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1
A Bibliometric Search of Citation Classics in Anesthesiology
2
R. S. Tripathi,1 J. M. Blum,2 T. J. Papadimos,3 A. L. Rosenberg2
3
1
4
1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5048, United States (current
5
institution: The Ohio State University Medical Center, Department of Anesthesiology, 410 West
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10th Avenue, Columbus, Ohio 43210, United States); [email protected]
7
2
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1500 East Medical Center Drive, Ann Arbor, Michigan, 48109-5048, United States;
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[email protected]; [email protected]
University of Michigan Medical School, Department of Anesthesiology, 1H247 UH, SPC 5048,
University of Michigan Medical School, Department of Anesthesiology, 1H247 UH, SPC 5048,
10
3
The Ohio State University Medical Center, Department of Anesthesiology, 410 West 10th
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Avenue, Columbus, Ohio, 43210, United States; [email protected]
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Corresponding Author
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Ravi S. Tripathi, MD
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Assistant Professor Clinical
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Department of Anesthesiology
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The Ohio State University Medical Center
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410 W. 10th Avenue
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Columbus, Ohio 43210
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Phone: (614) 293-8487
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FAX: (614) 293-8153
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E-mail: [email protected]
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1
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Abstract
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Background: Articles cited counts are catalogued and help identify landmark papers. This study
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provides a citation classics of anesthesiology literature using the framework of subspecialties to
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provide a review of well-developed areas of research in anesthesiology.
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Methods: A comprehensive list of the most-cited articles in anesthesia was compiled using a
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bibliometric database and general search terms such as “anesthesia” as well as subspecialty-
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specific search terms. Queries were reviewed for relevance to anesthesiology practice,
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categorized by subspecialty, and ranked according to their citation counts.
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Results: The database resulted in 2519 articles published between 1945 and 2008. The specialty
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areas most represented were chronic pain medicine (11%), pharmacology (9%), and pain
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sciences (9%).
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Conclusions: This citations classic allows for advances in anesthesiology and its subspecialties
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to be highlighted as well to provide useful manuscripts to guide patient care, direct future
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research, and serve as sources for future academic pursuit.
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Background
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It is ironic that as electronic access to medical literature becomes more pervasive, the
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ability for an individual to maintain a semblance of broad awareness of that body of knowledge
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becomes more difficult. The diversity of diseases, the patients, and the basic sciences that
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encompass the specialty of anesthesiology and its related specialties is reflected by a similar
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heterogeneity of the journals in which anesthesiology knowledge is published. As this body of
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knowledge increases, it is important to enhance methodologies that identify especially relevant
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and important papers within the overall field, as well as within its multiple subspecialties. With
2
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the development of Internet-based search engines, numerous methods to search for relevant
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medical literature now exist. While these databases are easy to use, the results of basic keyword
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or topic searches are often overwhelming and shed little light on the most relevant articles. There
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is a need to improve a practioners' ability to quickly find important articles.
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Articles that have value to others are often cited in subsequent manuscripts. These
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referenced papers are catalogued in bibliometric resources that track the number of times a paper
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is cited. Because the vast majority of published articles are never referenced even once, those
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that are cited often arguably had significant influence. The more times an article is cited, the
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more likely it is to have impacted the field and patient care [1]. These collections of cited
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articles are sometimes referred to as ‘Citation Classics.’ It is argued that citation classics have
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their limitations and the enthusiasm for defining manuscripts as such is varied [2-5]. However,
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citation classics are considered a reasonable proxy for the focus of contemporary experts in a
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field at a given period, reflect the state of scientific inquiry, and have been shown to follow
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proposed hierarchy of evidence with meta-analysis being the most-often cited articles and case
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reports the least cited [6].
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In 1987, Garfield catalogued citation classics from the Journal of the American Medical
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Association [7]. Since then, similar studies have been performed within multiple medical
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specialties [1,8-16]. These reviews have used different approaches for a variety of medical
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specialties, and investigations focusing on frequently-cited literature within anesthesiology have
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received little attention [17-21]. The most recent of these publications is now almost seven years
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old and does not include any articles published after 1997 [21]. Among the limitations of these
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articles are the authors’ confining their search only to anesthesiology journals [21], or in the case
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of Hall et al., limiting their search to a single anesthesiology journal [17]. Another limitation of
3
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previous citation classic surveys has been the paucity of attempts to explore for anesthesiology-
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centric articles within medical specialty areas not exclusive to anesthesiology (example: pain,
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pediatrics, obstetrics, neurosciences). Additionally, anesthesiology subspecialties have received
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essentially no careful review, and there are no data to date regarding the subspecialty influence,
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as reflected by citations counts for these areas [22].
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The primary aim of this study was to expand on these earlier works by examining
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literature related to the field of anesthesiology in both anesthesiology and non-anesthesiology
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journals. Similar to previous citation classics [16], databases were searched not only by specific
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journals, but also by specific search terms such as anesthesiology.
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The second goal of this paper was to improve the capture of highly-cited articles, with a
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primary subject pertaining to anesthesiology issues within subspecialties that may have been
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previously missed in surveys that did not explicitly make this focus a priority.
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Methods
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To develop the most comprehensive list of cited articles in anesthesiology and
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anesthesiology-related subspecialties, the search strategy was conducted using three methods.
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All of these searches used the ISI Web of Knowledge databases
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(http://www.isiwebofknowledge.com, Thomson Rheuters, 2008). Two of ISI Web of
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Knowledge’s databases are the Journal Citation Report (JCR) and Science Citation Expanded
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(SCI Expanded). JCR is a resource that lists the names of over 5900 journals, both scientific and
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technical, for their bibliometric information and impact factors. SCI Expanded is an index of
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articles in over 6670 scientific journals that include bibliographic information, cited references,
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and citation counts. All queries were performed during January and February 2010. The SCI
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was limited to articles published until and including 2009.
4
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Journal Search. Similar to previous citation classic for anesthesiology [21], the search
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began by identifying journals with the subject category “anesthesiology” using JCR 2008. Of
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the 22 journals designated as anesthesiology, individual queries were performed for each of 19
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journals published in the English language (Table 1). SCI Expanded was then searched for
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articles published within these journals. Bibliometric data on articles that were cited at least 100
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times were collected, similar to previous citation investigations [16].
