Discoveries of Distinction Table of Contents

"Discoveries of Distinction" highlights outstanding, timely, and innovative research on a range of important issues to CRNA professionals. All research studies presented in this column have been funded by the AANA Foundation.
For more information, please contact the AANA Foundation at (847) 692-7050, ext. 1170.
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 July 2016

Primary Author: LT Katherine Kidde, BSNkatherine kidde.PNG
Coauthors: LT Meredith Tverdosi, BSN, CDR; Mark Lenart MD, CDR; Johnnie Holmes, PhD, CRNA
Epidural analgesia provides safe and effective analgesia with a reduced side effect profile along with increased maternal participation in labor. While the number of women utilizing epidural analgesia for labor continues to grow, there is still a lack of evidence to support which infusion strategy is the most effective. The purpose of this study is to compare the effectiveness of three epidural infusion strategies for labor analgesia to test the hypothesis that a lower basal rate with a higher patient controlled bolus will result in lower drug consumption than the other two comparison regimens.

 May 2016

Primary Author: Katherine Ojalvo, BSN, RNkatherine ojalvo.PNG
Coauthors: Jennifer Cooley, BSN, RN; Karin Langford, BSN, RN
Based on recommendations from the National Institute of Health and Clinical Excellence, in 2011 Mayo Clinic Rochester instituted a policy mandating the use of ultrasounds for internal jugular central venous catheter placement in the operating room. In our study we compared rates of complications for central line insertion with and without ultrasound guidance between 2006 and 2012.

 March 2016

Primary Author: Nicholas Gabriel, PhD, CRNAnicholas gabriel.PNG
Coauthors: Bernadette Henrichs, PhD, CRNA; Mary Blegen, PhD, RN; Susan Chapman, PhD, RN
A doctoral study to determine relationships between a written examination, self-assessment, and performance assessment in simulation of practicing nurse anesthetists (CRNAs).
Primary Author: Brian Gegel, DNAP, CRNA
Coauthors: James Burgert, DNAP, CRNA; John Gasko, DNP, CRNA; Sabine Johnson, MS; Jennifer Florez, MSN, CRNA; Edward Dunton II, MSN, CRNA; Don Johnson, PhD, RN
This study was a prospective, between subjects, experimental design using Yorkshirecross swine randomly assigned to two groups; QuikClot Combat Gauze (QCG) (n=11) and control (n=11).

 January 2016

Primary Author: Tatjana Bevans, MSN, CRNA                                                                             
Coauthors: Cassandra Rice, PhD; Derek Sakata MD; Chris Reilly, PhD                            
Patients could benefit from an inhaled opioid for pain management in a clinical setting. We investigated the bioavailability and efficacy of inhaled remifentanil in rats. We concluded that rapid profound analgesia was achieved, and remifentanil and metabolites were measurable in rat blood following pulmonary exposure to remifentanil.
The Non-Complete Cause and the CRNA: An Assessment of Knowledge, Perception, and Experience
Primary Author: Briana Meseroll, DNP, CRNA
Coauthors: Nathaniel Apatov, PhD, CRNA; Carolyn Rutledge, PhD, FNP briana meseroll.PNG
Mounting economic pressures and the challenge to maintain competitive advantage have resulted in many healthcare entities to require their practitioners to enter into restrictive covenants such as non-compete clause (NCCs). Many student nurse anesthetists and practicing certified registered nurse anesthetists (CRNAs) are unaware of the non-compete clause in employee contracts. CRNAs are often surprised by the implication of signing a non-compete clause could have on their future abilities to successfully advocate for themselves and their profession, in order to best meet the needs of the population they serve. This study was completed using an anonymous, Web-based questionnaire distributed to students and CRNAs nationwide and demonstrated a significant knowledge gap in the nurse anesthesia community surrounding the NCC.

 September 2015

Primary Author: Ray Elmblad, DrAP, CRNA                                                                                
Coauthors: Gergana Kodjebacheva, PhD; Lynn Lebeck, PhD, CRNA                                              
Incivility in healthcare settings has potentially detrimental effects on healthcare providers and patient safety. This study examines the prevalence of incivility and the influence workplace incivility has on burnout among CRNAs in Michigan.

 May 2015


Comparative Resuscitation Measures for the Treatment of Desipramine Overdose

Primary Author: Joseph O’Sullivan, CRNA, PhD
Coauthors: Arthur Johnson, RN, PhD; Melissa Waterman, CRNA, MSN
A toxic dose of desipramine (tricyclic anti-depressant) causes cardiac arrhythmias and ultimately asystole. Resuscitation in the emergency room is difficult and almost always unsuccessful. Anecdotal evidence suggests that an infusion of lipid emulsion may be an effective treatment. The purpose of this study was to determine the optimal combination of lipid rescue and traditional ACLS therapy for the treatment of desipramine overdose using a porcine model. The results indicated that the groups that received vasopressin were more likely to survive than those that did not vasopressin and the groups that received lipid emulsion were more
likely to survive than those that did not receive lipid emulsion.

