Output Monitoring during Cesarean Delivery Using Spinal Anesthesia 856

Prevention of hemodynamic instability during cesarean delivery with spinal anesthesia has been the aim of several previous studies, most of which used noninvasive monitoring. Healthy women scheduled for an elective cesarean delivery were randomized to four different groups receiving 7 mg spinal bupivacaine with or without concomitant low-dose infusion of phenylephrine (0.25 μg · kg–1· min–1) or 10 mg spinal bupivacaine with or without phenylephrine infusion. All patients had 4 μg sufentanil added to the spinal anesthetic and had intravenous prehydration with 750 ml saline, 0.9%. The most favorable hemodynamic profile at cesarean delivery with spinal anesthesia was obtained with a low-dose bupivacaine (with sufentanil) spinal anesthetic combined with a low-dose infusion of phenylephrine and moderate prehydration. See the accompanying Editorial View on  page 765 

Figure. No caption available.

Figure. No caption available.

Addiction and Substance Abuse in Anesthesiology 905

Despite substantial advances in our understanding of addiction and substance abuse, these problems remain a major issue in the anesthesia workplace. As recently as 2005, the drug of choice for anesthesiologists entering addiction and substance abuse treatment was opioids. Individuals undergoing treatment should be evaluated for management of comorbid psychiatric conditions because successful treatment for addiction is less likely when comorbid psychopathology is not treated. Successful completion of a treatment program does not guarantee freedom from future relapse; thus, each case must be carefully evaluated before the decision is made to allow an addicted physician to return to the practice of anesthesiology. See the accompanying Editorial View on  page 762 

Perioperative Hemostatic Management of Patients Treated with Vitamin K Antagonists 918

Clinicians, including anesthesiologists, surgeons, and intensivists, need to correct coagulopathy in patients receiving oral anticoagulation therapy before elective surgery. Discontinuing warfarin or vitamin K treatment for several days is usually sufficient. In emergency cases, rapid correction is required. European and American guidelines recommend prothrombin complex concentrates (PCCs) for anticoagulation reversal in patients with life-threatening bleeding and an elevated international normalized ratio (INR). Recombinant activated factor VII is also a potential alternative to PCCs. Compared with human fresh frozen plasma, PCCs provide more rapid correction of the INR and improve bleeding control. Although many patients requiring rapid reversal of warfarin are currently treated with fresh frozen plasma, PCCs should be considered as an alternative therapy.

Hypercapnic Acidosis Attenuates Lung Injury Induced by Established Bacterial Pneumonia 837

Hypercapnic acidosis protects against lung injury from several conditions. This study investigated whether hypercapnic acidosis—induced by adding carbon dioxide to inspired gas—would be protective in an established rat model of Escherichia coli  pneumonia. After pneumonia was induced, rats were ventilated and all received normocapnia or hypercapnic acidosis for 6 h. A second set of experiments was carried out in an identical manner but all rats were given intravenous antibiotics. The endpoint was severity of lung injury. Whether animals were treated with or without antibiotics, hypercapnic acidosis reduced the magnitude of the lung injury induced by established E. coli  pneumonia. This study suggests administration of carbon dioxide to inspired gas may reduce lung injury after pneumonia. See the accompanying Editorial View on  page 771 

Capsaicin Combined with Local Anesthetics Preferentially Prolongs Sensory/Nociceptive Block in Rat Sciatic Nerve 872

Local anesthetics are capable of pronounced nociceptor-selective nerve blockade when used with capsaicin.

Comparison between Bispectral Index and Patient State Index as Measures of the Electroencephalographic Effects of Sevoflurane 799

Both Patient State Index and Bispectral Index predicted depth of sevoflurane anesthesia equally well.

Postoperative Malignant Hyperthermia: An Analysis of Cases from the North American Malignant Hyperthermia Registry 825

Postoperative malignant hyperthermia is uncommon, occurring in less than 2% of suspected malignant hyperthermia cases reported. Hyperthermia was not a presenting sign of postoperative malignant hyperthermia.

Long-term Outcome in Chest Trauma 864

Survivors of multiple traumas that included chest trauma demonstrate a persistent decrease in pulmonary-specific quality of life. See the accompanying Editorial View on  page 773