For over 15 yr, Dr. Guy Weinberg has examined the potential utility of lipid emulsion infusion to treat local anesthetic toxicity and its underlying mechanisms. This has led to widespread clinical application, not only in anesthesia, but also in life-saving treatment in other areas of medical care. He chose a life preserver image for his educational Web site,, and we used this theme to create the cover art.

Ether Day's William T. G. Morton: Public Benefactor … and Antisocial Narcissist? 1

George S. Bause 

Notorious Oxide 3

Peter Nagele 

Genetic Contributions to Opioid Side Effects: Helix Me, Helix Me Not 6

Roger B. Fillingim 

Transient Receptor Potential Ankyrin 1 as a Target for Perioperative Pain Management 8

Magdalene M. Moran 

An Appraisal of William Thomas Green Morton's Life as a Narcissistic Personality 10

Ramon F. Martin, Ajay D. Wasan, and Sukumar P. Desai 

W. T. G. Morton's demonstration of ether as an anesthetic was inspired by a narcissistic personality trait/disorder that also limited his further development of anesthesia as a specialty.

Effect of Nitrous Oxide Exposure during Surgery on the Homocysteine Concentrations of Children 15

Dubraiicka Pichardo, Igor A. Luginbuehl, Yaseer Shakur, Paul W. Wales, Ahmed El-Sohemy, and Deborah L. O'Connor 

Children exposed to nitrous oxide (≥2 h) showed increased postoperative plasma total homocysteine concentrations. The duration of exposure, initial plasma total homocysteine, and serum vitamin B12 concentrations were associated with this increase.

Aversive and Reinforcing Opioid Effects: A Pharmacogenomic Twin Study 22

Martin S. Angst, Laura C. Lazzeroni, Nicholas G. Phillips, David R. Drover, Martha Tingle, Amrita Ray, Gary E. Swan, and J. David Clark 

The clinical utility of opioids is limited by adverse drug effects including respiratory depression. This study was designed to gain a better understanding of the genetic and environmental mechanisms contributing to an individual's susceptibility to adverse opioid effects. A classical twin study paradigm was used to estimate the genetic and/or shared environmental contribution to acute adverse and affective opioid response. The ì-opioid receptor agonist alfentanil and saline placebo were administered as target-controlled infusions under carefully monitored laboratory conditions. Measured outcomes included respiratory depression, sedation, nausea, pruritus, drug liking, and drug disliking. This study demonstrates that genetic, environmental, and demographic factors work together to control adverse and reinforcing opioid responses, but contribute differently to specific responses.

Identification of Two Mutations (F758W and F758Y) in the N -methyl-D-aspartate Receptor Glycine-binding Site that Selectively Prevent Competitive Inhibition by Xenon without Affecting Glycine Binding 38

Scott P. Armstrong, Paul J. Banks, Thomas J. W. McKitrick, Catharine H. Geldart, Christopher J. Edge, Rohan Babla, Constantinos Simillis, Nicholas P. Franks, and Robert Dickinson 

We have identified two mutations that prevent xenon from binding at the glycine site of the N -methyl-D-aspartate receptor. These mutations could be used in knock-in animals to understand the mechanism(s) of xenon anesthesia and neuroprotection.

Solubility of Haloether Anesthetics in Human and Animal Blood 48

Joao H. N. Soares, Robert J. Brosnan, Fabíola B. Fukushima, Joanne Hodges, and Hong Liu 

Blood solubility for desflurane, sevoflurane, isoflurane, and methoxyflurane differs significantly between humans and most animals. Unlike in humans, desflurane blood solubility is not statistically different from sevoflurane blood solubility for some animal species.

Transfusion of Stored Autologous Blood Does Not Alter Reactive Hyperemia Index in Healthy Volunteers 56

Lorenzo Berra, Andrea Coppadoro, Binglan Yu, Chong Lei, Ester Spagnolli, Andrea U. Steinbicker, Kenneth D. Bloch, Tian Lin, Fatima Y. Sammy, H. Shaw Warren, Bernadette O. Fernandez, Martin Feelisch, Walter H. Dzik, Christopher P. Stowell, and Warren M. Zapol 

Transfusion of autologous blood stored for 40 days in healthy volunteers does not alter reactive hyperemia.

Noxious Stimulation Attenuates Ketamine-induced Neuroapoptosis in the Developing Rat Brain 64

Jia-Ren Liu, Qian Liu, Jing Li, Chongwha Baek, Xiao Hui Han, Umeshkumar Athiraman, and Sulpicio G. Soriano 

Concurrent noxious stimulation attenuates ketamine-induced neuroapoptosis and regulates cyclin D1 signaling in neonatal rats.

Comparative Effectiveness of Regional versus  General Anesthesia for Hip Fracture Surgery in Adults 72

Mark D. Neuman, Jeffrey H. Silber, Nabil M. Elkassabany, Justin M. Ludwig, and Lee A. Fleisher 

Among 18,158 patients undergoing hip fracture surgery in New York state, regional anesthesia was associated with a 29% lower adjusted odds of inpatient mortality and a 24% lower adjusted odds of an inpatient respiratory complication.

Sugammadex Ideal Body Weight Dose Adjusted by Level of Meeting Abstracts in Laparoscopic Bariatric Surgery 93

Sandra Llauradó, Antoni Sabaté, Eva Ferreres, Inmaculada Camprubí, and Anna Cabrera 

This study explored the sugammadex ideal body weight dose adjusted according to train-of-four ratio after laparoscopic bariatric surgery. Sugammadex dosing cannot be safely calculated based on ideal body weight.

