June 2007 AANA Journal

Table of Contents


Identifying a difficult intubation before extubation

Kent Taylor, CRNA
Print version: 2007;75:166.

Education News
Upgrading nurse anesthesia educational requirements (1933-2006) – Part 1: Setting standards 

Betty J. Horton, CRNA, DNSc
Print version: 2007;75:167-170.
Key words: AANA Doctoral Task Force, education history, nurse anesthesia.

Books and Multimedia of Interest
Atlas of Airway Management Techniques and Tools 

Reviewer: Laura Acosta, RN, MS
Print version: 2007;75:171.

Imagining in Time
The 1992 Annual Meeting in Denver
Kathy Koch, MLIS, CA
Print version: 2007;75:174-176.
Key words: AANA history, Annual Meeting, Denver.


A comparison of preoperative airway assessment techniques: The modified Mallampati and the upper lip bite test 
Christopher Evan Hester, CRNA, MSN
Shelli Ann Dietrich, CRNA, MSN
Samuel Wayne White, CRNA, MSN
Janet A. Secrest, RN, PhD
Kay Russell Lindgren, RN, PhD
Timothy Smith, CRNA, PhD, APN

The purpose of this study was to compare the preoperative anesthetic airway evaluation methods of the modified Mallampati test (MMT) and upper lip bite test (ULBT) with the direct laryngoscopic views obtained during tracheal intubation. Positive relationships were predicted for the MMT and ULBT with direct laryngoscopic view and between the MMT and ULBT. The findings of this study support those of a previous study of the ULBT. Because of the ease of the ULBT and the promising results of this small study, the authors recommend further research with a larger, more diverse sample.
Print version: 2007;75:177-182.
Key words: Airway assessment, modified Mallampati test, upper lip bite test.

Risk, benefits and complications of epidural steroid injections: A case report
Jared Snarr, CRNA, MSN
Acute low back pain, radiculopathy, and associated disabilities have a prevalence of 2% in the United States. Epidural steroid injections (ESIs) are commonly administered to relieve this pain and improve  mobility without surgery. This case report presents issues related to the treatment of an epidural hematoma in a patient receiving long-term anticoagulant therapy. It reviews the risks, benefits, side effects, complications, and contraindications to ESI and the American Society of Regional Anesthesia consensus recommendations for the performance of neuraxial procedures in patients receiving anticoagulant therapy.
Print version: 2007;75:183-188.
Key words: Corticosteroids, epidural steroid, injection, pain.

Use of heliox for intraoperative bronchospasm: A case report
Stacey L. Linck, CRNA, MA
Brochospasm can be a serious event that can lead to critical hypoxemia with ultimate brain damage or death. The author presents a case report of a patient who experienced refractory bronchospasm upon emergence from general anesthesia. Discussion includes the initial treatment attempted at resolving the bronchospasm, as well as the use of heliox in the ultimate resolution of the bronchospasm. The author concludes that it is prudent for the anesthesia provider to integrate knowledge of pharmacology and physiology of heliox into current practice.
Print version: 2007;75:189-192.
Key words: brochospasm, density, emergence, heliox, turbulence.

A literature review on anesthetic practice for carotid endarterectomy surgery basd on cost, hemodynamic stability, and neurologic status 
Mark C. Meitzner, CRNA, MSN
Julie A. Skurnowicz, CRNA, MSN
Anne Mitchell, PhD, CNM, NP

In this review of the literature, the authors evaluated the best anesthetic practice for carotid endarterectomy surgery and focused on 2 techniques: general anesthetic with an endotracheal tube and regional anesthetic block. According to the literature, there is an advantage to performing regional anesthesia with respect to cost and neurologic status. Information analyzed was inconclusive with respect to hemodynamic stability and anesthetic technique. The authors concluded that regional anesthesia may have some slight advantages; however, more investigation is warranted.
Print version: 2007;75:193-197.
Key words: Anesthesia, carotid endarterectomy, general anesthesia, regional anesthesia.