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Keyword Search. The second strategy was used to create a more complete and
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comprehensive list and to capture relevant articles not within anesthesiology journals. SCI
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Expanded was queried by keyword. To find articles related to anesthesiology among all
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scientific journals, the search terms “anesthes*” and “anaesth*” were used to retrieve articles that
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contained the keywords anesthesia, anesthesiology, anesthesiologist, anesthetists, anesthetics,
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anaesthesia, or anaesthesist. The symbol “*” is a wildcard to retrieve all search items that start
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with the preceding text. As done with the search by journal, bibliometric information on articles
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that had been cited more than 100 times in our database and published in English language were
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collected.
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Subspecialty Search. To organize the retrieved articles, this study defined 14 areas of
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anesthesiology practices that included the breadth of the field. Due to previous publication in the
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area of critical care [16], critical care was omitted from this study. SCI Expanded was searched
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by terms within these subject areas (see Table 2). This strategy resulted in 65 separated queries,
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from which duplicate articles were removed. Articles with at least 100 citations and published
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in the English languate were used for this analysis.
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The authors evaluated each article to ensure its relevance to anesthesiology by reviewing
citation information available, including article title, source journal, keywords, and abstract.
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Criterion included articles that were clinically relevant to the practice of anesthesiology. For
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example, articles regarding the preoperative diagnosis of carotid stenosis and the decision to treat
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medically or operatively were eliminated. Similarly, articles focusing on the postoperative
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surgical complications were also eliminated. On the other hand, articles that focused on the
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intraoperative management of patients undergoing carotid endartectomy were included.
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Postoperative complications and care that were related to anesthetic practice were kept. Articles
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that were no longer clinically relevant were removed. For example, due to the questionable
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future of aprotinin, only key articles regarding the use of this drug are highlighted. This study’s
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preliminary survey and previous studies [20] have shown that anesthesiology is dominated by
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pain literature; thus, this subspecialty was divided into two categories: acute/basic pain science
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and chronic pain management. Additional articles with a primary focus of basic
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science/mechanism, animal studies, and research methodology were excluded since the aim of
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this paper was to provide the practicing anesthetists with clinically-relevant articles.
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Once the irrelevant articles were removed, the authors categorized the articles according
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to subspecialty. Each of these categories was reviewed with leaders in their respective field at
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the University of Michigan to ensure validity of the searches. Articles are presented according to
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their subspecialty in descending order according to their citation counts. For articles published
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simultaneously in more than one journal, the cumulative citation count is reflected. The 20
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most-cited articles in each subspecialty are presented.
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Results
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Initial search strategies resulted in 19,478 articles. After excluding duplicates and
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irrelevant articles in the manner listed in methods, the database of articles specific to the conduct
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of anesthesiology itself included only 2519 articles (13% of the original search). The articles
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were published between 1945 (Whitacre’s “Clinical observation on the use of curare in
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anesthesia,” Anesthesiology) and 2008 (Devereaux’s POISE Trial, Lancet). The majority of the
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most-cited publications occurred between 1980 and 1990. Of the 10 most-cited articles, the
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mean publication year was 1981.
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The articles came from 103 distinct journals. The journals with the most articles were
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Anesthesiology (27%, n = 673), Pain (22%, n = 563), and British Journal of Anaesthesia (8%, n
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= 202). Seventy-two percent of the articles (n = 1,804) were published in anesthesiology-related
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journals as identified by JCR 2008 (see Table 1). The “non-anesthesiology” journal with the
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most highly-cited anesthesiology-related articles was the Lancet (2%, n = 42).
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Of the 1250 categorized articles, the most common topics were chronic pain medicine
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(11%, n = 139), pharmacology (9%, n = 109), and acute and basic pain sciences (9%, n = 108).
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Pharmacology (n = 6, 38%) was the most-cited category prior to and during the 1960s, with
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landmark papers such as Egler’s discussion of minimum alveolar concentration in
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Anesthesiology (1965). After 1970, pain articles predominate with landmark papers such as
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Melzack’s “The Mcgill Pain Questionnaire” in Pain (1975). This prevalence of pain articles
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continues for the remainder of the citations chronologically.
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Articles that are more-recently published will have a shorter exposure to the medical
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community; arguably, their times cited may be less often than older papers that have a longer
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presence in the literature. . In Table 3, we have presented the articles with the highest citation
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count for each year for the previous 20 years. This was done to highlight articles that have likely
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influenced clinical care but have not reached their citation peak due to their infancy, and thus, are
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not presented in our citation classics by subspecialty. The 20 most-cited articles by specialty are
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presented in Table 4 with their time cited and their overall rank in the entire database designated.
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Discussion
Access to the world’s contemporary scientific literature is increasingly more available via
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medical libraries, Internet data repositories, and web-based search engines. However, without
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preexisting knowledge of the most influential articles, finding the most relevant articles is
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difficult. The purpose of this study was to provide updated citation classics of anesthesiology
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literature using the framework of subspecialties within the general field to provide a review of
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well-developed areas of research in anesthesiology. As the field of anesthesiology advances in
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research and clinical science, this review would assist anesthesiology providers with areas of
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anesthesiology that are already well studied as well as shows areas with a paucity of research to
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guide short- and long-term goals for departments, divisions, and collaborations.
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Unlike a previous study for critical care articles [16], this study found the majority of
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highly-cited anesthesiology articles within primarily anesthesiology journals. In this study of
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anesthesiology citation classics, 72% of the articles came from publications that were designated
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as anesthesiology journals by the JCR. This is likely to reflect either the paucity of
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anesthesiology studies being submitted to non-anesthesiology journals, or a reflection of a
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quality or interest gap for anesthesiology-related studies in non-anesthesiology journals. As the
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practice of anesthetists expands from the operating room to the perioperative arena—including
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preoperative outpatient clearance, perioperative pain management, postoperative intensive care
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management, and even areas of palliative care—anesthesiology-related articles should show
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more prevalence in non-anesthesiology and general medical journals. Departmental chairs,
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administrators, and committees could use the placement of academic work in non-anesthesiology
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journals as a marker of excellence and significant contribution to the medical community by their
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faculty and divisions.
