February 2009 AANA Journal

Table of Contents 



Reader Questions AANA Journal Cover
Robert R. Jirgl, CRNA
Response: John B. Martin, CRNA
Print version: 2009;77(1):9.

Imagining in Time
Alice Magaw (Kessel): Her Life In and Out of the Operating Room

Jeffrey E. Nelson, CRNA, MNA
Steve F. Wilstead, CRNA, MNA

Alice Magaw (Kessel) was a pioneer in nursing research and the practice of nurse anesthesia through the publication of her clinical findings. This historical review provides information and new findings pertaining to this anesthetist. Primary historical sources, newspapers, legal documents, and other forms of information are utilized, as well as correspondence with individuals who had some association with Magaw.
Print version: 2009;77(1):12-16.
Keywords: Alice Magaw, nurse anesthesia history, open-drop ether technique, St Mary's Hospital.

Education News
Accreditation Requirements for Practice Doctorates in 14 Healthcare Professions

Marianne R. Phelps, PhD
Francis Gerbasi, CRNA, PhD
This column summarizes information gathered in the course of an American Association of Nurse Anesthetists commissioned study of practice doctorates in 14 healthcare professions. The purpose of the study, conducted early in 2007, was to inform discussions concerning the practice doctorate. The professions included in the study were audiology, chiropractic, clinical laboratory sciences, dentistry, medicine, nursing, nurse anesthesia, occupational therapy, optometry, osteopathic medicine, pharmacy, physical therapy, podiatry, and psychology. The data gathered were updated in March 2008.
Print version: 2009;77(1):19-26.
Keywords: Accreditation, practice doctorate, programs, requirements, standards.

Council on Accreditation of Nurse Anesthesia Educational Programs to be Reviewed During Fiscal Year 2010
Print version: 2009;77(1):75.



Anesthetic Management of a Pregnant Patient With an Automatic Implantable Cardioverter-Defibrillator: A Case Report
Sunny Yost, CRNA, MSN
Blake McDonald, CRNA, MSN
Manuel Vallejo, DMD, MD

There is little data currently available for the obstetric anesthetist to use as a reference for the anesthetic management of laboring women with automatic implantable cardioverter-defibrillators (AICDs). This case report involves a parturient with an AICD and a history of serious cardiac events. The information contained in this case report may be used by anesthesia providers in the obstetric suite confronted with this unique subset of patients that require in-depth anesthetic management. A review of the literature that contains information on safe and effective anesthesia used for laboring women with AICDs is described.
Print version: 2009;77(1):29-32.
Keywords: Arrhythmia, automatic implantable cardioverter-defibrillator (AICD), epidural, pregnancy.

Investigation of the Anxiolytic Effects of Luteolin, a Lemon Balm Flavonoid in the Male Sprague-Dawley Rat
CPT Terry Raines, CRNA, MSN, ANC, USA CPT Paul Jones, CRNA, MSN, ANC, USA CPT Naomie Moe, CRNA, MSN, ANC, USA CPT Robert Duncan, RN, BSN, ANC, USA Suzanne McCall
LTC Thomas E. Ceremuga, CRNA, PhD, ANC, USA

The purpose of this study was to investigate the anxiolytic effects of luteolin and its potential interaction with the gamma-aminobutyric acid (GABAA) receptor in male Sprague-Dawley rats. Lemon balm has traditionally been used as an herbal remedy in the treatment of many medical conditions, including anxiety. Luteolin is a major component of the essential oil lemon balm. The data suggest that luteolin does not produce anxiolysis by modulation of the GABAA receptor; however, luteolin may modulate motor movements and locomotion.
Print version: 2009;77(1):33-36.
Keywords: Anxiolysis, elevated plus-maze, lemon balm, luteolin, rat.

Acute Hypotension in a Patient Undergoing Posttraumatic Cervical Spine Fusion With Somatosensory and Motor-Evoked Potential Monitoring While Under Total Intravenous Anesthesia: A Case Report
David F. Cann, CRNA, MS
Recent advances in neurological, intraoperative monitoring techniques have allowed Certified Registered Nurse Anesthetists to assess the effects of spinal cord ischemia and compression as they occur. This case report describes a young, healthy man who sustained a cervical spine fracture and was scheduled for anterior spinal fusion with somatosensory and motor-evoked potential (MEP) monitoring while under total intravenous anesthesia. The patient experienced a brief period of intraoperative hypotension with evidence of abnormal MEPs. A wake-up test was performed, which showed normal functioning, and the case resumed an uneventful course.
Print version: 2009;77(1):38-41.
Keywords: Cervical fusion, hypotension, motor-evoked potential, somatosensory evoked potentials, total intravenous anesthesia.

Perceived Deprivation in Active Duty Military Nurse Anesthetists
Julie A. Pearson, CRNA, PhD, CAPT(ret), NC, USNR
Michael D. Fallacaro, CRNA, DNS
Joseph E. Pellegrini, CRNA, CAPT(ret), PhD, NC, USN

There is a shortage of military Certified Registered Nurse Anesthetists (CRNAs). Relative deprivation is a perception of unfairness due to discrepancies between what one has and what one could or should have that is dependent on feelings and facts. Feelings of relative deprivation could contribute to the military CRNA shortage. The purposes of this study were to measure relative deprivation in active duty military CRNAs and explore variables that correlate with relative deprivation. Further research is indicated to identify definitive factors that can be modified to improve feelings of deprivation as they relate to retention and recruitment of military CRNAs.
Print version: 2009;77(1):42-48.
Keywords: Military nurse anesthetists, nurse anesthesia workforce, relative deprivation, retention.

Factors at Admission Associated With 4 Months Outcome in Elderly Patients With Hip Fracture
Karin B. Björkelund, RNANIC, PhD
Ami Hommel, RN, PhD
Karl-Göran Thorngren, MD, PhD
Dag Lundberg, MD, PhD
Sylvia Larsson, RNAN, PhD

The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.
Print version: 2009;77(1):49-58.
Keywords: ASA physical status, complications, mortality, preoperative, postoperative confusion.

AANA Journal Course: Update for Nurse Anesthetists—Part 6—Should I Continue or Discontinue That Medication?
John Nagelhout, CRNA, PhD, FAAN
Sass Elisha, CRNA, EdD
Edward Waters, CRNA, MN
Patients are admitted for surgery while taking a wide array of medications, and nurse anesthetists must evaluate their effectiveness and compatibility with anesthesia. Anesthetists must be familiar with the basic pharmacology of each drug and the potential adverse effects and possible drug interactions that may occur when anesthetic drugs are administered. If a medication requires discontinuation, it must be ensured that the patient’s disease remains controlled throughout the perioperative period. This course reviews the current literature regarding the anesthetic management of several commonly encountered drug classes.
Print version: 2009;77(1):59-73.
Keywords: Anticoagulants, antidiabetic medication, cardiovascular drugs, preoperative medications, thyroid medications.

Volume 77 , Number 1
ISSN 0094-6354
On the Cover:
Susan Parry McMullan, CRNA, MSN, chief nurse anesthetist at Hinsdale Anesthesia Associates, Hinsdale, Illinois, uses trans­esophageal echocardiography to evaluate pre­operative heart function in a patient scheduled for coronary artery bypass graft surgery. McMullan is director of region 2 of the Illinois Association of Nurse Anesthetists. She is a doc­toral student at Rutgers, The State University of New Jersey, and a didactic instructor in the Rosalind Franklin University of Medicine and Science, Nurse Anesthesia Program, North Chicago, Illinois. (Photo taken by John Wheeler.)