Publications

Scholarly Journals--Published

• Leitzke A S, Rolland W B, Krafft P R, Lekic T, Klebe D, . . . Zhang J H. (2013). Isoflurane Post-Treatment Ameliorates GMH-Induced Brain Injury in Neonatal Rats. Stroke, 44(12), 3587-3590. Background and Purpose This study investigated whether isoflurane ameliorates neurological sequelae after germinal matrix hemorrhage (GMH) through activation of the cytoprotective sphingosine kinase/sphingosine-1-phosphate receptor/Akt pathway. Methods GMH was induced in P7 rat pups by intraparenchymal infusion of bacterial collagenase (0.3 U) into the right hemispheric germinal matrix. GMH animals received 2% isoflurane either once 1 hour after surgery or every 12 hours for 3 days. Isoflurane treatment was then combined with sphingosine-1-phosphate receptor-1/2 antagonist VPC23019 or sphingosine kinase 1/2 antagonist N,N-dimethylsphingosine. Results Brain protein expression of sphingosine kinase-1 and phosphorylated Akt were significantly increased after isoflurane post-treatment, and cleaved caspase-3 was decreased at 24 hours after surgery, which was reversed by the antagonists. Isoflurane significantly reduced posthemorrhagic ventricular dilation and improved motor, but not cognitive, functions in GMH animals 3 weeks after surgery; no improvements were observed after VPC23019 administration. Conclusions Isoflurane post-treatment improved the neurological sequelae after GMH possibly by activation of the sphingosine kinase/Akt pathway. (12/2013) (link)
• Patel P, Meineke M N, Rasmussen T, Anderson D L, Brown J, Siddighi S, & Applegate R L. (2013). The Relationship of Intravenous Dextrose Administration During Emergence from Anesthesia to Postoperative Nausea and Vomiting: A Randomized Controlled Trial. Anesth Analg, 117(1), 34-42. BACKGROUND: Postoperative nausea and vomiting (PONV) may occur despite antiemetic prophylaxis and is associated with unanticipated hospital admission, financial impact, and patient dissatisfaction. Previous studies have shown variable impact of IV dextrose on PONV. We sought to determine the relationship of IV dextrose administered during emergence from anesthesia to PONV. METHODS: This was a prospective, double-blind randomized placebo-controlled trial. Adult female ASA physical status I and II nondiabetic patients scheduled for outpatient gynecologic, urologic, or breast surgery were randomly assigned to infusion of 250 mL lactated Ringer's solution (group P; n = 75) or dextrose 5% in lactated Ringer's solution (group D; n = 87) over 2 hours beginning with surgical closing. Blood glucose was determined using a point-of-care device before transfer to the operating room, in the operating room immediately before study fluid infusion, and in the recovery room after study fluid infusion. No antiemetics were given before arrival in the recovery room. PONV scores were recorded at 0, 30, 60, and 120 minutes and 24 hours after arrival in the recovery room. Medication administration was recorded. RESULTS: Data from 162 patients with normal baseline blood glucose were analyzed. There were no significant intergroup differences in demographics, history of PONV, or tobacco use. There was no significant intergroup difference in PONV during the first 2 hours after anesthesia (group D 52.9% vs group P 46.7%; difference, 6.2%; 95% confidence interval [CI], -9.2% to 21.6%; P = 0.43). Patients in groups D or P who developed PONV within 2 hours of anesthesia had similar number of severity scores 1 during recovery stay (1.5 vs 1.0; difference, 0; 95% CI, 0%-0%; P = 0.93); and similar proportions of: PONV onset within 30 minutes of recovery room arrival (65.2% vs 57.1%; difference, 8.1%; 95% CI, -13.1% to 28.8%; P = 0.46); more than 1 dose of antiemetic medication (56.5% vs 62.9%; difference, 6.3%; 95% CI, -26.9% to 15.1%; P= 0.65); or more than 1 class of antiemetic medication (50.0% vs 54.3%; difference, 4.3%; 95% CI, -25.5% to 17.4%; P = 0.82). CONCLUSIONS: The administration of dextrose during emergence from anesthesia was not associated with a difference in the incidence of PONV exceeding 20% or in the severity of PONV in the first 2 hours after anesthesia. The relationship between PONV and the optimal dose and timing of IV dextrose administration remains unclear and may warrant further study. (07/2013) (link)
