On The Cover

Susan Parry McMullan, CRNA, MSN, chief nurse anesthetist at Hinsdale Anesthesia Associates, Hinsdale, Illinois, uses trans­esophageal echocardiography to evaluate pre­operative heart function in a patient scheduled for coronary artery bypass graft surgery. McMullan is director of region 2 of the Illinois Association of Nurse Anesthetists. She is a doc­toral student at Rutgers, The State University of New Jersey, and a didactic instructor in the Rosalind Franklin University of Medicine and Science, Nurse Anesthesia Program, North Chicago, Illinois. (Photo taken by John Wheeler.)

Articles

  • Anesthetic Management of a Pregnant Patient With an Automatic Implantable Cardioverter-Defibrillator: A Case Report There is little data currently available for the obstetric anesthetist to use as a reference for the anesthetic management of laboring women with automatic implantable cardioverter-defibrillators (AICDs). This case report involves a parturient with an AICD and a history of serious cardiac events. The information contained in this case report may be used by anesthesia providers in the obstetric suite confronted with this unique subset of patients that require in-depth anesthetic management. A review of the literature that contains information on safe and effective anesthesia used for laboring women with AICDs is described.
    Keywords: Arrhythmia, automatic implantable cardioverter-defibrillator (AICD), epidural, pregnancy.
    Version: 2009;77(1):29-32. Authors: Sunny Yost, CRNA, MSN Blake McDonald, CRNA, MSN Manuel Vallejo, DMD, MD
  • Investigation of the Anxiolytic Effects of Luteolin, a Lemon Balm Flavonoid in the Male Sprague-Dawley Rat The purpose of this study was to investigate the anxiolytic effects of luteolin and its potential interaction with the gamma-aminobutyric acid (GABAA) receptor in male Sprague-Dawley rats. Lemon balm has traditionally been used as an herbal remedy in the treatment of many medical conditions, including anxiety. Luteolin is a major component of the essential oil lemon balm. The data suggest that luteolin does not produce anxiolysis by modulation of the GABAA receptor; however, luteolin may modulate motor movements and locomotion.
    Keywords: Anxiolysis, elevated plus-maze, lemon balm, luteolin, rat.
    Version: 2009;77(1):33-36. Authors: CPT Terry Raines, CRNA, MSN, ANC, USA CPT Paul Jones, CRNA, MSN, ANC, USA CPT Naomie Moe, CRNA, MSN, ANC, USA CPT Robert Duncan, RN, BSN, ANC, USA Suzanne McCall LTC Thomas E. Ceremuga, CRNA, PhD, ANC, USA
  • Acute Hypotension in a Patient Undergoing Posttraumatic Cervical Spine Fusion With Somatosensory and Motor-Evoked Potential Monitoring While Under Total Intravenous Anesthesia: A Case Report Recent advances in neurological, intraoperative monitoring techniques have allowed Certified Registered Nurse Anesthetists to assess the effects of spinal cord ischemia and compression as they occur. This case report describes a young, healthy man who sustained a cervical spine fracture and was scheduled for anterior spinal fusion with somatosensory and motor-evoked potential (MEP) monitoring while under total intravenous anesthesia. The patient experienced a brief period of intraoperative hypotension with evidence of abnormal MEPs. A wake-up test was performed, which showed normal functioning, and the case resumed an uneventful course.
    Keywords: Cervical fusion, hypotension, motor-evoked potential, somatosensory evoked potentials, total intravenous anesthesia.
    Version: 2009;77(1):38-41. Authors: David F. Cann, CRNA, MS
  • Perceived Deprivation in Active Duty Military Nurse Anesthetists There is a shortage of military Certified Registered Nurse Anesthetists (CRNAs). Relative deprivation is a perception of unfairness due to discrepancies between what one has and what one could or should have that is dependent on feelings and facts. Feelings of relative deprivation could contribute to the military CRNA shortage. The purposes of this study were to measure relative deprivation in active duty military CRNAs and explore variables that correlate with relative deprivation. Further research is indicated to identify definitive factors that can be modified to improve feelings of deprivation as they relate to retention and recruitment of military CRNAs.
    Keywords: Military nurse anesthetists, nurse anesthesia workforce, relative deprivation, retention.
    Version: 2009;77(1):42-48. Authors: Julie A. Pearson, CRNA, PhD, CAPT(ret), NC, USNR Michael D. Fallacaro, CRNA, DNS Joseph E. Pellegrini, CRNA, CAPT(ret), PhD, NC, USN
  • Factors at Admission Associated With 4 Months Outcome in Elderly Patients With Hip Fracture The purpose of this descriptive cohort study was to describe patients with hip fracture on the basis of ASA physical status and to identify preoperative risk factors associated with postoperative outcome up to 4 months after surgery. Data were collected prospectively through the Swedish National Hip Fracture and Anesthetic registers and retrospectively from medical and nursing records. Risk factors for a poorer 4-month survival after hip fracture were ASA physical status 3 and 4, more extensive fractures, 85 years or older, male sex, and dependency in living. Elderly patients with hip fracture should be identified immediately at admission regarding risk factors leading to a poorer survival and more complications.
    Keywords: ASA physical status, complications, mortality, preoperative, postoperative confusion.
    Version: 2009;77(1):49-58. Authors: Karin B. Björkelund, RNANIC, PhD Ami Hommel, RN, PhD Karl-Göran Thorngren, MD, PhD Dag Lundberg, MD, PhD Sylvia Larsson, RNAN, PhD
  • Update for Nurse Anesthetists—Part 6—Should I Continue or Discontinue That Medication? Patients are admitted for surgery while taking a wide array of medications, and nurse anesthetists must evaluate their effectiveness and compatibility with anesthesia. Anesthetists must be familiar with the basic pharmacology of each drug and the potential adverse effects and possible drug interactions that may occur when anesthetic drugs are administered. If a medication requires discontinuation, it must be ensured that the patient’s disease remains controlled throughout the perioperative period. This course reviews the current literature regarding the anesthetic management of several commonly encountered drug classes.
    Keywords: Anticoagulants, antidiabetic medication, cardiovascular drugs, preoperative medications, thyroid medications.
    Version: 2009;77(1):59-73. Authors: John Nagelhout, CRNA, PhD, FAAN Sass Elisha, CRNA, EdD Edward Waters, CRNA, MN