On The Cover

LCDR Jason Patacsil, CRNA, MSN, NC, USN, secures an airway of a trauma patient in 1 of 12 operating rooms on the USNS Comfort. The hospital ship was deployed to Haiti after a magnitude 7.0 earthquake struck near Port-au-Prince on January 12. During the mission, 843 surgical cases were completed. Patacsil is a staff nurse anesthetist at Naval Hospital Pensacola, Florida. For more information on the USNS Comfort’s role in Operation United Response, see the Guest Editorial on page 264.

Articles

  • Use of Clevidipine for Intraoperative Hypertension Caused by an Undiagnosed Pheochromocytoma: A Case Report The severe intraoperative hypertension caused by an undiagnosed pheochromocytoma is a rare and challenging event for the anesthesia provider. If treatment is not prompt and successful, permanent and possibly lethal complications can ensue. This article reports what the author believes to be the first case study in which clevidipine (Cleviprex) was successfully used to treat a suspected, and later diagnosed, pheochromocytoma.
    Keywords: Catecholamine response, clevidipine (Cleviprex), intraoperative hypertension, pheochromocytoma.
    Version: 2010;78(4):288-290. Authors: Jonathan P. Kline, CRNA, MSNA
  • Inhalational Anesthesia for Organ Procurement: Potential Indications for Administering Inhalational Anesthesia in the Brain-Dead Organ Donor In this review article, the author reports that there is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. She concludes that further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs.
    Keywords: Brain-dead organ donor, inhalational anesthesia, organ procurement.
    Version: 2010;78(4):293-299. Authors: Laurie J. Elkins, CRNA, MS, CCRN
  • Determining the Relationship of Acute Stress, Anxiety, and Salivary a-Amylase Level With Performance of Student Nurse Anesthetists During Human-Based Anesthesia Simulator Training The purpose of this study was to determine the relationship between physiologic measures of stress and performance of student nurse anesthetists during anesthesia simulator training. Analysis of the descriptive statistics and means of each group suggests that low performers have increased stress and perform poorly, high performers have increased stress and perform superbly, and moderate performers have modest stress and perform moderately.
    Keywords: Anesthesia simulator training, salivary α-amylase, State-Trait Anxiety Inventory, stress, student nurse anesthetist.
    Version: 2010;78(4):301-309. Authors: CPT Kelly A. Chiffer McKay, CRNA, MSN, ANC, USA CPT John E. Buen, CRNA, MSN, ANC, USA Lt Col Kevin J. Bohan, CRNA, PhD, USAF, NC CDR John P. Maye, CRNA, PhD, NC, USN
  • Pseudocholinesterase Deficiency: A Comprehensive Review of Genetic, Acquired, and Drug Influences Pseudocholinesterase deficiency is an inherited or acquired condition in which the metabolism of succinylcholine, mivacurium, or ester local anesthetics is potentially impaired. The aim of this review article is to examine both the genetic aspects of pseudocholinesterase deficiency and the acquired aspects to help the reader stay abreast of established and current literature and theories. Nearly 250 articles were examined for importance, and 50 case reports, research studies, and review articles were cited.
    Keywords: Atypical pseudocholinesterase, BChE, butyrylcholinesterase, genetic variants, pseudocholinesterase.
    Version: 2010;78(4):313-320. Authors: Flanna K. Soliday, CRNA, MSN Yvette P. Conley, PhD Richard Henker, CRNA, PhD
  • Anesthetic Management for Lobectomy in a Patient With Coccidioidomycosis: A Case Report Coccidioidomycosis is a fungal disease with a wide variety of manifestations. The rare coccidioidomycosis cases requiring surgical intervention present unique challenges to anesthesia providers. The author states that careful attention to perioperative fungal therapies, invasive monitoring, and electrolyte stabilization remain pivotal concerns offering the best outcomes for patients with coccidioidomycosis.
    Keywords: Acute tubular necrosis, amphotericin B, coccidioidomycosis, difficult airway, fungal sepsis.
    Version: 2010;78(4):321-325. Authors: Abbie J. Choleva, RN, BSN
  • Acute Normovolemic Hemodilution in a Jehovah’s Witness Patient: A Case Report Patients who are Jehovah’s Witnesses refuse blood transfusions and blood products as a matter of faith. For surgical procedures during which substantial blood loss is possible, their refusal presents a challenge. Anesthetists must generally respect the requests of adults not to receive blood and thus should have a clear understanding of how they will respond in the event of bleeding. In this case report, acute normovolemic hemodilution contributed to the successful outcome of an anemic Jehovah’s Witness who was undergoing major surgery.
    Keywords: Acute normovolemic hemodilution, blood conservation, blood loss, blood transfusion, Jehovah’s Witness.
    Version: 2010;78(4):326-330. Authors: Eric Lindstrom, CRNA, MHS Robert Johnstone, MD
  • AANA Journal Course: Update for Nurse Anesthetists – Part 3 – Ultrasound in Anesthesia: Applying Scientific Principles to Clinical Practice The use of ultrasound as an adjunct to invasive anesthesia procedures is becoming commonplace; however, a major disadvantage often cited is that success is user-dependent, and using ultrasound is a unique skill that requires training and experience to become proficient. In this course, the author discusses the principles of sound, the Doppler effect, tissue properties, transducers, and clinical considerations.
    Keywords: Attenuation, Doppler, frequency, propagation velocity, ultrasound.
    Version: 2010;78(4):332-340. Authors: Christian R. Falyar, CRNA, DNAP