August 2010 AANA Journal

​Table of Contents


Books, Etc.
Evidence Trumps Belief: Nurse Anesthetists and Evidence-Based Decision Making
Reviewer: Mark Welliver, CRNA, DNP, ARNP
Print version: 2010;78(4):261.

Guest Editorial
Making a Difference: CRNAs Aboard the USNS Comfort Respond to the Disaster in Haiti
LCDR Shervette Thomas, CRNA, MSN, NC, USN
Print version: 2010;78(4):264-268.
Keywords: Haiti disaster response, USNS Comfort.
Legal Briefs 
Patient Privacy and Social Media
Amy L. Hader, JD
Evan D. Brown, JD
Print version: 2010;78(4):270-274.
Keywords: Confidentiality, Facebook, Health Insurance Portability and Accountability Act of 1996 (HIPAA), Internet, privacy.
Guest Editorial
Advancing Evidence-Based Nurse Anesthesia Practice
Lisa J. Thiemann, CRNA, MNA
John J. McFadden, CRNA, PhD
Print version: 2010;78(4):279-282.
Keywords: Evidence-based practice, evidence-based process, nurse anesthesia practice, quality care.
The Open Mind
The Normalization of Deviance: Do We (Un)Knowingly Accept Doing the Wrong Thing?
Richard C. Prielipp, MD, MBA, FCCM
Maria Magro, CRNA, MS, MSN
Robert C. Morell, MD
Sorin J. Brull, MD
Print version: 2010;78(4):284-287.
Answers to AANA Journal Course No. 29 Examination
Print version: 2010;78(4):341-345.
Use of Clevidipine for Intraoperative Hypertension Caused by an Undiagnosed Pheochromocytoma: A Case Report
Jonathan P. Kline, CRNA, MSNA
The severe intraoperative hypertension caused by an undiagnosed pheochromocytoma is a rare and challenging event for the anesthesia provider. If treatment is not prompt and successful, permanent and possibly lethal complications can ensue. This article reports what the author believes to be the first case study in which clevidipine (Cleviprex) was successfully used to treat a suspected, and later diagnosed, pheochromocytoma.
Print version: 2010;78(4):288-290.
Keywords: Catecholamine response, clevidipine (Cleviprex), intraoperative hypertension, pheochromocytoma.
Inhalational Anesthesia for Organ Procurement: Potential Indications for Administering Inhalational Anesthesia in the Brain-Dead Organ Donor
Laurie J. Elkins, CRNA, MS, CCRN
In this review article, the author reports that there is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. She concludes that further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs.
Print version: 2010;78(4):293-299.
Keywords: Brain-dead organ donor, inhalational anesthesia, organ procurement.
Determining the Relationship of Acute Stress, Anxiety, and Salivary α-Amylase Level With Performance of Student Nurse Anesthetists During Human-Based Anesthesia Simulator Training
CPT Kelly A. Chiffer McKay, CRNA, MSN, ANC, USA
Lt Col Kevin J. Bohan, CRNA, PhD, USAF, NC
CDR John P. Maye, CRNA, PhD, NC, USN
The purpose of this study was to determine the relationship between physiologic measures of stress and performance of student nurse anesthetists during anesthesia simulator training. Analysis of the descriptive statistics and means of each group suggests that low performers have increased stress and perform poorly, high performers have increased stress and perform superbly, and moderate performers have modest stress and perform moderately.
Print version: 2010;78(4):301-309.
Keywords: Anesthesia simulator training, salivary α-amylase, State-Trait Anxiety Inventory, stress, student nurse anesthetist.
Pseudocholinesterase Deficiency: A Comprehensive Review of Genetic, Acquired, and Drug Influences
Flanna K. Soliday, CRNA, MSN
Yvette P. Conley, PhD
Richard Henker, CRNA, PhD
Pseudocholinesterase deficiency is an inherited or acquired condition in which the metabolism of succinylcholine, mivacurium, or ester local anesthetics is potentially impaired. The aim of this review article is to examine both the genetic aspects of pseudocholinesterase deficiency and the acquired aspects to help the reader stay abreast of established and current literature and theories. Nearly 250 articles were examined for importance, and 50 case reports, research studies, and review articles were cited.
Print version: 2010;78(4):313-320.
Keywords: Atypical pseudocholinesterase, BChE, butyrylcholinesterase, genetic variants, pseudocholinesterase.
Anesthetic Management for Lobectomy in a Patient With Coccidioidomycosis: A Case Report
Abbie J. Choleva, RN, BSN
Coccidioidomycosis is a fungal disease with a wide variety of manifestations. The rare coccidioidomycosis cases requiring surgical intervention present unique challenges to anesthesia providers. The author states that careful attention to perioperative fungal therapies, invasive monitoring, and electrolyte stabilization remain pivotal concerns offering the best outcomes for patients with coccidioidomycosis.
Print version: 2010;78(4):321-325.
Keywords: Acute tubular necrosis, amphotericin B, coccidioidomycosis, difficult airway, fungal sepsis.
Acute Normovolemic Hemodilution in a Jehovah’s Witness Patient: A Case Report
Eric Lindstrom, CRNA, MHS
Robert Johnstone, MD
Patients who are Jehovah’s Witnesses refuse blood transfusions and blood products as a matter of faith. For surgical procedures during which substantial blood loss is possible, their refusal presents a challenge. Anesthetists must generally respect the requests of adults not to receive blood and thus should have a clear understanding of how they will respond in the event of bleeding. In this case report, acute normovolemic hemodilution contributed to the successful outcome of an anemic Jehovah’s Witness who was undergoing major surgery.
Print version: 2010;78(4):326-330.
Keywords: Acute normovolemic hemodilution, blood conservation, blood loss, blood transfusion, Jehovah’s Witness.

AANA Journal Course: Update for Nurse Anesthetists – Part 3 – Ultrasound in Anesthesia: Applying Scientific Principles to Clinical Practice
Christian R. Falyar, CRNA, DNAP
The use of ultrasound as an adjunct to invasive anesthesia procedures is becoming commonplace; however, a major disadvantage often cited is that success is user-dependent, and using ultrasound is a unique skill that requires training and experience to become proficient. In this course, the author discusses the principles of sound, the Doppler effect, tissue properties, transducers, and clinical considerations.
Print version: 2010;78(4):332-340.
Keywords: Attenuation, Doppler, frequency, propagation velocity, ultrasound.
August 2010 AANA Journal
Volume 78 , Number 4
ISSN 0094-6354
On the Cover:
LCDR Jason Patacsil, CRNA, MSN, NC, USN, secures an airway of a trauma patient in 1 of 12 operating rooms on the USNS Comfort. The hospital ship was deployed to Haiti after a magnitude 7.0 earthquake struck near Port-au-Prince on January 12. During the mission, 843 surgical cases were completed. Patacsil is a staff nurse anesthetist at Naval Hospital Pensacola, Florida. For more information on the USNS Comfort’s role in Operation United Response, see the Guest Editorial on page 264.