Citation Classics in Anesthetic Journals - Semantic Scholar

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From the Department of Anesthesia, University Clinics Basel, Kantonsspital, CH-4031 Basel, Switzerland .... USA, California leads the list of citation classics with.
Citation Classics in Anesthetic Journals Anja Baltussen,

MD,

and Christoph H. Kindler,

MD

From the Department of Anesthesia, University Clinics Basel, Kantonsspital, CH-4031 Basel, Switzerland

The number of citations an article receives after its publication reflects its recognition in the scientific community. In the present study, therefore, we identified and examined the characteristics of the top 100 most frequently cited articles published in anesthetic journals. These articles were identified using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1945 to present) and the Web of SCIENCE®. The mostcited article received 707 citations and the least cited article received 197 citations, with a mean of 283 citations per article. These citation classics were published between 1954 and 1997 in 5 high-impact anesthetic journals, led by Anesthesiology (73 articles) followed by Anesthesia & Analgesia (10), British Journal of Anesthesia (10),

T

he public, funding agencies, and academic institutions are today increasingly interested in measuring the research quality and productivity of individual scientists as an indication of their scholarly excellence. Political or independent institutions evaluate and compare the scientific activities of individuals, departments, and universities and publish rankings as, for example, “The List of the Worldwide Champions League of Research Institutions 1994 – 1999” (http://www.cest.ch/en/) to use such “scientific” information for policy decisions. The growing field of studying the output of scientific and technological literature is termed “Scientometrics,” and it includes all quantitative aspects of the science of science. A popular method for measuring the impact on the scientific community of an article or a researcher is the citation rating, which has become the modern “sales figure” for scientists. When publication A refers to publication B in the reference list, then publication A is the citing article and publication B becomes the cited article (1). Citation analysis is the area of bibliometrics

Accepted for publication August 26, 2003. Address correspondence and reprint requests to Christoph H. Kindler, MD, Department of Anesthesia, University Clinics Basel, Kantonsspital, CH-4031 Basel, Switzerland. Address email to [email protected]. DOI: 10.1213/01.ANE.0000096185.13474.0A ©2004 by the International Anesthesia Research Society 0003-2999/04

Anesthesia (6), and Acta Anaesthesiologica Scandinavica (2). Seventy-eight articles were original publications, 22 were review articles, and one was an editorial. They originated from nine countries, with the United States contributing 70 articles. Within the United States, California leads the list of citation classics with 25 articles. Twenty-nine persons authored two or more of the topcited articles. The main topics covered by the top-cited articles are pharmacology, volatile anesthetics, circulation, regional anesthesia, and lung physiology. This analysis of citation rates allows for the recognition of seminal advances in anesthesia and gives a historic perspective on the scientific progress of this specialty. (Anesth Analg 2004;98:443–51)

that examines these relationships. The number of citations (i.e., how many times a given article is counted in the reference lists of subsequent articles) is seen as a direct measure of the recognition that this publication has had in its scientific field; in some circumstances, it is also used as a measure of quality by granting bodies. One criticism of citation analysis is that the databases do not distinguish between positive or negative credits or citations. Although there is obviously considerable debate regarding the value of citation rates used to assess the quality of research (2,3), analysis of citation rates may allow for the identification of seminal advances in a specialty and may provide a historic perspective on its scientific progress. Therefore, various specialties have recently analyzed their so-called “citation classics” (i.e., the top 100 articles most frequently cited or articles cited more than 100 times, depending on the size of the specialty) (4 – 6). In addition, various journals have published their own citation classics (7–11). The British Journal of Anesthesia (BJA) published the “BJA citation classics 1945–1992” of the top 50 BJA articles in 1998 (12), and Anesthesia & Analgesia published a “bestseller” list with respect to authors and articles in the field of pain and analgesia (13). Furthermore, such lists are also the basis for the so-called “landmark” series as for example published in the Journal of the American Medical Association (JAMA) during 1983–1984 (14). Although articles in the anesthesia landmark series such as “CITATION CLASSIC” published during 1998 in the BJA Anesth Analg 2004;98:443–51

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or “CLASSIC PAPERS REVISITED” currently published in Anesthesiology are selected based on the citation ratings of a single journal or recommendations from members of the editorial board, a comprehensive list of all top cited articles in the field of anesthesia is not yet available. The purpose of the present study was therefore to identify and examine the characteristics, such as ranking, year of publication, publishing journal, type of article, institution of origin, country, state, topic, and authorship, of the top 100 most frequently cited articles published in anesthetic journals.

