AANA Journal Issue Details

On The Cover

Carol Staffieri, CRNA, APN, positions a patient in high Fowler position for a rotator cuff repair at Methodist Division of Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. “Adequate blood pressure maintenance and neutral head and neck position are extremely important during shoulder surgery,” explains Staffieri. The anesthesia staff at Methodist provides services to Rothman Shoulder and Elbow Specialists for approximately 2,000 procedures each year. (Photo taken by Linda Jobes, CRNA.)


  • Management of a Traumatic Tracheal Tear: A Case Report In this case report, the author describes a posterior tracheal tear in a healthy 8-year-old girl. The child sustained the injury while riding her scooter, when the handlebars of the scooter dislodged after running into the curb, causing the shaft to strike her in the manubrium of the sternum. The child presented with subcutaneous emphysema of the neck and the supraclavicular region bilaterally. This case represents the need for proper preparation and communication between providers to manage all possible scenarios of a traumatic tracheal tear.
    Keywords: Spontaneous ventilation, subcutaneous emphysema, tracheal tear.
    Version: 2011;79(6):468-470. Authors: Eric Barrett, CRNA, MSN
  • Diabetic Cardiac Autonomic Neuropathy and Anesthetic Management: Review of the Literature Cardiac autonomic neuropathy (CAN) is a serious complication among diabetic patients. It occurs in both type 1 and type 2 diabetes, and its progression results in poor prognosis and increased mortality. The authors of this review article conclude that great progress has been made over the years in the research of autonomic nerve dysfunction; however, much still remains unknown about this serious complication of diabetes mellitus. Future research will hopefully provide the evidence needed to prevent the progression and fatal events experienced by the many diabetic patients who have CAN.
    Keywords: Anesthesia, cardiac autonomic neuropathy, diabetic autonomic neuropathy, diabetes mellitus.
    Version: 2011;79(6):473-479. Authors: Ingrid Oakley, CRNA, DVM Lyne Emond, CRNA, MNA
  • Bronchial Thermoplasty: A Novel Treatment for Severe Asthma Requiring Monitored Anesthesia Care Bronchial thermoplasty is a novel and promising, nonpharmacologic treatment for certain individuals with severe persistent asthma. In this case report, the authors report the successful use of dexmedetomidine for sedation during bronchial thermoplasty, a new treatment for patients with severe persistent asthma refractory to inhaled corticosteroids and long-term b-2 agonists. As bronchial thermoplasty becomes a more common procedure using monitored anesthesia care, the authors believe that dexmedetomidine may be a prudent choice for producing safe and effective sedation.
    Keywords: Asthma, bronchial thermoplasty, dexmedetomidine.
    Version: 2011;79(6):480-483. Authors: Jamille A. Lee, RN, MSNA David W. Rowen, CRNA, MSNA David D. Rose, CRNA, PhD
  • Predictors of Situation Awareness in Student Registered Nurse Anesthetists Situation awareness (SA) is defined as one’s perception of the elements of the environment, the comprehension of their meaning, and the projection of their status in the near future. The concept of SA is well known in the aviation industry, which is characterized by complexity and dynamism. Findings from this study reveal cognition as the best predictor of SA in graduate student registered nurse anesthetists (SRNAs), with the addition of memory and automaticity contributing no additional predictive value to the model. The results of this study have the potential to make a positive impact on the admission, education, and training of SRNAs.
    Keywords: Awareness, education, simulation, situation awareness, training.
    Version: Print version: 2011;79(6):484-490. Authors: Suzanne M. Wright, CRNA, PhD Michael D. Fallacaro, CRNA, DNS
  • Model for a Reproducible Curriculum Infrastructure to Provide International Nurse Anesthesia Continuing Education There are no set standards for nurse anesthesia education in developing countries, yet one of the keys to the standards in global professional practice is competency assurance for individuals. The international nurse anesthesia continuing education project was developed in response to the difficulty that nurse anesthetists in developing countries face in accessing continuing education. The purpose of this project was to develop a nonprofit, volunteer-based model for providing nurse anesthesia continuing education that can be reproduced and used in any developing country.
    Keywords: Continuing education, developing countries, Health Volunteers Overseas, reproducible curriculum.
    Version: 2011;79(6):491-496. Authors: Shawn Bryant Collins, CRNA, DNP
  • Anesthetic Management of a Patient Undergoing an Ex Utero Intrapartum Treatment (EXIT) Procedure: A Case Report In this case report, a parturient presented for an ex utero intrapartum treatment (EXIT) procedure secondary to fetal cystic hygroma. The EXIT procedure involves partial delivery of the fetus with the fetal-placental circulation maintained. This allows for management of the obstructed fetal airway via direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. These complex and often challenging procedures have been performed about 100 times in the United States to date.
    Keywords: Anesthesia, difficult fetal airway, EXIT procedure, ex utero intrapartum treatment, fetal congenital malformations.
    Version: 2011;79(6):497-503. Authors: Abbie J. Choleva, CRNA, MSNA
  • Update for Nurse Anesthetists – Part 5 – Complex Regional Pain Syndrome: A Review of Diagnostics, Pathophysiologic Mechanisms, and Treatment Implications for Certified Registered Nurse Anesthetists The pathophysiologic mechanisms for complex regional pain syndrome (CRPS) are complex and elusive. The proposed etiologic mechanisms for CRPS include inflammatory responses, peripheral or central sensitization, and sympathetic dysfunction. In this course, the authors explain that anesthesia care of patients with CRPS is challenging. Treatments including physiotherapy, peripheral vasodilators, sympathetic blockade, analgesics, and other systemic medications can help optimize mobility, perfusion, and pain relief for affected patients. Discussion includes diagnosis and clinical manifestations, pathophysiologic mechanisms, sympathetic dysfunction, and treatment approaches.
    Keywords: Chronic regional pain syndrome, history, taxonomy, treatment.
    Version: 2011;79(6):505-510. Authors: Daniel Watts, RN, BS Michael Kremer, CRNA, PhD, FAAN