April 2010 AANA Journal

Table of Contents​

Another Case of Knotting of an Epidural Catheter
Jeffrey Huang, MD
Jay Lawrence, MD
Michael Sposato, CRNA, MS
Print version: 2010;78(2):93-95.
Health Insurance in the United States
Joseph J. Kraska, CRNA, PhD, MSNA
Lisa M. Riedel, CRNA, DNP
Print version: 2010;78(2):93-95.
Imagining in Time
Achieving the Opt Out for Medicare Physician Supervision for Nurse Anesthetists
Patrick M. Downey, CRNA
Print version: 2010;78(2):96-100.
Keywords: Health Care Financing Administration (HCFA),Centers for Medicare & Medicaid Services (CMS), opt out, physician supervision.
Guest Editorial
Chuck Biddle, CRNA, PhD
To the Readers of, and Contributors to, the AANA Journal: Your Participation is Vital!
Print version: 2010;78(2):105-107.
Keywords: AANA Journal, continuing education, mentorship, scholarly writing, submission and review.
Books, Etc.
Chemistry and Physics for Nurse Anesthesia: A Student Centered Approach
Reviewer: Mark D. Welliver, CRNA, DNP, ARNP
Print version: 2010;78(2):108.
AANA Journal Course No. 29 Examination
Print version: 2010;78(2):161-170.

Prolonged Apnea After Small Single Dose of Intravenous Tramadol
Ravindra Pandey, MD
Lenin B. Elakkumanan, MD, DNB
Rakesh Garg, MD, DNB
Pratyush Gupta, MD
Vanlal Darlong, MD
Jyotsna Punj, MD
The reputation of tramadol, as an analgesic lacking respiratory depression, has contributed to its increased clinical use in intraoperative and postoperative periods. It has been safely used even in patients with obstructive sleep apnea without any sedative effect postoperatively. The authors discuss an unusual case of respiratory depression and prolonged apnea after a small, single intravenous dose of tramadol.
Print version: 2010;78(2):110-112.
Keywords: Anesthesia, apnea, enantiomer, single dose, tramadol.
Effects of Celox and TraumaDEX on Hemorrhage Control in a Porcine Model
Brian T. Gegel, CRNA, MSN
James M. Burgert, CRNA, MSNA
Maj Cheryl Lockhart, RN, BSN, USAF, NC
Capt Robert Austin III, CRNA, MSN, USAF, NC
Capt Alejandro Davila, CRNA, MSN, USAF, NC
CPT Jacob Deeds, CRNA, MSN, ANC, USA
Capt Lonnie Hodges, CRNA, MSN, USAF, NC
CPT Andrew Hover, RN, BSN, ANC, USA
CPT Glenn Simpson, CRNA, MSN, ANC, USA
CPT Stephen Weaver, CRNA, MSN, ANC, USA
Capt William Wolfe, CRNA, MSN, USAF, NC
Don Johnson, RN, PhD
The purpose of this study was to compare the effectiveness of 2 hemostatic agents, chitosan-based Celox and the biopolymeric, microporous particles TraumaDEX, with a control group in a porcine model of hemorrhage. Celox and TraumaDEX were found to be statistically and clinically superior at controlling hemorrhage compared with the standard pressure dressing in the control group.
Print version: 2010;78(2):115-120.
Keywords: Celox, hemostasis, hemostatic agents, TraumaDEX, uncontrolled hemorrhage.
Anesthetic Management of a Pituitary Tumor Resection With Dexmedetomidine
Tim Brady, CRNA, MS
Dexmedetomidine is an alpha-2 agonist, mainly is used for sedating mechanically ventilated uncooperative patients in the intensive care setting. It also is being used by anesthesia providers for multiple purposes including cardiothoracic surgeries, neurological surgeries, awake-fiberoptic intubations, and for patients with a high risk for airway obstruction. This article reports the investigation of the off-label use of dexmedetomidine as an anesthetic adjunct for a transsphenoidal pituitary tumor resection in an adult.
Print version: 2010;78(2):125-128.
Keywords: Dexmedetomidine, neurosurgery, Precedex.
Operative Splenectomy for Treatment of Homozygous Beta Thalassemia in Afghan Children at a US Military Hospital
Maj Jason D. Bolt, CRNA, MSN, USAF, NC
COL Bruce A. Schoneboom, CRNA, PhD, ANC, USA, FAAN
Afghanistan is a war-ravaged country surrounded by mountainous terrain. Due to the geography and harsh living conditions people have intermarried among tribes for centuries. The right familial combinations can cause manifestations of genetic linked diseases, such as ß-thalassemia major. This article discusses the preoperative plan, intraoperative management, and postoperative care provided to infants and children who underwent open splenectomy at a US military forward operating field hospital in Afghanistan.
Print version: 2010;78(2):129-133.
Keywords: Afghanistan, Cooley anemia, humanitarian assistance, splenectomy, thalassemia.
Neuraxial Anesthesia for a Parturient With Hypogammaglobulinemia: A Case Report
Barbara Murza, CRNA, MSN, MS
Hypogammaglobulinemia, an immunodeficiency, predisposes one to infection. Clinical manifestations of this condition, in the parturient, may contraindicate neuraxial anesthesia. In this case report, the author concludes that patients presenting for neuraxial anesthesia with a history of immunodeficiency qualify for the most stringent aseptic techniques by the provider.
Print version: 2010;78(2):134-136.
Keywords: Antibodies, humoral immunity, hypogammaglobulinemia, neuraxial anesthesia.
Ischemic Optic Neuropathy After Spine Surgery
Vickie Pierce, CRNA, MNA
Phillip Kendrick, CRNA, PhD
Visual loss after anesthesia is a rare but distressing occurrence. It has been reported in patients who are positioned supine during general anesthesia, but it occurs more frequently in patients positioned prone for spine surgery procedures. The authors discuss anatomy of the visual pathway, definition and types of ischemic optic neuropathy, symptoms and onset, risk factors, patient management, treatment, outcomes, and preventive measures.
Print version: 2010;78(2):141-145.
Keywords: Blood loss, hypotension, ischemic optic neuropathy, visual loss.
Vagal Nerve Stimulation: A Case Report
David Higgins, CRNA, MS
David Dix, MD
Michelle E. Gold, CRNA, PhD
In this case report, a review is presented of the current literature regarding long-term antiepileptic drug therapy and its effect on anesthetic management, pathophysiology of
epilepsy and seizure propagation, and the effects of commonly used anesthetic agents on the seizure threshold. Also discussed are the physiology of vagal nerve stimulation,
benefits and potential complications that may occur with its implantation, and device mechanics as it relates to future surgical procedures.
Print version: 2010;78(2):146-150.
Keywords: Antiepileptic drug therapy, medically refractory epilepsy, vagal nerve stimulator.