• Ramsingh D S, Sanghvi C, Gamboa J, Cannesson M, & Applegate R L. (2013). Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial. J Clin Monit Comput, 27(3), 249-257. Intraoperative goal directed fluid therapy (GDT) guided by an arterial pressure-based cardiac output system has been reported to improve gastrointestinal (GI) recovery in high-risk patients. This study evaluates the impact of this approach on GI recovery in low to moderate risk patients undergoing major abdominal surgery. IRB approved randomized controlled trial in low to moderate risk adults scheduled for major surgery. Patients were randomized to standard (n = 20) or GDT (n = 18) groups, whose fluids were managed to maintain stroke volume variation (SVV) < 12 %. The primary outcome measure was GI recovery. Additional measures included quality of recovery score. Continuous, non-normally distributed by Mann-Whitney test; ordinal and nominal by Chi square analysis. GDT patients had lower average intraoperative SVV. The GDT group had faster return of GI function (p = 0.004) and higher quality of recovery scores. In low to moderate risk patients undergoing major abdominal surgery, intraoperative GDT guided by SVV optimization was associated with faster restoration of GI recovery and higher quality of recovery scores. These results suggest that outcome benefits related to the use of an intraoperative goal directed fluid protocol guided by SVV are not limited to high-risk patients. (06/2013) (link)
• Applegate R L, Ramsingh D S, Dorotta I, Sanghvi C, & Blood A B. (2013). EVALUATION OF MULTIPLE MODES OF OXIMETRY MONITORING AS AN INDEX OF SPLANCHNIC BLOOD FLOW IN A NEWBORN LAMB MODEL OF HYPOXIC, ISCHEMIC, AND HEMORRHAGIC STRESS. Shock, 39(6), 501-506. Early and aggressive treatment of circulatory failure is associated with increased survival, highlighting the need for monitoring methods capable of early detection. Vasoconstriction and decreased oxygenation of the splanchnic circulation are a sentinel response of the cardiovasculature during circulatory distress. Thus, we measured esophageal oxygenation as an index of decreased tissue oxygen delivery caused by three types of ischemic insult, occlusive decreases in mesenteric blood flow, and hemodynamic adaptations to systemic hypoxia and simulated hemorrhagic stress. Five anesthetized lambs were instrumented for monitoring of mean arterial pressure, mesenteric artery blood flow, central venous hemoglobin oxygen saturation, and esophageal and buccal microvascular hemoglobin oxygen saturation (StO(2)). The sensitivities of oximetry monitoring to detect cardiovascular insult were assessed by observing responses to graded occlusion of the descending aorta, systemic hypoxia due to decreased FIO2, and acute hemorrhage. Decreases in mesenteric artery flow during aortic occlusions were correlated with decreased esophageal StO(2) (R-2 = 0.41). During hypoxia, esophageal StO(2) decreased significantly within 1 min of initiation, whereas buccal StO(2) decreased within 3 min, and central venous saturation did not change significantly. All modes of oximetry monitoring and arterial blood pressure were correlated with mesenteric artery flow during acute hemorrhage. Esophageal StO(2) demonstrated a greater decrease from baseline levels as well as a more rapid return to baseline levels during reinfusion of the withdrawn blood. These experiments suggest that monitoring esophageal StO(2) may be useful in the detection of decreased mesenteric oxygen delivery as may occur in conditions associated with hypoperfusion or hypoxia. (06/2013) (link)