 March 2015


Development of a Traumatic Brain Injury Assessment Score Using Novel Biomarkers Discovered Through Autoimmune Profiling

Primary Author: John Buonora, CRNA, PhD
Coauthors: Michael Mousseau, BA; Lawrence Latour, PhD; Ramon DiazArrastia, MD, PhD; Harvey Pollard, MD, PhD; Sandro Rizoli, MD, PhD; Andrew Baker, MD; Shawn Rhind, PhD, Gregory Mueller, PhD
The goals of this research were to identify novel brain proteins targeted by traumatic brain injury (TBI)-induced autoantibodies and to determine if these proteins contribute to a circulating biomarker signature useful in the diagnosis and assessment of mild TBI.

 Janaury 2015


Effect of Elective Surgery on Subjective Health in Veterans with Chronic PTSD

Primary Author: LCDR Kenneth Wofford, CRNA, PhD, NC, USN
Coauthors: Michael Hertzberg, MD; Susan G. Silva, PhD; Charles Vacchiano, CRNA, PhD, FAAN

Posttraumatic stress disorder (PTSD) is common, is often chronic, and has been associated with greater risk of postoperative mortality in veterans. This study was conducted to determine if elective outpatient surgery had a persistent effect on the physical or mental health of veterans with chronic PTSD.

 November 2014


Administering Regional Anesthesia in the Adult Obese Surgical Patient: Exploration of CRNAs' Techniques to Manage Identified Challenges


Primary Author: Kristal Barbee, RN, BSN, MS
Coauthors: Lisa Dettmer, RN, BSN; Danielle Meade, RN, BS; Rachel Baldwin, RN, BSN
The purpose of this study was to explore the techniques CRNAs use to manage the challenges of administering regional anesthesia in the adult obese surgical population. The two research questions that guded this study are: 1) Do the challenges of the obese surgical population impact the CRNAs' ability to perform regional anesthesia? 2) What are the techniques practiced by CRNAs to manage identified challenges of administering regional anesthesia in the adult obese surgical population?

 September 2014


Primary Author: LaSonya Malbrough, CRNA, DNP, MS
This DNP Evidenced-based Practice Project was designed to present a pilot training model based on best practices intended to provide theoretical and technical skills for safe central line insertion utilizing 2-D ultrasound technology for advanced practice nurses at the master’s and doctoral educational levels.

 March 2014


The AANA Foundation Office-Based Anesthesia Study

Primary Author: Michael Kremer, CRNA, PhD, FAAN
Office-based surgery is a rapidly growing segment of anesthesia practice, with some 10 million procedures performed annually in office-based settings. AANA first developed its Standards for Office-Based Practice in 1999.

 January 2014


Acupuncture Blocks Cold Stress-Induced Increases in the HPA in the Rat

Primary Author: Ladan Eshkevari, CRNA, PhD, LAc
Susan Mulroney, PhD
Eva Permaul, BS
While acupuncture is used widely to treat chronic stress, the mechanism of action leading to reported health benefits is not understood. In a series of studies, Eshkevari and her team demonstrated how acupuncture could significantly reduce the stress hormone response in an animal model of chronic stress.

 September 2013


The Emotional Intelligence of Nurse Anesthesia Students

Shawn Collins
, CRNA, DNP, PhD, is director of the Nurse Anesthesia Program at Western Carolina University, Asheville, N.C.
A cross-sectional correlational study was conducted to explore the relationship between emotional intelligence and personal and academic factors of nurse anesthesia students at three points in a program: matriculation, at one year of study, and in the last semester of study, and to examine the relationship of these to clinical scores and national certification examination (NCE) scores.

 May 2013


Pain, Opioids and Pro-Inflammatory Immune Responses

Primary Author: Charles Griffis, CRNA, PhD
Michael Irwin, MD
Elizabeth Breen, PhD
Peggy Compton, RN, PhD
The proposed work was designed to evaluate the pro-inflammatory and cytokine responses to experimental pain with and without opioid analgesia in healthy controls.

 November 2012


The Shared Experiences of Student Registered Nurse
Anesthetists (SRNAs) whose Senior Year
was Disrupted by Hurricane Katrina 

First Author: Marjorie Getz-Everson, CRNA, PhD
Marsha Bennet, RN, DNS, APRN, ACRN
Dianna Dodd-McCue, DBA
Chuck Biddle, CRNA, PhD
This study was a focused ethnography detailing the experiences of Student Registered Nurse Anesthetists (SRNAs) whose senior year was disrupted by Hurricane Katrina. 

