February 2006 AANA Journal

Table of Contents


Dexmedetomidine as a sole sedating agent with local anesthesia in a high risk patient for axillofemoral bypass graft
Michael J. Kremer, CRNA, DNSc, FAAN
James M. Rich, CRNA, MA

The Certified Registered Nurse Anesthetist: Occupational responsibilities, perceived stressors, coping strategies, and work relationships
Abraham J. Lachman, CRNA
Tristan Roberts Perry, RN, PhD, MSN, BSN
Print version: 2006;74:9-10.

Books and Multimedia of Interest
Ruff's War: A Navy Nurse at the Frontline in Iraq
Reviewer: Ronald L. Van Nest, CRNA, MA, CAPT, NC, USN (ret.)

Critical Care: The Requisites in Anesthesiology
Reviewers: Lacy J. Rehe, RN, BSN
Donald M. Bell, CRNA, DNSc, APN
John C. Preston, CRNA, DNSc, APN
Beverly A. Bell, CRNA, MSNA, APN
Print version: 2006;74:11-12.

Legal Briefs
By Gene A. Blumenreich, JD
Print version: 2006;74:15-18.
Key words: Awareness, informed consent, standard of care

Education News
Televideo conferencing: Is it as effective as "in person" lectures for nurse anesthesia education?
Anthony S. Kerns, CRNA, MSN, ARNP
John P. McDonough, CRNA, EdD, ARNP
Jeffery A. Groom, CRNA, PhD, ARNP
Nicholas M. Kalynych, CRNA, MSHS
Gerald T. Hogan, Jr, CRNA, DNSc, ARNP

Print version: 2006;74:19-21.
Key words: Distance learning, real-time televideo conferencing, technology in education, 2-way video conferencing.

Guest Editorial
Professional standards and public accountability
Sandra K. Tunajek, CRNA, DNP, MSN
Print version: 2006;74:25-27.
Key words: Patient safety, performance outcomes, professional accountability, standards of care.

COA Programs to be Reviewed in Fiscal Year 2007
Print version: 2006;74:28. 


The Universal Oxygen Connector
Mark A. Lauer, CRNA, MS
Rebecca L. M. Gombkoto, CRNA, MS
Patients benefit from the administration of supplemental oxygen in the perioperative period. Supplemental oxygen has been shown to decrease postoperative hypoxemia, infection, and in some cases, nausea and vomiting. In this article, the authors describe the benefits of using the Univeral Oxygen Connector, that is, how it decreases material waste, decreases hospital costs, saves time and effort and, most importantly, promotes patient safety by providing a versatile system for oxygen delivery.
Print version: 2006;74:30-34.
Key words: Perioperative oxygen administration, supplemental oxygen, Universal Oxygen Connector.

Converting from an endotracheal tube to tracheostomy: Description of a proposed alternative approach
Keene B. Pickard, CRNA, MSNA
Replacing an existing endotracheal (ET) tube with a tracheostomy tube can be a challenging and high-risk procedure for the patient, surgeon, anesthetist, and operating room staff. In this article, the author details an approach designed to reduce the risks involved, and, at the same time, provide a safe, efficient, and simplified approach to surgically securing the airway.
Print version: 2006;74:35-38.
Key words: Airway fire, elective tracheostomy, long-term ventilation, surgical airway.

Off-pump coronary artery bypass grafting: A case report
Leanne P. Behny, CRNA, MSN
This article briefly outlines the historical evolution of cardiac surgery that led to the development of the technology necessary to perform off-pump coronary artery bypass grafting (OPCAB). A case report of a 72-year-old female who underwent OPCAB is outlined. Included is a discussion of some of the benefits and potential complications of coronary artery bypass grafting and OPCAB, along with anesthetic considerations for OPCAB procedures.
Print version: 2006;74:39-44.
Key words: Anesthesia, coronary artery bypass grafting, off-pump coronary artery bypass, history.

Gorham disease: An intraoperative case study
James Underwood, CRNA, MSN
John Buckley, CRNA, MSN
Bill Manning, CRNA, MSN
Gorham disease is a rare chronic disorder that is characterized by the abnormal proliferation of thin-walled capillaries and small lymphatic vessels that results in the massive osteolysis of adjacent bone. The case presented involves a 47-year-old man with Gorham disease complicated by unilateral chylothorax who was treated with thoracic duct ligation. The anesthetic implications associated with Gorham disase are discussed, and nonsurgical primary and adjunctive treatments for chylothorax are summarized.
Print version: 2006;74:45-48.
Key words: Chylothorax, Gorham disease, osteolysis, vanishing bone disease.

The role of COX-2 inhibitors in the perioperative setting: Efficacy and safety—A systematic review
Melissa Holmes Zemmel, CRNA, MSNA
A new class of nonsteroidal anti-inflammatory drugs (NSAIDs) selective for cylooxygenase-2 (COX-2) offers new options for managing perioperative pain; however, new and conflicting data have emerged regarding all nonsteroidal anti-inflammatory drugs, including those selective for COX-2. This article reviews 30 prospective studies on the role of COX-2 selective inhibitors in the perioperative setting. The studies examined a variety of variables, including efficacy, perioperative opioid reduction, and effects on platelet aggregation and renal function.
Print version: 2006;74:49-60.
Key words: COX-2, cyclooxygenase-2, perioperative pain, platelet aggregation, renal function.



AANA Journal Course, Part 6
Update for nurse anesthetists --
Migraine development, treatments, research advances, and anesthesia implications
LTC Joseph O'Sullivan, CRNA, MS, AN, USA
Joseph T. McCabe, PhD
The purpose of this AANA Journal course is to update anesthesia providers on the phenomenology and biological mechanisms underlying migraines. As experts in pain management who encounter this common ailment, anesthesia providers frequently are consulted to assist in patient care. Effective assessment and treatment of migraine will lead to better anesthesia management. Discussion includes age of onset and prevalence of migraines, clinical diagnoses of headaches, major factors in migraine development, pharmacological intervention, anesthesia management, and recent pharmacological research.
Print version: 2006;74:61-68.
Key words: Anesthesiology, calcitonin gene-related peptide, migraine, trigeminal nerve, vasodilation.

February 2006 AANA Journal
Volume 74 , Number 1
ISSN 0094-6354
On the Cover:
Michael Rieker, CRNA, DNP, director of the Nurse Anesthesia Program at Wake Forest University Baptist Medical Center, Winston-Salem, NC, begins a combined spinal-epidural block on a patient for her cesarean section. The photo was taken at Methodist Medical Center in Peoria, Ill, where Dr Rieker was formerly the lead nurse anesthetist for Obstetrics. (Photo taken by Angie Symonds, RN.)