Impact of pseudotumor cerebri (iodipathic intracranial hypertension) in pregnancy: A case report
Lt Col Jeff Worrell, CRNA, USAF-ret
Susan Lane, CRNA
The parturient diagnosed with PTC requires close monitoring of symptoms related to increased ICP. Pregnancy can exacerbate the symptoms of headache and contribute to further visual field deficits. This case report reviews anesthetic management and medical considerations for a pregnant patient with a history of pseudotumor cerebri (PTC). The patient received an epidural for labor analgesia, and the medications administered via the epidural catheter during labor successfully ameliorated the discomfort associated with labor contractions.
Print version: 2007;75:199-204.
Key words: Idiopathic intracranial hypertension, pregnancy, pseudotumor cerebri.

Artificial oxygen carriers: A current review 
Thad Henkel-Hanke, CRNA, DC, MS
Mark Oleck, CRNA, MS
Artificial oxygen carriers (AOCs) are not blood substitutes; they serve to carry oxygen to tissues and are either hemoglobin based or perfluorocarbon based. Driving the development of artificial oxygen carriers are concerns involving both the safety and quantity of the blood supply. No artificial oxygen carriers are currently approved for clinical use in the United States, and no North American trials are currently under way for perfluorocarbons. Discussion includes types and uses of AOCs, history, characteristics of ideal AOCs, side effects, and state of the art.
Print version: 2007;75:205-211.
Key words: Artificial oxygen carriers, hemoglobin-based oxygen carriers, perfluorocarbon-based oxygen carriers.

The use of ultrasound for placement of intravenous catheters 
Capt Hector Aponte, CRNA, MSN, USAF, NC
Capt Said Acosta, CRNA, MSN, USAF, NC
Donald Rigamonti, PhD
Barbara Sylvia, RN, PhD
Lt Col Paul Austin, CRNA, PhD, USAF-ret, NC
Maj Timothy Samolitis, CRNA, ND, USAF-ret, NC

Ultrasound has been used to aid cannulation of veins of the neck, chest, antecubital fossa, and femoral vein. This investigation compared the traditional method of peripheral intravenous (IV) cannulation of veins of the hands and forearms with ultrasound-guided IV cannulation of these veins. No significant differences were noted between groups in demographics, time to successful cannulation, number of attempts, and number of subjects in whom IV cannulation was successful on the first attempt. Ultrasound was as efficacious as the traditional method of IV cannulation in this subset of patients.
Print version: 2007;75:212-216.
Key words: Adult, human, peripheral catheterization, ultrasonography.



AANA Journal Course Part 2
Update for nurse anesthetists --
Anesthetic implications for cancer chemotherapy
Lindy Maracic, CRNA, MSN, ARNP
Joanne Van Nostrand, CRNA, MSN, ARNP

The effects of chemotherapy may be acute and self-limiting or chronic and present long after treatment has been completed. Patients who have had chemotherapy often undergo surgery that may or may not be related to their cancer, and chemotherapy administration can have a profound influence on anesthetic management. Safe administration of anesthesia includes knowledge of chemotherapeutic agents and their toxic effects. This course discusses the anatomic and physiologic effects of cancer chemotherapeutic agents and how they specifically affect patients receiving anesthesia.
Print version: 2007;75:219-226.
Key words: Anesthesia, cancer, chemotherapy, toxicity.

June 20077 AANA Journal
Volume 75 , Number 3
ISSN 0094-6354
On the Cover:
Renea Shore, RN, BSN, and Rich Griner, CRNA, MSN, move quickly while managing a pediatric induction at Brenner Children's Hospital, part of the Wake Forest University Baptist Medical Center (WFUBMC), in Winston-Salem, NC. Shore is a senior student in the Nurse Anesthesia Program at WFUBMC, and Griner is a clinical instructor in pediatric aenesthesia. (Photo was taken b Michael Rieker, CRNA, DNP, director of the Nurse Anesthesia Program at WFUBMC.)