• Doycheva D, Shih G, Chen H, Applegate R, Zhang J H, & Tang J P. (2013). Granulocyte-colony Stimulating Factor in Combination with Stem Cell Factor Confers Greater Neuroprotection after Hypoxic-Ischemic Brain Damage in the Neonatal Rats than a Solitary Treatment. Translational Stroke Research, 4(2), 171-178. Neonatal hypoxia-ischemia (HI) is a devastating condition resulting in neuronal cell death and often culminates in neurological deficits. Granulocyte-colony stimulating factor (G-CSF) has been shown to have neuroprotective activity via inhibition of apoptosis and inflammation in various stroke models. Stem cell factor (SCF) regulates hematopoietic stem cells in the bone marrow and has been reported to have neuroprotective properties in an experimental ischemic stroke model. In this study, we aim to determine the protective effects of G-CSF in combination with SCF treatment after experimental HI. Seven-day-old Sprague-Dawley rats were subjected to unilateral carotid artery ligation followed by 2.5 h of hypoxia. Animals were randomly assigned to five groups: Sham (n = 8), Vehicle (n = 8), HI with G-CSF treatment (n = 9), HI with SCF treatment (n = 9), and HI with G-CSF + SCF treatment (coadministration group; n = 10). G-CSF (50 mu g/kg), SCF (50 mu g/kg), and G-CSF + SCF (50 mu g/kg) were administered intraperitoneally 1 h post HI followed by daily injection for 4 consecutive days (five total injections). Animals were euthanized 14 days after HI for neurological testing. Additionally, assessment of brain, heart, liver, spleen, and kidney atrophy was performed. Both G-CSF and G-CSF + SCF treatments improved body growth and decreased brain atrophy at 14 days post HI. No significant differences were found in the peripheral organ weights between groups. Finally, the G-CSF + SCF coadministration group showed significant improvement in neurological function. Our data suggest that administration of G-CSF in combination with SCF not only prevented brain atrophy but also significantly improved neurological function. (04/2013) (link)
• Applegate R L, Gildea B, Patchin R, Rook J L, Wolford B, . . . Stier G. (2013). Telemedicine Pre-anesthesia Evaluation: A Randomized Pilot Trial. Telemedicine and E-Health, 19(3), 211-216. Objective: Pre-anesthesia evaluation allows discovery of conditions affecting perioperative planning, but when inadequate it may be associated with delays, cancellations, and preventable adverse events. Not all patients who could benefit will keep appointments. Telemedicine pre-anesthesia evaluation may provide for safe patient care while reducing patient inconvenience and cost. Herein we investigate the impact of telemedicine pre-anesthesia evaluation on perioperative processes. Subjects and Methods: This was a single-center prospective randomized trial in 200 adults scheduled for head and neck surgery at Loma Linda University Medical Center, Loma Linda, CA. Consenting patients not meeting criteria for telephone pre-anesthesia evaluation were randomly assigned to the in-person or telemedicine group. The primary outcome measure was inadequate evaluation caused surgical delay or cancellation. Secondary measures included prediction of difficult airway management and concordance of physical examination. Results: After consent, 40 patients met criteria for telephone screening. Five patients canceled surgery, none for inadequate pre-anesthesia evaluation; thus 155 were randomized. Delay occurred in 1 telemedicine patient awaiting results performed outside our system. Missing documentation at the time of the visit was less common for telemedicine. Difficult airway management was predicted equally but had low positive predictive value. Heart and lung examinations were highly concordant with day of surgery documentation. Patients and providers were highly satisfied with both evaluation modalities. Conclusions: Telemedicine and in-person evaluations were equivalent, with high patient and provider satisfaction. Telemedicine provides potential patient time and cost saving benefits without more day of surgery delay in our system. A prospective trial of patients from multiple surgical specialty clinics is warranted. (03/2013) (link)