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The keyword “anesthesia” is surprisingly not effective in retrieving anesthesiology-
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focused articles. To begin, the majority of these manuscripts are related to surgical procedures,
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outcomes, and complications with no focus on the conduct or issues related to anesthesiology.
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Furthermore, the specificity for “anesthesia” as a search term is also quite poor. For example,
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when “anesthes*” is queried in SCI Expanded to retrieve articles containing either anesthesia or
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anesthesiology, one of the most-cited articles retrieved is “Multilineage cell from human adipose
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tissue: implications for cell-based therapy” by Zuk and colleagues in Tissue Engineering (2001)
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due to the use of the phrase “under local anesthesia” in their abstract; however, this article is
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clearly not relevant to the practicing anesthetists. Another explanation for the poor specificity
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for keywords may relate to the previous finding that authors list various keywords in their
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manuscripts in order to increase the number of times their articles are referenced. It has been
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suggested that authors carefully choose the words used in their abstract to improve the chances
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of their article being found and cited [23]. Also, during a pilot search by keyword “anesthesia,”
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many classics articles were not included. One explanation includes articles published before the
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mid-1980s did not list keywords. Therefore, these landmark studies were less likely to be
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identified by the search “anesthesia.”
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A somewhat unique aspect of this recent survey of anesthesiology citation classics is the
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unique focus on anesthesiologist specialties, a method not previously performed. Examining the
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individual subspecialties, the predominance of pain articles and their high-citation rate is not
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surprising. Pain is a clinical entity that is used by many fields in medicine—anesthesiologist,
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physical medicine and rehabilitation, surgery, medicine, psychiatry and addiction medicine,
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nursing—so these articles have interest to a larger audience than articles on the basics of
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anesthesiologist and have skewed impact factors [22]. The same would apply for other
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subspecialties such as perioperative medicine. With both basic science pain and clinical pain
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management occupying a large part of the database, they may have prevented other
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subspecialties areas from being highlighted. However, the framework of this study allows
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articles within each area to be represented and highlighted.
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Ramsdell and associates compared the impact factors of pediatrics versus pain on
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anesthesiologist and presented the low impact of pediatric articles [22]. This study supports this
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with pediatrics and obstetrics representing the smallest percentiles of articles (both 3.4%).
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Furthermore, the most-cited pediatric article ranked only #53 overall and the most-cited obstetric
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articled ranked #222 overall. This is in contrast to the least most-cited chronic and basic science
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pain articles still ranking highly at #73 and #100 respectively. This clearly exemplifies the
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difference in impact factors for obstetrics and pediatric anesthesiologist specialty articles as
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compared to anesthesiologist pain studies. While this could be due to differences in the amount
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of pediatric anesthesiologist clinical trials or related basic science compared to pain research,
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other differences in emphasis in studies could also be a factor. One, in particular, is the
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predominance of studies related to issues in obtaining consent that are emphasized within
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pediatric anesthesiology and may not be as relevant and, therefore, cited as commonly by non-
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pediatric anesthesiologist studies. This could also apply to obstetrics patients and its associated
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difficulties in research. The decision to exclude articles pertaining to basic science research and
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non-human studies could also have contributed to this bias as many obstetric studies are
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performed on animals due to ethical concerns of performing a similar study on humans. The lack
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of research published in these areas could be an area of interest to future researchers looking to
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develop a niche.
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Certainly the articles presented likely have made an impact on the literature of
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anesthesiology as all articles have been cited at least 100 times. This is especially relevant when
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46% of all published clinical articles are never cited [11]. One flaw of citation classics, however,
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is that they are based on the assumption that authors are appropriately citing especially relevant
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and important studies. This may not also be the case. Authors are obviously most familiar with
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their own or work of their colleagues. These networks of authors and their work may lead to
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self-propagation in a given area [24,25]. Bornmann and Daniel proposed “non-scientific” factors
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that lead to authors citing other works, including time-dependent, field-dependent, journal-
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dependent, article-dependent, and author/reader-dependent factors [26]. It is not clear as to how
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these social networks affect the growth of the anesthesiologist knowledge base or its overall
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impression in the medical community. This would be a future area of investigation.
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While this article presents an update of earlier citation classics in anesthesiologist, most
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of the articles featured are still almost 20 years old. The year with the most publications in our
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database was 1986. This is not unexpected, as it has been reported that the true impact of an
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article cannot be assessed until 20 years after its publication with an article’s maximum citations
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per year occurring three to 10 years after publication. This time period varies with specialty as
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different journals and areas have different citation half-lives [27]. Finally, after an article’s
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highest number of citations peak in a given year, it will eventually be incorporated into common
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knowledge and no longer be as frequently cited, or its relevance will wane with new data
247
supplanting or augmenting it. Thus, many important articles are lost to time [15].
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The year of publication also affects an article’s citations because electronic citation
249
records were initially developed in 1979. Therefore, there is a bias to cite articles published
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since 1981 [12]. This presents two issues that this paper was unable to resolve. First, the articles
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retrieved by our search that were published prior to 1979 likely represent especially influential
11
252
papers as they are not routinely digitized and therefore require manual retrieval in order to be
253
cited within the era of electronic submissions. Moreover, there is a retrieval bias in this study
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that may have missed some highly-cited articles that were published prior to 1979 as these
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studies would not populate an electronic bibliometric search.
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There are other limitations within our study that should be recognized. First, by using a
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broad search strategy, this study retrieved almost 19,500 articles that required manual review by
258
the authors (RT, AR) in order to remove articles not primarily focusing on anesthesiologist
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topics. Using predetermined criteria for manual review of the preliminary database, it is unlikely
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that personal bias impacted the final data. In addition, the lists were reviewed individually and
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then the results were compared to minimize a single author influencing the results. Finally, the
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final lists were reviewed with many experts in the field who agreed with their validity as
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landmark or classic articles. Another limitation of this paper is the selection of only
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anesthesiologist journals published in English that would have failed to capture landmark articles
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published in other languages. Language barriers are a known bias to citation classics as authors
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are more likely to cite articles in their own language and English articles are more likely to be
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cited overall [4,9,10,28]. While the United Kingdom and United States of America have
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historically contributed to over half the anesthesia literature [18], many countries are starting to
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look at their researchers’ contributions to individual fields as well as the international fund of
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knowledge [29]. Representation of research in the anesthesia literature by groups from other
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countries has changed over the previous decade; Although the Unites States continues to publish
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more articles than any country, the percent of articles from the United States and United
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Kingdom have decreased and other countries such as Turkey, China, and India have contributed
274
an increasing the percentage of manuscripts to the anesthesia literature [30]. With the change in
12
275
health care in the United States and the evolving global economy, it will be interesting to see
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how future citation classics compare to current data with respect to the sources of literature.
