August 2008 AANA Journal

Table of Contents


The Effectiveness of 4% Intracuff Lidocaine in Reducing Coughing During Emergence From General Anesthesia in Smokers Undergoing Procedures Lasting Less Than 1.5 Hours 

Gary Yurina, CRNA 
Amy L. Ancona, CRNA, MS 
Print version: 2008;76(4):246.

Books, Etc.
Raj’s Practical Management of Pain
Reviewer: CDR Gregory G. Nezat, CRNA, PhD, NC, USN
Print version: 2008;76(4):248.

Guest Editorial
Infection Control Issue: Understanding and Addressing the Prevalence of Unsafe Injection Practices in Healthcare 
Wanda O. Wilson, CRNA, PhD, MSN
Print version: 2008;76(4):251-253.
Keywords: Hepatitis, infection control, medication vials, needle/syringe reuse.

Education News 
Simulation-Based Education: What’s in it for Nurse Anesthesia Educators? 
Nina Turcato, CRNA, DNP
Cliff Roberson, CRNA, MS
Karl Covert, PhD

Print version: 2008;76(4):257-262.
Keywords: Crisis resource management, experiential learning, nurse anesthesia education, simulation-based training.

Answers to the AANA Journal Course No. 27
Print version: 2008;76(4):302-306.


Preliminary Case Series Report: Use of the Laryngeal Mask Airway Fastrach Oral Endotracheal Tube With the Bullard Laryngoscope
Ken Spain, CRNA, MSEd
Use of the Bullard laryngoscope has been sporadic among anesthesia providers. Many colleagues report anecdotal evidence of difficulties manipulating the scope and introducing the endotracheal tube into the glottis. Several authors have reported using the Bullard laryngoscope, and some have compared ease of intubation with other devices such as the video-optical intubating stylet, the traditional laryngoscope, and an intubating stylet without video guidance. This article discusses the successful use of the Bullard laryngoscope.
Print version: 2008;76(4):265-267.
Keywords: Bullard laryngoscope, Fastrach, flexible tip endotracheal tube, oral endotracheal tube.

Methylene Blue for Refractory Hypotension: A Case Report 
LT Alicia J. Weissgerber, CRNA, MSN, NC, USN
Methylene blue has multiple indications for use, but recently it has been shown to be useful in treating refractory hypotension. This case report describes a 79-year-old man with a history of diastolic dysfunction who was admitted for elective coronary artery bypass graft surgery. The hypotension was refractory to vasoactive agents and volume repletion. Methylene blue was primed in the cardiopulmonary bypass pump and was effective in restoring hemodynamic stability. Furthermore, the patient required a decreased amount of vasoactive agents in the postoperative course.
Print version: 2008;76(4):271-274.
Keywords: Anaphylaxis, hypotension, methylene blue, nitric oxide.

Attrition in Nurse Anesthesia Educational Programs as Reported by Program Directors: The Class of 2005
Michael P. Dosch, CRNA, MS
Samantha Jarvis, CRNA, MS
Kimberly Schlosser, CRNA, MS

The attrition rate in nurse anesthesia educational programs is of interest to educators and the CRNA profession as an important outcome of the educational process. In this study, the authors report the beliefs of program directors about the rate of and reasons for attrition in the cohort graduating in 2005. The most common reason for attrition was withdrawal, followed by academic dismissal, then clinical dismissal. It was concluded that the attrition rate is low and comparable to that previously reported.
Print version: 2008;76(4):277-281.
Keywords: Academic persistence, education, nurse anesthetists, retention, student attrition.

Subcutaneous Carbon Dioxide Emphysema Following Laparoscopic Salpingo-Oophorectomy: A Case Report 
Stephanie Lindsey, CRNA, MSN
This case study describes a patient undergoing a laparoscopic salpingo-oophorectomy who had a sudden rise in end-tidal carbon dioxide and was found to have developed subcutaneous emphysema. Hyperventilation, close monitoring, and mechanical ventilation postoperatively resulted in a positive patient outcome. The mechanisms of carbon dioxide absorption, as well as risk factors, complications, treatment, and prevention of subcutaneous emphysema are described.
Print version: 2008;76(4):282-285. 
Keywords: Carbon dioxide, hyperventilation, insufflation, laparoscopy, subcutaneous emphysema.

An Educational Curriculum Used to Improve the Knowledge and the Perceptions of Certified Registered Nurse Anesthetist Clinical Educators
Sass Elisha, CRNA, EdD
The quality of clinical education has a significant impact on the development of adult learners. An educational curriculum using adult learning principles in an active learning format was developed for Certified Registered Nurse Anesthetist clinical educators (CRNACEs) to help improve the quality of the clinical learning experiences for student nurse anesthetists. This exploratory study sought to determine the extent to which an 8-hour educational course modified the behavioral perceptions and the knowledge of CRNACEs.
Print version: 2008;76(4):287-292.
Keywords: Clinical education, clinical educator development, clinical learning, curriculum development.


AANA Journal Course: Update for Nurse Anesthetists—Part 3—An Emerging Clinical Paradigm: The Cuffed Pediatric Endotracheal Tube 
John Aker, CRNA, MS
The use of a cuffed endotracheal tube (ET) has been discouraged in children up to 8 years of age. Recent literature suggests that this age-old argument is empirical rather than scientifically based. In this AANA Journal course, the author examines the history of pediatric endotracheal intubation, suggested methods for choosing the appropriate sized ET, emerging literature describing the advantages and disadvantages of the use of the cuffed ET in the young child, and potential clinical problems that develop with the use of the currently available manufactured cuffed pediatric ETs.
Print version: 2008;76(4):293-301.
Keywords: Cuffed endotracheal tube, pediatric endotracheal intubation, subglottic stenosis, uncuffed endotracheal tube.
August 2008 AANA Journal
Volume 76 , Number 4
ISSN 0094-6354
On the Cover:
A dramatic nighttime view of Minneapolis, the AANA’s destination for the 75th Annual Meeting, August 9-13, 2008. Attendees can take advantage of quality educational programs, the exhibit hall, social activities, and exploring the host city. Educational sessions feature topics ranging from the business of anesthesia to sessions on trauma and pharmacology to various corporate-sponsored lectures. Popular events include the Opening Ceremonies, Party With a Purpose, College Bowl, and the Annual Banquet. (Photo courtesy of Bruce Challgren/Meet Minneapolis.)