June 2008 AANA Journal

Table of Contents



Asystole During Laryngoscopy of a Patient With Pleural and Pericardial Effusions
Geraldine Syverud, CRNA
Marjorie A. Geiz-Everson, CRNA, MS
Kathleen Wren, CRNA, PhD
Latosha Kennedy, CRNA, MN
Print version: 2008;76(3):165-166. 

Education News
Clinical Faculty: Major Contributors to the Education of New CRNAs – Part 2

Elizabeth Merwin, RN, PhD, FAAN
Steven Stern, PhD
Lorraine M. Jordan, CRNA, PhD

Print version: 2008;76(3):167-171.
Keywords: CRNA clinical faculty, salary, workload. 

Imagining in Time
AANA’s First Annual Meeting: The First-Fruit of an Adventure

Kathy Koch, MLIS, CA
Print version: 2008;76(3):173-176.
Keywords: AANA history, Annual Meeting, Gertrude Fife, Helen Lamb.



Difficult Mask Ventilation in 5-Year-Old Due to Submental Hypertrophic Scar: A Case Report
Chris Rutledge, CRNA, MS
There are numerous scenarios and anatomical abnormalities that predispose a patient to difficult mask ventilation and, possibly, difficult intubation. This case proved not to involve difficult intubation but difficult mask ventilation. The change in hand position during mask ventilation allowed for better face-mask seal and prevented the hypertrophic scar from impeding positive-pressure mask ventilation. The alteration in conventional hand placement allowed the anesthesia provider to maintain adequate mask ventilation and, thus, a patent airway.
Print version: 2008;76(3):177-178.
Keywords: Difficult airway, hypertrophic scar, keloid, mask ventilation.

A Field-Expedient Ohmeda Universal Portable Anesthesia Complete Draw-over Vaporizer Setup
Brian T. Gegel, CRNA, MSN
The Ohmeda Universal Portable Anesthesia Complete (UPAC) draw-over anesthetic system provides a simple, durable, lightweight anesthesia delivery system for use in the battlefield and humanitarian operations. The authors state that the Gegel-Mercado setup strengthens the standard U-PAC draw-over system delivery because it increases fractional inspired oxygen concentrations, promotes hands-free operation, enhances circuit cleanliness that reduces cross contamination, and provides an alternate method for draw-over anesthesia administration in austere conditions.
Print version: 2008;76(3):185-187.
Keywords: Draw-over anesthesia, field anesthesia, Ohmeda Universal Portable Anesthesia Complete.

Inadvertent Discogram During Epidural Steroid Injection: A Case Report
Thomas E. Schultz, CRNA, PhD
Advocates of the use of fluoroscopy during epidural steroid injection cite studies that report up to 35% of attempts fail to be in the epidural space. This case study, while not the first to report inadvertent discogram during epidural steroid injection, reveals 1 instance in which relying on loss of resistance only would have resulted in inaccurate placement of the steroid. The author cautions that anesthesia providers must be aware of the potential for inaccurate placement of steroids without the aid of fluoroscopy in interventional pain management.
Print version: 2008;76(3):189-191.
Keywords: Discography, epidural steroid injection, interventional pain management.

Audiovisual Facilitation of Clinical Knowledge: A Paradigm for Dispersed Student Education Based on Paivio’s Dual Coding Theory
William Hartland, CRNA, PhD
Chuck Biddle, CRNA, PhD
Michael Fallacaro, CRNA, DNSc
In this article, the authors explore the application of Paivio’s Dual Coding Theory as a scientifically sound rationale for the effects of multimedia learning in programs of nurse anesthesia. They explore and highlight this theory as a practical infrastructure for programs that work with dispersed students, such as distance education models. The authors use “simulation-based video teaching interventions,” that were applied to a range of healthcare providers in a quasiexperimental model. Early reports of their study are published in this article.
Print version: 2008;76(3):194-198.
Keywords: Distance education, dual coding theory, nurse anesthesia education, simulation-based learning.

Anesthetic Management of an Infant Undergoing Radical Nephrectomy for Wilms Tumor: A Case Report
Markus Goodrich, CRNA, MSN
Virginia Keatley, RN, DNSc
Barbara Norwood, RN, EdD
Wilms tumor (WT) is a solid, malignant renal mass that can sometimes grow so large it spreads outside the kidney and invades other structures. The clinical manifestations caused by WT, most significantly hypertension, can appear as a barrage of pathophysiological events to the nurse anesthetist. The case presented involves an infant who underwent a radical nephrectomy because of a WT. The occurrence, symptoms, pathophysiology, and intraoperative anesthetic management of WT are discussed.
Print version: 2008;76(3):199-201.
Keywords: Nephroblastoma, pediatric anesthesia, pediatric hypertension, Wilms tumor.  