Methods Twenty-three journals dedicated to anesthesia and its subspecialties were selected from the Journal Citation Report 2001 under the subject category “Anesthesiology,” but five specialized pain journals were excluded form analysis (Table 1). The most frequently cited anesthetic articles published in the 18 analyzed anesthetic journals were identified using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1945 to present). The SCI-EXPANDED is a multidisciplinary database powered by the ISI, formerly known as the Institute for Scientific Information and now owned by the Thomson Corporation, and its Web of SCIENCE®, with searchable author abstracts covering the journal literature of the sciences; it indexes more than 5700 major journals across 164 scientific disciplines, providing access to current information and retrospective data from 1945 forward, and contains a current total of over 17 million records with an average of 17,750 new records per week. The Cited Reference Search option of the Web of SCIENCE® returns a site-configured maximum number of results, which is limited to 500. To find more than the maximum number of results, the data can be searched in segments, e.g., by searching one year or one journal at a time for data. For journals publishing articles with high citation rates, even this segmented search for one year of data yielded, in certain years, more than the maximum number of results. In these cases, each author’s name, according to the author index of the respective journal and year, was “hand-searched” using the Web of SCIENCE® interface. Data stored for each reference in the database include, among other categories, the title, author names, institutions and addresses, journal, abstract, and keywords. The top 101 (101 publications are listed in Table 2 as there were 3 joint positions at the 99th rank) most frequently cited anesthetic articles were read and reviewed online (PubMed) by both authors; when relevant information was not available online, the articles were obtained in a printed format by direct library access. The articles were analyzed and the data tabulated according to their specific features.

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Table 1. List of Screened Journals Acta Anaesthesiologica Scandinavica Anaesthesia and Intensive Care Anaesthesia Anaesthesist Anaesthesiologie Intensivmedizin Notfallmedizin Schmerztherapie Anaesthesiologie & Intensivmedizin Anesthesia & Analgesia Anesthesiology Annales Francaises d’Anesthe´sie et de Reanimation British Journal of Anaesthesia Canadian Journal of Anaesthesia/Journal Canadien d’Anesthe´sie European Journal of Anaesthesiology International Journal of Obstetric Anesthesia Journal of Cardiothoracic and Vascular Anesthesia Journal of Clinical Anesthesia Journal of Neurosurgical Anesthesiology Paediatric Anaesthesia Regional Anesthesia and Pain Medicine

Results Six-hundred-forty-one anesthetic articles were retrieved that were cited 100 times or more. Using the Web of SCIENCE® update of May 9, 2003, we selected the top 101 most frequently cited articles from this list for further analysis and ranked them according to the number of citations they received (Table 2). The most cited article received 707 citations and the 3 least cited articles received 197 citations. The mean number of citations per article was 283. The majority (50 articles) received between 197 and 250 citations, 23 articles received between 251 and 300, 12 articles received between 301 and 350, seven received between 351 and 450, six articles received between 451 and 550, and only 3 articles received more than 550 citations. The top 101 citation classics were published from 1954 to 1997. The decade from 1980 to 1989 produced the most citation classics with 34 articles, followed by the decade from 1970 to 1979 with 29 articles. The most classic papers published within given years were 7 articles in 1991 and 6 in 1980. Sixty percent of the classic articles were published before 1984. The topcited articles were all published in 5 high-impact anesthetic journals, led by Anesthesiology (73 articles) followed by Anesthesia & Analgesia (10 articles), BJA (10 articles), Anesthesia (6 articles), and Acta Anaesthesiologica Scandinavica (2 articles). Of the 101 articles, 78 were original publications, 22 were review articles, and one was an editorial. The 101 top-cited articles originated from 9 countries, with the United States (USA) contributing 70 articles, followed by the United Kingdom with 15 (Table 3). Only 8 articles originated from non-English speaking countries (Germany 3, Sweden 2, and Belgium, Denmark, and Italy with 1 each). Within the USA, California leads the list of citation classics with 25 articles, followed by Massachusetts (8 articles) and

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Table 2. Top 101 Anesthetic Citation Classics Ranked in Order of Citations Received Rank

Article

1.

Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984;61:276– 310. White PF, Way WL, Trevor AJ. Ketamine—its pharmacology and therapeutic uses. Anesthesiology 1982; 56:119–36. Revill SI, Robinson JO, Rosen M, Hogg MI. The reliability of a linear analogue for evaluating pain. Anaesthesia 1976;31:1191–8. Gronert GA. Malignant hyperthermia. Anesthesiology 1980;53:395–423. Eger EI II, Saidman LJ, Brandstater B. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. Anesthesiology 1965;26:756–63. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992;77:162–84. Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Anesthesiology 1979;50:149–51. Yaksh TL, Reddy SV. Studies in the primate on the analgetic effects associated with intrathecal actions of opiates, alpha-adrenergic agonists and baclofen. Anesthesiology 1981;54:451–67. Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990;72:153–84. Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 1987;66:729–36. Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979;51:285–7. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105–11. Woolf CJ, Chong MS. Preemptive analgesia—treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993;77:362–79. Reves JG, Fragen RJ, Vinik HR, Greenblatt DJ. Midazolam: pharmacology and uses. Anesthesiology 1985; 62:310–24. Slogoff S, Keats AS. Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 1985;62:107–14. Bromage PR, Camporesi E, Chestnut D. Epidural narcotics for postoperative analgesia. Anesth Analg 1980;59:473–80. Froese AB, Bryan AC. Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 1974;41:242–55. Quasha AL, Eger EI II, Tinker JH. Determination and applications of MAC. Anesthesiology 1980;53:315– 34. Melzack R, Torgerson WS. On the language of pain. Anesthesiology 1971;34:50–9. Maze M, Tranquilli W. Alpha-2 adrenoceptor agonists: defining the role in clinical anesthesia. Anesthesiology 1991;74:581–605. Qvist J, Pontoppidan H, Wilson RS, et al. Hemodynamic responses to mechanical ventilation with PEEP: the effect of hypervolemia. Anesthesiology 1975;42:45–55. Owens WD, Felts JA, Spitznagel EL, Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49:239–43. Lachmann B, Robertson B, Vogel J. In vivo lung lavage as an experimental model of the respiratory distress syndrome. Acta Scand Anaesth 1980;24:231–6. Stevens WC, Cromwell TH, Halsey MJ, et al. The cardiovascular effects of a new inhalation anesthetic, Forane, in human volunteers at constant arterial carbon dioxide tension. Anesthesiology 1971;35:8–16. Butterworth JF, Strichartz GR. Molecular mechanisms of local anesthesia: a review. Anesthesiology 1990; 72:711–34. Rao TL, Jacobs KH, El-Etr AA. Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 1983;59:499–505. Yelderman M, New W. Evaluation of pulse oximetry. Anesthesiology 1983;59:349–52. Eger EI II, Smith NT, Stoelting RK, et al. Cardiovascular effects of halothane in man. Anesthesiology 1970;32:396–409. Scott JC, Ponganis KV, Stanski DR. EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology 1985;62:234–41. Ali HH, Savarese JJ. Monitoring of neuromuscular function. Anesthesiology 1976;45:216–49. Benumof JL. Management of the difficult adult airway. With special emphasis on awake tracheal intubation. Anesthesiology 1991;75:1087–110. Sebel PS, Lowdon JD. Propofol: a new intravenous anesthetic. Anesthesiology 1989;71:260–77. Brain AI. The laryngeal mask—a new concept in airway management. Br J Anaesth 1983;55:801–5. Gregory GA, Eger EI II, Munson ES. The relationship between age and halothane requirement in man. Anesthesiology 1969;30:488–91.

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 11. 13. 14. 15. 16. 17. 17. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34.

Times cited 707 607 564 522 498a 493 473 455 453 446 442 442 399 392 366 364 349 349 348 340 332 331 330 317 313 312 310 306 300 299 296 295 290 287

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Table 2. (Continued) Rank

Article

35.

