Summer 1976

The Superintendents\u27s Obligation (page 3) Farm Machinery Noise can Damage Hearing (9) Back and Beyond (10) Tolerance to Benzimidazole-Derivative Fungacides by Fusarium Roseum on Kentucky Bluegrass Turf (13) Biological Pest Control Gaining Acceptance (16) Compare Fertilizer Values Before Buying (18) UMass Turfgrass Research Fund (19

Fall 1971

Maintenance Preparations for the Greater Hartford Open at Wethersfield Country Club (page 3) Maintain as a Growth Retardant by John M. Zak and Peter A. Kaskeski (5) Chicago Ordinance Curbs Power Equipment Noise (8) Turf Bulletin\u27s Photo Quiz by Frederick G. Cheney (9) The Mercury by Carl L. Klein (10) Homeowner\u27s Section--Fescues are Shady Characters by Robert W. Schery (14) 12 Trees and Shrubs for Summer Color (16) Editorial--Talkin\u27 Turfie by Frederick G. Cheney (20

Winter 1972

The Mode of Action of Arsenicals in the Soil by Cecil F. Kerr (page 3) The Golf Course Superintendent: A Job Description (5) Factors Affecting Carbohydrate Reserves of Cool Season Turfgrasses by L.J. Zanoni, L. F. Michelson, W.G. COlby, and M. Drake (6) Turf Bulletin\u27s Photo Quiz by Frederick G. Cheney (9) A Close Look at TCDD (10) Environmental News--Environmental Protection Agency Cancels Registration of Herbicide Amitrole (11) Homeowner\u27s Section--Crabgrass in Perspective by R.A. Peters (12) Merion Tees--Maintenance Suggestions (14) Use of Ammonium Sulfate in Fluid Fertilizers by Frank P. Achorn and W.C. Scott, Jr. (15) River Ecology and the Impact on Man (17) To Roll or Not to Roll (18) Editorial--Talkin\u27 Turfie (24

Summer 1971

Mercury - Is The Amount in Seafood Poisonous? by C.J. Gilgut (3) Comparison of Several Fertilizer Salts and Their Effect on Penn Cross Creeping Bentgrass Top Growth by Joseph Troll (5) Turf Bulletin\u27s Photo Quiz by Frederick G. Cheney (7) A Review of the Trace ELements by Mark Loper (8) Now is the Time to Cut Costs by Holman M. Griffin (12) For the Homeowner -- Thatch and its Control by Joseph Troll (14) Lawns Slow Pollution by Robert W. Schery (15) Decimate the Decibels (16) Benomyl for the Control of Fusarium Blight of \u27Merion\u27 Kentucky Bluegrass by J.M. Vargas, Jr. and Charles W. Laughlin (17) New Blueprint Emerges for Air Pollution Controls (19) Preparing Turf Area Seedbeds by Thomas G. Pardy (22) An Ecologist Talks about Pollution by Donald A. Spencer (23) Editorial--Looking Back at the Mass. Turf Conference by Frederick G. Cheney (Outside back cover

Ⅵ CLASSIC PAPERS REVISITED An Early Example of Evidence-based Medicine Hypoxemia due to Nitrous Oxide

Diffusion anoxia. By Bernard Raymond Fink. ANESTHESIOLOGY 1955; 16:511-14. In 1955, Dr. Bernard Raymond Fink published his findings that described the mechanism by which hypoxemia occurred when nitrous oxide-oxygen anesthesia was discontinued and room air breathing commenced. Using an ear oximeter and brachial artery blood gases, he measured oxygen saturation in eight healthy patients who had received 75% nitrous oxide-25% oxygen for gynecologic surgery. He showed that oxygen saturation decreased from 5% to 10% and often reached a value below 90% when the patient began room air breathing after the nitrous oxide-oxygen was discontinued. The effect was seen over a 10-min period. He concluded that "anoxia arises because the outward diffusion of nitrous oxide lowers the alveolar partial pressure of oxygen." This phenomenon can become a causative factor of cardiac arrest in patients with impaired pulmonary or cardiac reserves. IN 1955, Dr. B. Raymond (Ray) Fink (1914Fink ( -2000 was faculty in the Department of Anesthesiology, Columbia University College of Physicians and Surgeons (New York, New York) when he published one of the first articles describing a mechanism by which anesthesia could cause hypoxemia. 1 At the time, cyanosis was a recognized phenomenon during recovery from general anesthesia despite apparently good ventilation. It was also recognized that this was more frequent in patients anesthetized with a nitrous oxide-oxygen mixture. There were previous reports of a decrease in arterial oxygen saturation as measured by an ear oximeter when patients began to breathe room air, especially after a nitrous oxide-oxygen anesthetic. Ray followed this simple experiment with clinical observations in eight otherwise healthy patients undergoing gynecologic surgery who were anesthetized with 75% nitrous oxide-25% oxygen supplemented with sodium thiopental. Blood oxygen saturations were measured by either a Wood ear oximeter or brachial arterial blood analysis. Removal of the facemask at the end of the nitrous oxide-oxygen anesthetic resulted in a decrease in arterial oxygen saturation from 4.5% to 10.3% with an average of 7.9%, an effect that lasted approximately 10 min. The variability of change in oxygen saturation among the patients studied was attributed to differing levels of ventilation and lung volume. Fink observed that if patients were hyperventilating, the effect would be less, and the effect would be greater in patients with low lung volumes in which to dilute the nitrous oxide. The diffuAdditional material related to this article can be found on the ANESTHESIOLOGY Web site. Go to http://www.anesthesiology. org, click on Enhancements Index, and then scroll down to find the appropriate article and link