akça, Atul Barry, David A. Petrusca, Mohammad-Irfan Suleman, Nobutada Morioka, John J. Guarnaschelli, and Daniel I. Sessler

Initial Experience with a Novel Heat-Exchanging Catheter in Neurosurgical Patients
Anesth Analg 2002 95: 1752-1756. [Abstract] [Full Text]  

IMPLICATIONS: Because current systems for inducing therapeutic hypothermia are too slow, we tested an internal counter-current thermal management system during hypothermic neurosurgery. The SetPoint(R) catheter cooled at 3.9{degrees}C {+/-} 1.6{degrees}C/h and rewarmed at 2.0{degrees}C {+/-} 0.5{degrees}C/h. Catheter-based internal thermal management thus seems to be rapid and effective.

REGIONAL ANESTHESIA:

Jan Widman, Folke Hammarqvist, and Eva Selldén

Amino Acid Infusion Induces Thermogenesis and Reduces Blood Loss During Hip Arthroplasty Under Spinal Anesthesia
Anesth Analg 2002 95: 1757-1762. [Abstract] [Full Text]  

IMPLICATIONS: Infusion of a balanced mixture of amino acids during spinal anesthesia prevented core body temperature decrease. Bleeding was also less pronounced.

Yavuz Gürkan and Kamil Toker

Prophylactic Ondansetron Reduces the Incidence of Intrathecal Fentanyl-Induced Pruritus
Anesth Analg 2002 95: 1763-1766. [Abstract] [Full Text]  

IMPLICATIONS: Pruritus is a commonly reported side effect after intrathecal fentanyl administration during spinal anesthesia. This study was performed in a prospective, randomized, double-blinded, placebo-controlled manner to investigate the efficacy of prophylactic IV ondansetron in the prevention of pruritus after intrathecal fentanyl administration during spinal anesthesia. The incidence of pruritus was significantly more frequent in the placebo group compared with the ondansetron group (68% versus 39%) (P = 0.001).

Sandra Kampe, Peter Kiencke, Jens Krombach, Karen Cranfield, Stefan Mario Kasper, and Christoph Diefenbach

Current Practice in Postoperative Epidural Analgesia: A German Survey
Anesth Analg 2002 95: 1767-1769. [Abstract] [Full Text]  

IMPLICATIONS: We surveyed current German practice in postoperative epidural analgesia. We found that the availability of a 24-h acute pain service (41%) in German hospitals corresponds favorably to international practice. Epidural analgesia with the combination of local anesthetics and opioids was the most common modality in the ward setting.

James H. Diaz

Chronic Postoperative Epidural Abscess with Ascending Neuromyotonia (Case Report)
Anesth Analg 2002 95: 1770-1771. [Abstract] [Full Text]  

IMPLICATIONS: Clinicians are reminded that epidural abscesses may not follow epidural space violation, may present a confusing constellation of back pain and paraparesis, and may have serious consequences if not diagnosed accurately and managed aggressively with spinal decompression.

GENERAL ARTICLES:

Alexander Loeckinger, Axel Kleinsasser, Christian Keller, Andreas Schaefer, Christian Kolbitsch, Karl H. Lindner, and Arnulf Benzer

Administration of Oxygen Before Tracheal Extubation Worsens Gas Exchange After General Anesthesia in a Pig Model
Anesth Analg 2002 95: 1772-1776. [Abstract] [Full Text]  

IMPLICATIONS: Blood flow to lung units with a low VA/Q ratio was significantly larger in pigs that had been exposed to 100% oxygen before extubation as compared with those exposed to 30% oxygen before extubation.

Zilgia Benoît, Stephan Wicky, Jean-François Fischer, Philippe Frascarolo, Carine Chapuis, Donat R. Spahn, and Lennart Magnusson

The Effect of Increased FIO₂ Before Tracheal Extubation on Postoperative Atelectasis
Anesth Analg 2002 95: 1777-1781. [Abstract] [Full Text]  

IMPLICATIONS: For safety reasons, it is common to ventilate patients with 100% oxygen before tracheal extubation. This study demonstrates that this practice favors postoperative atelectasis.