• Applegate R L, Barr S J, Collier C E, & Allard M W. (2012). Considerations for Evaluating the Accuracy of Hemoglobin Monitoring Reply. Anesthesiology, 117(2), 430-431. (08/2012)
• Applegate R L, Barr S J, Collier C E, Rook J L, Mangus D B, & Allard M W. (2012). Evaluation of Pulse Cooximetry in Patients Undergoing Abdominal or Pelvic Surgery. Anesthesiology, 116(1), 65-72. Background: Intraoperative transfusion decisions generally are guided by blood loss estimation and periodic invasive hemoglobin measurement. Continuous hemoglobin measurement by pulse cooximetry (pulse hemoglobin; Rainbow (R) SET Pulse CO-Oximeter, Masimo Corporation, Irvine, CA) has good agreement with laboratory hemoglobin in healthy volunteers and could aid transfusion decision-making. Because intraoperative physiology may alter performance of this device, this study investigated pulse hemoglobin during surgery. Methods: Ninety-one adult patients undergoing abdominal or pelvic surgery in which large blood loss was likely were studied. Time-matched pulse hemoglobin measurements were recorded for each intraoperative arterial hemoglobin measurement obtained. Agreement between measurements was assessed by average difference (mean +/- SD, g/dl), linear regression, and multiple measures Bland-Altman analysis. Results: The average difference between 360 time-matched measurements (bias) was 0.50 +/- 1.44 g/dl, with wider limits of agreement (-2.3 to 3.3 g/dl) than reported in healthy volunteers. The average difference between 269 paired sequential pulse and arterial hemoglobin changes was 0.10 +/- 1.11 g/dl, with half between -0.6 and 0.7 g/dl of each other. The bias was larger in patients with blood loss of more than 1,000 ml; hemoglobin less than 9.0 g/dl; any intraoperative transfusion; or intraoperative decrease in arterial hemoglobin at the time of sampling >= 2 g/dl (all P < 0.001). The range of bias was narrower at deeper anesthesia (P < 0.001). Conclusions: Evaluation of the sensor and software version tested suggests that although pulse cooximetry may perform well in ambulatory subjects, in patients undergoing surgery in which large blood loss is likely, an invasive measurement should be used in transfusion decision-making. (01/2012) (link)
• Van Allen N R, Krafft P R, Leitzke A S, Applegate R L 2nd, Tang J, & Zhang J H. (2012). The role of Volatile Anesthetics in Cardioprotection: a systematic review. Med Gas Res, 2(1), 22. This review evaluates the mechanism of volatile anesthetics as cardioprotective agents in both clinical and laboratory research and furthermore assesses possible cardiac side effects upon usage. Cardiac as well as non-cardiac surgery may evoke perioperative adverse events including: ischemia, diverse arrhythmias and reperfusion injury. As volatile anesthetics have cardiovascular effects that can lead to hypotension, clinicians may choose to administer alternative anesthetics to patients with coronary artery disease, particularly if the patient has severe preoperative ischemia or cardiovascular instability. Increasing preclinical evidence demonstrated that administration of inhaled anesthetics - before and during surgery - reduces the degree of ischemia and reperfusion injury to the heart. Recently, this preclinical data has been implemented clinically, and beneficial effects have been found in some studies of patients undergoing coronary artery bypass graft surgery. Administration of volatile anesthetic gases was protective for patients undergoing cardiac surgery through manipulation of the potassium ATP (KATP) channel, mitochondrial permeability transition pore (mPTP), reactive oxygen species (ROS) production, as well as through cytoprotective Akt and extracellular-signal kinases (ERK) pathways. However, as not all studies have demonstrated improved outcomes, the risks for undesirable hemodynamic effects must be weighed against the possible benefits of using volatile anesthetics as a means to provide cardiac protection in patients with coronary artery disease who are undergoing surgery. (2012) (link)
