Loma Linda University

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Richard Applegate, MD
Vice Chair, Anesthesiology
School of Medicine
Professor, Anesthesiology
School of Medicine
Professor, Basic Sciences
School of Medicine
Professor, Nursing - Graduate
School of Nursing
Publications    Scholarly Journals--Published
  • 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): -. ( 1/2007 )
  • 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. ( 1/2006 ) Link...
    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.
  • 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. ( 1/2003 ) Link...
    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.
  • Applegate RL, Mason LJ, Thompson TL. "Anesthetic Management of Pediatric Cardiac Transplant." Seminars in Cardiothoracic and Vascular Anesthia 5. (2001): 55-61. ( 1/2001 )
  • 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. ( 1/2001 )
  • 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. ( 1/1997 ) Link...
    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.
  • 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. ( 1/1996 )
  • 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. ( 1/1996 ) Link...
    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]).
  • 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. ( 1/1993 )
  • Applegate RL, Cole DJ. "Neurophysiology and Cerebral Function." Current Opinion in Anesthesiology 5. (1992): 648-. ( 1/1992 )
  • 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. ( 1/1991 )
  • 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. ( 1/1991 ) Link...
    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.
  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 ( 1/2005 )
  • Applegate II RL. The Operating Room. In Adult Perioperative Anesthesia, DJ Cole and M Schlunt, editors. Philadelphia: Elsevier, Mosby, 2004. 38 - 95 ( 1/2004 )
  • Applegate II RL. Airway Management. In Adult Perioperative Anesthesia, DJ Cole and M Schlunt, editors. Philadelphia: Elsevier, Mosby, 2004. 168 - 182 ( 1/2004 )
  • 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. ( 1/2003 )
  • 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. ( 1/1999 )
  • 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 ( 1/1999 )
  • Engel T, Applegate RL, Chung D, Sanchez A. Management of the Difficult Airway, an interactive multimedia tutorial for personal computers. : Cook , 1996. ( 1/1996 )
  • Applegate RL, Applegate PM, Engel TP. Transesophageal Echocardiography Tutorial and Reference v1.0; an interactive multimedia tutorial for Macintosh Computers. : Bristlecone Software, 1994. ( 1/1994 )
  • Schell RM, Applegate RL. Obstetric and Gynecologic Recovery. In Manual of Post Anesthesia Care, Jacobsen, et al editors. : Saunders, 1992. ( 1/1992 )
  • Applegate II RL. Discharge from the PACU. In Manual of Post Anesthesia Care, Jacobsen, et al editors. : Saunders, 1992. ( 1/1992 )