December 2008 AANA Journal

Table of Contents


Severe Bradycardia After Propofol Induction
Jeffrey Huang, MD
Stacey Wilson, CRNA
Authors’ Correction: Chrysin is a Passiflora coerulea Extract
Veronika Butterweck, PhD
COL(ret) Normalynn Garrett, CRNA, PhD, AN, USA
LTC Thomas E. Ceremuga, CRNA, PhD, ANC, USA
Print version: 2008;76(6):413-414.

Legal Briefs
The Medical-Legal Quandary of Healthcare in Capital Punishment: An Ethical Dilemma for the Anesthesia Provider
Kevin W. Johnson, CRNA, MHS, DNPc
Print version: 2008;76(6):417-419.
Keywords: Beneficence, ethics, lethal injection, pancuronium bromide, sodium thiopental.

Education News
Cultural Competency Training in Nurse Anesthesia Education
Suzanne M. Wright, CRNA, MSNA
Print version: 2008;76(6):421-424.
Keywords: Cultural competency, diversity, nurse anesthesia education, patient safety, health disparities.

Council on Accreditation of Nurse Anesthesia Educational Programs to be Reviewed During fiscal Year 2009
Print version: 2008;76(6):431.

School List
List of Recognized Programs by the Council on Accreditation of Nurse Anesthesia Educational Programs
Print version:

Official Council Listings
Print version: 2008;76(6):468-469.

Index to Volume 76 of the AANA Journal
Print version: 2008;76(6):470-487.



Comparison of 2 Laryngeal Tracheal Anesthesia Techniques in Reducing Emergence Phenomena
LCDR Christopher Crerar, CRNA, MSN, USN
LT Edwardo Weldon, CRNA, MSN, USN
LCDR Jamie Salazar, RN, BSN, USN
LCDR Kelly Gann, RN, BSN, USN
CDR (ret) Joseph A Kelly, CRNA, MSN, USN
CAPT(ret) Joseph E Pellegrini, CRNA, PhD, USN
Endotracheal intubation (ETT) can cause emergence phenomena (EP) including coughing, sore throat, and dysphonia. Two methods used to prevent EP are the administration of local anesthetics directly onto airway structures using a specialized laryngotracheal instillation of topical anesthesia tube or the placement of a local anesthetic into the ETT cuff. The purpose of this research was to determine which method was better at preventing EP. The study demonstrated greater efficacy in decreasing the incidence and severity of EP by placing an alkalinized solution of lidocaine into the ETT cuff on intubation.
Print version: 2008;76(6):425-431.
Keywords: Alkalinized, emergence phenomena, laryngotracheal, lidocaine. 

Anesthesia in a Child with Pyruvate Dehydrogenase Deficiency: A Case Report
Debra A. Gilmore, CRNA, MSN
James Mayhew, MD, FAAP
Pyruvate dehydrogenase deficiency is an ´-linked mutation causing deficiencies of  pyruvate dehydrogenase phosphatase that results in elevated lactic acid and is aggravated by the ingestion of carbohydrates in the diet. In this case report, the authors report a pediatric patient with pyruvate dehydrogenase deficiency who presented for a left foot tendon transfer with an Achilles tendon lengthening secondary to left ankle equinus. The pathophysiology of pyruvate dehydrogenase deficiency is discussed as well as anesthetic management in patients with this  deficiency.
Print version: 2008;76(6):432-433.
Keywords: Ketogenic diet, lactic acidosis, pyruvate dehydrogenase, thiamine. 

Anesthesia for Cesarean Delivery in an Achondroplastic Dwarf: A Case Report
Jeffrey Huang, MD
Noah Babins, MD
The authors describe the anesthetic management of an achondroplastic dwarf who underwent cesarean delivery. There are more than 100 different types of dwarfism, and achondroplasia is the most common form of this rare condition. Limited neck extension, foramen magnum stenosis, a large tongue, large mandible, and atlanto-axial instability can lead to increased difficulty of airway management. The authors conclude that adequate preparation and planning are fundamental for successful anesthetic management of an achondroplastic dwarf undergoing cesarean delivery.
Print version: 2008;76(6):435-436.
Keywords: Achondroplastic dwarf, difficult airway, general anesthesia, regional anesthesia.

A Successful Partnership to Help Reduce Health Disparities: The Institute for Culturally Competent Care and the Kaiser Permanente School of Anesthesia/California State University Fullerton
Sass Elisha, CRNA, EdD
John Nagelhout, CRNA, PhD, FAAN
Saleena Gupte, DrPH
Karen Koh, MPH
Maria Maglalang, RN, MN, NP
Nilda Chong, MD, MPH, DrPH
An innovative partnership with Kaiser Permanente’s Institute for Culturally Competent Care enabled the Kaiser Permanente School of Anesthesia/California State University Fullerton to present a formal, 4-module cultural competency certification program within the nurse anesthesia curriculum. The goals of developing the cultural competency curriculum were to increase students’ awareness of cultural differences and to enhance students’ communication skills with an increasingly diverse patient population. This article describes the genesis and evolution of the collaboration as well as the impact of this ongoing educational effort.
Print version: 2008;76(6):437-442.
Keywords: Cultural awareness, culturally competent care, culturally sensitive patient care, cultural competency in education.

Multidisciplinary Management of Peripartum Cardiomyopathy During Repeat Cesarean Delivery: A Case Report
Janice Shannon-Cain, CRNA, MS
Eric Hunt, MD, PhD
Brian S. Cain, MD
Peripartum cardiomyopathy (PPCM) is a potentially fatal form of heart failure associated with pregnancy. The worldwide incidence of PPCM is about 1 in 3,000 to 1 in 15,000 pregnancies. This case report illustrates the recognition of peripartum cardiomyopathy and the risks early in pregnancy. It also describes the appropriate medical management, including transesophageal echocardiography, and the need for collaboration of multiple medical specialists before and during delivery to provide the best possible outcome for both mother and infant.
Print version: 2008;76(6):443-447.
Keywords: Awake intubation, cardiomyopathy, cesarean delivery, peripartum cardiomyopathy, pregnancy.

AANA Journal
Course: Update for Nurse Anesthetists—Part 5—Implications of Immune Function to Anesthesia Care
Charles A. Griffis, CRNA, PhD
Gayle Page, DNSc
Michael Kremer, CRNA, PhD, FAAN
Steven Yermal, CRNA, PhD
Multiple aspects of perianesthesia care and the perioperative environment can influence the functions of the immune system. This course reviews basic immune system functions and potential sources of immune system–altering perioperative stress. The effects of commonly used anesthesia drugs, opioids, and adjunct drugs on immune function are discussed. Patient populations at risk for increased morbidity due to perioperative immune depression are identified, along with patient-specific measures nurse anesthetists can take to reduce postoperative immune dysfunction.
Print version: 2008;76(6):449-454.
Keywords: Immune system, drug-induced immunosuppression, opioids, pain, perioperative metabolic stress response.

December 2008 AANA Journal
Volume 76 , Number 6
ISSN 0094-6354
On the Cover:
Student nurse anesthetists at Middle Tennessee School of Anesthesia (MTSA) in Madison, Tennessee, perform a fiberoptic intubation in the Simulations Skills Center. The Center is a part of a $3 million dollar expansion/renovation at the school. Pictured (l to r) are: Misenga Kabongo, placing a femoral arterial line using an arrow catheter; Huy Nguyen, managing fluids and various drips; Amber Todaro, performing the intubation; and Dawn Price, managing the tongue and having suction available. (Photo by Jim Closser, MTSA vice president for Advancement & Alumni.)