• Intensive insulin therapy in critically ill patients. Van den Berghe G, Wouters P, Weekers et al. N Engl J Med 2001; 345:1359-1367.

• A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB Anesthesiology 2002; 97:560-564

Dr. Kathryn McGoldrick gives a concise history of epidural needle design, and discusses the implications for the procedure.

• Pioneers in Epidural Needle Design. Frölich MA, Caton D. Anesth Analg 2001;93:215-20.

What are the advantages of neuraxial blockade? Dr. Raymond Sinatra reviews a comprehensive summary of several studies:

• Reduction of postoperative mortality and morbidity with epidural or spinal anesthesia: results from an overview of randomized trials. Anthony Rodgers, Natalie Walker, A McKee, H Kehlet, A van Zundert, D Sage, M Futter, G Saville, T. Clark, S MacMahon. British Medical Journal 2000;324 (1), 193-197

Pediatrics

What are the vulnerabilities of the pre-term infant? Dr. Charles Coté discusses the findings from a new study:

• Risk for birth defects among premature infants: a population-based study. Rasmussen SA, Moore CA, Paulozzi LJ, Rhodenhiser EP. J Pediatr 2001; 138: 668-73

Dr. Charles Coté analyzes a study on the use of jaw-thrust and CPAP in keeping infant airways clear:

• Effect of jaw-thrust and continuous positive airway pressure on tidal breathing in deeply sedated infants. Hammer J, Reber A, Trachsel D, Frei FJ. J Pediatr 2001; 138: 826-30

Current Practice

Dr. Kathryn McGoldrick talks about the advantages and disadvantages of retrobulbar and peribulbar anesthesia.

• Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: An anatomical comparison of extraconal and intraconal injections. Ripart J, Lefrant JY, de La Coussaye JE, Prat-Pradal D, Vivien B, Eledjam JJ. Anesthesiology 94:56-62, 2001

Dr. Douglas Coursin brings us up to date on sepsis control in Controlling Sepsis.

• Efficacy and safety of recombinant human activated Protein C for severe sepsis. Bernard GR, Vincent J-L, et al. N Engl J Med 2001; 344:699-709.
• Severe sepsis - a new treatment with both anticoagulant and antiflammatory properties. Matthay MA. N Engl J Med 2001; 344:759-761.

Drug Efficacy

Can dexamethasone be an effective prophylactic anti-emetic? Dr. Kathryn McGoldrick discusses a new study that compares the efficacy of ondansetron and dexamethasone.

• Dexamethasone is a cost-effective alternative to ondansetron in preventing PONV after paediatric strabismus repair. Subramaniam B, Madan R, Sadhasivam S, et al. Br J Anaesth 86:84-89, 2001

• Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomized trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J. Lancet 2000;356:2139-143

How do COX-2 inhibitors affect post-surgical pain? Dr. Raymond Sinatra reviews a recent study of their use after spinal surgery.

• Postoperative Analgesic Effects of Celecoxib or Rofecoxib After Spinal Surgery Reuben SS, Connelly NR. Anesthesia and Analgesia 2000;91:1221-8
  

Dr. Douglas Coursin discusses the newest anticoagulants, analyzing their safety and efficacy in conjunction with anesthesia

• Anticoagulation and Us
  
  
  • A synthetic pentasaccharide for the prevention of deep-vein thrombosis after total hip replacement. Turpie AGG, Gallus AS, Hoek JA. N Engl J Med 2001; 344: 619-625
  • Redesigning heparin. Rosenberg RD. N Engl J Med 2001; 344: 673-675
  • Sixth ACCP Consensus Conference on Antithrombotic Therapy. Dalen JE, Hirsh J, Guyatt GH. Chest 2001; 119:S1-S370

What is the best way to prevent apnea in premature infants after surgery? Dr. Charles Coté discusses a recent study.

• Post-operative recovery after inguinal herniotomy in ex-premature infants: comparison between sevoflurane and spinal anaesthesia. Williams JM, Stoddart PA, Williams SAR, Wolf AR. Br J Anaesth 2001; 86: 366-71

Can CARE be used as a prognostic indicator during cardiac surgery? Dr. Katherine Gricknik analyzes a recent study:

• The Cardiac Anesthesia Risk Evaluation Score: A clinically useful predictor of mortality and morbidity after cardiac surgery. Dupuis J-Y, Wang F, Nathan H, Lam M, Grimes S, Bourke M. Anesthesiology 2001;91:194-204.

