August 2011 AANA Journal Special Research Edition

​Table of Contents

Guest Editorial
The AANA Journal Special Research Edition: Two Views on Its Relevance
Chuck Biddle, CRNA, PhD
Louise Hershkowitz, CRNA, MSHA

Print version:
Keywords: Dissemination, evidence-based practice, informing practice, research.
Environmental and Financial Impact of a Hospital Recycling Program 
Lisa M. Riedel, CRNA, DNP, MS
Recycling decreases greenhouse gases emitted from waste disposal, and hospitals can play a part in lessening the effects of global climate change. The purpose of this study was to determine the environmental and financial impact of recycling at a 148-bed acute-care hospital. The study measured the amount of nonhazardous waste generated and disposal costs before and after adding single-stream recycling to its nonhazardous waste disposal practices. Study results show that recycling not only benefits the environment but also saves money.
Print version: 2011;79(4):S8-S14.
Keywords: Climate change, environment, financial analysis, recycling, waste management.

Knowledge of Palliative and End-of-Life Care by Student Registered Nurse Anesthetists
Margaret Faut Callahan, CRNA, PhD, FAAN
Susan Breakwell, RN, DNP, APHN-BC
Rosemarie Suhayda, RN, PhD
Individuals requiring palliative care frequently receive inadequate or no treatment. As part of a 5-year study funded by the National Institutes of Health, all graduate nursing students, including student registered nurse anesthetists (SRNAs), at a single institution participated in a 2–credit-hour course titled Interdisciplinary Palliative Care. The project team sought to identify SRNAs’ knowledge and attitudes regarding palliative and end-of-life care and to determine potential roles for CRNAs in this growing area of practice.
Print version: 2011;79(4):S15-S20.
Keywords: Hospice care, pain, palliative care, symptom management.

Perioperative Music and Its Effects on Anxiety, Hemodynamics, and Pain in Women Undergoing Mastectomy 
Pamela G. Binns-Turner, CRNA, PhD
Lynda Law Wilson, RN, PhD, FAAN
Erica R. Pryor, RN, PhD
Gwendolyn L. Boyd, MD
Carol A. Prickett, PhD, MT-BC
Interest has increased in the use of nonpharmacologic interventions such as music to minimize potential adverse effects of anxiety-reducing medications. This study used a quasi-experimental design to evaluate the effects of a perioperative music intervention. The music was provided continuously throughout the preoperative, intraoperative, and postoperative periods, for women diagnosed with breast cancer undergoing mastectomy. Changes in mean arterial pressure, heart rate, anxiety, and pain were measured.
Print version: 2011;79(4):S21-S27.
Keywords: Anxiety, blood pressure, music, pain, perioperative.

Investigation of the Anti-inflammatory, Antinociceptive Effect of Ellagic Acid as Measured by Digital Paw Pressure via the Randall-Selitto Meter in Male Sprague-Dawley Rats
CPT Jeffrey Gainok, CRNA, MSN, CCRN, ANC, USA
CPT Regina Daniels, CRNA, MSN, CCRN, ANC, USA
CPT David Golembiowski, RN, BSN, CCRN, ANC, USA
CPT Patricia Kindred, CRNA, MSN, CCRN, ANC, USA
CPT Rob Strickland, RN, BSN, CCRN, ANC, USA
Normalynn Garrett, CRNA, PhD, COL(ret), ANC, USA
Ellagic acid (EA), a dietary supplement, is purported to have anti-inflammatory, antinociceptive properties via cyclooxygenase (COX) inhibition. This study was an investigation of these effects when EA is administered alone, with ketorolac (nonselective COX inhibitor), or with meloxicam (COX-2-specific inhibitor) in male Sprague-Dawley rats. The purpose of this study was to determine the efficacy of EA as an anti-inflammatory, antinociceptive agent and to examine interactions between EA and ketolorac or meloxicam compared with control substances and EA alone.
Print version: 2011;79(4):S28-S34.
Keywords: Anti-inflammatory, antinociceptive, cyclooxygenase, ellagic acid, Randall-Selitto meter.

Clinical Education Experiences: Perceptions of Student Registered Nurse Anesthetists
Sass Elisha, CRNA, EdD
Dana N. Rutledge, RN, PhD

Continual evaluation of all aspects of nurse anesthesia programs, including those during clinical learning, is necessary to help educate high-quality anesthesia practitioners. This study was a cross-sectional survey of student registered nurse anesthetists to examine their experiences and perceptions regarding clinical instruction. Included were questions about treatment during clinical education, helpfulness of activities or persons, ideal behavioral characteristics of preceptors, and level of satisfaction with clinical instruction.
Print version: 2011;79(4):S35-S42.
Keywords: Clinical education, clinical educator development, clinical learning, graduate nursing education.

Perioperative Administration of Gabapentin for Shoulder Arthroscopy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study 
CDR Dennis Spence, CRNA, PhD, NC, USN
LT Jason Goff, CRNA, MSN, NC, USN
LT Erin Mohan, CRNA, MSN, NC, USN
LT Kirsten Bowen, CRNA, MSN, NC, USN
CDR Lisa Osborne, CRNA, PhD, NC, USN
CDR John Maye, CRNA, PhD, NC, USN
Recent studies suggest that gabapentin has opioid-sparing effects and may reduce acute postoperative pain. Research is limited, however, on the efficacy of gabapentin when combined in a multimodal approach after shoulder arthroscopy under general anesthesia with an interscalene block. The primary outcome of this study was average pain scores of patients given gabapentin or a placebo, and the secondary outcome included differences in morphine equivalents, adverse effects, and sleep patterns.
Print version: 2011;79(4):S43-S50.
Keywords: Central sensitization, gabapentin, interscalene block, postoperative pain, shoulder arthroscopy.