 May 2012


Comparison of Tibial Intraosseous, Sternal Intraosseous, and Intravenous Routes of Administration on Pharmacokinetics of Epinephrine During Cardiac Arrest: A Pilot Study

First Author: James Burgert, CRNA, MSNA
Brian Gegel, CRNA, MSN
LTC Michael Loughren, CRNA, PhD
Thomas Ceremuga, CRNA, PhD, LTC(ret), ANC, USA
Manish Desai, MD
LTC Michael Schlicher, RN, PhD, ANC, USA
COL Joseph O’Sullivan, CRNA, PhD, ANC, USA
COL Paul Lewis, RN, PhD
Don Johnson, RN, PhD, COL(ret), AN, USAFR
The purpose of this study was to determine and compare the maximum concentration (Cmax) and time to maximum concentration (Tmax) of epinephrine administered via tibial intraosseous (IO), sternal IO, and intravenous (IV) routes in a porcine model of cardiac arrest during cardiopulmonary resuscitation. ​

 March 2012


Catecholamine Induced RyR1 Ca2+ Release in Malignant
Hyperthermia Sensitive Human B-Lymphocytes

First Author: Lt. Col. Susan Browder Perry, CRNA, PhD, MSN, USAF, NC
Christine Kasper, RN, PhD, FAAN, FACSM
Sheila Muldoon, MD
Rolf Bunger, MD, PhD
Col. Michaela Shafer, RN, PhD, USAF, NC
An experimental study to demonstrate increased sensitivity to adrenergic agonists in a Malignant Hyperthermia susceptible (MHS) vs Malignant Hyperthermia negative (MHN) human cell line model. ​

 August 2011


Nurse Anesthetists’ Perceptions Regarding Utilization
of Anesthesia Support Personnel

Author: Mary Bryant Ford, CRNA, PhD
A prospective descriptive survey of CRNAs working with anesthesia support personnel (ASP) was conducted in order to describe the ASP population in terms of their educational characteristics and training, specific job functions, and work environment.

 July 2011


A Comparison of the Prophylactic Combination of
Ondansetron and Dexamethasone Versus Palonosetron
and Dexamethasone on the Incidence and Severity of
Postdischarge Nausea and Vomiting in a Group of
High-Risk Women.

Lt. Kevin Michel, RN, BSN, NC, USN
Lt. Reginald Middlebrooks, RN, BSN, NC, USN
Lt. Jermaine White, RN, BSN, NC, USN
Cmdr. John Maye, CRNA, PhD, NC, USN
Cmdr. Carole Daniel, CRNA, MS, NC, USN
Cmdr. Brent Bushey, CRNA, MS, NC, USN
The goal of this investigation was to compare the efficacy of two multimodal approaches on the incidence of postdischarge nausea and vomiting in high-risk patients.

 June 2011


Perioperative Administration of Gabapentin for Shoulder
Arthroscopy: A Prospective Randomized, Double-Blind,
Placebo-Controlled Study

Primary Author: CDR Dennis Spence, CRNA, PhD, NC, USN
Coauthors: LT Jason Goff, RN, BSN, NC, USN,
LT Erin Mohan, RN, BSN, NC, USN,
LT Kirsten Bowen, RN, BSN, NC, USN
CDR Lisa Osborne, CRNA, PhD, NC, USN
CDR John Maye, CRNA, PhD, NC, USN
The purpose of this investigation was to determine if the perioperative administration of gabapentin for 48 hours is more efficacious than placebo in patients scheduled for arthroscopic shoulder surgery.

 May 2011


Evaluation of the Anxiolytic Effects of Contemporary
Herbal Supplements and Potential Interactions with
Midazolam in the Laboratory Rat

Author: Thomas Ceremuga, CRNA, PhD, BA, BSN, MSN
This study evaluates the potential anxiolytic effects of various herbal supplements and their possible interactions with midazolam in the rat model.

 April 2011


Improving Transfer of Care Events in Nurse Anesthesia

Author: Suzanne Wright, CRNA, PhD
The purpose of this research is to 1) examine current transfer of care practices of Certified Registered Nurse Anesthetists as they manage patients undergoing general anesthesia, and 2) design, implement, and evaluate a communication tool, grounded in an algorithmic framework, with a goal to improve the quality and effectiveness of the anesthesia transfer of care event.

 March 2011


Perioperative Hypoglycemia in Patients with Diabetes:
Comparing the Incidence after Low Normal Fasting
Preoperative Blood Glucose to that after High Fasting
Preoperative Blood Glucose Treated with Correctional Insulin

First Author: Howard Drews III, RN, BSN (pictured)
Coauthors: Suzanne Brentin, RN, BSN
Catherine Ersig, RN, BSN
Amy Trent, RN, BSN
A retrospective chart review including 587 patients was performed to examine the incidence of perioperative hypoglycemia.