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Conclusions
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In summary, since the advent of anesthesiology and especially over the previous 60 years,
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the body of knowledge in anesthesiology has flourished. We provide a review of landmark
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papers in anesthesiology. This review could be used for practioners of all levels of training.
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Residents and junior attendings could use this article as a reference to articles with historical
282
interest. Senior attendings and administrators could use this article to see the citation counts of
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their works compared to colleagues for academic interest. To all clinicians, classic articles
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within the various anesthesiology specialties are especially relevant to affect patient care, future
285
research and as sources of inspiration to the academic pursuit of the field.
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List of Abbreviations
287

JCR –Journal Citation Report
288

SCI Expanded – Science Citation Expanded
289
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291
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Competing Interests
The authors declare that they have no competing interests.
Authors’ Contributions
RT conceived of the study and wrote the manuscript. JB participated in writing and
293
editing the manuscript. TP participated in writing and editing the manuscript. AR conceived of
294
the study and wrote the manuscript.
13
295
296
Acknowledgements and Funding
The authors wish to thank Keri Hudec, technical editor with The Ohio State University
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Department of Anesthesiology, and Barbara Hammond, admnistrative assistant with University
298
of Michigan Department of Anesthesiology. Funding was provided by the Department of
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Anesthesiology.
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17
366
Table 1. Anesthesiology journals used for journal search.
Acta Anaesthesiologica Scandinavica
Anaesthesia and Intensive Care
Anaesthesia
Anaesthesist
Anesthesia &Analgesia
Anesthesiology
British Journal of Anaesthesia
Canadian Journal of Anaesthesia
Clinical Journal of Pain
European Journal of Anesthesiology
European Journal of Pain
International Journal of Obstetric Anesthesia
Journal of Cardiothoracic and Vascular Anesthesia
Journal of Clinical Anesthesia
Journal of Neurosurgical Anesthesiology
Minerva Anesthesiologica
Pain
Pediatric Anesthesia
Regional Anesthesia and Pain Medicine
368
369
18
370
Table 2. Specific anesthesiology subspecialties areas and search terms used.
Subject Area
Airway management
Focus
Intubation, difficult airway
Cardiothoracic
Cardiothoracic anesthesiology
and vascular
and intraoperative cardiac
anesthesiology
pathology
Search Terms
“difficult-airway” intubation
“bypass” “cardiac” “cardio*”
“heart” “transfusion” “thoracic”
“single lung” “one lung” “lung
isolation” “vascular” “aneurysm"
“sedation” “monitored-
General anesthesiology
Articles that pertained to field as
and physiology
a whole
anesthesia-care” “MAC” “lineplacement” “cannula*”
“neurosurgery” “crani*”
Head and neck surgery
Neuroanesthesia and
“cerebral-blood-flow”
(including
anesthesiology for head and neck
“intracranial-pressure” “carotid
neurophysiology)
surgery
endart*”
Hemodynamic monitors and
monitors of depth of
“monitor” “safety” “record”
anesthesiology (excluding
“inform*” “echo*”
Monitors
monitors of surgical techniques)
Including environmental and
“obstetric anes*” “labor
occupational studies
analgesia”
Obstetric anesthesiology
Basic sciences included
Pain (basic science and
pharmacology and acute
clinical management)
physiology, while chronic
“pain” “opioid” “opiate”
included clinical management of
19
patients with chronic pain
Including both anesthesiology
“pediatric” “paediatric”
Pediatric anesthesiology
and pain
Precardiovascular screening for
non-cardiac surgery, preoperative
“preop*” “periop*” “intraop*”
Preoperative medicine
optimization, and other diseaserisk stratification
Postoperative pain management,
Postoperative care
nausea and vomiting, and other
“postop*” “PACU”
physiologic complications of
“postanesthesia”
anesthesiology (excluding
“postanaesthesia”
pulmonary)
“local anes” “local anaes”
“nondepolariz*”
Mainly volatile anesthetics,
“succinylcholine” “malignant
intravenous anesthetics, and
hyper*” “intravenous anes”
Pharmacology
neuromuscular blocking drugs
“intravenous anaes” “inhalation
(local anesthetics and opiods were
anes*” “volatile anes*”
addressed elsewhere)
“neuromuscular-block*”
“paralytic”
Safety and use of regional and
“regional anes*” “regional
neuraxial anesthesiology
anaes*” “neuraxial anes*”
including pharmacology and
“neuraxial anaes*” “epidural”
Regional and neuraxial
anesthesiology
20
physiology
“spinal” “subarachnoid”
“intrathecal” “ambulatory
surgery”
Intraoperative ventilatory
management, pulmonary
“ventilator” “hypoxia”
Pulmonary
physiology, and postoperative
pathology
Intraoperative fluid optimization
“transfusion” “fluid” “blood”
Fluid management
and transfusion medicine
* Indicates a wildcard to return any string of characters
“Subject” indicates the subspecialty area. “Focus” indicates the desired content of the subject
or subspecialty area. “Search terms” are the actualy keywords used for the searches.
371
372
21
373
Table 3. 20 Years of Most cited articles by year since 1989.