Workplace Aggression: Assessment of Prevalence in the Field of Nurse Anesthesia
Amelia Sakellaropoulos, CRNA, MS
Janine Pires, CRNA, MS
Donna Estes, CRNA, MS
Donna Jasinski, CRNA, PhD
Workplace aggression is a serious issue with a broad range of consequences including negative work environment and reduced employee well-being. The purpose of this study was to assess the prevalence of workplace aggression in nurse anesthesia and determine its effect on the work environment of Certified Registered Nurse Anesthetists. Data analyses from the Workplace Aggression Research Questionnaire revealed converging patterns of verbal, active, and direct aggression.
Print version: 2011;79(4):S51-S57.
Keywords: Abuse, harassment, threatening behavior, workplace aggression.

A Comparison of the Pain Perceived During Intravenous Catheter Insertion After Injection With Various Local Anesthetics
Ryan M. Beck, CRNA, MS
Frank J. Zbierajewski, CRNA, MS
Melissa K. Barber, CRNA, MS
Milo Engoren, MD
Robert Thomas, MD
Insertion of an intravenous (IV) catheter is required for most surgical procedures and can provoke anxiety and pain. This study compared the pain surgical patients experienced with 4 local anesthetics (1% lidocaine, 1% lidocaine buffered with sodium bicarbonate, 2% chloroprocaine, or 0.5% bupivacaine) when an 18-gauge IV catheter was inserted in the dorsum of the hand. A secondary objective was to determine the association, if any, between pain on drug injection and IV catheter insertion.
Print version: 2011;79(4):S58-S61.
Keywords: Intravenous cannulation, local anesthetics, pain.

Congruence of Perceived Effective Clinical Teaching Characteristics Between Students and Preceptors of Nurse Anesthesia Programs 
Courtney Smith, CRNA, MSN
Annmarie Swain, CRNA, MSN
Barbara Penprase, RN, PhD
The teaching effectiveness of clinical instructors is pivotal to the quality of education that student registered nurse anesthetists gain from the clinical arena. A review of the literature highlighted a gap in research evaluating the teaching characteristics that are valuable and effective from both the clinical instructor’s and the student’s point of view. The purpose of this study was to assess the importance of 24 clinical instructor characteristics and the congruence of clinical instructor and student perception of these characteristics.
Print version: 2011;79(4):S62-S68.
Keywords: Clinical faculty, educational personnel, faculty characteristics, mentoring, nurse anesthesia.

Prophylactic Isopropyl Alcohol Inhalation and Intravenous Ondansetron Versus Ondansetron Alone in the Prevention of Postoperative Nausea and Vomiting in High-Risk Patients
LT Kennett D. Radford, CRNA, MS, NC, USN
LT Thomas N. Fuller, CRNA, MS, NC, USN
CDR Brent Bushey, CRNA, MS, NC, USN
CDR Carole Daniel, CRNA, MS, NC, USN
Joseph E. Pellegrini, CRNA, PhD, CAPT(ret), NC, USN
Postoperative nausea and vomiting (PONV) is a common problem following general anesthesia. Patients identified as high risk for PONV are often treated prophylactically with intravenous (IV) ondansetron and an additional agent. Limited options exist for a second agent with no adverse effects. The purpose of this investigation was to determine if combining inhalation of isopropyl alcohol vapors, an agent with no adverse effects, with IV ondansetron is more effective than IV ondansetron alone in the prevention of PONV in high-risk patients.
Print version: 2011;79(4):S69-S74.
Keywords: Aromatherapy, isopropyl alcohol, ondansetron, postoperative nausea and vomiting.

Evaluation of the Anxiolytic Properties of Tetrahydropalmatine (THP), a Corydalis Yanhusuo Compound, in the Male Sprague-Dawley Rat
CPT Herman Henkes, CRNA, MSN, ANC, USA
MAJ Michael Franz, BSN, ANC, USA
MAJ Orin Kendall, CRNA, MSN, ANC, USA
CPT Jacqueline Monroe, CRNA, MSN, ANC, USA
CPT Anna Legaspi, CRNA, MSN, ANC, USA
MAJ Christopher Haese, CRNA, MSN, ANC, USA
1LT Daniel Williams, RN, BSN, ANC, USA
Suzanne McCall, ALAT
Arthur Don Johnson, RN, PhD
Thomas E. Ceremuga, CRNA, PhD, LTC(ret), ANC, USA
Herbal medications can have adverse effects and interactions with perioperative medicines and may cause serious consequences or complications. Tetrahydropalmatine (THP), an active component isolated from the Chinese herbal plant Corydalis yanhusuo, is used in Asia for its analgesic, sedative, and hypnotic properties. This study investigated the anxiolytic effects of THP and its potential interaction with the benzodiazepine binding site on the γ-aminobutyric acid receptor in the male Sprague-Dawley rat.
Print version: 2011;79(4):S75-S80.
Keywords: Anxiolysis, Corydalis yanhusuo, elevated plus-maze, Sprague-Dawley rat, tetrahydropalmatine. 
August 2011 AANA Journal Special Research Edition
Volume 79 , Number 4
ISSN #0094-6354
On the Cover:
Listing of articles. See list at left.