• Macknet M R, Allard M, Applegate R L, & Rook J. (2010). The Accuracy of Noninvasive and Continuous Total Hemoglobin Measurement by Pulse CO-Oximetry in Human Subjects Undergoing Hemodilution. Anesthesia and Analgesia, 111(6), 1424-1426. BACKGROUND: Total hemoglobin (tHb) is one the most frequently ordered laboratory measurements. Pulse CO-Oximetry (TM) (Masimo Corp., Irvine, CA) is a multi-wavelength spectrophotometric method for noninvasive and continuous hemoglobin monitoring (SpHb). In this study, we evaluated the accuracy of SpHb compared with laboratory CO-Oximeter measurement of tHb from arterial blood samples in 20 healthy volunteer subjects undergoing hemodilution. METHODS: After enrollment, approximately 500 mL of blood was drawn from subjects through an arterial or venous catheter. Each subject then rapidly received crystalloid IV fluid to compensate for the decrease in intravascular volume and reduce the hemoglobin concentration. Subjects received a maximum of 30 mL/kg IV fluid. SpHb was continuously monitored and recorded, and serial arterial blood samples were taken during the procedure. SpHb accuracy was analyzed by pairing SpHb and tHb measurements after the arterial blood draw with the resulting tHb test result. Bias, precision, and the average root-mean-square error were calculated. RESULTS: One hundred sixty-five tHb measurements were collected. The average decrease in tHb during the blood removal and hemodilution procedure was 2.4 +/- 0.8 g/dL (mean +/- SD). The average difference between 335 paired measurements of SpHb and tHb was -0.15 g/dL, 1 SD of the difference was 0.92 g/dL, and the average root-mean-square difference was 0.94 g/dL. The difference between SpHb and tHb was < 2.0 g/dL for 97% of the measurements. The difference was < 1.5 g/dL for 97% of the measurements when tHb was < 10 g/dL. CONCLUSIONS: Pulse CO-Oximetry-based SpHb measurement is accurate within 1.0 g/dL (1 SD) compared with laboratory CO-Oximeter tHb measurement in subjects undergoing hemodilution. (12/2010) (link)
• Dorotta I, Kimball-Jones P, Applegate II RL. "Anesthetic Management for the Adult Patient Undergoing Deep Hypothermic Circulatory Arrest." Seminars in Cardiothoracic and Vascular Anesthia . (2007): -. (01/2007)
• Kerr R, Applegate II RL. "Accurate Placement of the Right Atrial Air Aspiration Catheter: A Descriptive Study and Prospective Trial of Intravascular Electrocardiography." Anesthesia and Analgesia 103.1 (2006): 435-438. Appropriate positioning of the right atrial air aspiration catheter is critical to successful aspiration of air. The intravascular electrocardiography patterns currently used to position the right atrial air aspiration catheter have not been validated by echocardiography. In 10 patients, using simultaneous transesophageal echocardiography and intravascular electrocardiography, we found that the largest monophasic P wave without a biphasic component correlated with the right atrial-superior vena cava junction. Using this pattern, we performed a prospective trial on 10 subjects and demonstrated appropriate positioning in only 8. This preliminary study suggests that intravascular electrocardiography may not yield appropriate positioning in all patients. (01/2006) (link)
• Ashwal S, Holshouser BA, del Rio MJ, Tong KA, Applegate RL, Bailey LL. "Serial proton magnetic resonance spectroscopy of the brain in children undergoing cardiac surgery." Pediatric Neurology 29.2 (2003): 99-110. We used proton magnetic resonance spectroscopy to study 11 children (age < 8 years) with congenital heart disease undergoing cardiopulmonary bypass to determine whether low (10 +/- 4; n = 6) vs high (20 +/- 4; n = 5) perfusate hematocrits during bypass resulted in changes in brain metabolites which correlate with neurologic injury. Long and short echo time single voxel magnetic resonance spectroscopy in occipital gray