April 2012 AANA Journal

Table of Contents

Education News
The Use of Electronic Portfolios in Nurse Anesthesia Education and Practice
Sharon J. Hawks, CRNA, DNP
Print version: 2012;80(2):89-93.
Keywords: Competency, electronic, learning outcome, portfolio.
AANA Journal Course No. 31 Examination
Print version: 2012;80(2):141-150.
Please note:
In question number 17, multiple choice answer number 4, the word “to” has been changed to “by” so it correctly says: “as distance from the radiation source is doubled, the dose is decreased by 75%.” Although it appears incorrectly in the April 2012 AANA Journal, it has been corrected in the online versions of the exam.
17. What does the inverse square law tell us?
1. as distance from the radiation source is doubled, the dose is decreased by 50%
2. as distance from the radiation source is halved, the dose is decreased by 50%
3. as distance from the radiation source is doubled, the dose is decreased by 25%
4. as distance from the radiation source is doubled, the dose is decreased by 75%
Calendar of Events
Print version: 2012;80(2):155-158.
Role of Splenic Artery Partial Embolization in a Patient With Portal Hypertension and Pancytopenia Undergoing Hysterectomy Under Anesthesia
Ravindra Pandey, MD
Rakesh Garg, MD, DNB, MNAMS
Vanlal Darlong, MD
Jyotsna Punj, MD
Anil Kumar, MD
Management of a patient with portal hypertension and hypersplenism scheduled for elective surgery is a challenge for anesthesia providers. Splenectomy has been the most frequently used procedure for hypersplenism, but it is associated with a 30-day mortality rate of 20%. In patients with idiopathic portal hypertension, partial splenic embolization can be effective in preventing variceal bleeding, reducing splenic volume, and substantially increasing the platelet count. The authors report such a case that was scheduled for elective surgery in which preoperative splenic artery embolization improved the hematologic parameters and, thus, helped provide an uneventful perioperative period.
Print version: 2012;80(2):96-98.
Keywords: Elective surgery, pancytopenia, portal hypertension, splenic artery partial embolization.

Effects of Topical Lidocaine on Successful Extubation Time Among Patients Undergoing Elective Carotid Endarterectomies
Jeremy Watkins, CRNA, DMPNA
Doohee Lee, PhD, MPH
William A. White Jr, CRNA, DMP
Susan Mundy, CRNA, MS
Little research has been done on the effects that topical intratracheal anesthesia has on the length of time required to successfully extubate patients after surgical interventions. The results of this research suggest important implications in anesthesia practice. The use of lidocaine laryngotracheal anesthesia with induction of general anesthesia for patients undergoing carotid endarterectomy leads to an increase in mean extubation time of nearly 2 minutes. The anesthetist benefits from knowing that the use of this common anesthetic technique has the potential to lengthen patient recovery times.
Print version: 2012;80(2):99-104.
Keywords: Anesthesia, emergence phenomenon, extubation, lidocaine, topical anesthesia.

Total Artificial Heart Freedom Driver in a Patient With End-Stage Biventricular Heart Failure
Kristin Friedline, CRNA, MSNA
Pamela Hassinger, CRNA, MSNA
The authors of this case report describe a 61-year-old man admitted with acute decompensated heart failure, which progressively worsened, eventually requiring implantation of a temporary total artificial heart (TAH-t, SynCardia Systems Inc, Tucson, Arizona). Following stabilization, the patient was switched to the Freedom driver (SynCardia). Higher rates of survival to transplant have already been proved with the TAH-t. Potential benefits for the portable Freedom driver include increased mobility, decreased cost, and improved quality of life.
Print version: 2012;80(2):105-112.
Keywords: Cardiomyopathy, Freedom driver, heart failure, total artificial heart.
Rapunzel Syndrome in a Pediatric Patient: A Case Report
Elizabeth Middleton, CRNA, MSN
Lynn Fitzgerald Macksey, CRNA, MSN
J. Duncan Phillips, MD
In this case report, the authors describe the youngest reported case of intussusception and Rapunzel syndrome due to trichobezoars. A 2.5-year-old girl was hospitalized with complaints of abdominal pain and vomiting for 2 days. Diagnostic laparoscopic-assisted exploration of the abdomen revealed 4 separate intestinal intussusceptions along with multiple dark intraluminal masses within the small intestine. Laparotomy allowed palpation of the entire small intestine with extraction of the masses, which were found to be human hair (trichobezoars). The intussusceptions were reduced, and the multiple masses were removed through a single enterotomy.
Print version: 2012;80(2):115-119.
Keywords: Bezoar, pediatric, Rapunzel syndrome, trichobezoar.
Opioid Abuse Among Nurse Anesthetists and Anesthesiologists
E. Laura Wright, CRNA, PhD
Teena McGuiness, RN, PhD, CRNP, FAAN
Linda D. Moneyham, RN, PhD, FAAN
Joseph E. Schumacher, PhD
Art Zwerling, CRNA, DNP, DAAPM
Elizabeth Stullenbarger, RN, DSN
This article reviews the literature regarding opioid abuse and dependency among nurse anesthetists and anesthesiologists and offers implications for future research. Abuse and dependency on potent opioids have long been recognized as problems among nurse anesthetists and anesthesiologists. The authors conclude that the medical, nursing, and nurse anesthesia communities recognize this risk and have taken steps to improve prevention, early identification, and treatment of the problem. To accomplish these goals, continued dedication from these professions is crucial.
Print version: 2012;80(2):120-128.
Keywords: Addiction, anesthesiologist, nurse anesthetist, opioid dependency, substance abuse.

AANA Journal Course: Update for Nurse Anesthetists – Part 1 – Anesthetic-Induced Anaphylaxis
Carol L. Norred, CRNA, PhD
Anaphylaxis is a severe allergic reaction that can be life threatening with rapid onset and can occur with or without exposure to a known allergen. The purpose of this course is to update nurse anesthetists about anesthetic-induced anaphylaxis. The pathophysiologic process of anaphylaxis is discussed, along with descriptions of the allergic immune response and the mediators and mechanisms of mast cell activation. Also discussed are inflammatory mediators, clinical presentation, anaphylaxis severity scale, risk factors for anaphylaxis, impediments to the recognition of anaphylaxis, intraoperative management, treatment, and laboratory testing for anaphylaxis.
Print version: 2012;80(2):129-140.
Keywords: Anaphylaxis, anesthesia, hypersensitivity reaction, IgE.
April 2012 AANA Journal
Volume 80 , Number 2
ISSN 0094-6354
On the Cover:
Anne Sage, CRNA, MSN, is shown when she was a student performing a preoperative assessment on a professional patient actor while a faculty member evaluates her performance from a concealed location. The Standard Patient Assessment laboratory, along with a fresh cadaver lab, mock operating room, simulation lab, virtual hospital, and numerous other learning labs comprise the 25,000 square-foot Center for Applied Learning at Wake Forest Baptist Health (WFBH), Winston-Salem, North Carolina. (Photo taken by Michael Rieker, CRNA, DNP, director of the Nurse Anesthesia Program at WFBH.)