Year
First Author. Title. Journal. (# Rank in Overall Database / Times Cited)
1989
Bidstrup, BP. Reduction in blood-loss and blood use after cardiopulmonary bypass
with high-dose aprotinin (trasylol). J Thorac Cardiov Sur 1989. (#95 / 398)
1990
Paulson, OB. Cerebral autoregulation. Cerebrovas Brain Met 1990. (#25 / 697)
1991
Woolf, CJ. The induction and maintenance of central sensitization is dependent on Nmethyl-D-aspartic acid receptor activation - implications for the treatment of postinjury
pain hypersensitivity states. Pain 1991. (#9 / 1059)
1992
Watcha, MF. Postoperative nausea and vomiting - its etiology, treatment, and
prevention. Anesthesiology 1992. (#22 / 713)
1993
Coderre, TJ. Contribution of central neuroplasticity to pathological pain - review of
clinical and experimental-evidence. Pain 1993. (#7 / 1183)
1994
Vandermeulen, EP. Anticoagulants and spinal epidural-anesthesia. Anesth Analg
1994. (#118 / 365)
1995
Vlaeyen, JWS. Fear of movement (re)injury in chronic low-back-pain and its relation
to behavioral performance. Pain 1995. (#67 / 445)
1996
Roach, GW. Adverse cerebral outcomes after coronary bypass surgery. New Engl J
Med 1996. (#15 / 843)
22
1997
Mihic, SJ. Sites of alcohol and volatile anaesthetic action on gaba(a) and glycine
receptors. Nature 1997. (#29 / 670)
1998
Rampil, IJ. A primer for eeg signal processing in anesthesia. Anesthesiology 1998.
(#70 / 443)
1999
Sindrup, SH. Efficacy of pharmacological treatments of neuropathic pain: an update
and effect related to mechanism of drug action. Pain 1999. (#45 / 545)
2000
Vlaeyen, JWS. Fear-avoidance and its consequences in chronic musculoskeletal pain:
a state of the art. Pain 2000. (#36 / 632)
2001
Farrar JT. Clinical importance of changes in chronic pain intensity measured on an 11point numerical pain rating scale. Pain. (#40 / 578)
2002
Eagle KA. ACC/AHA guidelines update for perioperative cardiovascular evaluation for
noncardiac surgery. Circulation. (#79 / 433)
2003
Sandham JD. A randomized, controlled trial of the use of pulmonary-artery catheters in
high-risk surgical patients. New Engl J Med. (#131 / 348)
2004
Myles PS. Bispectral index monitoring to prevent awareness during anaesthesia.
Lancet. (#366 / 214)
2005
Apkarian AV. Human brain mechanisms of pain perception and regulation in health and
disease. Eur J Pain. (#219 / 282)
2006
Mangano DT. The risk associated with aprotinin in cardiac surgery. New Engl J Med.
(#129 / 350)
2007
Dworkin RH. Pharmacologic management of neuropathic pain. Pain. (#1105 / 139)
23
2008
Devereux PJ. Effects of extended-release metoprolol succinate in patients undergoing
non-cardiac surgery (POISE trial). Lancet. (#991 / 147)
374
24
375
Table 4. Most cited articles in anesthesiology by subspecialty.
Specialty Rank. (Overall Rank). First author. Title. Journal Year. (Times Cited)
AIRWAY
1. (19) Cormack RS. Difficult tracheal intubation in obstetrics. Anaesthesia 1984. (793)
2. (23) Mendelson CL. The aspiration of stomach contents into the lungs during obstetric
anesthesia. Am J Obstet Gynecol 1946. (702)
3. (26) Mallampati SR. A clinical sign to predict difficult tracheal intubation - a prospectivestudy. Can Anaesth Soc J 1985. (681)
4. (77) Samsoon GLT. Difficult tracheal intubation - a retrospective study. Anaesthesia 1987.
(437)
5. (84) Benumof JL. Management of the difficult adult airway - with special emphasis on
awake tracheal intubation. Anesthesiology 1991. (424)
6. (96) Sellick BA. Cricoid pressure to control regurgitation of stomach contents during
induction of anaesthesia. Lancet 1961. (398)
7. (117) Brain AIJ. The laryngeal mask - a new concept in airway management. Brit J Anaesth
1983. (366)
8. (135) Roberts RB. Reducing risk of acid aspiration during cesarean-section. Anesth Analg
1974. (344)
9. (151) Caplan RA. Practice guidelines for management of the difficult airway - an updated
report by the American Society of Anesthesiologists task force on management of the
difficult airway. Anesthesiology 2003. (329)
10. (294) Wilson ME. Predicting difficult intubation. Brit J Anaesth 1988. (243)
11. (333) Olsson GL. Aspiration during anesthesia - a computer-aided study of 185-358
25
anesthetics. Acta Anaesth Scand 1986. (227)
12. (359) Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm.
Anesthesiology 1996. (217)
13. (340) Warner MA. Clinical significance of pulmonary aspiration during the perioperative
period. Anesthesiology 1993. (202)
14. (476) King BD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation
performed during general anesthesia. Anesthesiology 1951. (195)
15. (490) Henderson JJ. Difficult airway society guidelines for management of the unanticipated
difficult intubation. Anaesthesia 2004. (192)
16. (503) Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977.
(191)
17. (532) Crosby ET. The unanticipated difficult airway with recommendations for management.
Can J Anaesth 1998. (186)
18. (621) Verghese C. Survey of laryngeal mask airway usage in 11,910 patients: safety and
efficacy for conventional and nonconventional usage. Anesth Analg 1996. (176)
19. (627) Cooper JD. Evolution of tracheal injury due to ventilatory assistance through cuffed
tubes - a pathologic study. Ann Surg 1969. (176)
20. (652) Brain AIJ. The intubating laryngeal mask. II: a preliminary clinical report of a new
means of intubating the trachea. Brit J Anaesth 1997. (173)
CARDIOTHORACIC AND VASCULAR ANESTHESIOLOGY
1. (15) Roach GW. Adverse cerebral outcomes after coronary bypass surgery. New Engl J Med
1996. (843)
26
2. (33) Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990. (651)
3. (49) Harker LA. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary
bypass - acquired transient platelet dysfunction associated with selective alpha-granule
release. Blood 1980. (#49 / 535)
4. (48) Butler J. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993.
