AANA Foundation

Discoveries of Distinction

"Discoveries of Distinction" highlights outstanding, timely, and innovative research on a range of important issues to CRNA professionals. All research studies presented in this column have been funded by the AANA Foundation or presented in the AANA Foundation State of the Science Poster Session.

For more information, please contact the AANA Foundation at foundation@aana.com.

July 2019

Type II Diabetes Mellitus: Amy Reed
Relationships Between Preoperative
Physiologic Stress, Gastric Content
Volume and Quality and the Risk of
Pulmonary Aspiration

Primary Author:
Amy Reed, PhD, CRNA

Pulmonary aspiration is a potentially fatal anesthetic complication occurring when gastric contents enter the respiratory system. Current fasting guidelines aim to decrease the risk of pulmonary aspiration; however, these guidelines are for healthy individuals and fail to account for type II diabetes mellitus (DM II) patients (ASA, 2011).

May 2019

Incidence and Risk Factors of Kelsey Nelson
Gastric-to-Pulmonary Aspiration
in Patients Undergoing Elective
Upper Gastrointestinal Endoscopy

Primary Author:
Kelsey Nelsen, BSN, RN, PHN

Amy Gnagey, APRN, CRNA, DNAP
J. Kyle Bohman, MD
Oludare Olatoye, MD
Rochelle Molitor, MD
Nathan Smischney, MD
and Adam Jacob, MD

Gastric-to-pulmonary aspiration is a recognized risk during upper gastrointestinal endoscopy. The risk of aspiration is suspected to be significant in this population due to manipulation of the oropharynx and underlying gastrointestinal pathologies, but a thorough assessment of this risk is lacking.

March 2019

Running on EMPTY? Accuracy in Evaluating Michele Ardigo
Gastric Ultrasound Images Before and
After Brief Training

Primary Author: Michele Ardigo DNP, CRNA

Jonathan Kline, MSNA, CRNA
Brian Selai, MSN, CRNA
Marilyn A. Pugh, PhD

Ultrasound evaluation (UE) of gastric contents may represent an excellent quantitative diagnostic tool. Research has determined the use of gastric UE beneficial in determining gastric content.

November 2018

The Effect of Data-Entry TemplateBryan Wilbanks November 2018
Design and Anesthesia Provider
Workload on Documentation Accuracy,
Documentation Efficiency, and User-

Primary Author: Bryan Anthony Wilbanks,

This study used observational data collection and psychometric instruments (for perceived workload and user satisfaction) at three hospitals that each used different methods of data-entry for perioperative documentation (auto-filling with unstructured data, computerassisted data selection with semi-structured documentation, and paper-based documentation).

July 2018

Development of a Training Program in Aaron Ostrowski July 2018
Peripherally Inserted Central Catheter
Placement for Certified Registered
Nurse Anesthetists Utilizing an
N-of-1 Methodology

Primary Author:
Aaron Ostrowski, DNP, CRNA

Suzanne Morrison, DNP, CRNA
John O’Donnell, DrPH, CRNA

Patients were waiting an average of 23 hours for reliable, long-term central venous access in our hospital, and expansion of the IV team service was not an option. A training program in the insertion of peripherally inserted central catheters (PICCs) for CRNAs was developed to provide another cost-effective resource in our hospital to meet patients’ needs.

March 2018

Perceptions of Acupuncture and Acupressure 
Amanda Faircloth March 2018by Anesthesia Providers: A Quantitative 
Descriptive Study

Primary Author: Amanda Faircloth, PhD,
Coauthors: Arkadiy Dubovoy, MD; Chuck Biddle, PhD, CRNA; Diane Dodd-McCue, DBA; and John F. Butterworth IV, MD

This study assessed U.S. anesthesia providers’ perceptions of acupuncture and acupressure. After institutional review board approval, 96 anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical
centers, community hospitals, children’s hospitals, and veterans affairs hospitals) were selected for participation in an anonymous, pretested, online survey.

September 2017

Student Registered Nurse Anesthetists: Michele Ballister September 2017
The Impact of Structured High Fidelity
Simulation on Anesthesia Ready Time

Primary Author: Michele Ballister,

Student registered nurse anesthetists (SRNAs) at a large academic medical center are limited in clinical training experiences due to the subjective observations of local anesthesia departments that SRNAs decrease OR efficiency because they require too much instruction. Utilizing the Iowa Model of Evidenced-Based Practice to Promote
Quality Care, the investigator inserted a six week structured simulation program into the nurse anesthesia curriculum prior to the SRNAs’ first clinical rotation.

July 2017

Differential Expression of Jennifer Coyner July 2017
Phosphorylated Mitogen-Activated
protein kinase (pMAPK) in the lateral
amygdala of mice selectively bred
for high and low fear

Primary Authors:
LTC Jennifer Coyner, PhD, CRNA

Jennifer McGuire, PhD
Robert Ursano, MD, PhD
Clarissa Parker, PhD
Abraham Palmer, PhD
Luke R. Johnson, PhD

This research examines the cellular and molecular mechanisms that underlie conditioned fear learning in a mouse model of high and low fear. Individuals with posttraumatic stress disorder (PTSD) demonstrate a higher ‘fear load’ compared to individuals that do not have PTSD.