Price HL, Linde HW, Jones RE, et al. Sympatho-adrenal responses to general anesthesia in man and their relation to hemodynamics. Anesthesiology 1959;20:563–75. Smith AL, Wollman H. Cerebral blood flow and metabolism: effects of anesthetic drugs and techniques. Anesthesiology 1972;36:378–400. Savarese JJ, Ali HH, Basta SJ, et al. The clinical neuromuscular pharmacology of mivacurium chloride (BW B1090U). A short-acting nondepolarizing ester neuromuscular blocking drug. Anesthesiology 1988;68:723–32. Stevens WD, Dolan WM, Gibbons RT, et al. Minimum alveolar concentrations (MAC) of isoflurane with and without nitrous oxide in patients of various ages. Anesthesiology 1975;42:197–200. Michenfelder JD. The interdependency of cerebral functional and metabolic effects following massive doses of thiopental in the dog. Anesthesiology 1974;41:231–6. Tinker JH, Michenfelder JD. Sodium nitroprusside: pharmacology, toxicology and therapeutics. Anesthesiology 1976;45:340–54. Cohen EN, Bellville JW, Brown BW. Anesthesia, pregnancy, and miscarriage: a study of operating room nurses and anesthetists. Anesthesiology 1971;35:343–7. Eger EI II. Isoflurane: a review. Anesthesiology 1981;55:559–76. Prys-Roberts C, Greene LT, Melocher R, Foex P. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971;43:531–47. Rigler ML, Drasner K, Krejcie TC, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg 1991;72:275–81. Tverskoy M, Cozacov C, Ayache M, et al. Postoperative pain after inguinal herniorrhaphy with different types of anesthesia. Anesth Analg 1990;70:29–35. Cooper JB, Newbower RS, Kitz RJ. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology 1984;60:34–42. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987;42:487–90. Tuman KJ, McCarthy RJ, March RJ, et al. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 1991;73:696–704. Flacke JW, Bloor BC, Flacke WE, et al. Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology 1987;67:11–9. Frostell CG, Blomqvist H, Hedenstierna G, et al. Inhaled nitric oxide selectively reverses human hypoxic pulmonary vasoconstriction without causing systemic vasodilation. Anesthesiology 1993;78:427–35. Bromage PR, Robson JG. Concentrations of lignocaine in blood after intravenous intramuscular epidural and endotracheal administration. Anaesthesia 1961;16:461–79. Mazze RI, Trudell JR, Cousins MJ. Methoxyflurane metabolism and renal dysfunction: clinical correlation in man. Anesthesiology 1971;35:247–52. Cooper JB, Newbower RS, Long CD, McPeek B. Preventable anesthesia mishaps: a study of human factors. Anesthesiology 1978;49:399–406. Catley DM, Thornton C, Jordan C, et al. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology 1985;63:20–8. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 1995;82:1474–506. Salmoiraghi GC, Weight F. Micromethods in neuropharmacology: an approach to the study of anesthetics. Anesthesiology 1967;28:54–64. Clark DL, Rosner BS. Neurophysiologic effects of general anesthetics. I. The electroencephalogram and sensory evoked responses in man. Anesthesiology 1973;38:564–82. Edwards G, Morton HJV, Pask EA, Wylie WD. Deaths associated with anaesthesia. Anaesthesia 1956;11: 194–220. Bromage PR, Camporesi EM, Durant PA, Nielsen CH. Rostral spread of epidural morphine. Anesthesiology 1982;56:431–6. Scanlon JW, Brown WU, Jr., Weiss JB, Alper MH. Neurobehavioral responses of newborn infants after maternal epidural anesthesia. Anesthesiology 1974;40:121–8. Butler WJ, Bohn DJ, Bryan AC, Froese AB. Ventilation by high-frequency oscillation in humans. Anesth Analg 1980;59:577–84. Steward A, Allott PR, Cowles AL, Mapleson WW. Solubility coefficients for inhaled anaesthetics for water, oil and biological media. Br J Anaesth 1973;45:282–93. Yamamoto T, Yaksh TL. Comparison of the antinociceptive effects of pre- and posttreatment with intrathecal morphine and MK801, an NMDA antagonist, on the formalin test in the rat. Anesthesiology 1992;77:757–63. Gattinoni L, Pesenti A, Bombino M, et al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 1988;69:824–32.

36. 37. 37. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 49. 51. 52. 53. 54. 54. 56. 57. 58. 59. 60. 61. 62. 63. 64.

Times cited 283 282 279 279 273a 272 270 270 266a 265 264 261 258 255 253 253 251 248 247 243 243 237 236 234 231 227 225 223 222 221

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Table 2. (Continued) Rank

Article

65. 66.

Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg 1993;76:182–91. Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg 1994;79:1165–77. Greenblatt DJ, Abernethy DR, Locniskar A, et al. Effect of age, gender, and obesity on midazolam kinetics. Anesthesiology 1984;61:27–35. Tremper KK, Barker SJ. Pulse oximetry. Anesthesiology 1989;70:98–108. Woolf CJ. Recent advances in the pathophysiology of acute pain. Br J Anaesth 1989;63:139–46. Denborough MA, Lovell RR, Forster JF, et al. Anaesthetic deaths in a family. Br J Anaesth 1962;34:395–6. Glass PS, Bloom M, Kearse L, et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997;86:836–47. Katz RL, Bigger JT. Cardiac arrhythmias during anesthesia and operation. Anesthesiology 1970;33:193– 213. Gardner RM. Direct blood pressure measurement—dynamic response requirements. Anesthesiology 1981;54:227–36. Katz J, Kavanagh BP, Sandler AN, et al. Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology 1992;77:439–46. Saidman LJ, Eger EI II. Effect of nitrous oxide and of narcotic premedication on the alveolar concentration of halothane required for anesthesia. Anesthesiology 1964;25:302–6. Gronert GA, Theye RA. Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology 1975;43:89–99. Jorfeldt L, Lofstrom B, Pernow B, et al. Effect of local anaesthetics on central circulation and respiration in man and dog. Acta Scand Anaesth 1968;12:153–69. Trudell JR. A unitary theory of anesthesia based on lateral phase separations in nerve membranes. Anesthesiology 1977;46:5–10. Crandell WB, Pappas SG, Macdonald A. Nephrotoxicity associated with methoxyflurane anesthesia. Anesthesiology 1966;27:591–607. Saidman LJ, Eger EI II, Munson ES, et al. Minimum alveolar concentrations of methoxyflurane, halothane, ether and cyclopropane in man: correlation with theories of anesthesia. Anesthesiology 1967;28:994–1002. Fratacci MD, Frostell CG, Chen TY, et al. Inhaled nitric oxide. A selective pulmonary vasodilator of heparin-protamine vasoconstriction in sheep. Anesthesiology 1991;75:990–9. Mapleson WW. The elimination of rebreathing in various semi-closed anaesthetic systems. Br J Anaesth 1954;26:323–32. Nussmeier NA, Arlund C, Slogoff S. Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology 1986;64:165–70. Rehder K, Forbes J, Alter H, et al. Halothane biotransformation in man: a quantitative study. Anesthesiology 1967;28:711–5. Dawkins CJ. An analysis of the complications of extradural and caudal block. Anaesthesia 1969;24:554– 63. Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994;81:1005–43. Lynch C, Vogel S, Sperelakis N. Halothane depression of myocardial slow action potentials. Anesthesiology 1981;55:360–8. Wallin RF, Regan BM, Napoli MD, Stern IJ. Sevoflurane: a new inhalational anesthetic agent. Anesth Analg 1975;54:758–66. Tanelian DL, Kosek P, Mody I, MacIver MB. The role of the GABAA receptor/chloride channel complex in anesthesia. Anesthesiology 1993;78:757–76. Kolton M, Cattran CB, Kent G, et al. Oxygenation during high-frequency ventilation compared with conventional mechanical ventilation in two models of lung injury. Anesth Analg 1982;61:323–32. Ngai SH, Berkowitz BA, Yang JC, et al. Pharmacokinetics of naloxone in rats and in man: basis for its potency and short duration of action. Anesthesiology 1976;44:398–401. Johnstone M. The human cardiovascular response to fluothane anaesthesia. Br J Anaesth 1956;28:392–410. Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 1990;72:828–33. Dahl JB, Kehlet H. Non-steroidal anti-inflammatory drugs: rationale for use in severe postoperative pain. Br J Anaesth 1991;66:703–12. Payne JP, Hughes R. Evaluation of atracurium in anaesthetized man. Br J Anaesth 1981;53:45–54. Tucker GT, Mather LE. Pharmacology of local anaesthetic agents. Pharmacokinetics of local anaesthetic agents. Br J Anaesth 1975;47(suppl):213–24. Michenfelder JD, Theye RA. The effects of anesthesia and hypothermia on canine cerebral ATP and lactate during anoxia produced by decapitation. Anesthesiology 1970;33:430–9.

67. 67. 67. 70. 70. 72. 73. 73. 73. 76. 76. 76. 79. 79. 81. 81. 81. 81. 85. 85. 87. 87. 89. 90. 90. 92. 93. 94. 94. 96. 97.

Times cited 220 219 218 218 218 217 217 216 215 215 215 212 212 212 210 210 209 209a 209 209 208 208 207 207 206 205 205 203a 202 201 201 200 198

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Table 2. (Continued) Rank 97. 99. 100. 101.