(469)
5. (62) Royston D. Effect of aprotinin on need for blood-transfusion after repeat open-heartsurgery. Lancet 1987. (458)
6. (85) Slogoff S. Does perioperative myocardial ischemia lead to postoperative myocardialinfarction. Anesthesiology 1985. (424)
7. (95) Bidstrup BP. Reduction in blood loss and blood use after cardiopulmonary bypass with
high dose aprotinin (trasylol). J Thorac Cardiov Sur 1989. (398)
8. (121) Woodman RC. Bleeding complications associated with cardiopulmonary bypass.
Blood 1990. (360)
9. (122) Rao TLK. Reinfarction following anesthesia in patients with myocardial infarction.
Anesthesiology 1983. (354)
10. (129) Mangano DT. The risk associated with aprotinin in cardiac surgery. New Engl J Med
2006. (350)
11. (132) Furnary AP. Continuous intravenous insulin infusion reduces the incidence of deep
sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac
Surg 1999. (348)
12. (133) Adams JE. Diagnosis of perioperative myocardial infarction with measurement of
cardiac troponin I. New Engl J Med 1994. (347)
27
13. (150) Wan S. Inflammatory response to cardiopulmonary bypass - mechanisms involved and
possible therapeutic strategies. Chest 1997. (330)
14. (192) Gardner TJ. Stroke following coronary artery bypass grafting: a 10-year study. Ann
Thorac Surg 1985. (298)
15. (228) Flacke JW. Reduced narcotic requirement by clonidine with improved hemodynamic
and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology
1987. (276)
16. (231) Svensson LG. Deep hypothermia with circulatory arrest. Determinants of stroke and
early mortality in 656 patients. J Thorac Cardiov Surg 1993. (274)
17. (240) Zhao ZQ. Inhibition of myocardial injury by ischemic postconditioning during
reperfusion: comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol
2003. (270)
18. (244) Furnary AP. Continuous insulin infusion reduces mortality in patients with diabetes
undergoing coronary artery bypass grafting. J Thorac Cardiov Sur 2003. (268)
19. (290) Cremer J. Systemic inflammatory response syndrome after cardiac operations. Ann
Thorac Surg 1996. (244)
20. (295) Nussmeier NA. Neuropsychiatric complications after cardiopulmonary bypass cerebral protection by a barbiturate. Anesthesiology 1986. (243)
GENERAL ANESTHESIOLOGY AND PHYSIOLOGY
1. (28) Kurz A. Perioperative normothermia to reduce the incidence of surgical-wound infection
and shorten hospitalization. New Engl J Med 1996. (675)
2. (41) Owens WD. ASA physical status classifications - study of consistency of ratings.
Anesthesiology 1978. (569)
28
3. (136) Cooper JB. Preventable anesthesia mishaps:a study of human factors. Anesthesiology
1978. (342)
4. (138) Frank SM. Perioperative maintenance of normothermia reduces the incidence of
morbid cardiac events. A randomized clinical trial. Jama 1997. (341)
5. (143) Cooper JB. An analysis of major errors and equipment failures in anesthesia
management - considerations for prevention and detection. Anesthesiology 1984. (340)
6. (206) Gross JB. Practice guidelines for sedation and analgesia by non-anesthesiologists - an
updated report by the American Society of Anesthesiologists task force on sedation and
analgesia by non-anesthesiologists. Anesthesiology 2002. (288)
7. (211) Schmied H. Mild hypothermia increases blood loss and transfusion requirements
during total hip arthroplasty. Lancet 1996. (286)
8. (212) Prys-Roberts C. Studies of anaesthesia in relation to hypertension. II. Haemodynamic
consequences of induction and endotracheal intubation. Brit J Anaesth 1971. (285)
9. (213) Price HL. Sympatho-adrenal responses to general anesthesia in man and their relation
to hemodynamics. Anesthesiology 1959. (285)
10. (233) Denborough MA. Anaesthetic deaths in a family. Lancet 1960. (274)
11. (252)Weissman C. The metabolic response to stress - an overview and update.
Anesthesiology 1990. (264)
12. (296) Keats AS. ASA classification of physical status - recapitulation. Anesthesiology 1978.
(243)
13. (360) Joris JL. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg
1993. (217)
14. (411) Tiret L. Complications associated with anesthesia - a prospective survey in France. Can
29
Anaesth Soc J 1986. (206)
15. (413) Prys-Roberts C. Studies of anaesthesia in relation to hypertension. I. Cardiovascular
responses of treated and untreated patients. Brit J Anaesth 1971. (206)
16. (428) Sessler DI. Mild perioperative hypothermia. New Engl J Med 1997. (202)
17. (443) Rubinstein EH. Skin-surface temperature gradients correlate with fingertip blood flow
in humans. Anesthesiology 1990. (201)
18. (473) Bruce DL. Causes of death among anesthesiologists: a 20-year survey. Anesthesiology
1968. (195)
19. (474) Eger EI. Hazards of nitrous oxide anesthesia in bowel obstruction and pneumothorax.
Anesthesiology 1965. (195)
20. (483) Goldman L. Risks of general anesthesia and elective operation in the hypertensive
patient. Anesthesiology 1979. (194)
HEAD AND NECK SURGERY
1. (10) Lassen NA. Cerebral blood flow and oxygen consumption in man. Physiol Rev 1959.
(1015)
2. (25) Paulson OB. Cerebral autoregulation. Cerebrovas Brain Met 1990. (697)
3. (47) Reivich M. Arterial pCO2 and cerebral hemodynamics. Am J Physiol 1964. (539)
4. (70) Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology 1998.