Variability in Blood and Blood Component Utilization as Assessed by an Anesthesia Information Management System 99

Steven M. Frank, Will J. Savage, Jim A. Rothschild, Richard J. Rivers, Paul M. Ness, Sharon L. Paul, and John A. Ulatowski 

Methods are described for using data acquired from an anesthesia information management system to assess blood and blood component utilization. Significant variability in blood utilization was identified among individual medical providers compared with their peers.

Utilization of Critical Care Services among Patients Undergoing Total Hip and Knee Arthroplasty: Epidemiology and Risk Factors 107

Stavros G. Memtsoudis, Xuming Sun, Ya-Lin Chiu, Michael Nurok, Ottokar Stundner, Stephen M. Pastores, and Madhu Mazumdar 

In this study, the authors determined the incidence of critical care service utilization among orthopedic patients, analyzed patient and healthcare system-related demographics and identified risk factors for requiring critical care service.

Effects of Pharyngeal Cooling on Brain Temperature in Primates and Humans: A Study for Proof of Principle 117

Yoshimasa Takeda, Hiroshi Hashimoto, Koji Fumoto, Tetsuya Danura, Hiromichi Naito, Naoki Morimoto, Hiroshi Katayama, Soichiro Fushimi, Akihiro Matsukawa, Aiji Ohtsuka, and Kiyoshi Morita 

Pharyngeal cooling was initiated before return of spontaneous circulation. Pharyngeal cooling can rapidly and selectively induce hypothermia without having adverse effects on systemic circulation and the pharyngeal epithelium.

Age-dependent Role of Microvascular Endothelial and Polymorphonuclear Cells in Lipopolysaccharide-induced Acute Kidney Injury 126

Francis M. Wulfert, Matijs van Meurs, Neng F. Kurniati, Rianne M. Jongman, Martin C. Houwertjes, Peter Heeringa, Michel M.R.F. Struys, Jan G. Zijlstra, and Grietje Molema 

The glomerular endothelial response and the interaction with the innate immune system in sepsis is age-dependent in mice. This might explain the vulnerability of the kidney in the elderly.

Transient Receptor Potential Ankyrin 1 Ion Channel Contributes to Guarding Pain and Mechanical Hypersensitivity in a Rat Model of Postoperative Pain 137

Hong Wei, Mari Karimaa, Timo Korjamo, Ari Koivisto, and Antti Pertovaara 

Blocking the transient receptor potential ankyrin 1 channel in the operated skin area in the rat reduced sustained and mechanically evoked postoperative pain behavior, whereas blocking the spinal transient receptor potential ankyrin 1 channel reduced tactile allodynia-like behavior.

Regulation of Peripheral Clock to Oscillation of Substance P Contributes to Circadian Inflammatory Pain 149

Jing Zhang, Huili Li, Huajing Teng, Ting Zhang, Yonglun Luo, Mei Zhao, Yun-Qing Li, and Zhong Sheng Sun 

Spinal substance P is involved in circadian nociception transmission, which is regulated by peripheral clock in dorsal root ganglia.

Gene Expression in Skin, Muscle, and Dorsal Root Ganglion after Plantar Incision in the Rat 161

Christina M. Spofford and Timothy J. Brennan 

Tissue-specific gene expression after incision reveals unique patterns when compared with other pain models.

Testing the Link between Sympathetic Efferent and Sensory Afferent Fibers in Neuropathic Pain 173

Srinivasa N. Raja and Rolf-Detlef Treede 

This article is a revisiting of original material published as: Raja SN, Treede RD, Davis KD, Campbell JN: Systemic α-adrenergic blockade with phentolamine: A diagnostic test for sympathetically maintained pain. ANESTHESIOLOGY 1991; 74:691–8.


Spinal Subdural Hematoma after Labor Epidural Placement 178

David W. Barbara, Benjamin C. Smith, and Katherine W. Arendt 

Muscle Trauma from Tourniquet (Mis)Use 179

Vidya Chidambaran, Joanna Rosing, Ximena Soler, and Senthilkumar Sadhasivam 


Lipid Emulsion Infusion: Resuscitation for Local Anesthetic and Other Drug Overdose 180

Guy L. Weinberg 

Rapid infusion of lipid emulsion can reverse toxicity caused by lipophilic drugs, including local anesthetics.


Obesity Hypoventilation Syndrome: A Review of Epidemiology, Pathophysiology, and Perioperative Considerations 188

Edmond H. L. Chau, David Lam, Jean Wong, Babak Mokhlesi, and Frances Chung 

Obesity hypoventilation syndrome is associated with increased morbidity and mortality. It is often unrecognized in surgical patients. This review presents the prevalence, pathophysiology, clinical assessment, and perioperative management of this disease entity.


Remodel 206

Mary Oak 

“Perseverant Heart” 209

Kristin Adams Forner 

Case Reports

Dialysis Access Flow Phenomenon Demonstrated via  an Internal Jugular Central Venous Catheter Uniquely Positioned within a Superior Vena Cava Stenosis 212

David M. Rosenfeld, Karl A. Poterack, Samuel R. Money, Nitin N. Katariya, and Terrence L. Trentman 

An Unusual Cause of Fat Embolism Syndrome 216

Xavier Repessé, Laurent Bodson, Siu Ming Au, Bernard Page, Jean-François Côté, Cristi Marin, Mostafa El Hajjam, Cyril Charron, and Antoine Vieillard-Baron 

Foreign Body Removal – Relax! 219

Victor C. Baum 

In Reply

David J. Murray, Catherine Krucylak, and Jacob AuBuchon 

Is Simulation the Best Way to Assess Pediatric Anesthesia Skills? 219

Harshad Gurnaney, Aditee Ambardekar, and Alan Jay Schwartz 

In Reply

James J. Fehr and David J. Murray 

Cover Art Commentary for the ANESTHESIOLOGY March 2012 Issue 220

Margaret B. Garahan 

In Reply

James C. Eisenach 


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