August 2012 AANA Journal Special Research Edition

The AANA Journal is now available in a digital edition.
The Table of Contents is reproduced below for your convenience.

Digital Edition

Comparison of Tibial Intraosseous, Sternal Intraosseous, and Intravenous Routes of Administration on Pharmacokinetics of Epinephrine During Cardiac Arrest: A Pilot Study
James Burgert, CRNA, MSNA
Brian Gegel, CRNA, MSN
LTC Michael Loughren, CRNA, PhD, ANC, USA
Thomas Ceremuga, CRNA, PhD, LTC(ret), ANC, USA
Manish Desai, MD
LTC Michael Schlicher, RN, PhD, ANC, USA
COL Joseph O’Sullivan, CRNA, PhD, ANC, USA
COL Paul Lewis, RN, PhD, ANC, USA
Don Johnson, RN, PhD, Col(ret), USAFR, NC

The purpose of this study was to determine and compare the maximum concentration and time to maximum concentration of epinephrine administered via tibial intraosseous (IO), sternal IO, and intravenous (IV) routes in a porcine model of cardiac arrest during cardiopulmonary resuscitation. The findings of this study suggest that higher doses of epinephrine may be needed when administered via the IO route to patients in cardiac arrest, compared with the IV route.
Print edition: 2012;80(4):S6-S10.
Keywords: Advanced Cardiac Life Support, cardiac arrest, epinephrine, intraosseous.
Anesthesia Clinical Performance Outcomes: Does Teaching Method Make a Difference?
Nina E. McLain, CRNA, PhD
Chuck Biddle, CRNA, PhD
J. James Cotter, PhD

The purpose of this study was to compare traditional methods of instruction to the use of audiovisual patient safety vignettes in terms of their impact on student registered nurse anesthetists’ recall and subsequent clinical performance. These vignettes used simulated, crisis-oriented anesthetic events known to be associated with catastrophic patient outcomes. In this study, crisis-oriented, anesthesia patient safety vignettes had the potential to affect recall and clinical performance in a simulated environment.
Print Edition: 2012;80(4):S11-S16.
Keywords: Anesthesia apparatus checkout procedure, anesthesia clinical performance outcomes, patient safety, patient simulation, teaching methods.
Perioperative Hypoglycemia in Patients With Diabetes: Incidence After Low Normal Fasting Preoperative Blood Glucose Versus After Hyperglycemia Treated With Insulin
Howard L. Drews III, CRNA, MSN
Amy L. Castiglione, CRNA, MSN
Suzanne N. Brentin, CRNA, MSN
Catherine R. Ersig, CRNA, MSN
Tamra K. Dukatz, CRNA, MSN
Barbara E. Harrison, RN, PhD, APRN
Fatema M. Omran, MD
Solomon I. Rosenblatt, MD

Perioperatively, insulin to treat hyperglycemia is administered judiciously to minimize the risk of hypoglycemia. In patients with diabetes in whom preoperative blood glucose levels are on the low end of normal, hypoglycemia risk may be underestimated. This retrospective study enrolled subjects with presenting preoperative blood glucose values in these ranges: 70 to 89 mg/dL (low normal group) and above 249 mg/dL (hyperglycemia-treated group). These groups were compared for subsequent perioperative hypoglycemia development.
Print edition: 2012;80(4):S17-S24.
Keywords: Diabetes, glycemic, hypoglycemia, perioperative.
Intrathecal Hydromorphone for Postoperative Analgesia After Cesarean Delivery: A Retrospective Study
Erik Rauch, CRNA, DNP
Despite compelling evidence for the safety and efficacy of intrathecal hydromorphone, the use of this opioid intrathecally for the pain management of patients undergoing cesarean delivery has not been widely accepted. The purpose of this retrospective study was to compare the reported efficacy and safety of pain management in women who received intrathecal hydromorphone vs in women who received intrathecal fentanyl or a local anesthetic for their cesarean delivery.
Print edition: 2012;80(4):S25-S32.
Keywords: Analgesia, cesarean delivery, hydromorphone, intrathecal, pain management.
Utility of Cocaine Drug Screens to Predict Safe Delivery of General Anesthesia for Elective Surgical Patients
Joshua L. Baxter, CRNA, DNP
Anne W. Alexandrov, RN, PhD, CCRN, FAAN

Cocaine has been associated with acute hemodynamic changes, causing anesthesia providers to be concerned about adverse hemodynamic events during general anesthesia. In this original research, the authors sought to determine if there were differences in the prevalence of adverse hemodynamic events and if hemodynamic instability could be predicted in cocaine-positive patients undergoing general anesthesia for elective surgery.
Print edition: 2012;80(4):S33-S36.
Keywords: Cocaine, drug screen, hemodynamic instability, urine drug screen.
Comparison of Fascia Iliaca Compartment Block and 3-in-1 Block in Adults Undergoing Knee Arthroscopy and Meniscal Repair
LT Jerrol B. Wallace, CRNA, MSN, NC, USN
LT Joseph A. Andrade, CRNA, MSN, NC, USN
LCDR Jasen P. Christensen, CRNA, MSN, NC, USN
CDR Lisa A. Osborne, CRNA, PhD, NC, USN
Joseph E. Pellegrini, CRNA, PhD, CAPT(ret), NC, USN
Peripheral nerve blocks have become a popular method for treatment of pain after lower-extremity surgical procedures. Two peripheral nerve blocks for knee arthroscopy include the 3-in-1 block and the fascia iliaca compartment block (FICB). This was a randomized controlled trial of 60 adult patients undergoing knee arthroscopy under general anesthesia and with a 3-in-1 block or FICB using the same local anesthetic admixture. Onset of block, time to postoperative analgesic requirements, pain scores, and overall satisfaction scores were measured.
Print edition: 2012;80(4):S37-S44.
Keywords: Fascia iliaca, leg block, lower extremity, regional anesthesia.
Training Rotations at Hospitals as a Recruitment Tool for Certified Registered Nurse Anesthetists
Ruth E. Wachtel, PhD, MBA
Franklin Dexter, MD, PhD

