August 2011 AANA Journal

Table of Contents

 
Departments

Letters
Anesthesia Provider Fingerbreadth and Preoperative Airway Assessment
Cheyenne Ferrell
L. Lee Glenn, PhD
Response
Judith H. Wakim, RN, EdD, CNE
Print version: 2011;79(4):280.

Answers to AANA Journal Course No. 30 Examination
Print version: 2011;79(4):345-349.

Articles

Caudal Regression Syndrome: A Case Report
Brian Knight, CRNA, MS
Caudal regression syndrome is a rare, sporadic neural tube defect characterized by incomplete development of terminal spinal segments. In this case report, the author describes a neonate with caudal regression syndrome undergoing placement of a diverting colostomy and includes a review of the literature regarding this syndrome and its possible causes of development. The author concludes that anesthesia in newborns with caudal regression syndrome may be challenging because of a variety of associated anomalies that providers should be prepared to encounter sometime in their anesthesia career.
Print version: 2011;79(4):281-282.
Keywords: Caudal regression syndrome, sacral agenesis, VACTERL, VATER.

Size Effect on Delivered Versus Calculated Dosages of Propofol: A Bench Experiment Using the Baxter InfusOR Syringe Pump
Randall W. Klotz, CRNA, MEd, MSN
Each year thousands of anesthetics are undertaken using the Baxter InfusOR syringe pump. Anesthesia providers use various configurations, consisting of 20-, 30-, or 60-mL syringes, when delivering propofol with this syringe pump. In this study, the author compared delivered vs calculated dosages of propofol using the Baxter InfusOR syringe pump with 20-, 30-, and 60-mL syringes. In addition, the author examined the ethical and legal implications of using a syringe other than a 60 mL when delivering propofol with a Baxter InfusOR syringe pump.
Print version: 2011;79(4):287-291.
Keywords: Anesthetic delivery systems, conscious sedation, propofol, syringe pumps, unconscious sedation.

A Child with Propionic Acidemia Undergoing Dental Restorations: A Case Report
Erin L. Sebens, CRNA, MS
Propionic acidemia is an autosomal recessive disease in which there is a deficiency of propionyl-CoA carboxylase, an enzyme necessary near the end of the catabolic pathway to metabolize several essential amino acids. Clinical features of propionic acidemia affect many body systems and prompt specific anesthetic care. In this case report, specific anesthetic rationales are explained related to propionic acidemia for the entire intraoperative period. Signs and symptoms and treatments of an acute decompensation also are discussed.
Print version: 2011;79(4):295-299.
Keywords: Ketoacidosis, metabolic disorders, propionic acidemia.

Effect of Epidural Normal Saline Bolus Prior to Catheter Removal on Parturient Sensory and Motor Function Recovery: A Pilot Study
LT Maria Williams, CRNA, MSN, NC, USN
LT Tiffany Dodson, CRNA, MSN, NC, USN
LT Rafal B. Banek, CRNA, MSN, NC, USN
CDR Lisa Osborne, CRNA, PhD, NC, USN
Joseph Pellegrini, CRNA, PhD, CAPT(ret), NC, USN
CDR Dennis Spence, CRNA, PhD, NC, USN

A normal saline bolus administered before discontinuation of the epidural catheter reportedly hastens return of motor function following epidural anesthesia; however, this technique has not been investigated in parturients following vaginal delivery. The preliminary pilot results of this study suggest that epidural administration of normal saline immediately after discontinuance of a dilute concentration of local anesthetic infusion may accelerate recovery of motor function in parturients, although not as dramatically as with a higher concentration of local anesthetics.
Print version: 2011;79(4):305-310.
Keywords: Epidural analgesia, motor, obstetrics, saline injection, sensory dermatome.

Prolonged Neuromuscular Block in a 74-Year-Old Patient
Allen Branch, CRNA, MS
John Rafacz, CRNA, MS
Lisa Boudreaux, RN, MS, CCRN

Pseudocholinesterase abnormalities are an inherited trait that causes aberrant metabolism of certain ester-based drugs. Individuals who unknowingly possess this anomaly pose a great challenge to anesthesia providers because of the diverse and unexpected duration of action of succinylcholine. The authors of this case report point out that this anomaly poses a grave concern, particularly in freestanding surgical centers when the patient may need hospital admission. They add that it is important to educate affected individuals, as they may require general anesthetics for future procedures in which succinylcholine might be administered for laryngoscopy.
Print version: 2011;79(4):317-321.
Keywords: Dibucaine number, prolonged apnea, pseudocholinesterase deficiency.

The National Study of Sleep-Related Behaviors of Nurse Anesthetists: Personal and Professional Implications
Chuck Biddle, CRNA, PhD
John Aker, CRNA, DNAP

Concerns regarding sleep-related fatigue are well studied in domains in which human behavior has immediate or potentially negative consequential impact on others, such as long-haul trucking, aviation, and the military. This study is the first to report on a national sampling of the sleep-related behaviors of Certified Registered Nurse Anesthetists. The authors state that patient safety is at the core of the mission statements of both the American Association of Nurse Anesthetists and the American Society of Anesthesiologists, and they urge further study and full transparency on the part of both professional groups in proactive management of anesthesia provider workplace fatigue.
Print version: 2011;79(4):324-331.
Keywords: Fatigue, patient safety, provider regulation, sleep, sleep dysfunction.

 


 

AANA Journal Course: Update for Nurse Anesthetists—Part 3—Sorting Through the Confusion: Adverse Cognitive Change After Surgery in Adults
LCDR Ken Wofford, CRNA, MS, NC, USN
Charles Vacchiano, CRNA, PhD

Cognitive change after surgery has become a common topic of research; however, postoperative delirium, emergence delirium, and postoperative cognitive dysfunction are not always phenomenologically distinct. The difficulty in distinguishing between different types of cognitive change after surgery is further complicated by the variety of measurement techniques applied to emergence delirium and postoperative cognitive dysfunction. To be effective clinicians and educated consumers of research into cognitive change after surgery, nurse anesthetists must be aware of the differences and similarities in postoperative delirium, emergence delirium, and postoperative cognitive dysfunction. In this course, the authors compare the history, characteristics, and limitations of the existing definitions for postoperative delirium, emergence delirium, and postoperative cognitive dysfunction.
Print version: 2011;79(4):335-342.
Keywords: Emergence delirium, postoperative cognitive dysfunction, postoperative delirium.

August 2011 AANA Journal
Volume 79 , Number 4
ISSN 0094-6354
On the Cover:
Jill Schroeder, CRNA, MSNA (left), and Lukeythia Bastardi, CRNA, DNAP, are shown here as students at Virginia Commonwealth University (VCU), Department of Nurse Anesthesia, Richmond, Virginia, where they developed the Baricity Educational Spinal Tool or BEST (patent pending) for their doctorate in nurse anesthesia capstone project. The device was designed to demonstrate how local anesthetic with varying baricity moves in cerebral spinal fluid. (Photo taken by Elizabeth Howell, CRNA, MSNA, assistant professor of nurse anesthesia at VCU.)