October 2009 AANA Journal

Table of Contents


Disuse of Stethoscope Earmolds
Robert R. Jirgl, CRNA
Print version: 2009;77(5):330.

Books, Etc.
Anesthesiology Keywords Review
Reviewer: David G. Potter, CRNA, MBA
Print version: 2009;77(5):332.

State of the Science General and Oral Poster Sessions
Print version: 2009;77(5):373-404.


Anesthetic Management of an Obstetric Patient With Charcot-Marie-Tooth Disease: A Case Study
Macy Brock, CRNA, MSN
Cherry Guinn, RN, EdD
Monica Jones, MD
Charcot-Marie-Tooth disease (CMT) is categorized as an inherited peripheral neuropathic disease leading to distal  muscle atrophy, sensory disturbances, and absent reflexes in the extremities. This case report describes the anesthetic management of an obstetric patient with CMT type 1A that used a combined spinal-epidural technique for labor. Previous similar case reports were reviewed and an extensive literature search was conducted to organize the limited body of research regarding use of regional anesthesia in patients with CMT.
Print version: 2009;77(5):335-337.
Keywords: Charcot-Marie-Tooth disease, epidural, obstetric, spinal.

Rescue Ventilation: Resolving a “Cannot Mask Ventilate, Cannot Intubate” Situation During Exchange of a Combitube for a Definitive Airway
James M. Rich, CRNA, MA
Andrew M. Mason, MB, BS, MRCS, LRCP
H.A. Tillmann Hein, MD
Michael Foreman, MD
This case demonstrates the utility of the endotracheal Combitube as a rescue ventilation device for a patient with a large body mass index who is difficult or impossible to ventilate by bag-valve-mask ventilation and who also may initially be impossible to intubate. Additionally, it demonstrates the utility of having several options available for tracheal intubation to improve the success of establishing a definitive airway.
Print version: 2009;77(5):339-342.
Keywords: Airway exchange, Combitube, failed airway, failed intubation, rescue ventilation.

Attitudes Toward Physician-Nurse Collaboration in Anesthesia
Cassandra L.Taylor, CRNA, DNP, DMP, CNE
When anesthesiologists and nurse anesthetists work together, the nature of their interactions has the potential to influence the patient care they provide. The purpose of this study was to compare the attitudes of anesthesiologists and nurse anesthetists toward collaboration with each other. The results of this study provide some divergent perspectives regarding collaboration previously demonstrated between physicians and nurses may also exist in the specialty field of anesthesia.
Print version: 2009;77(5):343-348.
Keywords: Anesthesiology, collaboration, delivery of healthcare, nurse anesthetist, physician-nurse relationship.

Extended-Release Epidural Morphine vs Continuous Peripheral Nerve Block for Management of Postoperative Pain After Orthopedic Knee Surgery: A Retrospective Study
Nicole R. Schmidt, CRNA, MSN
Joseph A. Donofrio, CRNA, MSN
David A. England, CRNA, MSN
Leah B. McDonald, CRNA, MSN
Carrie L. Motyka, PhD, APRN-BC
Lisa A. Mileto, CRNA, MS
The authors of this study compare the efficacy and safety of extended-release epidural morphine and perineural infusion to control pain after total knee arthroplasty. The main end point of the study was pain scores up to 48 hours postoperatively, and the ancillary end points were supplemental opioid requirements and adverse effects. The results of the study showed no significant differences between the 2 groups for the levels of pain preoperatively, immediately postoperatively, and at 48 hours postoperatively.
Print version: 2009;77(5):349-354.
Keywords: Extended-release epidural morphine, peripheral nerve catheter, postoperative pain management.

Intraosseous Infusion of Blood Products and Epinephrine in an Adult Patient in Hemorrhagic Shock
James M. Burgert, CRNA, MSNA
In this case report, a properly placed intraosseous (IO) catheter was valuable in the resuscitation of a critically ill patient in hemorrhagic shock. The author concludes that IO infusion is an underutilized but clinically useful procedure in emergent situations where intravenous access is difficult or too time consuming to achieve. Anesthesia providers should seek education and training from those experienced in IO placement techniques and consider use
of the IO route early in the resuscitative process.
Print version: 2009;77(5):359-363.
Keywords: EZ-IO, hemorrhagic shock, intraosseous infusion, intraosseous transfusion.

AANA Journal Course: Update for Nurse Anesthetists—Part 4—Myocardial Infarction and Subsequent Death in a Patient Undergoing Robotic Prostatectomy
Judy Thompson, CRNA, MS, APRN
This course features a description of a patient undergoing a radical prostatectomy for cancer with a robotic system. The author explains that there are a number of positional and technical considerations for patients undergoing robotic surgical procedures, especially in relation to the requirement of low-lithotomy and steep Trendelenburg positions. The needed positioning, combined with the problems associated with insufflation, presents a unique challenge in anesthetic management
Print version: 2009;77(5):365-371
Keywords: Drug-eluting stents, pneumoperitoneum, robotic surgery, thrombosis, Trendelenburg position.

October 2009 AANA Journal
Volume 77 , Number 5
ISSN 0094-6354
On the Cover:
While in the cardiovascular anesthesia rotation at Southern Arizona VA Health Care System, Tucson, Arizona, Capt Daniel Moore, RN, BSN, places a central line under the watchful eye of Kim Vinayak, CRNA. “Moore was a student nurse anesthetist at David Grant Medical Center, Travis AFB, California, the only United States Air Force clinical site for the US Army Graduate Program in Anesthesia Nursing,” said Lt Col Brian Koonce, CRNA, MSN, USAF, NC, who submitted the photo. Capt Daniel Moore, CRNA, MSN, USAF, NC, is now a staff nurse anesthetist and clinical instructor at David Grant Medical Center, Travis AFB, California.