These findings support the low rate of epidural infection in children.

Epidural analgesia for perioperative pain control was not associated with decreased cancer recurrence.

Mixed venous oxygen saturation did not associate with anesthetic depth.

Stored rat erythrocytes cause lung injury both in healthy and in lipopolysaccharide-primed rats. See the accompanying Editorial View on  page 1 

The pathophysiology and current status of neuroprotective strategies for hypoxic-ischemic encephalopathy are reviewed.

This randomized multicenter study evaluated a multimodal approach to reduce postoperative nausea and vomiting (PONV) using an oral dose of the neurokinin-1 receptor antagonist casopitant and an intravenous dose of ondansetron hydrochloride in premenopausal or perimenopausal adult women (N = 702) with a history of PONV and/or motion sickness undergoing a laparoscopic/laparotomic gynecologic surgical procedure or laparoscopic cholecystectomy with general anesthesia. Patients received ondansetron 4 mg with or without casopitant (0 mg, 50 mg, 100 mg, or 150 mg) or casopitant alone. A significantly greater proportion of patients in all of the active casopitant plus ondansetron groups achieved a complete response (no vomiting, retching, rescue medication, or premature withdrawal during the first 24 h after anesthesia) versus  ondansetron alone (59–62% vs.  40%, respectively). All active doses were well tolerated. Combination therapy with casopitant and ondansetron protected against PONV in the 24-h postoperative period.

Figure. No caption available.

Figure. No caption available.

Gantacurium is an ultra-short-acting neuromuscular blocker that is rapidly chemically degraded in vitro via  l-cysteine adduction and preliminary data suggest that exogenous intravenous l-cysteine abolishes gantacurium blockade. CW 002 and CW 011 are two new analogues of gantacurium designed to have increased durations of action. The rate of l-cysteine adduction in vitro  (t ½) was longer for the analogues compared with gantacurium (CW 002, 11.4 min; CW 011, 13.7 min; and gantacurium, 0.2 min) and was inversely related to blockade duration. CW 002 and CW 011 were three times longer acting than gantacurium (28.1 and 33.3 min vs.  10.4 min), but only half the duration of cisatracurium. Intravenous l-cysteine abolished blockade 2 to 3 min after approximately 4–5 × ED95doses of all three compounds. Modification of gantacurium analogues alters the rate of neuromuscular blockade which may be inactivated by l-cysteine administration.

Hydrogen sulfide–induced hypothermia and suspended animation–like states may offer cytoprotection and antiinflammatory and antiapoptotic effects in mechanically ventilated patients, and may reduce ventilator-induced lung injury (VILI). In this in vivo  study, mice received hydrogen sulfide (80 parts per million) while ventilated with a tidal volume of 12 ml/kg body weight for 6 h with synthetic air, and in a second series, at either mild hypothermia or normothermia. VILI occurred after mechanical ventilation after both hypothermia and normothermia characterized by pulmonary edema increased apoptosis, cytokine release, neutrophil recruitment, and up-regulation of the stress proteins heme oxygenase-1 and heat shock protein 70. These effects were prevented in mice administered hydrogen sulfide during ventilation at either mild hypothermia or normothermia. Inhalation of hydrogen sulfide during mechanical ventilation protects against VILI by inhibition of inflammatory and apoptotic responses independently of its ability to induce mild hypothermia during ventilation. See the accompanying Editorial View on  page 4