Times cited

Article Stanley TH. Intrathecal opiates, a potent tool to be used with caution. Anesthesiology 1980;53:523–4. Dowdy EG, Kaya K. Studies of the mechanism of cardiovascular responses to CI-581. Anesthesiology 1968;29:931–43. Shafer SL, Varvel JR. Pharmacokinetics, pharmacodynamics, and rational opioid selection. Anesthesiology 1991;74:53–63. Strichartz G. Molecular mechanisms of nerve block by local anesthetics. Anesthesiology 1976;45:421–41.

198 197 197 197

a

Articles reprinted in anesthetic landmark series and revisited by the original authors themselves (CLASSIC PAPERS REVISITED, Anesthesiology since September 2001) or commented by contemporary experts (CITATION CLASSIC, British Journal of Anaesthesia during 1998).

Table 3. Country of Origin and Respective Number of Articles Identified as an Anesthetic Citation Classic Country United States of America United Kingdom Canada Germany Sweden Australia Belgium Denmark Italy

No. of Citation Classics 70 15 6 3 2 2 1 1 1

Minnesota (7 articles). Twelve states contributed more than one article to the top 101 citation list (Table 4). Of the total articles, 58 originated from multi-institutional collaboration, 4 from multinational collaborations (Rank 19, 43, 49/2, and 62 in Table 2), and 43 from individual institutions. Sixty-eight different institutions produced the 101 top-cited articles; only 14 articles did not originate in an anesthetic department (Departments of Anatomy, Medical Sciences, Pharmacology, Physiology, Psychology, and Surgery). In all anesthetic citation classics, the first author was affiliated with an academic department. Ten institutions produced more than one citation classic article (Table 5). The Department of Anesthesia and Perioperative Care, University of California, San Francisco, California and the Department of Anesthesia, Stanford University, Palo Alto, California share the lead in this list with nine classic articles each. Only one nonanesthetic institution, the Department of Anatomy and Developmental Biology of the University College and Middlesex School of Medicine in London, United Kingdom, produced more than one classic paper. The number of authors of the top-cited articles ranged from 1 to 11. Fifteen articles were authored by a single author and 30 articles by 2 authors. Twenty-nine persons authored two or more of the top-cited articles. Table 6 presents a list of these “frequent authors,” which is clearly led by E. I Eger II, who authored nine classic papers. E. I Eger II and P. R. Bromage are the

Table 4. State of Origin and Respective Number of Articles Identified as an Anesthetic Citation Classic State California Massachuesetts Minnesota North Carolina Washington Texas New York Utah Pennsylvania New Hampshire Missouri Illinois

No. of Citation Classics 25 8 7 5 4 4 3 2 2 2 2 2

only authors who are first author on three anesthetic classic papers. Pharmacology, excluding volatile anesthetics, is the main topic covered by these highly cited articles; 27 articles deal with pharmacological issues. Considerable attention also was given to volatile anesthetics (16 articles), circulation (12 articles), regional anesthesia (11 articles), lung physiology (9 articles), and analgesia and pain (8 articles). Other topics include anesthetic complications, airway management, and monitoring.

Discussion The list of the top-cited anesthetic articles (Table 2) identifies authors and topics that reflect major advances in anesthesia during the last 50 years, although some articles have been subjected to retrospective criticism for inaccuracies or unwarranted conclusions. Nevertheless, this list provides a fascinating insight into the history and development of anesthetic practice. For example, we find at position one Cousins and Mather with intrathecal and epidural administration of opioids; at position three Revill et al. with the description of a linear analog for evaluating pain; at position five Eger EI II et al. with the introduction of the minimum alveolar concentration as a standard of

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Table 5. Institution of Origin of First Author and Respective Number of Articles Identified as an Anesthetic Citation Classic

Rank 1 2 3 4 5 6 6 6 6 6

No. of Citation Classics

Department

Institution

Anesthesia Anesthesia Anesthesiology Anesthesia Anesthesiology Anesthesiology Anesthesiology Anatomy and Developmental Biology Anesthesiology Anesthesiology

University of California (San Francisco, CA) Stanford University (Palo Alto, CA) Mayo Medical School (Rochester, MN) Harvard Medical School (Boston, MA) Duke University (Durham, NC) University of Washington (Seattle, WA) University of Pennsylvania (Philadelphia, PA) University College and Middlesex School of Medicine (London, United Kingdom) University of Texas, Southwestern Medical Center (Dallas, TX) Texas Heart Institute (Houston, TX)