matter and neurologic assessment were performed preoperatively and 2 and 5 days postoperatively. We also determined whether prolonged periods at low flow rates during bypass affected spectroscopy variables. We found no significant differences in metabolite ratios between the low vs high hematocrit groups or the lower vs higher flow rate groups (repeated measures analysis of variance of observation ranks converted to normal scores). However, our study was limited by statistical power due to the small sample size, therefore no conclusions could be made. Additional studies involving a greater number of patients are necessary. In all 11 children, magnetic resonance spectroscopy detected a significant decrease in brain N-acetyl-aspartate, and increases in myoinositol and glutamate/glutamine after surgery (Quade test) demonstrating that magnetic resonance spectroscopy is sensitive in detecting subtle postoperative changes in brain metabolites. (01/2003) (link)
• Applegate RL, Mason LJ, Thompson TL. "Anesthetic Management of Pediatric Cardiac Transplant." Seminars in Cardiothoracic and Vascular Anesthia 5. (2001): 55-61. (01/2001)
• Mason LJ, Applegate RL, Thompson TL. "Anesthesia for Noncardiac Surgery in Pediatric Patients Following Cardiac Transplantation." Seminars in Cardiothoracic and Vascular Anesthia 5. (2001): 62-66. (01/2001)
• Sardari FF, Schlunt ML, Applegate RL, Gundry SR. "The Use of Transesophageal Echocardiography to Guide Sternal Division for Cardiac Operations via Mini-Sternotomy." Journal of Cardiac Surgery 12.2 (1997): 67-70. Cardiac surgery utilizing the mini-sternotomy technique offers many advantages, including lessened pain and hospitalization. Mid-line upper sternotomy (or mini-sternotomy) can provide adequate exposure of the ascending aorta, the aortic root, the right atrial appendage and the dome of the left atrium. Inherent in providing adequate exposure is the level at which the sternum is "T'd" off. The lower aspect of the sternotomy is "T'd" off at the second, third, or fourth intercostal space depending on the patient's anatomy. We describe a technique that uses transesophageal echocardiography to determine the precise location for "T'ing" off the sternotomy, rather than approximating the sternotomy site by physical exam and chest radiograph. This technique will reliably delineate the sternotomy site, irrespective of a patient's body size and habitus. (01/1997) (link)
• Cole DJ, Drummond JC, Patel PM, Nary JC, Applegate RL. "Effect of Oncotic Pressure of Diaspirin Crosslinked Hemoglobin on Brain Injury After Temporary Focal Cerebral Ischemia in Rats." Anesthesia and Analgesia 83. (1996): 342-347. (01/1996)
• Schell RM, Applegate RL, Cole D. "Salt, Starch, and Water on the Brain. J Neurosurg Anesthesiol." Journal of Neurosurgical Anesthesiology 8.2 (1996): 178-182. sotonic fluids have been thoroughly studied and for the vast majority of neurosurgical patients are both safe and effective. Conversely, HS may have some transient beneficial effects on cerebral physiology in animal models of brain injury. However, further studies are needed to measure the functional outcome rather than early parameters of CNS function with HS resuscitation. In addition, HS has a defined risk. Until the risk-benefit ratio of HS is better defined in humans, physicians should exercise caution and adhere to the Hippocratic oath. However, if this risk-benefit ratio is defined, HS may hold promise for the clinical conditions cited herein as well as other novel uses (cardiopulmonary bypass, spinal trauma [55,56]). (01/1996) (link)
• Hozumi T, Shakudo M, Applegate R, Shah PM. "Accuracy of Cardiac Output Estimation with Biplane Transesophageal Echocardiography." Journal of the American Society of Echocardiography 6. (1993): 62-68. (01/1993)
• Applegate RL, Cole DJ. "Neurophysiology and Cerebral Function." Current Opinion in Anesthesiology 5. (1992): 648-. (01/1992)
