June 2010 AANA Journal

Table of Contents


Author's CorrectionPrint reference: 2010;78(3):251.

Effects of Guided Imagery on Postoperative Outcomes in Patients Undergoing Same-Day Surgical Procedures: A Randomized, Single-Blind Study
Maj Eric A. Gonzales, CRNA, MS, USAF, NC
Capt Rachel J.A. Ledesma, CRNA, MS, USAF, NC
Capt Danielle J. McAllister, CRNA, MS, USAF, NC
Lt Col Susan M. Perry, CRNA, MS, USAF, NC
Lt Col Christopher A. Dyer, CRNA, MS, USAF, NC
CDR John P. Maye, CRNA, PhD, NC, USN
The purpose of this investigation was to evaluate the effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures. The authors conclude that the use of guided imagery in the ambulatory surgery setting can significantly reduce preoperative anxiety, which can result in less postoperative pain and earlier postoperative anesthesia care unit discharge times.
Print version: 2010;78(3):181-188.
Keywords: Alternative therapies, guided imagery, postoperative outcomes, same-day surgery.
Combined Spinal/General Anesthesia With Postoperative Femoral Nerve Block for Total Knee Replacement in a Patient With Familial Hyperkalemic Periodic Paralysis: A Case Report
Maria C. Barker, CRNA, MSNA
Familial hyperkalemic periodic paralysis (HYPP) is a rare muscle disease that leads to intermittent skeletal muscle weakness when serum potassium is elevated. Surgery and anesthesia yield many conditions that may provoke an episode of weakness in these patients. This case report illustrates a successful use of a combined spinal/general anesthetic with a femoral nerve block for postoperative pain control for a total knee replacement in a patient with HYPP.
Print version: 2010;78(3):191-194.
Keywords: Familial hyperkalemic periodic paralysis, femoral nerve block, regional anesthesia, spinal anesthesia.
Lumbar Epidural Catheter Placement in the Presence of Low Back Tattoos: A Review of the Safety Concerns
Dawn Welliver, CRNA, MS
Mark Welliver, CRNA, DNP
Tammy Carroll, CRNA, MSN
Peggy James, MD
The authors report that the available evidence does not identify any specific risks associated with epidural catheter placement through low back tattoos, although tissue coring with tissue transport to deeper sites has been confirmed. A strong evidence-based guideline for placing epidural needles and catheters through tattoos remains an unfulfilled goal. The authors recommend the avoidance of piercing tattoos when performing epidural punctures until there is sound evidence of short-term and long-term safety.
Print version: 2010;78(3):197-201.
Keywords: Epidural, evidence-based practice, pigment dyes, tattoo, tissue coring.
Caudal Anesthesia in a Patient With Severe Pulmonary Hypertension
Doanh T. Ly, CRNA, MSN
Pulmonary hypertension (PHTN) is a severe disease that can cause profound hemodynamic alterations in the body. The author states that the anesthesia provider needs to be vigilant and recognize the unique anesthetic considerations in order to avoid catastrophic outcomes. She concludes that caudal anesthesia is used today primarily in the pediatric population; however, this case report emphasizes the importance of maintaining the skills necessary to perform caudal anesthesia in adults.
Print version: 2010;78(3):202-206.
Keywords: Caudal anesthesia, pulmonary hypertension, pulmonary vascular resistance.
Overview of Complex Regional Pain Syndrome and Recent Management Using Spinal Cord Stimulation
Kevin Ann Hyatt, CRNA, MSN
Complex regional pain syndrome (CRPS) is a puzzling condition characterized by various abnormalities involving the peripheral and central nervous system. The author explains that its precise cause and progressive stages are under investigation, as little definitive knowledge currently exists.The unique symptoms and presentations within individual patients make it paramount for practitioners to keep abreast of progress in the diagnosis, management, and outcomes of CRPS.
Print version: 2010;78(3):208-212.
Keywords: Central sensitization, complex regional pain syndrome, cortical reorganization, neurogenic inflammation, spinal cord stimulation.
Patient Outcomes Comparing CRNA-Administered Peripheral Nerve Blocks and General Anesthetics: A Retrospective Chart Review in a US Army Same-Day Surgery Center
CPT Young J. Yauger, CRNA, MSN, ANC, USA
LCDR Jay A. Bryngelson, CRNA, MSN, NC, PHS
LT Kaori Donohue, CRNA, MSN, NC, PHS
CPT Lori A. Lawhorn, CRNA, MSN, ANC, USA
MAJ (ret) Brian M. Pitcher, CRNA, MSN, ANC, USA
COL Bruce A. Schoneboom, CRNA, PhD, FAAN, ANC, USA