9 9 6 5 4 2 2 2 2 2

Table 6. List of Authors Who Contributed More than One Anesthetic Citation Classic Author Eger EI II Bromage PR Michenfelder JD Saidman LJ White PF Froese AB Bryan AC Cooper JB Gronert GA Stevens WC Woolf CJ Cousins MJ Greenblatt DJ Mapleson WW Savarese JJ Slogoff S Strichartz GR Tinker JH Yaksh TL Ali HH Frostell CG Trudell JR Mather LE Theye RA Zapol WM Camporesi EM Newbower RS Munson ES Lehane JR

No. of Citation Classics 9 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

anesthetic potency; at 11th position Cormack and Lehane about difficult tracheal intubation; at 15th position Slogoff and Keats about perioperative myocardial ischemia; at 22nd position Owens et al. with the ASA physical status classification; at position 30 Ali and Savarese about the monitoring of neuromuscular function; at position 33 Brain and the laryngeal mask as a new concept in airway management; and at position 51 Bromage and Robson about toxicity of lidocaine. These articles are just a few examples of some of

Position on Author List First Author—3, second—3, fourth—1, fifth—1, last—1 First Author—3 First Author—2, last—1 First Author—2, second—1 First Author—1, second—1, last—1 First Author—1, fifth—1, last—1 Third Author—1, last—2 First Author—2 First Author—2 First Author—2 First Author—2 First Author—1, last—1 First Author—1, last—1 First Author—1, last—1 First Author—1, last—1 First Author—1, last—1 First Author—1, last—1 First Author—1, last—1 First Author—1, last—1 First Author—1, second—1 First Author—1, second—1 First Author—1, second—1 Last Author—2 Last Author—2 Last Author—2 Second Author—2 Second Author—2 Third Author—1, last—1 Fourth Author—1, last—1

the milestone publications that have had an important impact on anesthetic practice. Other classic articles describe the pharmacology of anesthetic drugs such as the articles at positions 2 (ketamine), 14 (midazolam), 24 (isoflurane), 32 (propofol), 37 (mivacurium, isoflurane), and 94 (atracurium). Most of the anesthetic citation classic articles are still regularly cited. The sum of the citations of an article is logically dependent on its publication year, as citations accumulate over time. Scientific papers usually

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are not cited until 1 or 2 years after their publication and generally reach a maximum after 3 to 10 years, at which time they continue to be cited, but at a less frequent rate (1). The decline of the citation rate (citations per year) can be described as the half-life of a publication and is determined to be the time when the citation rate has decreased to half of the maximum. It has been reported that the true impact and fame of an article often cannot be accurately assessed for at least two decades (5,7,10 –12). This normal life span of a publication shows that evaluating the rank and significance of recent publications is, at best, limited; thus, articles that are not listed here will eventually deserve classic status. Another problem of citation behavior is the so-called “obliteration by incorporation,” i.e., original seminal work is absorbed in current knowledge and it is no longer explicitly cited. Interestingly, some authors of landmark series noted that the true intellectual milestones and discoveries may in fact not be found in the most cited articles themselves but in their reference lists (4,6,8), underlining the fact that the absolute number of citations an article has accumulated cannot be used as a sole measurement of its “importance.” Several observations can be made from the articles included in our study concerning the authors and institutions of origin. Sixty-nine percent of the anesthetic citation classics originated in the USA. This is very comparable with the origin of citation classics in general surgical journals (78% United States) (4), in clinical dermatologic journals (75%) (5), and in otolaryngology-head and neck surgery journals (84%) (6). In the Citation Classics of JAMA, 95% of all articles originated in the USA (7). This finding confirms the overwhelming influence that the USA has on medical research because of its large population and the financial resources available to the scientific community. This dominance might even be fostered by a tendency for American authors to cite local papers and for European authors to publish in and cite American journals (4,6). An interesting difference can be found both between surgery and general medicine and anesthesia with respect to the institutions and states from where the classic papers originated. Whereas surgical classics (Massachusetts, New York, Pennsylvania, Washington, DC) and JAMA classics (New York, Massachusetts, Maryland, Pennsylvania) mainly originated from the East coast (4,7), California is clearly the leading state in producing anesthetic citation classics (Tables 4 and 5). Neither the University of California, San Francisco nor Stanford University, Palo Alto were among the top 12 institutions contributing to classic surgical articles, but they share the lead in producing anesthetic classics with nine articles each. The finding that academic productivity of surgical and anesthesia departments is not interlinked was not expected and

