April 2009 AANA Journal

Table of Contents


Medical-Legal Quandry of Healthcare in Capital Punishment
Evan Koch, CRNA, MSN
New Ways to Set Up Propofol Infusion
Jeffery Huang, MD
Todd Gorman, CRNA
Print version: 2009;77(2):89.

Books, Etc.
Simulation in Anesthesia

Reviewer: Elizabeth Howell, CRNA, MSNA
Print version: 2009;77(2):90.

Education News
Doctoral Education: Which Degree to Pursue?

Robert Hawkins, CRNA, DNP
Greg Nezat, CRNA, PhD
Print version: 2009;77(2):92-96.
Keywords: Doctor of nursing practice, doctor of philosophy, education.

AANA Journal Course No. 28 Examination
Print version: 2009;77(2):147-156.



Bilateral Transversus Abdominis Plane Nerve Blocks for Analgesia Following Cesarean Delivery: Report of 2 Cases
John D. Scharine, CRNA, MSNA, APNP
The author describes 2 case reports that use transversus abdominis plane (TAP) nerve blocks for analgesia following emergency cesarean delivery. Bilateral single shot TAP blocks provided prolonged and extremely effective analgesia. Patients displayed early oral intake, early ambulation, and low pain scores. No postoperative narcotics were used by either patient throughout the hospital stay. A technique for TAP blocks is described with discussion of risks and suggested uses.
Print version: 2009;77(2):98-102.
Keywords: Nerve block, transversus abdominis plane nerve block, TAP nerve block.

α2-Adrenergic Agonists and Their Role in the Prevention of Perioperative Adverse Cardiac Events
Stephanie A. Chalikonda, CRNA, MSN
In today’s climate of rising healthcare costs with more patients seeking surgical services, the need for medical therapies to prevent crippling cardiac events has never been greater. The purpose of this review article is to summarize the current data pertaining to α2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events. The author points out that, to date, no other pharmacological agent on the market has a more diverse therapeutic profile than α2 agonists.
Print version: 2009;77(2):103-108. Keywords: α2-Adrenergic Agonists, clonidine, myocardial ischemia.

Preoperative Fluid Bolus and Reduction of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Gynecologic Surgery
Kathy Guinn Lambert, CRNA, MSN
Judith H. Wakim, RN, EdD, CNE
Nicholas E. Lambert, CRNA, MSN

A randomized clinical trial of patients undergoing laparoscopic gynecologic surgery was conducted to determine the effect of a calculated preoperative fluid bolus on postoperative nausea and vomiting (PONV). The exact mechanism of how preoperative hydration decreases the incidence of PONV is uncertain; however, the occurrence of PONV decreased during this study. The authors conclude that preoperative intravenous fluid administration is a simple, non–time-consuming, cost-effective means to reduce the occurrence of PONV, and it warrants consideration as routine therapy.
Print version: 2009;77(2):110-114.
Keywords: Laparoscopic gynecologic surgery, postoperative nausea and vomiting reduction, preoperative fluid bolus.

Anesthetic Considerations for the Patient with Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome)
Kathleen M. Z. Peiffer, CRNA, MSN
Hereditary hemorrhagic telangiectasia (HHT), Osler-Weber-Rendu syndrome, is an uncommon disease but may be present in many people who remain undiagnosed. It is an autosomal dominant disorder characterized by multiple arteriovenous malformations and telangiectases that affect multiple organ systems. In this case report, the authors state that anesthetic care of patients with HHT involves very specific interventions with regard to control of bleeding, maintaining adequate oxygenation, and balancing hemodynamic values to optimize perfusion without compromising anesthetic depth.
Print version: 2009;77(2):115-118.
Keywords: Arteriovenous malformations, hereditary hemorrhagic telangiectasia, Osler-Weber-Rendu syndrome, telangiectasia.

New Estimates for CRNA Vacancies
Elizabeth Merwin, RN, PhD, FAAN
Steven Stern, PhD
Lorraine M. Jordan, CRNA, PhD
Michelle Bucci, MA, MPH

A national survey to estimate vacancy rates of Certified Registered Nurse Anesthetists (CRNAs) in hospitals and ambulatory surgical centers was conducted in 2007. Poisson regression methods were used to improve the precision of the estimates. Results from this study found the vacancy rate was higher in rural hospitals than in nonrural hospitals, and it was lower in ambulatory surgical centers. The remarkable factor since the last survey was the unusually large rate of new CRNAs entering the market, yet the vacancy rates remain relatively high.
Print Version: 2009;77(2):121-129.
Keywords: Certified Registered Nurse Anesthetist, demand, labor market, vacancies, workforce.

Effect of Timing of Fluid Bolus on Reduction of Spinal-Induced Hypotension in Patients Undergoing Elective Cesarean Delivery
LT Walter Williamson, CRNA, MS, NC, USN
LT David Burks, CRNA, MS, NC, USN
LT Jessica Pipkin, CRNA, MS, NC, USN Joseph F. Burkard, CRNA, DNSc, CDR(ret), NC, USN
CDR Lisa A. Osborne, CRNA, PhD, NC, USN
Joseph E. Pellegrini, CRNA, PhD, CAPT(ret), NC, USN

Spinal-induced hypotension (SIH) remains the most common complication associated with subarachnoid block (SAB) for cesarean delivery. Recent evidence indicates that a 20-mL/kg bolus via pressurized infusion system administered at the time of SAB (coload) may provide better prophylaxis than the traditional administration of a 20-mL/kg crystalloid infusion (preload) about 20 minutes before SAB; however, this method raises some concerns. Based on the results of this study, the authors believe that a combination preload and coload of fluid is a beneficial method of minimizing SIH.
Print version: 2009;77(2):130-136.
Keywords: Cesarean, fluid timing, hypotension, obstetrics, spinal. 

AANA Journal Course: Update for Nurse Anesthetists—Part 1—The Cerebral Oximeter: What is the Efficacy?
Amanda Rouse Bruns, CRNA, MSN
Barbara R. Norwood, RN, EdD
Gerry Ann Bosworth, RN, PhD
Linda Hill, CRNA, DNP, DNSc, APN

Patients having surgical procedures are at risk for anoxia that may cause cognitive impairment. Continuous monitoring of cerebral oxgenation and perfusion with an instrument such as a cerebral oximeter is needed to give insight into the cause of cerebral insults and cerebral response to specific interventions, all of which could help prevent damage to the brain. This critical review of the literature on the efficacy, mechanics, and usefulness of the cerebral oximeter will be helpful to anesthesia providers in evaluating the controversy surrounding its use.
Print Version: 2009;77(2)137-144.
Keywords: Cerebral oximetry, cerebral perfusion, near-infrared spectroscopy.

April 2009 AANA Journal
Volume 77 , Number 2
ISSN 0094-6354
On the Cover:
Heidi Shields, CRNA, MSN, intubates a patient at Lakeview Medical Center Ambulatory Surgery Center, Suffolk, Virginia, in preparation for a tonsillectomy. At the time the photo was taken, Shields was a student at Old Dominion University, Nurse Anesthesia Program, Norfolk, Virginia. She is now a nurse anesthetist at Bon Secours Maryview Medical Center, Portsmouth, Virginia. (Photo taken by Aimee M. Joseph, CRNA, MSN.)