Recruiting newly graduating Certified Registered Nurse Anesthetists (CRNAs) is expensive. In addition, recruitment in rural areas is especially challenging. The authors of this research article analyzed the first jobs of all 95 graduates of the University of Iowa’s CRNA training program, from the initial graduating class of 1997 through the class of 2009. They also compared the location of the student’s first job to where the student lived at the time of application to the program.
Print edition: 2012;80(4)S45-S48.
Keywords: Healthcare disparities; healthcare facilities, manpower, and services; healthcare quality, access, and evaluation; health manpower; rural health services.
Stress: Perceptions, Manifestations, and Coping Mechanisms of Student Registered Nurse Anesthetists
Anthony Chipas, CRNA, PhD
Dan Cordrey, RN, BSN, CCRN
David Floyd, RN, BSN
Lindsey Grubbs, RN, BSN, CCRN
Sarah Miller, RN, BSN
Brooks Tyre, RN, BSN

Stress is a response to change from the norm. Stress affects all individuals to varying degrees and can be positive, such as eustress, or negative, such as distress. The purpose of this qualitative, cross-sectional study was to investigate the stressors of the typical student registered nurse anesthetist, with the objective of identifying trends in the perceptions, manifestations, and coping mechanisms of stress.
Print edition: 2012;80(4):S49-S55.
Keywords: Coping, depression, stress, student registered nurse anesthetist, suicide.
Effects of Using Simulation Versus CD-ROM in the Performance of Ultrasound-Guided Regional Anesthesia
John Gasko, CRNA, DNP
Arthur “Don” Johnson, RN, PhD, Col(ret), USAFR, NC
John Sherner, CRNA, MSN, COL(ret), ANC, USA
John Craig, CRNA, DNP
Brian Gegel, CRNA, MSN
James Burgert, CRNA, MSNA
CPT Samuel Sama, RN, BSN, ANC, USA
1LT Thomas Franzen, RN, BSN, ANC, USA

The purpose of this study was to determine which method of teaching, CD-ROM, simulation, or a combination of both, was more effective in increasing the performance of ultrasound-guided regional anesthesia. No studies have investigated these methods. The framework for this study was critical thinking. The study was a prospective, mixed (between and within) subjects, experimental design.
Print edition: 2012;80(4):S56- S59.
Keywords: CD-ROM, human simulation, ultrasound-guided regional anesthesia.
Practice in Computer-Based Testing Improves Scores on the National Certification Examination for Nurse Anesthetists
Michael P. Dosch, CRNA, PhD
This retrospective study examined whether practice in computer-based tests (CBTs) in student registered nurse anesthetists improved scores on the National Certification Examination (NCE). A group of students with extensive practice in CBTs was compared with a group of students whose tests were administered primarily on paper. Groups were matched on age, grade point average (GPA), and gender. Higher GPA was associated with higher NCE scores overall.
Print edition: 2012;80(4):S60-S66.
Keywords: Certification of nurse anesthetists, computer-based testing, education of nurse anesthetists, practice effect, test mode effect.
Risk Factors for Development of Postoperative Sore Throat and Hoarseness After Endotracheal Intubation in Women: A Secondary Analysis
Maria Jaensson, RNA, MSc
Anil Gupta, MD, PhD, FRCA
Ulrica G. Nilsson, RNA, PhD

Postoperative sore throat and hoarseness are common and disturbing complications following endotracheal intubation, and women are more frequently affected by these symptoms. This study explores risk factors associated with postoperative sore throat and hoarseness in women following intubation. In this prospective cross-sectional study, 97 patients undergoing elective ear, nose, and throat surgery or plastic surgery were included. Eight different variables were analyzed to detect possible associations for the development of postoperative sore throat or hoarseness.
Print edition: 2012;80(4):S67-S73.
Keywords: Endotracheal intubation, hoarseness, postoperative complications, risk factors, sore throat.
Health-Promoting Collaboration in Anesthesia Nursing: A Qualitative Study of Nurse Anesthetists in Norway
Gertrud Averlid, RNA, MPH
Susanna Bihari Axelsson, PhD

This article presents a study of different factors that may contribute positively or negatively to the work environment of nurse anesthetists in Norway. It focuses on factors that nurse anesthetists perceive as health promoting at work and indicates how a healthy work environment can be created. A qualitative method was used, which included interviews with a strategic sample of 14 nurse anesthetists working in anesthesia departments.
Print edition: 2012;80(4):S74-S80.
Keywords: Health promotion, leadership, management, nurse anesthetists, workplace.
August 2012 AANA Journal Special Research Edition
Volume 80 , Number 4
ISSN #0994-6354
On the Cover:
Listing of articles. See article list at left.