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lacks a good explanation; academic productivity obviously depends more on local individuals than on the cooperation between anesthetic and surgical departments. Another observation is not surprising. The list of frequent authors on anesthetic citation classics (Table 6) gives a sampling of some of the world’s bestrecognized anesthesiologists; however, not all famous anesthesiologists were mentioned, which is consistent with an earlier study in another medical specialty (6). Nevertheless it is tempting to speculate that publishing citation classics will help one to ascend the academic staircase; journal editors may consider inviting such authors to publish subsequent work or to write review articles in their journals. In many cross-discipline studies of top-cited articles, methodological publications and review articles predominate, thus reflecting the need of clinicians for a critical evaluation and summary of the rapidly expanding medical literature (5,7). In addition, referring indirectly to a multitude of additional references is another good reason for citing methodological or review publications, given the restrictions on the maximum number of allowed references of manuscripts used today by many journals. We were therefore surprised to see that original research articles accounted for 77% of all anesthetic citation classics, although 5 of the top 10 classics indeed were review articles (Rank 1, 2, 4, 6, and 9 in Table 2). The citation analysis presented in this study has several limitations. First, our survey of the literature was limited for practical reasons to cited articles originally published in anesthetic journals. Therefore some anesthetic citation classics that were originally published in other medical or scientific journals are not recognized as such on our list in Table 2. For example, such articles include the descriptions of the development of electrodes for blood Po2 and Pco2 determination by J. W. Severinghaus and A. F. Bradley, which they published in different papers in the Journal of Applied Physiology. Their most important article (15) has been cited 820 times, which would put them somewhere at the top of anesthetic classics with respect to received citations. Other articles by these authors have been cited 370 times or more and obviously would also qualify as anesthetic citation classics (16,17). This is equally true for the article co-authored by M. A. Schumacher, another anesthesiologist, that described the cloning of the capsaicin receptor (18). This article was published in 1997 in Nature and has already received 875 citations. Furthermore, in the list of the most cited JAMA articles, two anesthetic publications were included (7). Foldes et al. (19) compared the toxicity of IV given local anesthetics and Taves et al. (20) examined the nephrotoxicity after methoxyflurane anesthesia; as of May 9, 2003, they have received

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304 and 173 citations, respectively. This list of examples of classic anesthetic articles originally published in journals outside of the field of anesthesia is by no means comprehensive, and there are other such articles that are not examined in this study. Further limitations of the study can be attributed to the inherent problems of citation analyses as previously described (2,3,13,21,22). It is well recognized that the reasons for citing specific articles may not be entirely appropriate. One major problem is “incomplete citing.” The assumption here is that scientists and authors are supposed to credit those in their reference lists who influenced them most significantly in their work; however, the truth is that many authors try to support, as best and as easily as they can, the interpretation of their own results when attempting to convince or “persuade” the readers (21). Another problem is oriented or biased citing, including various types of conscious or unconscious biases, such as selfcitation (bias towards one’s own work), in-house (bias towards friends or colleagues), journal or powerful person (bias towards reviewers, editors, members of grant awarding bodies), review (bias towards secondary sources instead of the original discoverer), negative citation (bias towards potential negative credits), national and cultural (bias towards national parochialism), English language (bias towards publishing and referencing English articles), and omission bias (bias towards not referencing competitors or sources contradictory to one’s own results) (23). In addition, an editorial in the 10 January 2002 issue of Nature (Volume 415, page 101) entitled “Errors in citation statistics” points out another potential pitfall in citation analysis, i.e., inaccuracies in the database used for citation statistics, especially when articles are authored by a consortium rather than by individual scientists. All these criticisms and biases should caution us when using citation rates to evaluate individual scientists (2,3,24); however, citation frequency can be considered as one of several valid and legitimate indicators in identifying classic work (6). We tend to remember those works that receive the greatest public recognition (7). This list of classic papers therefore represents a value or index related to how often a specific article has been used. These classic articles have influenced many people and should help to bring to our attention the many important advances in anesthesia made during the last 50 years. Truly classic articles will withstand the test of time by having a prolonged frequency of citations over decades. A citation index is not a measure of quality or importance but a measure of recognition (23) and the number of citations an article receives over the years tells us

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something about the impact of that article on the scientific community (2). The authors thank Joan Etlinger for her expert editorial assistance.

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