CARDIOVASCULAR ANESTHESIOLOGY:

Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vasc, WRITING COMMITTEE MEMBERS, Lee A. Fleisher, Joshua A. Beckman, Kenneth A. Brown, Hugh Calkins, Elliott Chaikof, Kirsten E. Fleischmann, William K. Freeman, James B. Froehlich, Edward K. Kasper, Judy R. Kersten, Barbara Riegel, John F. Robb, ACC/AHA TASK FORCE MEMBERS, Sidney C. Smith, Jr, Alice K. Jacobs, Cynthia D. Adams, Jeffrey L. Anderson, Elliott M. Antman, Christopher E. Buller, Mark A. Creager, Steven M. Ettinger, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Sharon A. Hunt, Bruce W. Lytle, Rick Nishimura, Joseph P. Ornato, Richard L. Page, Barbara Riegel, Lynn G. Tarkington, and Clyde W. Yancy

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) (Special Article)
Anesth Analg 2008 106: 685-712. [Full Text] [PDF] [CME]  

Roman Sniecinski, Fania Szlam, Edward P. Chen, Stephen O. Bader, Jerrold H. Levy, and Kenichi A. Tanaka

Antithrombin Deficiency Increases Thrombin Activity After Prolonged Cardiopulmonary Bypass
Anesth Analg 2008 106: 713-718. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Antithrombin levels are severely decreased after cardiopulmonary bypass with deep hypothermic circulatory arrest. The administration of hemostatic blood products in this setting without repletion of anticoagulant elements such as antithrombin may lead to excessive systemic thrombin generation, creating a potentially hypercoaguable state.

Fania Szlam, Taro Taketomi, Chelsea A. Sheppard, Christine L. Kempton, Jerrold H. Levy, and Kenichi A. Tanaka

Antithrombin Affects Hemostatic Response to Recombinant Activated Factor VII in Factor VIII Deficient Plasma
Anesth Analg 2008 106: 719-724. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Hemophilia A was modeled using factor VIII-deficient plasma and hemostatic responses to recombinant activated factor VII (rFVIIa) were studied in vitro in the presence of normal and reduced antithrombin levels. We observed enhanced thrombin generation in the presence of decreased antithrombin concentrations, an effect enhanced by rFVIIa.

Thorsten Haas, Dietmar Fries, Corinna Velik-Salchner, Elgar Oswald, and Petra Innerhofer

Fibrinogen in Craniosynostosis Surgery
Anesth Analg 2008 106: 725-731. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Impairment of fibrinogen polymerization and decreased total clot strength during craniosynostosis surgery in children, due to massive blood loss and necessary intravascular volume therapy were successfully treated by substituting human fibrinogen concentrates, thereby avoiding the need for fresh frozen plasma or platelets.

Kenichi A. Tanaka, Taro Taketomi, Fania Szlam, Andreas Calatzis, and Jerrold H. Levy

Improved Clot Formation by Combined Administration of Activated Factor VII (NovoSeven®) and Fibrinogen (Haemocomplettan® P)
Anesth Analg 2008 106: 732-738. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: The main hemostatic effect of recombinant-activated factor (rFVIIa) is to increase the rate of thrombin generation, whereas fibrinogen increases fibrin clot strength. Using both rFVIIa and fibrinogen, in vitro clot formation was most improved in whole blood after cardiopulmonary bypass.

Fellery de Lange, Wilbert L. Jones, George Burkhard Mackensen, and Hilary P. Grocott

The Effect of Limited Rewarming and Postoperative Hypothermia on Cognitive Function in a Rat Cardiopulmonary Bypass Model
Anesth Analg 2008 106: 739-745. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Hypothermia, when instituted during cardiopulmonary bypass and maintained into the postoperative period with limited rewarming, decreases postoperative cognitive dysfunction.

Steven R. Insler, Mohamed H. Bakri, Fady Nageeb, Edward Mascha, Tomislav Mihaljevic, and Daniel I. Sessler

An Evaluation of a Full-Access Underbody Forced-Air Warming System During Near-Normothermic, On-pump Cardiac Surgery
Anesth Analg 2008 106: 746-750. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: The addition of an underbody forced-air warming system to the near-normothermic thermal management protocol used at the Cleveland Clinic significantly increased pre-bypass temperature. However, supplemental warming had no further clinically important effect on core temperature and patients in both groups were normothermic upon leaving the operating room.