(443)
5. (71) Rosner MJ. Cerebral perfusion pressure: management protocol and clinical results. J
Neurosurg 1995. (442)
6. (74) Muizelaar JP. Adverse effects of prolonged hyperventilation in patients with severe head
injury: a randomized clinical trial. J Neurosurg 1991. (439)
30
7. (107) Thomas DJ. Effect of haematocrit on cerebral blood-flow in man. Lancet 1977. (377)
8. (123) Rosomoff HL. Cerebral blood flow and cerebral oxygen consumption during
hypothermia. Am J Physiol 1954. (354)
9. (127) Scott JC. EEG quantitation of narcotic effect: the comparative pharmacodynamics of
fentanyl and alfentanil. Anesthesiology 1985. (352)
10. (153) Weir B. Time course of vasospasm in man. J Neurosurg 1978. (329)
11. (173) Giller CA. Cerebral arterial diameters during changes in blood pressure and carbon
dioxide during craniotomy. Neurosurgery 1993. (313)
12. (187) Smith AL. Cerebral blood flow and metabolism: effects of anesthetic drugs and
techniques. Anesthesiology 1972. (302)
13. (188) Cohen PJ. Effects of hypoxia and normocarbia on cerebral blood flow and metabolism
in conscious man. J Appl Physiol 1967. (302)
14. (189) Shiozaki T. Effect of mild hypothermia on uncontrollable intracranial hypertension
after severe head injury. J Neurosurg 1993. (301)
15. (191) Clifton GL. A phase II study of moderate hypothermia in severe brain injury. J
Neurotraum 1993. (298)
16. (194) Marion DW. The use of moderate therapeutic hypothermia for patients with severe
head injuries: a preliminary report. J Neurosurg 1993. (295)
17. (200) Pierce EC. Cerebral circulation and metabolism during thiopental anesthesia and
hyperventilation in man. J Clin Invest 1962. (291)
18. (237) Grubb RL. Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow,
and oxygen utilization in humans. J Neurosurg 1977. (272)
19. (276) Clark DL. Neurophysiologic effects of general anesthetics. I. Electroencephalogram
31
and sensory evoked responses in man. Anesthesiology 1973. (251)
20. (289) Sundt TM. Cerebral blood flow measurements and electroencephalograms during
carotid endarterectomy. J Neurosurg 1974. (245)
MONITORS
1. (42) Glass PS. Bispectral analysis measures sedation and memory effects of propofol,
midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997. (568)
2. (92) Daniel WG. Safety of transesophageal echocardiography. A multicenter survey of
10,419 examinations. Circulation 1991. (404)
3. (131) Sandham JD. A randomized, controlled trial of the use of pulmonary-artery catheters in
high-risk surgical patients. New Engl J Med 2003. (348)
4. (198) Pauca AL. Prospective evaluation of a method for estimating ascending aortic pressure
from the radial artery pressure waveform. Hypertension 2001. (291)
5. (225) Shanewise JS. ASE/SCA guidelines for performing a comprehensive intraoperative
multiplane transesophageal echocardiography examination: recommendations of the
American Society of Echocardiography Council for Intraoperative Echocardiography and the
Society of Cardiovascular Anesthesiologists task force for certification in perioperative
transesophageal echocardiography. Anesth Analg; J Am Soc Echocardiog 1999. (184+95)
6. (261) Gan TJ. Bispectral index monitoring allows faster emergence and improved recovery
from propofol, alfentanil, and nitrous oxide anesthesia. Anesthesiology 1997. (260)
7. (263) Gardner RM. Direct blood pressure measurement – dynamic response requirements.
Anesthesiology 1981. (260)
8. (307) Thys DM. Practice guidelines for perioperative transesophageal echocardiography - a
report by the American Society of Anesthesiologists and the Society of Cardiovascular
32
Anesthesiologists task force on transesophageal echocardiography. Anesthesiology 1996.
(238)
9. (334) Bedford RF. Complications of percutaneous radial-artery cannulation: an objective
prospective study in man. Anesthesiology 1973. (227)
10. (342) Sebelz PS. A multicenter study of bispectral electroencephalogram analysis for
monitoring anesthetic effect. Anesth Analg 1997. (224)
11. (366) Myles PS. Bispectral index monitoring to prevent awareness during anaesthesia: the BAWARE randomised controlled trial. Lancet 2004. (214)
12. (401) Liu J. Electroencephalographic bispectral index correlates with intraoperative recall
and depth of propofol-induced sedation. Anesth Analg 1997. (207)
13. (424) Randolph AG. Ultrasound guidance for placement of central venous catheters: a metaanalysis of the literature. Crit Care Med 1996. (203)
14. (467) Johansen JW. Development and clinical application of electroencephalographic
bispectrum monitoring. Anesthesiology 2000. (195)
15. (468) Song DJ. Titration of volatile anesthetics using bispectral index facilitates recovery
after ambulatory anesthesia. Anesthesiology 1997. (195)
16. (482) Severinghaus JW. Accuracy of response of 6 pulse oximeters to profound hypoxia.
Anesthesiology 1987. (194)
17. (499) Smith WD. Measuring the performance of anesthetic depth indicators. Anesthesiology
1996. (191)
18. (599) Katoh T. Electroencephalographic derivatives as a tool for predicting the depth of
sedation and anesthesia induced by sevoflurane. Anesthesiology 1998. (179)
19. (641) Tavernier B. Systolic pressure variation as a guide to fluid therapy in patients with
33
sepsis-induced hypotension. Anesthesiology 1998. (174)
20. (647) Shah KB. A review of pulmonary artery catheterization in 6,245 patients.
Anesthesiology 1984. (174)
OBSTETRICAL ANESTHESIOLOGY
1. (222) Cohen EN. Anesthesia, pregnancy, and miscarriage: a study of operating room nurses
and anesthetists. Anesthesiology 1971. (281)
2. (259) Thorp JA. The effect of intrapartum epidural analgesia on nulliparous labor: a
randomized, controlled, prospective trial. Am J Obstet Gynecol 1993. (261)
3. (277) Hawkins JL. Anesthesia-related deaths during obstetric delivery in the United States,
1979-1990. Anesthesiology 1997. (250)
4. (299) Scanlon JW. Neurobehavioral responses of newborn infants after maternal epidural
anesthesia. Anesthesiology 1974. (242)
5. (320) Kaunitz AM. Causes of maternal mortality in the United States. Obstet Gynecol 1985.