AANA Journal Course: Update for Nurse Anesthetists—Part 1—Anesthesia Case Management for Thyroidectomy
Sass Elisha, CRNA, EdD
Michael Boytim, CRNA, EdD
Sandy Bordi, CRNA, MSN
Jeremy Heiner, CRNA, MSN
John Nagelhout, CRNA, PhD, FAAN
Ed Waters, CRNA, MN
The anatomic and physiologic effects associated with hyperthyroidism can cause end-organ damage, hyperdynamic effects causing extreme cardiovascular lability, and tracheal distortion causing difficult airway management. In this AANA Journal course, the authors describe the anatomy and physiology associated with thyroid gland structure and function, pathophysiology, preoperative medication regimens, preoperative anesthetic management, intraoperative anesthetic management, and postoperative management.
Print version: 2010;78(2):151-160.
Keywords: Antithyroid medications, nerve integrity monitor endotracheal tube, recurrent laryngeal nerve injury, thyroidectomy, thyroid storm.
April 2010 AANA Journal
Volume 78 , Number 2
ISSN 0094-6354
On the Cover:
Javier Ruiz, RN, MSN, student, and Pamela Binns-Turner, CRNA, PhD, program director, Union University School of Nursing, Nurse Anesthesia Track, Jackson, Tennessee, are performing an induction for an anesthetic during the university’s annual mission trip to the Dominican Republic in February 2009. In 4 days, students and faculty delivered 40 anesthetics for surgical procedures and provided medical care to 940 people in villages. Ruiz is currently in the nurse anesthesia program; his MSN was earned before entering the Nurse Anesthesia Track