Miklos D. Kertai

Preoperative Coronary Revascularization in High-Risk Patients Undergoing Vascular Surgery: A Core Review (Review Article)
Anesth Analg 2008 106: 751-758. [Abstract] [Full Text] [PDF]  

Giora Landesberg and Morris Mosseri

PRO: Preoperative Coronary Revascularization in High-Risk Patients Undergoing Vascular Surgery (Editorial)
Anesth Analg 2008 106: 759-763. [Full Text] [PDF]  

Santiago Garcia and Edward O. McFalls

CON: Preoperative Coronary Revascularization in High-Risk Patients Undergoing Vascular Surgery (Editorial)
Anesth Analg 2008 106: 764-766. [Full Text] [PDF]  

Mojca Konia, Jeffrey Uppington, Peter Moore, and Hong Liu

Ascending Aortic Pseudoaneurysm: A Late Complication of Coronary Artery Bypass (Echo Rounds)
Anesth Analg 2008 106: 767-768. [Full Text] [PDF] [CME] [Echo Loops]   

Thomas M. Burch, Mark F. Davidson, and Sara J. Pereira

Use of Transesophageal Echocardiography in the Evaluation and Surgical Treatment of a Patient with an Aneurysmal Interatrial Septum and an Intracardiac Thrombus Traversing a Patent Foramen Ovale (Echo Rounds)
Anesth Analg 2008 106: 769-770. [Full Text] [PDF] [CME] [Echo Loops]   

Mikhail R. Sukernik and William R. Davidson, Jr

Incidental Finding of Incompletely Ligated Left Atrial Appendage in a Patient with Systemic Hypotension (Echo Rounds)
Anesth Analg 2008 106: 771-772. [Full Text] [PDF] [CME] [Echo Loops]   

PEDIATRIC ANESTHESIOLOGY:

Athanasios G. Kaditis, Etsuro K. Motoyama, Walter Zin, Nobuhiro Maekawa, Isuta Nishio, Taiyo Imai, and Joseph Milic-Emili

The Effect of Lung Expansion and Positive End-Expiratory Pressure on Respiratory Mechanics in Anesthetized Children
Anesth Analg 2008 106: 775-785. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Physiological studies in anesthetized, paralyzed, and mechanically ventilated children showed that the resting lung volume is markedly decreased even after lung recruitment total lung capacity maneuvers and positive end-expiratory pressure as clinically recommended. In addition, the viscoelastic (tissue) component of respiratory system resistance, which had been considered insignificant, was found to be a major component of the total resistance and may affect the clinical management of ventilated patients.

Thomas R. Vetter

A Clinical Profile of a Cohort of Patients Referred to an Anesthesiology-Based Pediatric Chronic Pain Medicine Program
Anesth Analg 2008 106: 786-794. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Pediatric patients previously under the care of another subspecialist for their chronic pain and subsequently referred to an anesthesiology-based pediatric chronic pain medicine program seem to be experiencing significantly worse health-related quality of life.

Patrick Meybohm, Grischa Hoffmann, Jochen Renner, Andreas Boening, Erol Cavus, Markus Steinfath, Jens Scholz, and Berthold Bein

Measurement of Blood Flow Index During Antegrade Selective Cerebral Perfusion with Near-Infrared Spectroscopy in Newborn Piglets
Anesth Analg 2008 106: 795-803. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Selective cerebral perfusion at 50 mL {middle dot} kg-1 {middle dot} min-1 may result in higher intracranial pressure compared with baseline. The results of the present study also indicate that near-infrared spectroscopy-derived blood blow index adds further information about changes of cerebral perfusion during bypass and selective cerebral perfusion during congenital heart surgery in infants and newborns.

AMBULATORY ANESTHESIOLOGY:

Diana S. Bass, Deborah K. Attix, Barbara Phillips-Bute, and Terri G. Monk

An Efficient Screening Tool for Preoperative Depression: The Geriatric Depression Scale-Short Form
Anesth Analg 2008 106: 805-809. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Validity for an efficient screening tool for depression is established, and depression prevalence rates in a presurgical sample are demonstrated, highlighting the need for screening in this population.

Jill MacLaren and Zeev N. Kain

A Comparison of Preoperative Anxiety in Female Patients with Mothers of Children Undergoing Surgery (Brief Report)
Anesth Analg 2008 106: 810-813. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Mothers of children undergoing surgery are more anxious than women undergoing minor surgery themselves. Predictors of maternal anxiety include child age and maternal monitoring coping.

