On The Cover

Javier Ruiz, RN, MSN, student, and Pamela Binns-Turner, CRNA, PhD, program director, Union University School of Nursing, Nurse Anesthesia Track, Jackson, Tennessee, are performing an induction for an anesthetic during the university’s annual mission trip to the Dominican Republic in February 2009. In 4 days, students and faculty delivered 40 anesthetics for surgical procedures and provided medical care to 940 people in villages. Ruiz is currently in the nurse anesthesia program; his MSN was earned before entering the Nurse Anesthesia Track.

Articles

  • Prolonged Apnea After Small Single Dose of Intravenous Tramadol The reputation of tramadol, as an analgesic lacking respiratory depression, has contributed to its increased clinical use in intraoperative and postoperative periods. It has been safely used even in patients with obstructive sleep apnea without any sedative effect postoperatively. The authors discuss an unusual case of respiratory depression and prolonged apnea after a small, single intravenous dose of tramadol.
    Keywords: Anesthesia, apnea, enantiomer, single dose, tramadol.
    Version: 2010;78(2):110-112. Authors: Ravindra Pandey, MD Lenin B. Elakkumanan, MD, DNB Rakesh Garg, MD, DNB Pratyush Gupta, MD Vanlal Darlong, MD Jyotsna Punj, MD
  • Effects of Celox and TraumaDEX on Hemorrhage Control in a Porcine Model The purpose of this study was to compare the effectiveness of 2 hemostatic agents, chitosan-based Celox and the biopolymeric, microporous particles TraumaDEX, with a control group in a porcine model of hemorrhage. Celox and TraumaDEX were found to be statistically and clinically superior at controlling hemorrhage compared with the standard pressure dressing in the control group.
    Keywords: Celox, hemostasis, hemostatic agents, TraumaDEX, uncontrolled hemorrhage.
    Version: 2010;78(2):115-120. Authors: Brian T. Gegel, CRNA, MSN James M. Burgert, CRNA, MSNA Maj Cheryl Lockhart, RN, BSN, USAF, NC Capt Robert Austin III, CRNA, MSN, USAF, NC Capt Alejandro Davila, CRNA, MSN, USAF, NC CPT Jacob Deeds, CRNA, MSN, ANC, USA Capt Lonnie Hodges, CRNA, MSN, USAF, NC CPT Andrew Hover, RN, BSN, ANC, USA CPT John Roy, CRNA, MSN, ANC, USA CPT Glenn Simpson, CRNA, MSN, ANC, USA CPT Stephen Weaver, CRNA, MSN, ANC, USA Capt William Wolfe, CRNA, MSN, USAF, NC Don Johnson, RN, PhD
  • Anesthetic Management of a Pituitary Tumor Resection With Dexmedetomidine Dexmedetomidine is an alpha-2 agonist, mainly is used for sedating mechanically ventilated uncooperative patients in the intensive care setting. It also is being used by anesthesia providers for multiple purposes including cardiothoracic surgeries, neurological surgeries, awake-fiberoptic intubations, and for patients with a high risk for airway obstruction. This article reports the investigation of the off-label use of dexmedetomidine as an anesthetic adjunct for a transsphenoidal pituitary tumor resection in an adult.
    Keywords: Dexmedetomidine, neurosurgery, Precedex.
    Version: 2010;78(2):125-128. Authors: Tim Brady, CRNA, MS
  • Operative Splenectomy for Treatment of Homozygous Thalassemia Major in Afghan Children at a US Military Hospital Afghanistan is a war-ravaged country surrounded by mountainous terrain. Due to the geography and harsh living conditions people have intermarried among tribes for centuries. The right familial combinations can cause manifestations of genetic linked diseases, such as ß-thalassemia major. This article discusses the preoperative plan, intraoperative management, and postoperative care provided to infants and children who underwent open splenectomy at a US military forward operating field hospital in Afghanistan.
    Keywords: Afghanistan, Cooley anemia, humanitarian assistance, splenectomy, thalassemia.
    Version: 2010;78(2):129-133. Authors: Maj Jason D. Bolt, CRNA, MSN, USAF, NC COL Bruce A. Schoneboom, CRNA, PhD, ANC, USA, FAAN
  • Neuraxial Anesthesia for a Parturient With Hypogammaglobulinemia: A Case Report Hypogammaglobulinemia, an immunodeficiency, predisposes one to infection. Clinical manifestations of this condition, in the parturient, may contraindicate neuraxial anesthesia. In this case report, the author concludes that patients presenting for neuraxial anesthesia with a history of immunodeficiency qualify for the most stringent aseptic techniques by the provider.
    Keywords: Antibodies, humoral immunity, hypogammaglobulinemia, neuraxial anesthesia.
    Version: 2010;78(2):134-136. Authors: Barbara Murza, CRNA, MSN, MS
  • Ischemic Optic Neuropathy After Spine Surgery Visual loss after anesthesia is a rare but distressing occurrence. It has been reported in patients who are positioned supine during general anesthesia, but it occurs more frequently in patients positioned prone for spine surgery procedures. The authors discuss anatomy of the visual pathway, definition and types of ischemic optic neuropathy, symptoms and onset, risk factors, patient management, treatment, outcomes, and preventive measures.
    Keywords: Blood loss, hypotension, ischemic optic neuropathy, visual loss.
    Version: 2010;78(2):141-145. Authors: Vickie Pierce, CRNA, MNA Phillip Kendrick, CRNA, PhD
  • Vagal Nerve Stimulation: A Case Report In this case report, a review is presented of the current literature regarding long-term antiepileptic drug therapy and its effect on anesthetic management, pathophysiology of epilepsy and seizure propagation, and the effects of commonly used anesthetic agents on the seizure threshold. Also discussed are the physiology of vagal nerve stimulation, benefits and potential complications that may occur with its implantation, and device mechanics as it relates to future surgical procedures.
    Keywords: Antiepileptic drug therapy, medically refractory epilepsy, vagal nerve stimulator.
    Version: 2010;78(2):146-150. Authors: David Higgins, CRNA, MS David Dix, MD Michelle E. Gold, CRNA, PhD
  • AANA Journal Course: Update for Nurse Anesthetists—Part 1—Anesthesia Case Management for Thyroidectomy The anatomic and physiologic effects associated with hyperthyroidism can cause end-organ damage, hyperdynamic effects causing extreme cardiovascular lability, and tracheal distortion causing difficult airway management. In this AANA Journal course, the authors describe the anatomy and physiology associated with thyroid gland structure and function, pathophysiology, preoperative medication regimens, preoperative anesthetic management, intraoperative anesthetic management, and postoperative management.
    Keywords: Antithyroid medications, nerve integrity monitor endotracheal tube, recurrent laryngeal nerve injury, thyroidectomy, thyroid storm.
    Version: 2010;78(2):151-160. Authors: Sass Elisha, CRNA, EdD Michael Boytim, CRNA, EdD Sandy Bordi, CRNA, MSN Jeremy Heiner, CRNA, MSN John Nagelhout, CRNA, PhD, FAAN Ed Waters, CRNA, MN