May 2017

The Implementation of a High-Fidelity Victoria Goode May 2017
Simulation Process Improvement
Protocol Using Malignant Hyperthermia

Primary Authors:
Victoria Goode, PhD, CRNA

Pamela DeGuzman, RN, PhD; Kenneth Scully, MS; Virginia Rovnyak, PhD; Ivora Hinton, PhD; Elizabeth Merwin, RN, PhD; Elayne Kornblatt Phillips, RN, MPH, PhD, FAAN

Patient safety and the delivery of quality care are major concerns for healthcare in the United States. Special populations (e.g., obese patients) need study in order to support patient safety, quantify risks, advance education for healthcare-workers, and establish healthcare policy.

September 2016

Job Satisfaction, Burnout, andJoshua Lea September 2016
Turnover Intention Among Certified
Registered Nurse Anesthetists

Primary Author: Joshua Lea, MS, MBA, CRNA
Coauthors: Christine Brown-Mahoney, PhD; Irene Jillson, PhD

Certified Registered Nurse Anesthetists (CRNAs) are essential
members of the surgical team, and demand for them is increasing as the United States tries to control healthcare costs. Despite the economic benefits of employing CRNAs, like other highly trained healthcare professionals, CRNAs are difficult and expensive to replace.

July 2016

Katherine_KiddeA Comparison of Epidural Strategies for Labor Analgesia 

Primary Author: LT Katherine Kidde, BSN
Coauthors: LT Meredith Tverdosi, BSN, CDR; Mark Lenart MD, CDR; Johnnie Holmes, PhD, CRNA

Epidural analgesia provides safe and effective analgesia with a reduced side effect profile along with increased maternal participation in labor. While the number of women utilizing epidural analgesia for labor continues to grow, there is still a lack of evidence to support which infusion strategy is the most effective. The purpose of this study is to compare the effectiveness of three epidural infusion strategies for labor analgesia to test the hypothesis that a lower basal rate with a higher patient controlled bolus will result in lower drug consumption than the other two comparison regimens.

May 2016

Katherine_OjalvoThe Effect of Ultrasound Guidance and Vessel Transduction on Central Venous Catheter Placement Complications

Primary Author: Katherine Ojalvo, BSN, RN
Coauthors: Jennifer Cooley, BSN, RN; Karin Langford, BSN, RN

Based on recommendations from the National Institute of Health and Clinical Excellence, in 2011 Mayo Clinic Rochester instituted a policy mandating the use of ultrasounds for internal jugular central venous catheter placement in the operating room. In our study we compared rates of complications for central line insertion with and without ultrasound guidance between 2006 and 2012.

March 2016

Nicholas_GabrielA Study of Relationships Among Three Assessment Methods of Nurse Anesthetists 

Primary Author: Nicholas Gabriel, PhD, CRNA
Coauthors: Bernadette Henrichs, PhD, CRNA; Mary Blegen, PhD, RN; Susan Chapman, PhD, RN

A doctoral study to determine relationships between a written examination, self-assessment, and performance assessment in simulation of practicing nurse anesthetists (CRNAs).

Brian_Gegel The Efficacy of QuikClot Combat Gauze, Fluid Resuscitation and Movement on Hemorrhage Controlin a Porcine Model of Hypothermia

Primary Author: Brian Gegel, DNAP, CRNA
Coauthors: James Burgert, DNAP, CRNA; John Gasko, DNP, CRNA; Sabine Johnson, MS; Jennifer Florez, MSN, CRNA; Edward Dunton II, MSN, CRNA; Don Johnson, PhD, RN 
This study was a prospective, between subjects, experimental design using Yorkshirecross swine randomly assigned to two groups; QuikClot Combat Gauze (QCG) (n=11) and control (n=11).

January 2016

Tatjana_BevansPharmacokinetics and Analgestic Properties of Inhaled Remifentanyl

Primary Author: Tatjana Bevans, MSN, CRNA
Coauthors: Cassandra Rice, PhD; Derek Sakata MD; Chris Reilly, PhD      
Patients could benefit from an inhaled opioid for pain management in a clinical setting. We investigated the bioavailability and efficacy of inhaled remifentanil in rats. We concluded that rapid profound analgesia was achieved, and remifentanil and metabolites were measurable in rat blood following pulmonary exposure to remifentanil. 

Briana_MeserollThe Non-Compete Cause and the CRNA: An Assessment of Knowledge, Perception, and Experience 
Primary Author: Briana Meseroll, DNP, CRNA
Coauthors: Nathaniel Apatov, PhD, CRNA; Carolyn Rutledge, PhD, FNP

Mounting economic pressures and the challenge to maintain competitive advantage have resulted in many healthcare entities to require their practitioners to enter into restrictive covenants such as non-compete clause (NCCs). Many student nurse anesthetists and practicing certified registered nurse anesthetists (CRNAs) are unaware of the non-compete clause in employee contracts. CRNAs are often surprised by the implication of signing a non-compete clause could have on their future abilities to successfully advocate for themselves and their profession, in order to best meet the needs of the population they serve. This study was completed using an anonymous, Web-based questionnaire distributed to students and CRNAs nationwide and demonstrated a significant knowledge gap in the nurse anesthesia community surrounding the NCC. 