Anil Agarwal, Ghanshyam Yadav, Devendra Gupta, Manish Tandon, Prabhat Kumar Singh, and Uttam Singh

The Role of a Flash of Light for Attenuation of Venous Cannulation Pain: A Prospective, Randomized, Placebo-Controlled Study (Brief Report)
Anesth Analg 2008 106: 814-816. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Venous cannulation is frequently performed without any analgesia. We observed a significant reduction in the incidence and severity of venous cannulation pain after a flash of light. This is a safe, effective, and easy-to-use method to minimize venous cannulation pain.

Frances Chung and Nicole Assmann

Car Accidents After Ambulatory Surgery in Patients Without an Escort (Case Report)
Anesth Analg 2008 106: 817-820. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: We describe two cases in which a patient without an escort was discharged after an ambulatory surgical procedure and while driving themselves home were involved in a motor vehicle accident. Discharge without an escort after anesthesia or sedation is not recommended and appropriate arrangements to transport the patient home are needed.

ANESTHETIC PHARMACOLOGY:

Ahmed R. Barakat, Markus N. Schreiber, Joachim Flaschar, Michael Georgieff, and Stefan Schraag

The Effective Concentration 50 (EC₅₀) for Propofol with 70% Xenon Versus 70% Nitrous Oxide
Anesth Analg 2008 106: 823-829. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Patients breathing 70% xenon in oxygen required 1.5 {micro}g/mL propofol supplementation in 50% of patients to avoid a response to skin incision, compared with 2.2 {micro}g/mL with nitrous oxide. Xenon therefore seems to be clinically more potent than nitrous oxide but still requires minimal supplement of a hypnotic anesthetic.

Nurdan Bedirli, Ebru Ofluoglu, Mustafa Kerem, Gulten Utebey, Murat Alper, Demet Yilmazer, Abdulkadir Bedirli, Onur Ozlu, and Hatice Pasaoglu

Hepatic Energy Metabolism and the Differential Protective Effects of Sevoflurane and Isoflurane Anesthesia in a Rat Hepatic Ischemia-Reperfusion Injury Model
Anesth Analg 2008 106: 830-837. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Ischemia-reperfusion injury to the liver can lead to changes in blood flow, cytokine energy content, and liver structure. This study, performed in a rat hepatic injury model, demonstrates that sevoflurane, but not isoflurane, protects against such injury.

Liya Yang and James M. Sonner

The Anesthetic-Like Effects of Diverse Compounds on Wild-Type and Mutant -Aminobutyric Acid Type A and Glycine Receptors
Anesth Analg 2008 106: 838-845. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Chemically diverse nonvolatile or poorly volatile compounds show anesthetic-like modulation of glycine and {gamma}-aminobutyric acid type A receptors, and reduced modulation of mutant receptors that are relatively resistant to volatile anesthetics, consistent with a common mechanism of action.

Martin Barann, Isabelle Linden, Stefan Witten, and Bernd W. Urban

Molecular Actions of Propofol on Human 5-HT_3A Receptors: Enhancement as Well as Inhibition by Closely Related Phenol Derivatives
Anesth Analg 2008 106: 846-857. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: The kinetics of the action of propofol and its lesser hydrophobic derivatives 2-isopropylphenol and phenol on human 5-HT3A receptors were examined. At least two separate inhibitory actions on 5-HT3A receptors could be identified for propofol, whereas the enhancing action seen for the two related smaller phenol derivatives could no longer be detected. 5-HT-dependent and 5-HT-independent interactions could be distinguished for all three drugs. Propofol was less potent than expected from its hydrophobic properties. Underlying mechanisms appear to involve the phenolic hydroxyl group, hydrophobic interactions, and steric restrictions.

Takashi Kawano, Katsuya Tanaka, Kazuaki Mawatari, Shuzo Oshita, Akira Takahashi, and Yutaka Nakaya

Hyperglycemia Impairs Isoflurane-Induced Adenosine Triphosphate-Sensitive Potassium Channel Activation in Vascular Smooth Muscle Cells
Anesth Analg 2008 106: 858-864. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: The present study demonstrated that acute hyperglycemia impaired isoflurane-induced vascular adenosine triphosphate-sensitive potassium channel activity via activation of protein kinase C. These results indicated that hyperglycemia may contribute to perioperative risk by impairing isoflurane-induced cardiovascular protective mechanisms via activation of vascular adenosine triphosphate-sensitive potassium channels.

