October 2008 AANA Journal

Table of Contents


Books, Etc.
Perianesthesia Patient Care for Uncommon Diseases
Reviewer: Zulay M. Hernandez, CRNA, MSN
Print version: 2008;76(5):326. 

Prevention of Kinked Anesthesia Gas Sampling Line With an Open Coiled Spring
Larry Shire, DDS, FAAPD 
The Varying Nature of the Professional Educational Preparation Among Clinical Anesthesia Providers Who Practice Unsafe Injection Practices
George H. Cox, CRNA, MHS, BSN
Print version: 2008;76(5):327-328. 

Education News
Mentoring: The Courage to Cultivate New Leaders
Henry C. Talley V, CRNA, PhD, MSN
Print version: 2008;76(5):331-334.
Keywords: Anesthesia practice, mentor, mentoring.

State of the Science General and Oral Poster Sessions
Print version: 2008;76(5):363-393.



Dexmedetomidine: A Useful Adjunct to Con­sider in Some High–­Risk Situations 
Mariann A. Haselman, CRNA, MSNA 
Dexmedetomidine is a relatively selective α2 agonist with sympatholytic, sedative, amnestic, and analgesic proper­ties. It is indicated for the short–term sedation of patients needing mechanical ventilation in the intensive care unit. This article provides a comprehensive review of the phar­macology, pharmacokinetics, and adverse effects of dex­medetomidine. A thorough understanding of this drug will enable the anesthesia provider to determine situations in which dexmedetomidine may be a useful drug to consider, whether as an adjunct or as a sole agent.
Print version: 2008;76(5):335-340.
Keywords: Adjunct, analgesia, anxiolysis, dexmedetomidine, sedation. 
The Efficacy of Ketorolac as an Adjunct to the Bier Block for Controlling Postoperative Pain Following Nontraumatic Hand and Wrist Surgery
LT Jesse J. Rivera, CRNA, MSN, NC, USN
LT Dante J. Villecco, CRNA, MSN, NC, USN
LT Bryan K. Dehner, CRNA, MSN, NC, USN
CDR(ret) Joseph F. Burkard, CRNA, DNSc, NC, USN
CDR Lisa A. Osborne, CRNA, PhD, NC, USN
CAPT Joseph E. Pellegrini, CRNA, PhD, NC, USN
Research indicates that using a combination of ketorolac and lidocaine in the administration of a Bier block results in significant postoperative analgesia and decreased inflam­mation; however, the optimal dose of ketorolac to coadminister with the local anesthetic has not been established. This study was performed to determine if a 20-mg dose of ketorolac is effective in providing prolonged postoperative analgesia without adverse effects. Based on the results of this study, the authors recommend that 20 mg ketorolac be considered in intravenous regional anesthesia.
Print version: 2008;76(5):341-345.
Keywords: Bier block, hand surgery, intravenous regional anesthesia, ketorolac, outpatient surgery.
Masseter Muscle Rigidity, Elevated Creatine Kinase, and Rhabdomyolysis Following Succinylcholine Administration: A Case Report
Lynn R. Fitzpatrick, CRNA, MSN 
In this case report, the author details the onset of masseter muscle rigidity, elevated creatine kinase levels, and rhab­domyolysis following a sevoflurane mask induction and succinylcholine administration in a 12-­year­-old boy. The patient had no family or personal history of neuromuscular disease or malignant hyperthermia. Hyperkalemia, meta­bolic acidosis, and rhabdomyolysis occurred within 75 minutes of masseter muscle rigidity. Masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis are discussed in this article.
Print version: 2008;76(5):349-354.
Keywords: Elevated creatine kinase, masseter muscle rigidity, rhabdomyolysis, succinylcholine.


AANA Journal Course: Update for Nurse Anesthetists—Part 4—Gender Differences in Pain: Does X = Y?
Matthew Toomey, CRNA, MSNA 
Increasing evidence suggests that men and women differ in their responses to pain. The aims of this course are to update anesthesia providers about the differences between genders in pain sensitivity and treatment and to elucidate the com­plex aspects of the biology of such differences. Included are the history of female participation in pharmacological test­ing, psychological factors in pain, the role of gonadal hor­mones in pain, pregnancy, gender differences in opioid anal­gesia and postoperative pain, and gender influence on mini­mum alveolar concentration.
Print version: 2008;76(5):355-359.
Keywords: Analgesia, gender, pain.

October 2008 AANA Journal
Volume 76 , Number 5
ISSN 0094-6354
On the Cover:
John Martin, CRNA, manages the anesthetic of a patient while he keeps track of blood loss and runs a cell salvage machine at Oklahoma Surgical Hospital in Tulsa, Oklahoma. The patient, located to the left and not visible in the photo, is undergoing back surgery with spinal fusion and instru­mentation. “All of the CRNAs that I work with learn to operate the ‘cell saver,’ and we have all had several inservices to keep us up to date,” said Martin. (Photo taken by Janis Thomas, CST.)