Michael S. Stix and Cornelius J. O’Connor, Jr.

Maximum Minute Ventilation Test for the ProSeal^TM Laryngeal Mask Airway
Anesth Analg 2002 95: 1782-1787. [Abstract] [Full Text]  

IMPLICATIONS: One of the distinguishing features of the ProSealTM laryngeal mask airway (PLMA) is that it can cause upper airway obstruction, even when it is correctly inserted behind the cricoid cartilage. We used a hyperventilation test, the maximum minute ventilation test, to aid in the diagnosis of upper airway obstruction after PLMA insertion.

A.- S. Eichenberger, S. Proietti, S. Wicky, P. Frascarolo, M. Suter, D. R. Spahn, and L. Magnusson

Morbid Obesity and Postoperative Pulmonary Atelectasis: An Underestimated Problem
Anesth Analg 2002 95: 1788-1792. [Abstract] [Full Text]  

IMPLICATIONS: We compared the resolution over time of pulmonary atelectasis after a laparoscopic procedure by performing computed tomography scans in two different groups of patients: 1 group had 10 nonobese patients, and in the other group there were 20 morbidly obese patients.

Babatunde O. Ogunnaike, Stephanie B. Jones, Daniel B. Jones, David Provost, and Charles W. Whitten

Anesthetic Considerations for Bariatric Surgery (Review Article)
Anesth Analg 2002 95: 1793-1805. [Full Text]  

Aline Albi, François Baudin, Moussa Matmar, Denis Archambeau, and Yves Ozier

Severe Hypernatremia After Hypertonic Saline Irrigation of Hydatid Cysts (Case Report)
Anesth Analg 2002 95: 1806-1808. [Abstract] [Full Text]  

IMPLICATIONS: Patients with iatrogenic hypernatremia and serum sodium levels >170 mmol/L either die or sustain severe central nervous system damage. We report the first case of an adult patient who survived an extreme iatrogenic acute hypernatremia (200 mmol/L) resulting from a hypertonic saline irrigation of multiple intraabdominal hydatid cysts. It is a unique report of an intraoperatively developed serum sodium increase without subsequent neurological damage.

Greg Stratmann and Jonathan L. Benumof

Near Tracheal Extubation Because of Edema of the Face and Tongue (Case Report)
Anesth Analg 2002 95: 1809-1811. [Abstract] [Full Text]  

IMPLICATIONS: Edema of the face and tongue can cause migration of the endotracheal tube out of the trachea. The present case illustrates the importance of preventing this potentially disastrous complication because reintubation might be impossible when the edema is severe.

MEETING REPORT:

Ralf Baron, Howard L. Fields, Wilfrid Jänig, Cheryl Kitt, and Jon D. Levine

National Institutes of Health Workshop: Reflex Sympathetic Dystrophy/Complex Regional Pain Syndromes— State-of-the-Science
Anesth Analg 2002 95: 1812-1816. [Full Text]  

LETTERS TO THE EDITOR:

Neville W. Goodman, Peter Pronovost, Sean Berenholtz, Todd Dorman, Elizabeth Martinez, and William Merritt

Evidence-Based Medicine Needs Proper Critical Review • Response
Anesth Analg 2002 95: 1817-1818. [Full Text]  

Radha Sukhani, Kenneth D. Candido, and Alon P. Winnie

Interscalene Brachial Plexus Block: Shoulder Paresthesia versus Deltoid Motor Response: Revisiting the Anatomy to Settle the Controversy • Response
Anesth Analg 2002 95: 1818-1819. [Full Text]  

Ziya Salihoglu, Sener Demiroluk, Oktay Demirkiran, Mete Duren, and Nihat Yavuz

Videoendoscopic Parathyroidectomy: Gaseous or Gasless Technique?
Anesth Analg 2002 95: 1819. [Full Text]  