John P. Williams, Jonathan P. Thompson, David J. Rowbotham, and David G. Lambert

Human Peripheral Blood Mononuclear Cells Produce Pre-Pro-Nociceptin/Orphanin FQ mRNA (Brief Report)
Anesth Analg 2008 106: 865-866. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Peripheral blood mononuclear cells (PBMC) transcribe mRNA for the nociceptin/orphanin FQ(N/OFQ) receptor (NOP). Here we show that these cells also transcribe the peptide precursor pre-pro-N/OFQ, suggesting NOP-mediated autoregulation of PBMC function.

TECHNOLOGY, COMPUTING, AND SIMULATION:

Jochen Mayer, Joachim Boldt, Michael W. Wolf, Johannes Lang, and Stefan Suttner

Cardiac Output Derived from Arterial Pressure Waveform Analysis in Patients Undergoing Cardiac Surgery: Validity of a Second Generation Device
Anesth Analg 2008 106: 867-872. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Measurement of cardiac output using improved arterial pressure waveform analysis without manual calibration (FloTrac/Vigileo) was comparable with intermittent pulmonary artery thermodilution cardiac output measurement in patients undergoing cardiac surgery.

Daryn H. Moller and Ira J. Rampil

Spectral Entropy Predicts Auditory Recall in Volunteers
Anesth Analg 2008 106: 873-879. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Spectral and Response Entropy were found to be predictive of recall in anesthetized volunteers and warrant further study in surgical patients.

Sinan Yavas, David Lizdas, Nikolaus Gravenstein, and Samsun Lampotang

Interactive Web Simulation for Propofol and Fospropofol, a New Propofol Prodrug (Technical Communication)
Anesth Analg 2008 106: 880-883. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: A new website demonstrates the pharmacokinetics and pharmacodynamics of fospropofol and shows how it differs from propofol.

CRITICAL CARE AND TRAUMA:

Omar Y. Al-Rawi, Stephen H. Pennefather, Richard D. Page, Ishani Dave, and Glen N. Russell

The Effect of Thoracic Epidural Bupivacaine and an Intravenous Adrenaline Infusion on Gastric Tube Blood Flow During Esophagectomy (Brief Report)
Anesth Analg 2008 106: 884-887. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Hypotension associated with epidural anesthesia impairs perfusion of the gastric tube.

OBSTETRIC ANESTHESIOLOGY:

Scott Segal and Steven Y. Wang

The Effect of Maternal Catecholamines on the Caliber of Gravid Uterine Microvessels
Anesth Analg 2008 106: 888-892. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Epinephrine, in concentrations found in the plasma of laboring women, attenuated the vasoconstriction caused by norepinephrine in an ex vivo rat model of isolated uterine microvessels.

ECONOMICS, EDUCATION, AND POLICY:

Fabian O. Kooij, Toni Klok, Markus W. Hollmann, and Jasper E. Kal

Decision Support Increases Guideline Adherence for Prescribing Postoperative Nausea and Vomiting Prophylaxis
Anesth Analg 2008 106: 893-898. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Poor adherence is a potential flaw for any guideline, which may be improved using decision support (DS). We implemented a DS system in an anesthesia information management system (AIMS) and improved adherence to the departmental guidelines for prescribing postoperative nausea and vomiting prophylaxis.

NEUROSURGICAL ANESTHESIOLOGY:

Vincent Bonhomme, Pierre Maquet, Christophe Phillips, Alain Plenevaux, Pol Hans, Andre Luxen, Maurice Lamy, and Steven Laureys

The Effect of Clonidine Infusion on Distribution of Regional Cerebral Blood Flow in Volunteers
Anesth Analg 2008 106: 899-909. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Clonidine-induced sedation is functionally and electrophysiologically similar to early stage nonrapid eye movement sleep. Similarities with observations made during general anesthesia and vegetative state suggest alterations in the activity of a network common to all these states.

