December 2009 AANA Journal

Table of Contents


Will the Addition of Sciatic Nerve Block to a Femoral Nerve Block Provide Better Pain Control Following Anterior Cruciate Ligament Repair Surgery?
Travis W. Johnson, CRNA, MSN
LCDR Tammy K. Jansen, CRNA, MSN, USN, NC
Joseph E. Pellegrini, CRNA, PhD
Comparison of Inhalation of Isopropyl Alcohol vs Promethazine in the Treatment of Postoperative Nausea and Vomiting (PONV) in Patients Identified as High Risk for Developing PONV
Allan Schwartz, CRNA, DDS
Joseph E. Pellegrini, CRNA, PhD
Print version: 2009;77(6):417-418.

Books, Etc. 
Current Therapy in Pain
Reviewer: Lisa Osborne, CRNA, PhD

Rapid Sequence Intubation and Rapid Sequence Airway
Reviewer: Alan Jon Smally, MD, FACEP

Handbook for Stoelting’s Anesthesia and Co-Existing Disease
Reviewer: Ryann Lavenia, CRNA, MS, ARNP
Print version: 2009;77(6):419-422.
Education News
Evidence-Based Practice for Lifelong Learning
John J. McFadden, CRNA, PhD
Lisa J. Thiemann, CRNA, MNA
Print version: 2009;77(6):423-426.
Keywords: Evidence-based practice, evidence-based process.
School List
Index to Volume 77 of the AANA Journal
Print version: 2009;77(6):474-493.

Airway Management in a Bleeding Adult Following Tonsillectomy: A Case Report
Manjit Singh Brar, CRNA, MS
In this case report, the author describes a morbidly obese man with a history of obstructive sleep apnea who underwent elective tonsillectomy. The author concludes that difficult situations such as a bleeding airway, which occurred in this case, require a thorough assessment of the airway, careful planning to ensure that alternative devices and plans are available, asking for additional expert support, and the availability of a backup surgeon for establishing an emergency surgical airway.
Print version: 2009;77(6):428-430.
Keywords: Bleeding oropharynx, GlideScope, Macintosh blade.
CRNA-Physician Collaboration in Anesthesia
Terri S. Jones, CRNA, DNP
Joyce J. Fitzpatrick, RN, PhD, FAAN
In this study, a sample of nurse anesthetists and anesthesiologists affiliated with postgraduate training programs in the state of Texas responded to a survey designed to gather attitudes toward physician-nurse collaboration using an adaptation of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. The findings suggest that Certified Registered Nurse Anesthetists who deal with role conflict or unclear expectations as well as limited scope of practice may have increased job stress and dissatisfaction.
Print version: 2009;77(6):431-436.
Keywords: Anesthesia care team, attitudes, physician-nurse collaboration.
Clinical Benefits of Visualization of Airway Anatomy and Manipulation of the Endotracheal Tube Cuff With the GlideScope in the Morbidly Obese Patient During Tracheotomy 
Michael T. Hartman, CRNA, MSN
John Lang, DO
In this article, the authors describe the successful use of a video laryngoscope (Glidescope) for assistance in visualizing the endotracheal tube cuff within the airway of two morbidly obese patients. The authors said that they avoided the known potential complications of extubation during retraction as well as cuff rupture requiring tube exchange during a tracheotomy, and they believe these complications were deterred with the use of the video laryngoscope.
Print version: 2009;77(6):437-438.
Keywords: Difficult airway, GlideScope, morbidly obese, tracheotomy.
Health Insurance in the United States 
Lisa M. Riedel, CRNA, DNP
Lack of insurance and inadequate insurance have serious consequences for individuals, families, and the country. This article provides facts about the current system of health insurance in the United States and current government reform efforts. The author concludes that as providers and consumers of healthcare, we should keep our eye on the ultimate goal—providing affordable insurance coverage for all.
Print version: 2009;77(6):439-444.
Keywords: Health insurance, medical bankruptcy, underinsured, uninsured, universal healthcare.
Anxiolytic Effects of L-theanine – a Com-ponent of Green Tea – When Combined With Midazolam, in the Male Sprague-Dawley Rat 
LTC Traci Heese, CRNA, MSN, ANC, USA MAJ Jack Jenkinson, RN, BSN, ANC, USA MAJ Cheryl Love, CRNA, MSN, ANC, USA MAJ Ronald Milam, CRNA, MSN, ANC, USA MAJ Lillian Perkins, CRNA, MSN, ANC, USA CPT Cynthia Adams, CRNA, MSN, ANC, USA
Suzanne McCall
Thomas E. Ceremuga, CRNA, PhD, LTC (ret), ANC, USA
The purpose of this study was to determine if the green tea component L-theanine has anxiolytic effects in the rat model and to investigate possible modulation of the GABAA receptor by L-theanine in the rat central nervous system (CNS). Although the data did not support the hypothesis that L-theanine has anxiolytic effects in the rat model, the findings suggest that L-theanine in combination with midazolam modulates the CNS by increasing anxiolysis and decreasing fine and basic motor movements.
Print version: 2009;77(6):445-449.
Keywords: Anxiolysis, elevated plus-maze, green tea, L-theanine, rats.

AANA Journal Course: Update for Nurse Anesthetists—Part 5—Evaluation of Older Adults 
Henry C. Talley, CRNA, PhD, MSN, MS
Costellia H. Talley, RN-BC, PhD, ACNS-BC
Older adults have specific management needs, and these demands continue to pose challenges to anesthesia providers. These challenges relate to the accrual of numerous and diverse anatomic and physiologic changes that occur in older adults throughout the course of aging. In this course, the authors discuss risks of anesthesia and surgery, the preanesthesia evaluation, age-related physiologic changes in older adults, and age-related physiologic changes in organ subsystems.
Print version: 2009;77(6):451-460.
Keywords: Aging, anesthesia assessment, evaluation, older adult.
December 2009 AANA Journal
Volume 77 , Number 6
ISSN 0094-6354
On the Cover:
Students Lynne Edwards (closest to front) and Lisa Cummings practice the technique of spinal anesthesia in the clinical skills laboratory of the Wake Forest University Baptist Medical Center Nurse Anesthesia Program, Winston-Salem, North Carolina. The skills lab is one portion of the program of applied learning, which includes a human cadaver lab, a simulation lab, and a mock operating room, where students participate in multidisciplinary crew resource management training. (Photo by Michael Rieker, CRNA, DNP, director, Nurse Anesthesia Program.)