December 2011 AANA Journal

Table of Contents

Are Pigs the Right Model for Lipid Resuscitation?
Brian Zider, BS
Guy Weinberg, MD
CDR Brent A. Bushey, CRNA, MS, NC, USN

Syringe Size Effect on Delivered Versus Calculated Dosages of Propofol: A Bench Experiment Using the Baxter InfusOR Syringe Pump

Mark A. Klapperich, CRNA
Randall W. Klotz, CRNA, MEd, MSN
Print version: 2011;79(6):453-455.
Authors’ Corrections
Print version: 2011;79(6):455.
Imagining in Time
Ira P. Gunn: Educator, Advocate, Legend
Maura S. McAuliffe, CRNA, PhD, FAAN
Kathy J. Koch, MLIS, CA
Print version: 2011;79(6):459-463.
Keywords: Credentialing, education, Ira Gunn, nurse anesthesia history, US Army Nurse Corps.
School List
List of Recognized Programs by the Council on Accreditation of Nurse Anesthesia Educational Programs
Print version: 2011;79(6):511-522.
Index to Volume 79 of the AANA Journal
Print version: 2011;79(6):523-534.
Calendar of Events
Print version: 2011;79(6):535-538.
Management of a Traumatic Tracheal Tear: A Case Report
Eric Barrett, CRNA, MSN
In this case report, the author describes a posterior tracheal tear in a healthy 8-year-old girl. The child sustained the injury while riding her scooter, when the handlebars of the scooter dislodged after running into the curb, causing the shaft to strike her in the manubrium of the sternum. The child presented with subcutaneous emphysema of the neck and the supraclavicular region bilaterally. This case represents the need for proper preparation and communication between providers to manage all possible scenarios of a traumatic tracheal tear.
Print version: 2011;79(6):468-470.
Keywords: Spontaneous ventilation, subcutaneous emphysema, tracheal tear.
Diabetic Cardiac Autonomic Neuropathy and Anesthetic Management: Review of the Literature
Ingrid Oakley, CRNA, DVM
Lyne Emond, CRNA, MNA
Cardiac autonomic neuropathy (CAN) is a serious complication among diabetic patients. It occurs in both type 1 and type 2 diabetes, and its progression results in poor prognosis and increased mortality. The authors of this review article conclude that great progress has been made over the years in the research of autonomic nerve dysfunction; however, much still remains unknown about this serious complication of diabetes mellitus. Future research will hopefully provide the evidence needed to prevent the progression and fatal events experienced by the many diabetic patients who have CAN.
Print version: 2011;79(6):473-479.
Keywords: Anesthesia, cardiac autonomic neuropathy, diabetic autonomic neuropathy, diabetes mellitus.
Bronchial Thermoplasty: A Novel Treatment for Severe Asthma Requiring Monitored Anesthesia Care
Jamille A. Lee, RN, MSNA
David W. Rowen, CRNA, MSNA
David D. Rose, CRNA, PhD
Bronchial thermoplasty is a novel and promising, nonpharmacologic treatment for certain individuals with severe persistent asthma. In this case report, the authors report the successful use of dexmedetomidine for sedation during bronchial thermoplasty, a new treatment for patients with severe persistent asthma refractory to inhaled corticosteroids and long-term b-2 agonists. As bronchial thermoplasty becomes a more common procedure using monitored anesthesia care, the authors believe that dexmedetomidine may be a prudent choice for producing safe and effective sedation.
Print version: 2011;79(6):480-483.
Keywords: Asthma, bronchial thermoplasty, dexmedetomidine.
Predictors of Situation Awareness in Student Registered Nurse Anesthetists
Suzanne M. Wright, CRNA, PhD

Michael D. Fallacaro, CRNA, DNS
Situation awareness (SA) is defined as one’s perception of the elements of the environment, the comprehension of their meaning, and the projection of their status in the near future. The concept of SA is well known in the aviation industry, which is characterized by complexity and dynamism. Findings from this study reveal cognition as the best predictor of SA in graduate student registered nurse anesthetists (SRNAs), with the addition of memory and automaticity contributing no additional predictive value to the model. The results of this study have the potential to make a positive impact on the admission, education, and training of SRNAs.
Print version: 2011;79(6):484-490.
Keywords: Awareness, education, simulation, situation awareness, training.
Model for a Reproducible Curriculum Infrastructure to Provide International Nurse Anesthesia Continuing Education
Shawn Bryant Collins, CRNA, DNP
There are no set standards for nurse anesthesia education in developing countries, yet one of the keys to the standards in global professional practice is competency assurance for individuals. The international nurse anesthesia continuing education project was developed in response to the difficulty that nurse anesthetists in developing countries face in accessing continuing education. The purpose of this project was to develop a nonprofit, volunteer-based model for providing nurse anesthesia continuing education that can be reproduced and used in any developing country.
Print version: 2011;79(6):491-496.
Keywords: Continuing education, developing countries, Health Volunteers Overseas, reproducible curriculum.
Anesthetic Management of a Patient Undergoing an Ex Utero Intrapartum Treatment (EXIT) Procedure: A Case Report
Abbie J. Choleva, CRNA, MSNA
In this case report, a parturient presented for an ex utero intrapartum treatment (EXIT) procedure secondary to fetal cystic hygroma. The EXIT procedure involves partial delivery of the fetus with the fetal-placental circulation maintained. This allows for management of the obstructed fetal airway via direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. These complex and often challenging procedures have been performed about 100 times in the United States to date.
Print version: 2011;79(6):497-503.
Keywords: Anesthesia, difficult fetal airway, EXIT procedure, ex utero intrapartum treatment, fetal congenital malformations.
AANA Journal Course: Update for Nurse Anesthetists – Part 5 – Complex Regional Pain Syndrome: A Review of Diagnostics, Pathophysiologic Mechanisms, and Treatment Implications for Certified Registered Nurse Anesthetists
Daniel Watts, RN, BS
Michael Kremer, CRNA, PhD, FAAN
The pathophysiologic mechanisms for complex regional pain syndrome (CRPS) are complex and elusive. The proposed etiologic mechanisms for CRPS include inflammatory responses, peripheral or central sensitization, and sympathetic dysfunction. In this course, the authors explain that anesthesia care of patients with CRPS is challenging. Treatments including physiotherapy, peripheral vasodilators, sympathetic blockade, analgesics, and other systemic medications can help optimize mobility, perfusion, and pain relief for affected patients. Discussion includes diagnosis and clinical manifestations, pathophysiologic mechanisms, sympathetic dysfunction, and treatment approaches.
Print version: 2011;79(6):505-510.
Keywords: Chronic regional pain syndrome, history, taxonomy, treatment.
December 2011 AANA Journal
Volume 79 , Number 6
ISSN 0094-6354
On the Cover:
Carol Staffieri, CRNA, APN, positions a patient in high Fowler position for a rotator cuff repair at Methodist Division of Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. “Adequate blood pressure maintenance and neutral head and neck position are extremely important during shoulder surgery,” explains Staffieri. The anesthesia staff at Methodist provides services to Rothman Shoulder and Elbow Specialists for approximately 2,000 procedures each year. (Photo taken by Linda Jobes, CRNA.)