Masahiko Kumazawa, Hiroki Iida, Masayoshi Uchida, Mami Iida, Motoyasu Takenaka, Naokazu Fukuoka, Tomohiro Michino, and Shuji Dohi

The Effects of Transient Cerebral Ischemia on Vasopressin-Induced Vasoconstriction in Rabbit Cerebral Vessels
Anesth Analg 2008 106: 910-915. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Topical application of arginine-vasopressin (AVP) (10-9 M, 10-7 M, and 10-5 M), but not a lower concentration (10-11 M), induced pial arteriolar vasoconstriction in rabbits. The constrictor effect of 10-7 M AVP was reduced after transient (5-min) cerebral ischemia.

John Dingley, Catherine Hobbs, James Ferguson, Janet Stone, and Marianne Thoresen

Xenon/Hypothermia Neuroprotection Regimes in Spontaneously Breathing Neonatal Rats After Hypoxic-Ischemic Insult: The Respiratory and Sedative Effects
Anesth Analg 2008 106: 916-923. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: In spontaneously breathing neonatal rats, we found that up to 50% xenon can be safely administered under conditions of NT or hypothermia for at least 5 h without CO2 retention, whereas 70% xenon was associated with respiratory acidosis.

Gareth L. Ackland, Jane Harrington, Paul Downie, James W. Holding, Deepak Singh-Ranger, Konstandina Griva, Michael G. Mythen, and Stanton P. Newman

Dehydration Induced by Bowel Preparation in Older Adults Does Not Result in Cognitive Dysfunction
Anesth Analg 2008 106: 924-929. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Dehydration in elderly patients, a common perioperative problem in the elderly population, may provoke postoperative cognitive dysfunction. Despite moderate dehydration after bowel preparation, no cognitive deficits developed in patients of an age associated with a significant incidence of postoperative cognitive dysfunction.

NEUROSURGICAL ANESTHESIA:

Yuri Yamamoto, Masahiko Kawaguchi, Hironobu Hayashi, Toshinori Horiuchi, Satoki Inoue, Hiroyuki Nakase, Toshisuke Sakaki, and Hitoshi Furuya

The Effects of the Neuromuscular Blockade Levels on Amplitudes of Posttetanic Motor-Evoked Potentials and Movement in Response to Transcranial Stimulation in Patients Receiving Propofol and Fentanyl Anesthesia
Anesth Analg 2008 106: 930-934. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Tetanic stimulation of peripheral nerves prior to transcranial stimulation can augment the amplitudes of motor-evoked potentials (MEPs), so called "posttetanic MEPs." Under propofol/fentanyl anesthesia, posttetanic MEPs monitoring was feasible at a deep level of neuromuscular blockade without patient movement in response to transcranial stimulation.

Arnaud Robitaille, Stephan R. Williams, Marie-Hélène Tremblay, François Guilbert, Mélanie Thériault, and Pierre Drolet

Cervical Spine Motion During Tracheal Intubation with Manual In-Line Stabilization: Direct Laryngoscopy versus GlideScope® Videolaryngoscopy
Anesth Analg 2008 106: 935-941. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: During intubation with manual in-line stabilization by an assistant, videolaryngoscopy produced better glottic visualization than direct laryngoscopy, but did not significantly decrease movement of the nonpathologic cervical spine.

GENERAL ARTICLES:

Stefan Jochberger, Feruza Ismailova, Wolfgang Lederer, Viktoria D. Mayr, Günter Luckner, Volker Wenzel, Hanno Ulmer, Walter R. Hasibeder, Martin W. Dünser For the "Helfen Berührt" Study Team

Anesthesia and Its Allied Disciplines in the Developing World: A Nationwide Survey of the Republic of Zambia
Anesth Analg 2008 106: 942-948. [Abstract] [Full Text] [PDF] [Data Supplement] [Data Supplement]   

IMPLICATIONS: In this prospective study, we evaluated the situation of anesthesia, intensive care medicine, emergency medicine, and pain therapy in 78.2% of Zambian hospitals registered at the Zambian Ministry of Health to perform minor or major surgery. Considering the standards used in hospitals of industrialized nations, our results are startling and merit dissemination to broad readership to alert clinicians in developed countries.

PAIN MEDICINE:

Tiffany Sun, Ozlem Sacan, Paul F. White, Jayne Coleman, Rod J. Rohrich, and Jeffrey M. Kenkel

Perioperative Versus Postoperative Celecoxib on Patient Outcomes After Major Plastic Surgery Procedures
Anesth Analg 2008 106: 950-958. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Celecoxib, 400 mg po, given preoperatively and/or after major plastic surgery and for 4 days, was effective in improving postoperative pain management as well as the speed and quality of recovery. There was no increase in the incidence of postoperative side effects or wound complications. Finally, perioperative administration of celecoxib offered no clinically significant advantages over postoperative administration alone.