• Schell RM, Shah PM, Applegate RL, Shah P, Schmidt CA. "Remote Asynergy Detected by Biplane Transesophageal Echocardiography during Myocardial Revascularization without Cardiopulmonary Bypass." Anesthesia and Analgesia 73.5 (1991): 642-645. (01/1991)
• Schell RM, Brauer FS, Cole DJ, Applegate RL. "Persistent Sacral Nerve Deficits after Continuous Spinal Anesthesia." Canadian Journal of Anesthesia 38.7 (1991): 908-911. Neurological deficits following spinal anaesthesia are rare. We report two cases of persistent sacral nerve root deficits after continuous spinal anaesthesia (CSA) performed with hyperbaric lidocaine through a lumbar microcatheter. In both cases the dose of 5% lidocaine (5.7 and 4.3 ml) was greater than usual. In the immediate postoperative period the constellation of neurological deficits included perianal hypaesthesia, lower extremity paresis, urinary retention, and difficult defaecation. Both patients have residual perianal hypaesthesia and difficult defaecation. In these cases, the high-dose requirements of local anaesthetic via microcatheter CSA with focal sensory block suggests nonuniform distribution of the hyperbaric lidocaine. Microcatheter CSA may convey a unique risk of maldistribution of the local anaesthetic solution and local neurotoxicity. (01/1991) (link)

Abstract

• Applegate R, Collier C, Mangus D, Barr S, Macknet M, Hassanian M, & Allard M. (2013). EVALUATION OF ABSOLUTE AND TREND ACCURACY OF REVISION G NONINVASIVE AND CONTINUOUS HEMOGLOBIN MONITORING DURING MAJOR SURGERY. Anesth Analg, 116, 310-310. (05/2013)
• Leitzke A S, Rolland W B, Krafft P R, Lekic T, Klebe D, Applegate R, & Zhang J. (2013). ISOFLURANE POST-TREATMENT AMELIORATES GERMINAL MATRIX HEMORRHAGE-INDUCED BRAIN INJURY BY ACTIVATING THE SPHINGOSINE KINASE/AKT PATHWAY IN NEONATAL RATS. Anesth Analg, 116, 153-155. (05/2013)
• Wolford B, Gildea B, Applegate R L, Stier G, Patchin R, & Nyirady J. (2011). TELEMEDICINE PRE-ANESTHESIA CONSULTATION PROVIDES ACCURATE AIRWAY EXAM INFORMATION. Journal of Investigative Medicine, 59(1), 135-136. (01/2011)
• King N C, Blair B M, Collier C, Applegate R L, Sanghvi C, & Allard M. (2011). COMPARISON OF SVV TO SCVO2 IN PATIENTS UNDERGOING MAJOR SURGICAL PROCEDURES. Journal of Investigative Medicine, 59(1), 132-132. (01/2011)

Books and Chapters

• Mason LJ, Applegate II RL, Thompson T, Kim M. Pediatric Cardiac and Lung Transplantation In Pediatric Cardiac Anesthesia, Fourth Edition, Lake C editor. Philadelphia: Lippincott Williams & Wilkins, 2005. 551 - 581 (01/2005)
• Applegate II RL. The Operating Room. In Adult Perioperative Anesthesia, DJ Cole and M Schlunt, editors. Philadelphia: Elsevier, Mosby, 2004. 38 - 95 (01/2004)
• Applegate II RL. Airway Management. In Adult Perioperative Anesthesia, DJ Cole and M Schlunt, editors. Philadelphia: Elsevier, Mosby, 2004. 168 - 182 (01/2004)
• Applegate PM and Applegate RL. Perioperative Transesophageal Echocardiography, in TEE on DVD, version 2.0. Konstadt S, Shernan S, Oka Y, Nanda N editors. Philadelphia: Lippincott Williams & Wilkins, 2003. (01/2003)
• Engel TP, Applegate RL, Chung D, Sanchez A, Iwase Y. Management of the Difficult Airway, Japanese language version an interactive multimedia tutorial for personal computers. : Cook , 1999. (01/1999)
• Schell RM, Applegate RL, Reves JG. Cardiopulmonary Bypass. In Atlas of Anesthesia, RD Miller and JG Reves, editors. Philadelphia: Churchill Livingstone, 1999. 9.1 - 9.30 (01/1999)
• Engel T, Applegate RL, Chung D, Sanchez A. Management of the Difficult Airway, an interactive multimedia tutorial for personal computers. : Cook , 1996. (01/1996)
• Applegate RL, Applegate PM, Engel TP. Transesophageal Echocardiography Tutorial and Reference v1.0; an interactive multimedia tutorial for Macintosh Computers. : Bristlecone Software, 1994. (01/1994)
• Schell RM, Applegate RL. Obstetric and Gynecologic Recovery. In Manual of Post Anesthesia Care, Jacobsen, et al editors. : Saunders, 1992. (01/1992)
• Applegate II RL. Discharge from the PACU. In Manual of Post Anesthesia Care, Jacobsen, et al editors. : Saunders, 1992. (01/1992)