June 1993 AANA Journal

Table of Contents

Contents

Letters
Factors which predict performance on the National Certification Examination for Nurse Anesthetists; Epidural and intrathecal analgesia; Always read the label
Print version: 1993;61(3):210-212.

Washington Scene
By Kathleen A. Michels, RN, JD, FAAN
Medicare rural hospital pass-through for CRNA services
Print version: 1993;61(3):216-217.
Keywords: Health Care Financing Administration (HCFA), Intermediary, Medicare, rural pass-through.

Education News
By Cathy Mastropietro, CRNA, MEd, MSN
Nurse anesthesiology faculty: What is your commitment?
Print version: 1993;61(3):218-222.
Keywords: Committed hours, faculty workload, time/activity ratio, workload determination formulas.

AANA Latex Allergy Protocol
Print version: 1993;61(3):223-224.

Legal Briefs
By Gene A. Blumenreich, JD
The law and the AIDS-infected healthcare worker
Print version: 1993;61(3):225-228.
Keywords: Acquired immune deficiency syndrome (AIDS), emotional damages, human immunodeficiency virus (HIV), mere fright.

Practice Issues
By Michael Fallacaro, CRNA, DNS
A biting commentary on monitored anesthesia care with conscious sedation
Print version: 1993;61(3):229-232.
Keywords: Intravenous conscious sedation, monitored anesthesia care.

Guest Editorial
By Karen Zaglaniczny, CRNA, PhD
Council on Certification Professional Practice Analysis
Print version: 1993;61(3):241-255.
Keywords: Certified Registered Nurse Anesthetist, Council on Certification of Nurse Anesthetists, national certification examination, Professional Practice Analysis.

Sedation by infusion: A clinical trial in cardiac surgery patients
By Michael J. Kremer, CRNA, MSN
The provision of adequate sedation and analgesia for critically ill ventilator-dependent patients can be problematic for everyone involved in their care. Based on the results of this original research, the more costly sedative-analgesic infusion appeared to be comparable to conventional treatment with incremental morphine and midazolam.
Print version: 1993;61(3):273-276.
Keywords: Analgesia, cardiac surgery, infusion, sedation.

Anesthetic management of a patient with moyamoya disease: A case report
By CPT Lisa A. Petty, CRNA, MHS, US, AN
Moyamoya disease, while rare, presents the anesthetist with clinical challenges similar to those provided by other more common intracranial vascular lesions. Several anesthetic techniques have been successfully employed; one such method is presented.
Print version: 1993;61(3):277-281.
Keywords: Anesthetic management, encephalo-duro-arterio-synangiosis, intracranial carotid artery stenosis, moyamoya disease.

Anesthetic management of cerebral aneurysm clipping during pregnancy
By Terrie E. Gill, CRNA, MS
Shobha Mani, MD
Daniel R. Dessables, MD
Anesthesia goals for the pregnant neurosurgical patient in this case report included maintenance of uteroplacental perfusion, as well as ensuring optimal maternal and fetal well-being. Maternal monitoring consisted of invasive arterial blood pressure, central venous pressure, and urine output, in addition to the standard monitors for anesthesia. Fetal monitoring consisted of fetal heart rate by external Doppler and uterine activity by external tocometer.
Print version: 1993;61(3):282-286.
Keywords: Cerebral aneurysm, neurosurgical anesthesia, pregnancy.

A method of evaluating efficiency in the operating room
By Debra Miliczki Weimer, CRNA, MSN
This article describes a four-step approach which can be utilized by hospital managers to evaluate operating room efficiency and suggest possible strategies to improve it. Regardless of which strategies are implemented, the author concludes that the cooperation of all concerned is essential so that the best use is made of personnel, time, and supplies to maximize cost-efficiency.
Print version: 1993;61(3):287-292.
Keywords: Coordination strategies, delay factors, operating room efficiency, time study.

Anesthesia for the homeless
By Susan Benedict, CRNA, DSN, FAAN
William P. Fehder, CRNA, MS
Healthcare for the homeless is often crisis-oriented and fragmented. The challenge for CRNAs is to provide care for the homeless to ensure that they have a comfortable and safe surgical experience in the absense of adequate information about concomitant health problems such as substance abuse, psychiatric illness, or infections. The purpose of this study was to identify the anesthesia services required by homeless individuals from an urban area.
Print version: 1993;61(3):309-313.
Keywords: Homeless, undomiciled, perioperative.

AANA Journal Course: Update for nurse anesthetists– Anesthetic techniques for patients with valvular heart disease presenting for noncardiac procedures
By Anthony T. Pemerton, CRNA, BSN
In order to safely anesthetize patients with valvular heart disease who present for noncardiac surgery, the anesthesia practitioner must have a thorough understanding of the pathophysiology associated with each lesion. In this second chapter of the AANA Journal Update Course, the author provides a review of the pathophysiology and specific compensatory mechanisms for aortic stenosis, aortic insufficiency, mitral stenosis, and mitral regurgitation, as well as the characteristic findings in the patient interview, physical examination, and diagnostic studies. Anesthetic and monitoring considerations pertinent to each valvular lesion are also offered.
Print version: 1993;61(3):314-324.
Keywords: Monitoring, noncardiac surgery, preoperative evaluation, valvular heart disease.

Book Reviews
Pharmacokinetics for Anesthesia
Reviewer: Craig Atkins, CRNA, MS

Principles and Practice of Nurse Anesthesia
Reviewer: Linda Johnson, CRNA
Print version: 1993;61(3):337-338.

General and Subscription Information
Print version: 1993;61(3):210.

AANA Annual Meeting Quickview
Print version: 1993;61(3):215.

Index to Advertisers
Print version: 1993;61(3):340.

June 1993 AANA Journal
Volume 61 , Number 3
ISSN 0094-6354
On the Cover: