June 2006 AANA Journal

Table of Contents


Books and Multimedia of Interest
Print version
: 2006;74:178-179.
Clinical Anesthesia
Reviewer: Chuck Biddle, CRNA, PhD

Perioperative Care in Cardiac Anesthesia and Surgery
Reviewer: Connie Lorette Calvin, CRNA, MS

Imagining in Time
The life and trial of Dagmar Nelson–Part 1
Ronald L. Van Nest, CRNA, MA
Print version: 2006;74:183-187.


Isoproterenol-induced elevated bispectral indexes while undergoing radiofrequency ablation: A case report
Robert Mathews, CRNA, MSNA
The use of bispectral index (BIS) for monitoring neuronal function under general anesthesia has been expanding in practice; however, the meanings of the values are not always clear and have been shown to be altered by such drugs as ketamine, ephedrine, and physostigmine. Presented here is a case of elevated BIS values associated with the use of isoproterenol during radiofrequency ablation. This rise in the BIS values appeared to have no correlation to the stimulation produced by the procedure.
Key words: Bispectral index, dexmedetomidine, isoproterenol, radiofrequency ablation.
Print version: 2006;74:193-195.

Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: Interscalene and intersternocleidomastoid
LCDR Janet L. Dewees, CRNA, MS, NC, USN
LT Cary T. Schultz, CRNA, NC, USN
CDR Fred K. Wilkerson, CRNA, MS, NC, USN
CDR Joseph A. Kelly, CRNA, MS, NC, USN
CDR Andrew R. Biegner, CRNA, MS, NC, USN
CAPT Joseph E. Pellegrini, CRNA, DNSc, NC, USN
In this research article, the authors conduct a prospective, randomized study to compare differences between groups of patients given a brachial plexus block using an interscalene (IS) or an intersternocleidomastoid (ISCM) approach. The study indicated that using the ISCM approach to achieve brachial plexus blockade may offer several advantages over the IS approach. Such advantages may be beneficial, especially with the continuously increasing trend toward outpatient surgical procedures.
Key words: Analgesia, brachial plexus, interscalene, intersternocleidomastoid, regional implications.
Print version: 2006;74:201-206.

Unintended subdural injection: A complication of epidural anesthesia–A case report
Adrian Kalil, CRNA, BSN
Epidural anesthesia is practiced in virtually every clinical setting. Its safety and versatility have supported increasing use for more and varied therapies. In a healthy patient in whom near-complete left hemiparesis developed following a routine continuous epidural anesthetic for labor, subdural deposit of the local anesthetic was suspected. This case report and discussion may help illustrate the mechanism behind this complication and how it can be detected, treated, and, possibly, avoided.
Key words: Complications, dura-arachnoid interface, lumbar epidural, unintended subdural injection.
Print version: 2006;74:207-211.

Assigning surgical cases with regional anesthetic blocks to anesthetists and operating rooms based on operating room efficiency
Cormac T. O'Sullivan, CRNA, MSN
Franklin Dexter, MD, PhD

The popularity of regional anesthesia blocks for intraoperative anesthesia and postoperative pain management supports the inclusion of the administration of regional anesthesia into discussions about operating room (OR) efficiency. This article reviews the literature on OR efficiency with a focus on day-of-surgery decision making. Vignettes show regional anesthesia block placement is a variable that can affect the efficiency of use of OR time. Clinical examples highlight OR management issues and staff assignment decisions on the day of surgery.
Key words: Operating room efficiency, operating room management, regional anesthesia, surgical case assignment.
Print version: 2006;74:213-218.

Anesthesia concerns for children with tuberous sclerosis
Steve Septer, CRNA, MSN
Edward S. Thompson, CRNA, PhD, ARNP, FAAN
Ann Willemsen-Dunlap, CRNA, PhD
Tuberous sclerosis (TS) is a relatively rare, autosomal dominant syndrome that displays high genetic penetrance in affected families. In this case report, the authors describe a child with TS scheduled to receive a general anesthetic for laser treatment of facial angiofibromas. The laser procedure was performed, and there were no surgical or anesthetic complications; however, the potential for complications due to TS remained high throughout the provision of anesthesia care.
Key words: Anesthesia, Bourneville, children, tuberous sclerosis.
Print version: 2006;74:219-225.

Medical therapy to reduce perioperative cardiac complications
Kevan Kemp, CRNA
Darryl Potyk, MD, FACP

In this review article, the authors state that some 25 million people in the United States undergo noncardiac surgery each year. About 8 million of these have known cardiac disease, major cardiac risk factors, or are older than 65 years. Therefore, it is not surprising that cardiac complications occur when these patients are subjected to stress during the perioperative period. The article includes discussion of risk-reduction strategies, coronary revascularization, medical therapies, and pulmonary artery catheters.
Key words: Beta-blockers, perioperative cardiac complications.
Print version: 2006;74:227-232.

AANA Journal Course 2
Update for nurse anesthetists
Eisenmenger syndrome: An anesthetic conundrum

Joseph A. Joyce, CRNA, BS
A patient with Eisenmenger syndrome (ES) presents a daunting anesthetic challenge. Already in a debilitated state, physically and emotionally, even the slightest degradations in cardiac and circulatory parameters are greatly magnified, explains the author of this AANA Journal course. The course includes discussion of history, pathophysiology, signs and symptoms, current medical management, complications, anesthetic considerations and management, and monitoring.
Key words: Congenital heart defect, Eisenmenger syndrome, pulmonary hypertension, right-to-left cardiac shunt, systemic vascular resistance.
Print version: 2006;74:233-239.

June 2006 AANA Journal
Volume 74 , Number 3
ISSN 0094-6354
On the Cover:
John Hanlon, CRNA, MSNA, ARNP, chief nurse anesthetist, Lowell General Hospital (LGH), Lowell, Mass, prepares to intubate a patient. Hanlon said the picture was taken for the purpose of developing an educational presentation for children and adolescents having surgery. Quoting Hanlon: "The anesthesia department at LGH uses the presentation in the pediatric and adolescent patient pre-screen area. Our goal is to continually assist our anesthesia nurse practitioner and members of the anesthesia care team by reducing patients' fears of anesthesia."