On The Cover

Susan Murrell, CRNA, MSN, uses the GlideScopeVideo Laryngoscope (GVL) to intubate the trachea in a patient undergoing general endotracheal anesthesia at the VA San Diego Medical Center, San Diego, California. The GVL consists of an integrated camera mounted at the end of a curved laryngeal blade that displays the captured image on an attached color monitor. When compared to traditional laryngoscopy, the GVL often allows for an improved view of the glottis. (Photo taken by Jeff Johnson, CRNA, MSN, VA San Diego Medical Center.)

Articles

  • Nerve Agents: Implications for Anesthesia Providers In this review article, the author points out that the possibility of encountering a person who has been exposed to a nerve agent is a reality today. Different types of nerve agents that are currently being manufactured as well as the symptomatic and definitive treatment of the patient who presents with acute nerve agent toxicity are discussed. The physiology of the neuromuscular junction and the autonomic nervous system receptors that nerve agent toxicity affects also are reviewed.
    Keywords: Chemical weapons, cholinesterase inhibitors, nerve agents, nerve gas.
    Version: 2008; 76(2)95-97. Authors: Paula Kay Hrobak, CRNA, MSN
  • Intraoperative Detection of Methemoglobinemia in a Patient Given Benzocaine Spray to Relieve Discomfort From a Nasogastric Tube: A Case Report This case report describes a patient who had a high methemoglobin level secondary to liberal use of benzocaine oral spray. The patient was successfully treated with methylene blue intravenously and recovered uneventfully. The author states that when arterial blood gas with a normal partial pressure of oxygen is inconsistent with a low pulse oximeter reading and with the physical appearance of the patient, methemoglobinemia should be considered as a differential diagnosis. If methemoglobinemia is left untreated, it may be fatal.
    Keywords: Benzocaine spray, methemoglobinemia, methylene blue.
    Version: 2008;76(2):99-102. Authors: Barb Young, CRNA, MS
  • The Effectiveness of 4% Intracuff Lidocaine in Reducing Coughing During Emergence From General Anesthesia in Smokers Undergoing Procedures Lasting Less Than 1.5 Hours Coughing commonly occurs in patients emerging from general endotracheal anesthesia and is prominent in smokers due to underlying airway irritation. Reduction of coughing by instilling lidocaine into the endotracheal tube cuff has been shown to be effective in long cases, but research has not confirmed efficacy of this technique in short cases. In this study, the authors used a randomized, double blind, posttest-only design. A correlation between use of intracuff lidocaine and a decrease in emergence coughing in procedures lasting less than 1.5 hours in patients who smoke was not found.
    Keywords: Emergence coughing, endotracheal tube cuff, intracuff lidocaine, smokers
    Version: 2008;76(2):105-108. Authors: Laura E. Wetzel, CRNA, MS Amy L. Ancona, CRNA, MS Andrew S. Cooper, CRNA, MS Amy J. Kortman, CRNA, MS Gayle Loniewski, CRNA, MS Lynn L. Lebeck, CRNA, PhD
  • A Review of Recent Studies Relating Ligand Diffusion, General Anesthesia, and Sleep In this review article, the author discusses chreode theory of molecule diffusion, nonspecific volatile anesthetic activity, the relationship between general anesthesia and sleep, and a theory of sleep. Three specific theories are described. The first theory describes the diffusion of molecules across a protein surface to a receptor. A second theory involving the role of chreodes presents a mechanism of action of nonspecific anesthetic agents. And, the third theory proposes that an external agent influences sleep in a way similar to that of the nonspecific anesthetic molecules.
    Keywords: Nonspecific anesthetic mechanism, protein surface water, sleep from nitrogen effect, sleep theory.
    Version: 2008;76(2):109-112. Authors: Lemont B. Kier, PhD, BS
  • The Effects of Chrysin, a Passiflora incarnata Extract, on Natural Killer Cell Activity in Male Sprague-Dawley Rats Undergoing Abdominal Surgery COL(ret) Normalynn Garrett, CRNA, PhD, AN, USA Surgery is associated with suppression of natural killer (NK) cell activity and may contribute to cell metastasis. Chrysin, a passion flower extract, may be beneficial because of its potential to attenuate surgical suppression of NK cell activity. The authors divided 37 male Sprague-Dawley rats into 3 treatment groups; analysis of covariance, with preoperative NK cell activity as the covariate, was used to compare differences in NK cell activity among the groups. The findings suggest that chrysin may attenuate surgical suppression of NK cell activity, thereby minimizing metastatic spread of cancer.
    Keywords: Anxiety, chrysin, natural killer cells, passion flower.
    Version: 2008;76(2):113-117. Authors: MAJ Denise M. Beaumont, CRNA, MSN, AN, USA MAJ Terrence M. Mark Jr, CRNA, MSN, AN, USA CPT Reginald Hills, BSN, AN, USA Patricia Dixon, MS Bruce Veit, PhD
  • Current Antifibrinolytic Therapy for Coronary Artery Revascularization The purpose of this review article is to describe the clinical significance of antifibrinolytic therapy and the current implications associated with its use. The authors discuss 2 main classes of antifibrinolytics that are used in coronary artery bypass graft procedures: synthetic lysine analogues and serine protease inhibitors. Both classes of antifibrinolytics have been shown to decrease the incidence of blood transfusion; however, new data have emerged regarding an increase in adverse outcomes associated with serine protease inhibitors.
    Keywords: Antifibrinolytics, aprotinin, cardiac bypass, hemostatis, transfusion.
    Version: 2008;76(2):121-124. Authors: Jason Trudell, CRNA, MSN Nicholas McMurdy, CRNA, MSN
  • Mitral Valve Replacement: A Case Report In this article, the authors state that mitral regurgitation is the most commonly encountered valvular lesion in anesthesia clinical practice. Knowledge of the pathophysiology and proper anesthetic management is crucial to achieving optimal outcomes. A case is reported, followed by a detailed discussion on mitral regurgitation. The goals for the anesthetist include preservation of forward flow with minimal regurgitation and decreased pulmonary congestion. Invasive monitoring and transesophageal echocardiography have improved diagnostics and anesthetic management.
    Keywords: Mitral valve, mitral regurgitation, mitral valve replacement
    Version: 2008;76(2):125-129. Authors: Derek Reckard, CRNA, MSN Eric Cipcic, CRNA, MSN Carol Mackin, CRNA, MSN
  • AANA Journal Course: Update for Nurse Anesthetists—Part 1—Toward Reducing Peri-operative Transfusions Despite the ever-increasing safety of the supply of blood products, disease transmission is listed as the primary patient concern regarding transfusions. The author of this course states the primary concerns for anesthetists center on risks associated with blood transfusions, such as transfusion-related acute lung injury, anaphylactic transfusion reaction, clerical errors resulting in ABO incompatibility, and blood products contaminated with infectious organisms. These concerns have contributed to renewed efforts to minimize blood transfusion without negative patient consequences.
    Keywords: Acute normovolemic hemodilution, aprotinin, erythropoietin, preoperative autologous donation, transfusion triggers.
    Version: 2008;76(2):131-137. Authors: Joseph A. Joyce, CRNA, BS