October 2011 AANA Journal

Table of Contents


Guest Editorial 
Peering into Peer Review: Galileo, ESP, Dr Scott Reuben, and Advancing Our Professional Evolution
Chuck Biddle, CRNA, PhD
Print version: 2011;79(5):365-366.
Keywords: Peer review, scientific misconduct, scholarly publication.

Manufacturing Defects in an Epidural Catheter
Jeffrey Huang, MD
Steven Kavalin, CRNA
Print version: 2011;79(5):367.

Print version:

Calendar of Events 
Print version:


Carbon Dioxide Embolism During Pneumoperitoneum for Laparoscopic Surgery: A Case Report
Heather J. Smith, RN, BSN
In this case report, the author describes a patient who underwent a suction dilation and curettage, followed by an exploratory laparoscopic procedure to examine her uterus. After placement of the Veress needle and insufflation of the abdomen, a co2 embolism developed that caused severe hypotension, bradycardia, and loss of end-tidal co2 tracing. Rapid recognition and treatment prevented the patient from suffering any long-term adverse medical events.
Print version: 2011;79(5):371-373.
Keywords: Abdominal insufflation, carbon dioxide embolism, laparoscopic surgery.

Effects of Immobilization Stress and Hormonal Treatment on Nociception 
LTC Danette F. Cruthirds, CRNA, MSN, ANC, USA
Capt Amanda L. Siangco, CRNA, MSN, NC, USAF
Capt Clinton J. Hartman, CRNA, MSN, MBA, NC, USAF
Capt Danny C. Sandefur, CRNA, MSN, NC, USAF
Capt James M. Spencer Jr, CRNA, MSN, NC, USAF
Lt Col Christopher A. Dyer, CRNA, MSN, NC, USAF
D. Omar Larco, BS
T. John Wu, PhD
The purpose of this study was to evaluate the effects of stress and estradiol (E2) on pain tolerance. The authors state that with the exception of stressed rats treated with the ERβ agonist, there was no hormone effect on β-endorphin levels. These studies suggest that E2’s effect on pain thresholds may be mediated via the ERα, while the interaction between chronic stress and ERβ may also enhance pain threshold.
Print version: 2011;79(5):375-380.
Keywords: Estrogen receptor agonists, hot plate test, pain, restraint stress, stress.

Recurrent Seizures in Pregnancy—Epilepsy or Eclampsia: A Diagnostic Dilemma? A Case Report 
Ravindra Pandey, MD
Rakesh Garg, MD, DNB
Vanlal Darlong, MD
Jyotsna Punj, MD
Puneet Khanna, MD
Peripartum seizure is a serious disease with substantial morbidity and mortality for the mother and fetus. The authors of this case report point out that maximum vigilance is required for such patients, and therapy needs to be titrated according to the patient’s response, keeping in mind its impact on the fetus.
Print version: 2011;79(5):388-390.
Keywords: Eclampsia, epilepsy, pharmacotherapy, pregnancy, recurrent seizures.

Renal Transplantation from an Unrelated Living Donor to a Malignant Hyperthermia–Susceptible Patient: A Case Report 
Marli Kern, CRNA, MSNA
Transplantation is the optimal treatment for patients with end-stage renal disease; therefore, the incidence of living donor transplantation is increasing. This case report provides an example of kidney transplantation from an unrelated living donor to a malignant hyperthermia–susceptible recipient with Alport syndrome. The donor and the recipient had uneventful clinical courses and, to date, the renal transplantation has been successful.
Print version: 2011;79(5):397-400.
Keywords: Alport syndrome, malignant hyperthermia, nontriggering anesthetic technique, renal transplantation, total intravenous anesthetic.

Intrapartum Seizure in a Patient Undergoing Cesarean Delivery: Differential Diagnosis and Causative Factors 
Maria Hirsch, CRNA, DNAP
Seizures in the pregnant patient are assumed to be eclampsia unless other causes are known. This case describes the unusual occurrence of grand mal seizures in a 28-year-old patient undergoing a repeat cesarean delivery during spinal anesthesia. Included is a review of the current literature regarding seizures in the parturient and causative factors for this patient.
Print version: 2011;79(5):403-407.
Keywords: Cesarean delivery, closed head injury, seizures, traumatic brain injury.