(234)
6. (337) Knilljon RP. Anesthetic practice and pregnancy. Controlled survey of women
anesthetists in United Kingdom. Lancet 1972. (226)
7. (446) Pritchar JA. Changes in blood volume during pregnancy and delivery. Anesthesiology
1965. (201)
8. (477) Polley LS. Relative analgesic potencies of ropivacaine and bupivacaine for epidural
analgesia in labor: implications for therapeutic indexes. Anesthesiology 1999. (194)
9. (494) Kennell, J. Continuous emotional support during labor in a US hospital. A randomized
controlled trial. JAMA 1991. (192)
10. (542) Lester BM. Regional obstetric anesthesia and newborn behavior: a reanalysis toward
34
synergistic effects. Child Dev 1982. (186)
11. (602) Nimmo WS. Narcotic analgesics and delayed gastric emptying during labor. Lancet
1975. (179)
12. (609) Rochat RW. Maternal mortality in the United States: report from the Maternal
Mortality Collaborative. Obstet Gynecol 1988. (178)
13. (767) Ramin SM. Randomized trial of epidural versus intravenous analgesia during labor.
Obstet Gynecol 1995. (163)
14. (768) Scott DB. Serious nonfatal complications associated with extradural block in obstetric
practice. Brit J Anaesth 1990. (163)
15. (774) Amieltison C. A new neurologic and adaptive capacity scoring system for evaluating
obstetric medications in full-term newborns. Anesthesiology 1982. (163)
16. (789) Corbett TH. Birth defects among children of nurse-anesthetists. Anesthesiology 1974.
(162)
17. (986) Morgan M. Amniotic fluid embolism. Anaesthesia 1979. (148)
18. (1053) Collis RE. Randomized comparison of combined spinal-epidural and standard
epidural analgesia in labor. Lancet 1995. (143)
19. (1072) Norris MC. Complications of labor analgesia: epidural versus combined spinal
epidural techniques. Anesth Analg 1994. (142)
20. (1117) Eisenach JC. Patient-controlled analgesia following cesarean section: a comparison
with epidural and intramuscular narcotics. Anesthesiology 1988. (139)
PAIN, ACUTE AND BASIC
1. (1) Zimmermann M. Ethical guidelines for investigations of experimental pain in conscious
animals. Pain 1983. (2729)
35
2. (3) Martin WR. Effects of morphine-like and nalorphine-like drugs in nondependent and
morphine-dependent chronic spinal dog. J Pharmacol Exp Ther 1976. (2461)
3. (4) Bennett GJ. A peripheral mononeuropathy in rat that produces disorders of pain sensation
like those seen in man. Pain 1988. (1891)
4. (7) Coderre TJ. Contribution of central neuroplasticity to pathological pain: review of clinical
and experimental evidence. Pain 1993. (1183)
5. (9) Woolf CJ. The induction and maintenance of central sensitization is dependent on Nmethyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain
hypersensitivity states. Pain 1991. (1059)
6. (11) Hylden JLK. Intrathecal morphine in mice: a new technique. Eur J Pharmacol 1980.
(990)
7. (16) Vonvoigtlander PF. U-50,488: a selective and structurally novel non-Mu (kappa) opioid
agonist. J Pharmacol Exp Ther 1983. (839)
8. (35) Meller ST. Nitric oxide (NO) and nociceptive processing in the spinal cord. Pain 1993.
(634)
9. (37) Yaksh TL. Intrathecal morphine inhibits substance P release from mammalian spinal
cord in vivo. Nature 1980. (624)
10. (38) Mayer DJ. Central nervous system mechanisms of analgesia. Pain 1976. (620)
11. (44) Yaksh TL. Narcotic analgestics: CNS sites and mechanisms of action as revealed by
intracerebral injection techniques. Pain 1978. (558)
12. (45) Sindrup SH. Efficacy of pharmacological treatments of neuropathic pain: an update and
effect related to mechanism of drug action. Pain 1999. (545)
13. (51) Yaksh TL. Studies on direct spinal action of narcotics in production of analgesia in rat. J
36
Pharmacol Exp Ther 1977. (532)
14. (64) Fitzgerald M. Capsaicin and sensory neurones - a review. Pain 1983. (454)
15. (82) Gracely RH. Painful neuropathy; altered central processing maintained dynamically by
peripheral input. Pain 1992. (428)
16. (87) Lebars D. Diffuse noxious inhibitory controls (DNIC). II. Lack of effect on nonconvergent neurons, supraspinal involvement and theoretical implications. Pain 1979. (418)
17. (91) Mense S. Nociception from skeletal muscle in relation to clinical muscle pain. Pain
1993. (405)
18. (98) Mao JR. Mechanisms of hyperalgesia and morphine tolerance: a current view of their
possible interactions. Pain 1995. (393)
19. (99) Handwerker HO. Segmental and supraspinal actions on dorsal horn neurons responding
to noxious and non-noxious skin stimuli. Pain 1975. (393)
20. (100) Yaksh TL. Behavioral and autonomic correlates of the tactile evoked allodynia
produced by spinal glycine inhibition: effects of modulatory receptor systems and excitatory
amino acid antagonists. Pain 1989. (390)
PAIN, CHRONIC MANAGEMENT
1. (2) Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain
1975. (2699)
2. (6) Scott J. Graphic representation of pain. Pain 1976. (1233)
3. (8) Melzack R. The short-form McGill Pain Questionnaire. Pain 1987. (1088)
4. (12) Rosenstiel AK. The use of coping strategies in chronic low back pain patients:
relationship to patient characteristics and current adjustment. Pain 1983. (930)
5. (13) Price DD. The validation of visual analog scales as ratio scale measures for chronic and
37
experimental pain. Pain 1983. (911)
6. (14) Kerns RD. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain
1985. (849)
7. (17) Jensen MP. The measurement of clinical pain intensity: a comparison of six methods.
Pain 1986. (821)
8. (24) Revill SI. Reliability of a linear analog for evaluating pain. Anaesthesia 1976. (699)
9. (30) Waddell G. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fearavoidance beliefs in chronic low back pain and disability. Pain 1993. (665)
10. (34) Vonkorff M. Grading the severity of chronic pain. Pain 1992. (650)
11. (36) Vlaeyen JWS. Fear-avoidance and its consequences in chronic musculoskeletal pain: a
state of the art. Pain 2000. (632)
12. (39) Arner S. Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain.
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13. (40) Farrar JT. Clinical importance of changes in chronic pain intensity measured on an 11point numerical pain rating scale. Pain 2001. (578)
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PREOPERATIVE MANAGEMENT
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POSTOPERATIVE CARE
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