 February 2011


Impact of Isoflurane and Sevoflurane on Cortical Activity:
In Vivo Multi-Channel Electrophysiology Studies and
Implications in Monitoring Consciousness

Author: Jessica Ouyang, CRNA, MS (pictured)
Coauthor: Jingshen Zhang, PhD

To what extent and in what fashion inhalational agents affect electrophysiological signals in the central nervous system are the questions that not only interest researchers who utilize microwire multi-channel electrodes to study neuronal activities, but also are relevant in anesthesia practice.

 January 2011


A Preventive Intervention for Rising Intraocular Pressure:
Development of an Observation Scale

Author: Bonnie Molloy, CRNA, PhD, APRN
The aim of this study was to link gold standard IOP tonometry measurements to an observation scale enabling caregivers to determine when to institute neuroprotective measures to optimize ocular perfusion.

 December 2010


The Effects of an ACLS Simulation-Based Educational
Intervention on Performance, Self-Efficacy, and General
Knowledge in a Group of First-Year Nurse Anesthesia

First Author: Juan Gonzalez, CRNA, PhD (pictured)
Coauthors: Jeffrey Groom, CRNA, PhD
Claudette Spalding, RN, PhD
Jessie Colin, RN, PhD
Paulette Johnson, PhD
The purpose of this dissertation study was to determine if a simulation-based advanced cardiac life support (ACLS) educational intervention could improve the management of cardiac and respiratory emergencies using a patient simulator in a group of first-year nurse anesthesia students (NAS).

 November 2010


A Prospective Comparison of Evening Insulin Glargine Dosing Strategies and Preoperative Blood Glucose Values in Patients with Type 1 and Type 2 Diabetes Undergoing Surgery

First Author: Tamra Dukatz, CRNA, MSN (pictured)
Coauthors: Solomon Rosenblatt, MD
Rebecca Jahn, CRNA, MSN
Craig Ramsdell, MD
Alla Sakharova, MD
Michelle Henry, CRNA, MSN
Marina Mutz-Arndt, CRNA, MSN
Virginia Miller, CRNA, MSN
Kathy Rogers, BSN
Mamtha Balasubramaniam, MS
The aim of this study was to test three evening insulin glargine dosing strategies for achievement of target preoperative fasting blood glucose range (100-179 mg/dL).

 October 2010


Nurse Anesthesia Faculty Clinical Development

Pamela Schwartz, CRNA, DNP
The purpose of this pilot project was to offer third-year nurse anesthesia trainees (NAT-3), clinical leadership opportunities and increase the quality of new CRNA clinical educators.

 September 2010


Predictors of Situation Awareness in Graduate Student Registered Nurse Anesthetists

Suzanne Wright, CRNA, PhD
Guided by Endsley’s theory of situation awareness (SA), the purpose of this study was to provide nurse anesthesia educators with a best evidence predictor model of SA in graduate student nurse anesthetists for curricular implementation.

 July 2010


The Implementation of a Doctor of Nursing Practice
Curriculum for Nurse Anesthesia Program

Susan DeCarlo-Piccirillo, CRNA, DNP
The purpose of this project was to implement a Doctor of Nurse Anesthesia Practice (DNAP) curriculum at the University of New England (UNE) in Portland, Maine. This project encompassed a feasibility study for the implementation of the clinical nurse anesthesia practice doctorate.

 June 2010


In Vivo Characterization of the Opioid Antagonist Nalmefene
in Mice

Melissa Osborn, CRNA, MSNA (pictured)
John Lowery
Alex Skorput
Denise Giuvelis
Edward Bilsky
The current study assessed the antagonist properties of nalmefene which substitutes the ketone with a methylene group, maintaining the double bond and its influence on the overall structure of the molecule.

 May 2010


The Effects of Electroacupuncture in a Chronic Model of Stress in the Rat

Ladan Eshkevari, CRNA, PhD, LAc (pictured)
Susan Mulroney, PhD
This study investigated the possible role of electroacupuncture (EA) in lowering stress hormones in a rat chronic-stress model by affecting the classic stress pathway of the hypothalamus-pituitary-adrenal axis.

 April 2010


Evaluation of the Relationship between Velocity of Cerebral
Blood Flow, Cerebral Tissue Oxygen Saturation, and Mean
Arterial Pressure in Sitting Orthopedic Shoulder Surgery

Charles Vacchiano, CRNA, PhD, CAPT, USN (Ret) (pictured)
Frank Titch, MSN, CRNA, LtCol, USAF (Ret)
Terri Monk, MD
This study is designed to measure and examine the covariation in middle cerebral artery blood flow velocity, regional cerebral tissue oxygen saturation, and mean arterial blood pressure in patients undergoing sitting shoulder surgery under general anesthesia.