Anesthetic Considerations for Patients with Postpolio Syndrome: A Case Report 
Donna Wheeler, CRNA, MS
Postpolio syndrome is a disorder related to the recurrence of neuromuscular symptoms in survivors of paralytic poliomyelitis. In this case report, the author discusses the anesthetic challenges and considerations in patients with postpolio syndrome, focusing on the importance of careful pharmacologic dosing of opioids and neuromuscular agents as well as perioperative and postoperative issues related to aspiration risks, cold intolerance, and positioning.
Print version: 2011;79(5):408-410.
Keywords: Anesthesia, neuromuscular disorder, postpolio syndrome.

Advancing Recertification for Nurse Anesthetists in an Environment of Increased Accountability 
Karen Plaus, CRNA, PhD, FAAN
Timothy J. Muckle, PhD
James P. Henderson, PhD
The purpose of this article is to present the essential concepts and current developments related to competence and continuing competence for nurse anesthetists. The National Board of Certification and Recertification for Nurse Anesthetists continues to seek input from nurse anesthetists and stakeholders in its deliberations on how to define the future requirements for continuing competence.
Print version: 2011;79(5):413-418.
Keywords: Continued competency, continued professional certification, credentialing, recertification.

Use of Dexmedetomidine for Monitored Anesthesia Care for Diskography in Adolescents 
James Furstein, CRNA, DNAP
Manish Patel, DO
Senthilkumar Sadhasivam, MD, MPH
Mohamed Mahmoud, MD
Procedural sedation in children and adolescents is becoming increasingly employed to facilitate successful diagnostic imaging studies. This case series describes the authors’ clinical experience in using dexmedetomidine as the sole sedative agent to facilitate diskography in 4 adolescent patients, ranging in age from 15 to 18 years, who presented with chief complaints of back pain and degenerative diskitis.
Print version: 2011;79(5):421-425.
Keywords: Dexmedetomidine, diskography, monitored anesthesia care.

Intrathecal Hydromorphone for Cesarean Delivery: In Search of Improved Postoperative Pain Management: A Case Report 
Erik Rauch, CRNA, MSN
The purpose of this article is to encourage the development of more research regarding this use of intrathecal hydromorphone, which the author states may provide more consistent analgesia because its lipid solubility falls between that of morphine or fentanyl. This case report supports an emerging hypothesis that intrathecal hydromorphone is not only safe but possibly more effective than other intrathecal opioids for pain management after cesarean delivery.
Print version: 2011;79(5):427-432.
Keywords: Cesarean delivery, hydromorphone, intrathecal, pain management.

AANA Journal Course: Update for Nurse Anesthetists—Part 4—The Physiology of the Nicotinic Acetylcholine Receptor and its Importance in the Administration of Anesthesia
Amanda C. Rossman, RN, BSN
The nicotinic acetylcholine receptor (nAChR) can be found widely throughout the body. Although the activation of this receptor leads to multiple functions dependent on its location within the body and subunit composition, all nAChRs aid in the communication between the extracellular and intracellular compartments. The author of this course concludes that the importance of the nAChR cannot be underestimated, for it is through the manipulation of this receptor that many anesthetic goals are achieved.
Print version: 2011;79(5):433-440.
Keywords: Anesthetic effects on nAChR, muscle-type nAChR, nAChR structure, neuronal-type nAChR, nicotinic acetylcholine receptor (nAChR).

October 2011 AANA Journal
Volume 79 , Number 5
ISSN 0094-6354
On the Cover:
Danielle Wilson, RN, BSN, practices airway management using a GlideScope video laryngoscope (Verathon Inc) with the Human Patient Simulator or HPS (Medical Education Technologies, Inc). Wilson is a student in the Department of Nurse Anesthesia, Ida V. Moffett School of Nursing, Samford University, Birmingham, Alabama. Experiential learning prior to starting clinical experience allows students to develop technical skills, direct laryngoscopy, and use of alternative methods of airway management. (Photo taken by Caroline Summers and submitted by Terri Cahoon, CRNA, DNP.)