Current Practice

Is it possible to foresee the likelihood of myocardial dysfunction after cardiopulmonary bypass? Dr. Katherine Grichnik comments on a study of what diastolic dysfunction can tell u

• Diastolic Dysfunction is Predictive of Difficult Weaning from Cardiopulmonary Bypass.Bernard F, Denault A, Babin D, Goyer C, Couture P, Couturier A, Buithieu J. Anesth Analg 2001;92:291-8

Dr. Richard Rosenquist comments on two studies of patient-controlled analgesia in the outpatient setting in Analgesia for Post-Operative Pain

• Patient-controlled Regional Analgesia (PCRA) at Home; Controlled Comparison between Bupivacaine and Ropivacaine Brachial Plexus Analgesia. Rawal N, Allvin R, Axellson K, Hallén J, Ekbäck G, Ohlsson T, Amilon A. Anesthesiology 2002;96:1290-6
• Continuous Infraclavicular Brachial Plexus Block for Postoperative Pain Control at Home. A Randomized, Double-blinded, Placebo-controlled Study. Ilfeld B, Morey T, Enneking F. Anesthesiology 2002;96:1297-1304.

Treatment Review

• Cauda Equina Syndrome After Spinal Anesthesia with Hyperbaric 5% Lignocaine: A Review of the Six Cases of Cauda Equina Syndrome Reported to the Swedish Pharmaceutical Insurance 1993-1997. Loo CC, Irestedt L. Acta Anaesthesiol Scand 1999; 43:371-37

• Inhaled Albuterol, but Not Intravenous Lidocaine, Protects Against Intubation-Induced Bronchoconstriction in Asthma. Maslow A, Regan M, Israel E, Darvish A, Mehrez M, Boughton R, Loring S. Anesthesiology 2000; 93: 1198-1204.

• Evaluation of transesophageal echocardiography for diagnosis of traumatic aortic injury. Goarin JP, Cluzel P, Gosgnach M, Lamine K, Coriat P, Riou B. Anesthesiology 2000; 93:1373-1377

Dr. Charles Coté discusses the implications of a case report on nitrous oxide and vitamin B₁₂ deficiency.

• Severe neurological impairment in an infant after nitrous oxide anesthesia. McNeely JK, Buczulinski B, Rosner DR. Anesthesiology 2000; 93 1549-50
  

Current Practice

What are the best tools to use in ocular anesthesia? Dr. Kathryn McGoldrick looks at the different options available, and their advantages and disadvantages.

• Topical anesthesia versus retrobulbar block for cataract surgery: the patients’ perspective. Boezaart A, Berry R, Nell M. J Clin Anesth. 2000; 12:58-6.

Pain Management

Dr. Beverly Philip presents the second part of a two-part series on how to best address the different components of pain that follow laparoscopic surgery:

• Multi-modal Analgesia After Laparoscopic Surgery: Part Two

…and Dr. David Lubarsky looks at algorithms for preventing PONV:

• Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Scuderi PE, James RL, Harris L, Mims GR 3^rd. Anesth Analg 2000 Dec; 91(6):1408-1

How can alpha-2 adrenergic agents such as dexmedetomidine and clonidine enhance your practice? Dr. Katherine Grichnik discusses a review of the most recent developments in these drugs, and implications for anesthetic practice…

• Clinical Uses of Alpha-2 Adrenergic Agonists Kamibayashi T, Maze M. Anesthesiology 2000; 93:1345-134

Pain Management

What signs are there that pain will persist after surgery? Dr. Richard Rosenquist discusses the results of a study of the surgeries and circumstances that can lead to long-term chronic pain:

• Chronic Pain as an Outcome of Surgery: A Review of Predictive Factors. Perkins, FM, Kehlet H. Anesthesiology 2000; 93:1123-1133.

…and Dr. David Lubarsky analyzes a study that evaluates the use of dexamethasone to prevent PONV:

• The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: A dose-ranging study Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM. Anesth Analg 2000; 91:1404-7

Pain Management

Dr. Beverly Philip presents the first part of a two-part series on how to best address the different components of pain that follow lapsroscopic surgery:

• Multi-modal Analgesia After Laparoscopic Surgery: Part One

How can you best manage chronic postoperative pain in breast cancer in patients? Dr. Richard Rosenquist discusses a study that examines the use of EMLA as a postoperative analgesic

• EMLA Reduces Acute and Chronic Pain after Breast Surgery for Cancer Fassoulaki A, Sarantopoulos C, Melemeni A, Hogan Q. Reg Anesth Pain Med 2000; 25:350-355.

Current Practice

Perioperative renal failure is a common concern in an anesthesia practice; Dr. Douglas Coursin gives us a commentary on currently available therapies:

• Renal Protection: All that Glitters is not Gold