R. M. Khan, F. Jafri, W. Huda, S. M. Ahmed, and M. Maroof

Acute Transient Sialodenopathy After the Use of PAXpress^TM
Anesth Analg 2002 95: 1819-1820. [Full Text]  

C. Schmidt, A. Reich, H. Van Aken, D. Stanojevic, M. Booke, Gregory A. Nuttall, and Lance J. Oyen

Dosing Aprotinin: Is Weight-Adjustment the Way to Go? • Response
Anesth Analg 2002 95: 1820-1821. [Full Text]  

Roland Walz, Michael Bund, and Charles Beattie

The Modified Nasal Trumpet Maneuver • Response
Anesth Analg 2002 95: 1821. [Full Text]  

Nilesh Parekh, Nicholas J. Wilkes, Susan V. Mallett, and Michael G. Mythen

Hyperchloremic Acidosis • Response
Anesth Analg 2002 95: 1821-1822. [Full Text]  

Hasmig Salibian, Sanjay Jain, David Gabriel, and Ruben J. Azocar

Conversion of an Oral to Nasal Orotracheal Intubation Using an Endotracheal Tube Exchanger
Anesth Analg 2002 95: 1822. [Full Text]  

Gerhard Schwarz, Georg Feigl, Reinhold Kleinert, Christian Dorn, Gerhard Litscher, Andreas Sandner-Kiesling, and Norbert Bock

Pneumatic Pulse Simulation for Teaching Peripheral Plexus Blocks in Cadavers
Anesth Analg 2002 95: 1822-1823. [Full Text]  

R. Peter Alston, Ian J. Deary, Michael J. Robson, Peter J. Andrews, and Michael J. Souter

Another Example of Regression to the Mean (Not)
Anesth Analg 2002 95: 1823. [Full Text]  

Thomas Schricker, Athos J. Rassias, and Mark P. Yeager

On the Failure of Insulin to Affect Hyperglycemia During Cardiac Surgery • Response
Anesth Analg 2002 95: 1823-1824. [Full Text]  

Benoît Vivien, Olivier Langeron, and Bruno Riou

Increase in Bispectral Index (BIS) While Correcting a Severe Hypoglycemia
Anesth Analg 2002 95: 1824-1825. [Full Text]  

S.K. Chua and M. B. Bloch

Epidural Morphine Alone Is Inadequate for Postthoracotomy Pain Relief • Response
Anesth Analg 2002 95: 1825. [Full Text]  

P. Zimmermann, T. Papenfuss, U. Schwemmer, and C. A. Greim

Vertical Infraclavicular Brachial Plexus Block in a Child with Cystic Fibrosis
Anesth Analg 2002 95: 1825-1826. [Full Text]  

Thomas M. Hemmerling, François Donati, and Ashraf A. Dahaba

The M-NMT Mechanosensor Cannot be Considered as a Reliable Clinical Neuromuscular Monitor in Daily Anesthesia Practice • Response
Anesth Analg 2002 95: 1826-1827. [Full Text]  

Francis Veyckemans, Marc Hamoir, Philippe Rombaux, Luc J. Van Obbergh, and Raymond Reding

Preoperative Tracheoscopy in Neonates with Esophageal Atresia
Anesth Analg 2002 95: 1827-1828. [Full Text]  

BOOK AND MULTIMEDIA REVIEWS:

William C. Wilson, Robert E. Shangraw, John P. Adams, Steffen Schmidt, and David J. Wlody

Trauma, Volume 40, No. 3 of International Anesthesiology Clinics • Fundamental Principles and Clinical Practice of Anaesthesia • Manual of Pain Management, 2nd Edition • Handbook of Obstetric Anesthesia • Books and Multimedia Received
Anesth Analg 2002 95: 1829-1831. [Full Text]  

GUEST REVIEWS:

GUEST REVIEWER LIST: April 1, 2002 to September 30, 2002
Anesth Analg 2002 95: 1832-1835. [Full Text]  

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