September 2015

Ray_ElmbladWorkplace Incivility Affecting CRNAs: A Study in Prevalence, Severity, Consequences with Proposed Interventions

Primary Author: Ray Elmblad, DrAP, CRNA
Coauthors: Gergana Kodjebacheva, PhD; Lynn Lebeck, PhD, CRNA
Incivility in healthcare settings has potentially detrimental effects on healthcare providers and patient safety. This study examines the prevalence of incivility and the influence workplace incivility has on burnout among CRNAs in Michigan. 

May 2015

Joseph_OSullivanComparative Resuscitation Measures for the Treatment of Desipramine Overdose

Primary Author: Joseph O’Sullivan, CRNA, PhD
Coauthors: Arthur Johnson, RN, PhD; Melissa Waterman, CRNA, MSN

A toxic dose of desipramine (tricyclic anti-depressant) causes cardiac arrhythmias and ultimately asystole. Resuscitation in the emergency room is difficult and almost always unsuccessful. Anecdotal evidence suggests that an infusion of lipid emulsion may be an effective treatment. The purpose of this study was to determine the optimal combination of lipid rescue and traditional ACLS therapy for the treatment of desipramine overdose using a porcine model. The results indicated that the groups that received vasopressin were more likely to survive than those that did not vasopressin and the groups that received lipid emulsion were more likely to survive than those that did not receive lipid emulsion.

March 2015

John_BbuonoraDevelopment of a Traumatic Brain Injury Assessment Score Using Novel Biomarkers Discovered Through Autoimmune Profiling

Primary Author: John Buonora, CRNA, PhD
Coauthors: Michael Mousseau, BA; Lawrence Latour, PhD; Ramon DiazArrastia, MD, PhD; Harvey Pollard, MD, PhD; Sandro Rizoli, MD, PhD; Andrew Baker, MD; Shawn Rhind, PhD, Gregory Mueller, PhD

The goals of this research were to identify novel brain proteins targeted by traumatic brain injury (TBI)-induced autoantibodies and to determine if these proteins contribute to a circulating biomarker signature useful in the diagnosis and assessment of mild TBI.

January 2015

Kenneth_WoffordEffect of Elective Surgery on Subjective Health in Veterans with Chronic PTSD

Primary Author: LCDR Kenneth Wofford, CRNA, PhD, NC, USN
Coauthors: Michael Hertzberg, MD; Susan G. Silva, PhD; Charles Vacchiano, CRNA, PhD, FAAN

Posttraumatic stress disorder (PTSD) is common, is often chronic, and has been associated with greater risk of postoperative mortality in veterans. This study was conducted to determine if elective outpatient surgery had a persistent effect on the physical or mental health of veterans with chronic PTSD. 

November 2014

Administering Regional Anesthesia Kristal Barbee
in the Adult Obese Surgical Patient:
Exploration of CRNA's Techniques to
Manage Identified Challenges 

Primary Author: Kristal Barbee, RN, BSN, MS
Coauthors: Lisa Dettmer, RN, BSN; Danielle Meade, RN, BS; Rachel Baldwin, RN, BSN

The purpose of this study was to explore the techniques CRNAs use to manage the challenges of administering regional anesthesia in the adult obese surgical population. The two research questions that guded this study are: 1) Do the challenges of the obese surgical population impact the CRNAs' ability to perform regional anesthesia? 2) What are the techniques practiced by CRNAs to manage identified challenges of administering regional anesthesia in the adult obese surgical population?

September 2014

Educational Teaching Model for Central Line LaSonya Malbrough
Insertion Utilizing 2-D Ultrasound Technology
for Integration into Nurse Anesthesia Programs

Primary Author: LaSonya Malbrough, CRNA, DNP, MS

This DNP Evidenced-based Practice Project was designed to present a pilot training model based on best practices intended to provide theoretical and technical skills for safe central line insertion utilizing 2-D ultrasound technology for advanced practice nurses at the master’s and doctoral educational levels. 

March 2014

The AANA Foundation Office-Based Michael Kremer
Anesthesia Study

Primary Author: Michael Kremer, CRNA, PhD, FAAN

Office-based surgery is a rapidly growing segment of anesthesia practice, with some 10 million procedures performed annually in office-based settings. AANA first developed its Standards for Office-Based Practice in 1999.

January 2014

Acupuncture Blocks Cold Stress-Induced Ladan Eshkevari
Increases in the HPA in the Rat

Primary Author: Ladan Eshkevari, CRNA, PhD, LAc
Susan Mulroney, PhD
Eva Permaul, BS

While acupuncture is used widely to treat chronic stress, the mechanism of action leading to reported health benefits is not understood. In a series of studies, Eshkevari and her team demonstrated how acupuncture could significantly reduce the stress hormone response in an animal model of chronic stress.