February 2011 AANA Journal

​February 2011
Volume 79, Number 1
ISSN 0094-6354

Table of Contents​


Case Report: Management of Elective Cesarean Delivery in the Presence of Placenta Previa and Placenta Accreta
Mark Gabot, CRNA, MSN
Sandra E. Morris, CRNA, MSN, CDR(ret), NC, USN
Andrew Liao, MD
Print version: 2011;79(1):9.
Guest Editorial 
Toward Globalization of a Profession
Sandra M. Ouellette, CRNA, MEd, FAAN
Betty J. Horton, CRNA, PhD, FAAN
Print version: 2011;79(1):12-14.
Keywords: Approval of nonphysician anesthesia programs worldwide, international anesthesia education standards, international anesthesia practice standards.


Accuracy of Fingerbreadth Measurements for Thyromental Distance Estimates: A Brief Report 
Martin Kiser, CRNA, MSN
Judith A. Wakim, RN, EdD, CNE
Linda Hill, CRNA, DSNc
There have been many contradicting studies as to how well preoperative airway assessments predict difficult intubation. This study assessed anesthesia providers’ estimated and actual fingerbreadth measurements to determine the effectiveness of the practice of using fingerbreadths as a measuring tool for thyromental distance. The authors found a statistically significant difference between estimated and actual fingerbreadth measurement for the index finger but not for the combinations of fingers.
Print version: 2011;79(1):15-18.
Keywords: Difficult intubation, fingerbreadth measurement, preoperative airway assessment, thyromental distance.
Pediatric Respiratory Complication After General Anesthesia With Exposure to Environmental Tobacco Smoke in the Home: A Case Report 
Annette Lyons, CRNA, MSNA
In this case report, the author presents information about long-term environmental tobacco smoke (ETS) exposure in the pediatric population. Studies show that children who are exposed to environmental ETS are more prone to airway and pulmonary complications perioperatively. Research suggests the importance of a thorough anesthetic preoperative evaluation to reduce the risks of respiratory complications by educating parents on the detrimental effects of exposing their children to ETS.
Print version: 2011;79(1):20-23.
Keywords: Anesthesia, pediatric, respiratory complications, tobacco.
CRNA Prescribing Practices: The Washington State Experience 
Louise Kaplan, PhD, ARNP, FNP-BC, FAANP
Marie-Annette Brown, PhD, ARNP, FNP-BC, FAAN
Dan Simonson, CRNA, MHPA
One year after implementation of a 2005 Washington State law that granted Certified Registered Nurse Anesthetists (CRNAs) authority to prescribe schedule II through IV controlled substances, only 30% of CRNAs held prescriptive authority. The purpose of this study was to describe Washington State CRNA prescribing practices and workforce and practice characteristics. A secondary purpose was to analyze factors related to Washington State CRNAs’ adoption of prescriptive authority for controlled substances II through IV.
Print version: 2011;79(1):24-29.
Keywords: Controlled substances, CRNA workforce, nurse anesthetists, prescribing practices, prescriptive authority.
Neuroimmune Activation and Chronic Pain
Charles A. Griffis, CRNA, PhD
Chronic pain is an extremely debilitating disease syndrome for which current treatment modalities are largely ineffective. This review article presents the recently proposed contributions of neuroimmune activation to the maintenance of chronic pain. Literature generated by the emerging field of central nervous system glial cell research, including genetic therapies, was reviewed to provide empirical support for this pathway. The clinical implications of neuroimmune activation to improved treatment of chronic pain states are discussed.
Print version: 2011;79(1):31-37.
Keywords: Chronic pain, neuroglia, neuroimmune activation, neuroinflammation.
Moral Distress in Certified Registered Nurse Anesthetists: Implications for Nursing Practice 
Linda Clerici Radzvin, RN, PhD, CRNP
The purpose of this exploratory, descriptive study was to determine if Certified Registered Nurse Anesthetists (CRNAs) experience moral distress in their nursing practice. The author stated that although a small number of nurse anesthetists experienced high levels of moral distress, CRNAs generally experienced moderate levels of moral distress. The author concluded that strategies must be developed to assist CRNAs dealing with ethical issues and in decreasing the occurrence of moral distress.
Print version: 2011;79(1):39-45.
Keywords: CRNAs, moral distress, nurses.
Polyuria With Sevoflurane Administration: A Case Report 
Lori Schirle, CRNA, MSN
Polyuria has been reported as a side effect of sevoflurane administration, but because of its relative rarity, many practitioners are not aware of this potential phenomenon. Polyuria in its extreme form can cause undesirable hemodynamic changes. A case report of a young man is presented that highlights polyuria as a probable side effect of sevoflurane administration. The author cautions clinicians to be aware of the possible occurrence of sudden-onset polyuria in the presence of sevoflurane.
Print version: 2011;79(1):47-50.
Keywords: Aquaporin-2, diabetes insipidus, polyuria, sevoflurane, vasopressin.
The Influence of Perioperative Care and Treatment on the 4-Month 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 study was to investigate if factors such as prolonged waiting time before surgery, anesthetic technique, perioperative hypoxemia, hypotension, and anemia are associated with outcome in terms of mortality, postoperative confusion, in-hospital complications, and length of hospital stay in elderly patients with hip fracture. The results of the study indicate the great importance of perioperative optimization of the patient’s oxygen saturation and hemoglobin level and a reduction of fasting and waiting time for surgery in order to minimize postoperative morbidity and mortality.
Print version: 2011;79(1):51-61.
Keywords: Anemia, fasting, hypoxemia, mortality, postoperative confusion.
Work Climate Related to Job Satisfaction Among Dutch Nurse Anesthetists 
Vera C. H. Meeusen, RNA, PhD, MA
Karen van Dam, PhD
Chris Brown-Mahoney, PhD
Andre A. J. van Zundert, MD, PhD, FRCA
Hans T. A. Knape, MD, PhD, FRCA
This study investigates the relationship between work climate and job satisfaction among Dutch nurse anesthetists. To achieve a higher level of job satisfaction among nurse anesthetists, the authors said it is necessary to improve some essential work climate characteristics, such as making the nurse anesthetist feel an important part of the organization’s mission statement, discussing progress at work, giving recognition for delivered work, encouraging development, and providing sufficient opportunities to learn and to grow.
Print version: 2011;79(1):63-70.
Keywords: Job satisfaction, nurse anesthetist, work climate.
AANA Journal Course: Update for Nurse Anesthetists – Part 6 – Intraoperative Magnetic Resonance Imaging for Neurosurgical Procedures: Anesthetic Implications 
Bernadette Henrichs, CRNA, PhD, CCRN
Robert P. Walsh, CRNA, MS, MBA
Intraoperative magnetic resonance imaging (IMRI) for tumor resection allows a neurosurgeon to pinpoint the exact location of the tumor before resection and to navigate to the tumor after the incision is made. Although the anesthetic management is not substantially different from that for other neurosurgical procedures, strategies to keep the patient and operating room personnel safe can be challenging. In this course, the authors discuss the technology for IMRI, safety precautions associated with the IMRI procedure, and anesthetic implications for IMRI.
Print version: 2011;79(1):71-77.
Keywords: Anesthetic implications, intraoperative magnetic resonance imaging, neurosurgery, patient and provider safety, tumor resection.