Dorraine D. Watts, RN, PhD
In this research article, the authors compare outcomes between patients receiving general anesthesia (GA) vs regional block (RB) in a military same-day surgery unit, where Certified Registered Nurse Anesthetists delivered all GA and RBs. The authors conclude that patients receiving RB had less pain and received less analgesia without any increase in postoperative nausea and vomiting, hospital time, or anesthesia-related complications.
Print version: 2010;78(3):215-220.
Keywords: Nausea and vomiting, pain, regional blocks.
Case Report: Anesthetic Management of Acute Fatty Liver of Pregnancy in the Postpartum Period 
LCDR Dennis Spence, CRNA, PhD, NC, USN
Acute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder that manifests during the third trimester. Early diagnosis, termination of pregnancy, and treatment of complications associated with AFLP significantly reduce maternal morbidity and mortality. In this case report, the author describes the management of a woman with AFLP in whom acute liver failure rapidly developed after a vaginal delivery with epidural analgesia at a small overseas hospital.
Print version: 2010;78(3):223-228.
Keywords: Acute fatty liver of pregnancy, epidural anesthesia for labor, long-chain hydroxyacyl-coenzyme-A dehydrogenase deficiency, morphine metabolites, neuraxial anesthesia.
Effects of Arterial Blood Pressure on Rebleeding Using Celox and TraumaDEX in a Porcine Model of Lethal Femoral Injury
James M. Burgert, CRNA, MSNA
Brian T. Gegel, CRNA, MSN
Capt Robert Austin III, CRNA, MSN, USAF, NC
Capt Alejandro Davila, CRNA, MSN, USAF, NC
CPT Jacob Deeds, CRNA, MSN, ANC, USA
Capt Lonnie Hodges, CRNA, MSN, USAF, NC
CPT Andrew Hover, RN, BSN, ANC, USA
Maj Cheryl Lockhart, RN, BSN, USAF, NC
CPT Glenn Simpson, CRNA, MSN, ANC, USA
CPT Stephen Weaver, CRNA, MSN, ANC, USA
Capt William Wolfe, CRNA, MSN, USAF, NC
Don Johnson, RN, PhD
Uncontrolled bleeding remains the leading cause of preventable death in trauma. This study was designed to identify the systolic blood pressure and mean arterial pressure at which rebleeding occurs when a clot is formed by a hemostatic agent, Celox or TraumaDEX, compared with a standard dressing. The authors conclude that Celox and TraumaDEX are statistically and clinically more effective in preventing rebleeding compared with the standard dressing (control) in the presence of elevated systolic and mean arterial blood pressures.
Print version: 2010;78(3):230-236.
Keywords: Celox, hemorrhage, hemostatic agent, rebleeding, TraumaDEX.
Apoptosis: Understanding Programmed Cell Death for the CRNA
Paul S. Bennetts, CRNA, MS
Janet D. Pierce, DSN, ARNP, CCRN
Apoptosis, or programmed cell death, is a physiologic mechanism employed by most multicellular organisms to maintain homeostasis of body tissues. The purpose of this article is to review current information about the process of apoptosis, the role of apoptosis in comorbid diseases, and the implications of the effects of anesthesia drugs on normal apoptotic mechanisms that need to be evaluated as potential sources of risk or benefit to surgical patients.
Print version: 2010;78(3):237-245.
Keywords: Apoptosis, caspase, programmed cell death.

AANA Journal Course: Update for Nurse Anesthetists – Part 2 – Cystic Fibrosis: A Systems Review
Melissa Wiehe, RN, BSN
Karri Arndt, CRNA, MS
Cystic fibrosis is a fatal genetic disorder that affects many organ systems in the body. It is traditionally thought of as a childhood disease affecting the lungs and pancreas, which does not accurately describe the disease in its entirety. Many organ systems are affected, from the heart and lungs to the reproductive system, and may warrant alterations in an anesthetic plan. This review highlights the pathologic conditions associated with multiple systems, therapy regimens, and potential complications and suggests anesthetic implications.
Print version: 2010;78(3):246-251.
Keywords: Anesthesia, cystic fibrosis, systemic effects. 
June 2010 AANA Journal
Volume 78 , Number 3
ISSN 0094-6354
On the Cover:
Current fashion in body art includes low back tattoos of varying designs and colors, a trend that presents unique concerns for anesthesia providers. In this AANA Journal, an article on epidural catheters in the presence of low back tattoos appears on page 197. The anesthetist on the cover is wearing Biogel Skinsense nonlatex gloves, manufactured by Mölnlycke Health Care, Gothenburg, Sweden. (Photo taken by Dawn Welliver, CRNA, MS.)