June 2001 AANA Journal

Table of Contents



Legal Briefs
How Settlement Affects the Legal Process
Gene A. Blumenreich, JD
Print version: 2001;69(3):169-172.
Key words: Consortium, informed consent, settlement, summary judgment, vicarious liability.

Education News
The Case for Teaching History to Student Nurse Anesthetists
Evan Koch, CRNA, MSN
Patrick Downey, CRNA
Joyce W. Kelly, CRNA, EdD
Wanda Wilson, CRNA, PhD
Print version: 2001;69(3):179-183.
Key words: AANA History and Archives Society, AANA Web site, anesthesia, education, history.

Books and Multimedia of Interest
Reviewer: Michael A. Fiedler, CRNA, MS


Reviewer: Henry C. Talley V, CRNA, MS
Print version: 2001;69(3):193-194.


1% Lidocaine Injection, EMLA Cream, or "Numby Stuff" for Topical Analgesia Associated With Peripheral Intravenous Cannulation
Kris A. Miller, CRNA, BS
Guruswamy Balakrishnan, MD
Gary Eichbauer, CRNA, MS
Ken Betley, CRNA, MS

Patients often fear the pain of intravenous (IV) cannulation. Of the 3 methods tested in this study, results seem to indicate that the Numby Stuff system is the superior method for decreasing the pain associated with peripheral IV cannulation.
Print version: 2001;69(3):185-187.
Key words: EMLA cream, iontophoresis, lidocaine, pain score.

Transmyocardial Laser Revascularization
Mary W. Bernheim, CRNA, MSN
Transmyocardial laser revascularization creates channels in the heart that promote angiogenesis and reestablish blood flow, giving an alternative to those with intractable angina and generally improving quality of life. This article describes the case of a 47-year-old man with worsening angina who underwent this surgery.
Print version: 2001;69(3):195-197.
Key words: Angina, angiogenesis, end-stage coronary artery disease, transmyocardial laser revascularization.

The Impact of Nalmefene on Side Effects Due to Intrathecal Morphine at Cesarean Section
CDR Joseph E. Pellegrini, CRNA, DNSc, NC, USN
CAPT Steven L. Bailey, MD, MC, USN
Jeffery Graves, MD
Judith A. Paice, RN, PhD, FAAN
Susan Shott, PhD
Margaret Faut-Callahan, CRNA, DNSc, FAAN

The side effects associated with intrathecal morphine usually require an opioid antagonist for full relief. The findings of this study indicate that nalmefene given prophylactically at a dose of 0.25 µg/kg does not decrease the incidence of side effects but increases the need for supplemental analgesics.
Print version: 2001;69(3):199-205.
Key words: Cesarean section, intrathecal opioids, nalmefene, neuraxial side effects of morphine, obstetrical anesthesia.

Undisclosed Port-Wine Stain — Anesthetic Implications and Psychosocial Considerations: A Case Report
John O'Donnell, CRNA, MSN
Sandra Sell, CRNA, MSN
Louis Rauso, CRNA, MSN
Joseph Goode, CRNA, MSN

Port-wine stains are congenital vascular lesions that have psychological and physiological implications. In this case study, the authors describe the anesthesia implications and outcome in a patient who refused to disclose her port-wine lesion in the preoperative interview and did not remove her makeup before surgery.
Print version: 2001;69(3):206-210.
Key words: Facial edema, patient disclosure, port-wine stain.

Amputation and Phantom Limb Pain: A Pain-Prevention Model
Thom Bloomquist, CRNA, MS, FAAPM
More than 200,000 surgical amputations are performed in the United States each year. Of these patients, 70% experience phantom limb pain after the procedure, and 50% still experience phantom pain 5 years later. This article reviews the mechanisms involved in phantom limb pain, interventions, and prevention.
Print version: 2001;69(3):211-217.
Key words: amputation, chronic nonmalignant pain, neuropathic pain, phantom limb pain.

Assessing Pain Responses During General Anesthesia
Margareta Warrén Stomberg, RNA
Björn Sjöström, RNA, PhD
Hengo Haljamäe, MD, PhD

This study of Swedish nurse anesthetists assesses which clinical signs, indirect as well as monitor-derived, are considered indicative of intraoperative pain or depth of anesthesia. The findings indicate that indirect physiological signs are still considered of major importance during the anesthetic management of surgical patients.
Print version: 2001;69(3):218-222.
Key words: Awareness, depth of anesthesia, general anesthesia, pain, physiological response.

AANA Journal
 Update for Nurse Anesthetists—Part 2
Preemptive Analgesia Applied to Postoperative Pain Management

Dede A. Farris, CRNA, MSNA
Michael A. Fiedler, CRNA, MS

When an analgesic is administered before the bombardment of painful stimuli that occurs with surgical incision, postoperative pain can be greatly diminished. Along with the benefits and application of preemptive analgesia, the authors discuss pain receptors, the physiologic effects of pain, and the components of sensory hypersensitivity.
Print reference: 2001;69(3):223-228.
Key words: Central sensitization, peripheral sensitization, preemptive analgesia, primary hyperalgesia, secondary hyperalgesia.

June 2001 AANA Journal
Volume 69 , Number 3
ISSN 0094-6354
On the Cover:
In honor of the 70th anniversary of the founding of the American Association of Nurse Anesthetists on June 17, 1931 (then known as the National Association of Nurse Anesthetists), this issue's cover features nurse anesthetist Agatha Hodgins, who was the Association's founder and first president. She is pictured here administering anesthesia during World War I. Hodgins and others from Lakeside Hospital in Cleveland, Ohio, were part of the Lakeside Unit that served at the American Ambulance Hospital at Neuilly, France. Part of Hodgins' work included training others in the use of nitrous oxide-oxygen anesthesia. After her return from France in 1915, Hodgins set up the Lakeside School of Anesthesia in Cleveland.