Esra Caliskan, Ayda Turkoz, Mesut Sener, Nesrin Bozdogan, Oner Gulcan, and Riza Turkoz

A Prospective Randomized Double-Blind Study to Determine the Effect of Thoracic Epidural Neostigmine on Postoperative Ileus After Abdominal Aortic Surgery
Anesth Analg 2008 106: 959-964. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: We evaluated the effect of additional thoracic epidural neostigmine (1 {micro}g/kg) to epidural bupivacaine on postoperative ileus in patients undergoing abdominal aortic surgery. According to our results, thoracic epidural neostigmine enables faster restoration of bowel sounds and shortens duration of postoperative ileus after abdominal aortic surgery with no adverse effects.

PAIN MECHANISMS:

Sara Comelli Brock and Carlos Rogério Tonussi

Intrathecally Injected Morphine Inhibits Inflammatory Paw Edema: The Involvement of Nitric Oxide and Cyclic-Guanosine Monophosphate
Anesth Analg 2008 106: 965-971. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: This work suggests how spinal injection of opioids can produce a peripheral, segmental antiinflammatory effect, and how this effect can be enhanced by drugs as clinically available phosphodiesterase inhibitors. These findings may help to improve segmental anesthesia procedures.

Il Ok Lee and Youngsun Seo

The Effects of Intrathecal Cyclooxygenase-1, Cyclooxygenase-2, or Nonselective Inhibitors on Pain Behavior and Spinal Fos-Like Immunoreactivity
Anesth Analg 2008 106: 972-977. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Prostaglandins in the spinal dorsal horn play an important role in initiating central sensitization. Blocking the action of cyclooxygenase limits central sensitization in a rat model. Surprisingly, in this study cyclooxygenase-2 inhibitors (celecoxib) appeared to be weaker antihyperalgesic drugs than the nonselective COX inhibitors (ketorolac).

Abdul-Shakoor Bhat, Surendra Kumar Tandan, Dinesh Kumar, Vamsi Krishna, and Vellanki Ravi Prakash

The Interaction Between Inhibitors of Nitric Oxide Synthase and Cyclooxygenase in Formalin-Induced Pain in Mice: An Isobolographic Study
Anesth Analg 2008 106: 978-984. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Inhibitors of nitric oxide synthase (NOS) and cyclooxygenase (COX) have traditionally been viewed as providing pain relief, primarily by decreasing inflammation and the sensitization of pain receptors peripherally. This study demonstrates that NOS and COX pathways are upregulated in the spinal cord in response to peripheral tissue injury, which suggests that NOS and COX inhibitors may be antinociceptive primarily through a central effect.

Linda S. Barter, Laurie O. Mark, Steven L. Jinks, Earl E. Carstens, and Joseph F. Antognini

Immobilizing Doses of Halothane, Isoflurane or Propofol, Do Not Preferentially Depress Noxious Heat-Evoked Responses of Rat Lumbar Dorsal Horn Neurons with Ascending Projections
Anesth Analg 2008 106: 985-990. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: We found that neurons with ascending spinal projections and neurons without such projections had similar sensitivity to immobilizing doses of isoflurane, halothane, and propofol. This suggests that anesthetic depression would equally affect transmission of nociceptive information locally, within a reflex pathway, and to sites more rostral within or beyond the spinal cord.

REGIONAL ANESTHESIA:

Klaus Hofmann-Kiefer, Tim Eiser, Daniel Chappell, Stephan Leuschner, Peter Conzen, and Dirk Schwender

Does Patient-Controlled Continuous Interscalene Block Improve Early Functional Rehabilitation After Open Shoulder Surgery?
Anesth Analg 2008 106: 991-996. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Compared with opioid-based patient-controlled analgesia, patient-controlled continuous interscalene block improved analgesia, but not function, during early rehabilitation of the shoulder joint in patients undergoing open shoulder procedures.

Tatiana Sidiropoulou, Oreste Buonomo, Eleonora Fabbi, Maria Beatrice Silvi, Georgia Kostopanagiotou, Alessandro Fabrizio Sabato, and Mario Dauri

A Prospective Comparison of Continuous Wound Infiltration with Ropivacaine Versus Single-Injection Paravertebral Block After Modified Radical Mastectomy
Anesth Analg 2008 106: 997-1001. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Continuous wound infiltration with ropivacaine can be a useful alternative to thoracic paravertebral block for pain management after mastectomy.

Byung Seop Shin, Justin Sang Ko, Mi Sook Gwak, Mikyung Yang, Chung Su Kim, Tae Soo Hahm, Sang Min Lee, Hyun Sung Cho, Sung Tae Kim, Ji Hye Kim, and Gaab Soo Kim

The Effects of Prehydration on the Properties of Cerebrospinal Fluid and the Spread of Isobaric Spinal Anesthetic Drug
Anesth Analg 2008 106: 1002-1007. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Rapid crystalloid prehydration can affect cerebrospinal fluid flow in the lumbar region, reducing cephalic spread of 0.5% isobaric tetracaine and delaying the time to reach peak sensory level.

Yavuz Demiraran, Ozcan Ozturk, Ender Guclu, Abdulkadir Iskender, Mehmet Hakan Ergin, and Abdurahman Tokmak

Vasoconstriction and Analgesic Efficacy of Locally Infiltrated Levobupivacaine for Nasal Surgery
Anesth Analg 2008 106: 1008-1011. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Postoperative analgesia with locally infiltrated levobupivacaine was significantly more potent and longer lasting than that achieved by lidocaine plus epinephrine in patients undergoing nasal surgery.

Steven Renes, Laura Clark, Mathieu Gielen, Huub Spoormans, Janneke Giele, and Anupama Wadhwa

A Simplified Approach to Vertical Infraclavicular Brachial Plexus Blockade Using Hand-Held Doppler (Brief Report)
Anesth Analg 2008 106: 1012-1014. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: Use of a Doppler ultrasound device results in a more lateral insertion point than the classical insertion point. This technique provides a high probability of localizing either the medial or posterior cord of the brachial plexus on the first insertion attempt.

ANALGESIA:

Jeffrey D. Swenson, Jennifer J. Davis, and Jennifer A. DeCou

A Novel Approach for Assessing Catheter Position After Ultrasound-Guided Placement of Continuous Interscalene Block (Case Report)
Anesth Analg 2008 106: 1015-1016. [Abstract] [Full Text] [PDF]  

IMPLICATIONS: We present a novel technique for confirming correct catheter tip position in the interscalene space using ultrasound to view the injection of agitated contrast. This method facilitates ultrasound-guided placement of peripheral nerve catheters.

LETTERS TO THE EDITOR:

Steven L. Shafer

Full Disclosure Matters!
Anesth Analg 2008 106: 1017. [Full Text] [PDF]  

David Wax

Thromboembolic Risk with Bifurcated Infusion Tubing
Anesth Analg 2008 106: 1017-1018. [Full Text] [PDF]  

George Herzlinger

Thromboembolic Risk with Bifurcated Infusion Tubing
Anesth Analg 2008 106: 1018. [Full Text] [PDF]  

Thomas E. Schulte and John H. Tinker

Narkomed 6400 Anesthesia Machine Failure
Anesth Analg 2008 106: 1018-1019. [Full Text] [PDF]  

Robert Clark

Narkomed 6400 Anesthesia Machine Failure
Anesth Analg 2008 106: 1019. [Full Text] [PDF]  

Adejare Windokun

Database Analysis of Atypical Drug Transactions
Anesth Analg 2008 106: 1019. [Full Text] [PDF]  

Richard H. Epstein

Database Analysis of Atypical Drug Transactions
Anesth Analg 2008 106: 1019-1020. [Full Text] [PDF]  

Matthias L. Riess and Tatyana Strong

Near-Embolization of a Rubber Core from a Propofol Vial
Anesth Analg 2008 106: 1020-1021. [Full Text] [PDF]  

Jonathan V. Roth

Near-Embolization of a Rubber Core from a Propofol Vial
Anesth Analg 2008 106: 1021. [Full Text] [PDF]  

Paul S. Tumber, Anuj Bhatia, and Vincent W. Chan

Ultrasound-Guided Lateral Femoral Cutaneous Nerve Block for Meralgia Paresthetica
Anesth Analg 2008 106: 1021-1022. [Full Text] [PDF]  

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BOOK AND MULTIMEDIA REVIEWS:

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Anesth Analg 2008 106: 1024. [Full Text] [PDF]  

ERRATA:

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Erratum
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