Influence of Spinal Needle Orientation During Administration of Subarachnoid Blocks on Discharge Criteria in Same-Day Surgical Patients
Doddi Brewer, CRNA, MS
Sarah Baxter, CRNA, MS
Debra Marsh, CRNA, MS
David Saraceno, CRNA, MS
Kimberly R. Barber, PhD
Lynn L. Lebeck, CRNA, PhD
Subarachnoid block is an acceptable anesthetic choice for many outpatient procedures but is often underused because it may result in delayed discharge. The purpose of this study was to determine if the orifice orientation, cephalad or lateral, with a 25-gauge Whitacre spinal needle, using a hyperbaric lidocaine solution, affects the length of time required to meet discharge criteria in a same-day surgical unit.
Print version: 2008;76(3):203-207.
Keywords: Bevel orientation, lidocaine, spinal anesthesia, Whitacre needle.

High-Frequency Jet Ventilation During Radio–frequency Ablation: A Case Report
Paul E. Perkins, CRNA, MSN
High-frequency jet ventilation (HFJV) has been used in emergency airway scenarios and various surgical procedures. This case report describes a 49-year-old man undergoing radiofrequency ablation in which HFJV was used. This event, its management, and the following discussion on the mechanics of HFJV and its use in radiofrequency ablation procedures make this case an educational value to all anesthesia providers.
Print version: 2008;76(3):209-212.
Keywords: High-frequency jet ventilation, radiofrequency ablation, peak inspiratory pressure.

What Keeps Some Program Directors in Their Positions so Long? An Examination of Job Longevity Among Anesthesia Program Directors 
Betty J. Horton, CRNA, PhD
Francis Gerbasi, CRNA, PhD
Sandra L. Lovell, CRNA, MA, MS

The turnover rate of nurse anesthesia faculty, program directors, and assistant program directors has been monitored by the Council on Accreditation of Nurse Anesthesia Educational Programs for several years. This article reports the results of a study in which 25 long-time nurse anesthesia program directors were interviewed to gain insights into faculty retention. The interviews revealed reasons for becoming an anesthesia educator, positive and negative aspects of the job, changes over time, and reasons for longevity in their positions. 
Print version: 2008;76(3):213-220.
Keywords: Faculty retention, longevity as educators, nurse anesthesia program directors.



AANA Journal Course: Update for Nurse Anesthetists—Part 2—Evidence-Based Anesthesia: Fever of Unknown Origin in Parturients and Neuraxial Anesthesia
CDR Lisa Osborne, CRNA, PhD, NC, USN
LT Michelle Snyder, CRNA, MSN, NC, USN
LT Dante Villecco, CRNA, MSN, NC, USN
LT Aaron Jacob, CRNA, MSN, NC, USN
LT Shawn Pyle, CRNA, MSN, NC, USN
Nancy Crum-Cianflone, MD, MPH
In this AANA Journal course, the authors performed an evidenced- based project in an effort to establish a guideline for their obstetric clinical practice. The authors said it is difficult to estimate the risk of an infrequently occurring event, and they recommend evaluation of each individual to determine the risks and benefits of the anesthetic, administering antibiotics before the regional anesthetic and adhering to strict aseptic technique, and postprocedure monitoring for early detection and treatment of complications.
Print version: 2008;76(3):221-226.
Keywords: Chorioamnionitis, epidural, infection, neuraxial, regional.

June 2008 AANA Journal
Volume 76 , Number 3
ISSN 0094-6354
On the Cover:
Keith Norman, CRNA, and Amy Dickinson, CRNA, MSN, use the McGrath video laryngoscope during a rapid sequence induction/difficult airway procedure at The Medical Center, Bowling Green, Kentucky. The McGrath system consists of a handle with color LCD monitor, adjustable camera stick, and a disposable curved blade. “Recent technology has transformed how the department approaches the difficult airway,” said Norman, chief CRNA at The Medical Center. “We chose this device due to its true portability and favorable learning curve.” (Photo taken by Joe Imel.)