On The Cover

John Hanlon, CRNA, MSNA, ARNP, chief nurse anesthetist, Lowell General Hospital (LGH), Lowell, Mass, prepares to intubate a patient. Hanlon said the picture was taken for the purpose of developing an educational presentation for children and adolescents having surgery. Quoting Hanlon: "The anesthesia department at LGH uses the presentation in the pediatric and adolescent patient pre-screen area. Our goal is to continually assist our anesthesia nurse practitioner and members of the anesthesia care team by reducing patients' fears of anesthesia."

Articles

  • Isoproterenol-induced elevated bispectral indexes while undergoing radiofrequency ablation: A case report The use of bispectral index (BIS) for monitoring neuronal function under general anesthesia has been expanding in practice; however, the meanings of the values are not always clear and have been shown to be altered by such drugs as ketamine, ephedrine, and physostigmine. Presented here is a case of elevated BIS values associated with the use of isoproterenol during radiofrequency ablation. This rise in the BIS values appeared to have no correlation to the stimulation produced by the procedure.
    Keywords: Bispectral index, dexmedetomidine, isoproterenol, radiofrequency ablation.
    Version: 2006;74:193-195. Authors: Robert Mathews, CRNA, MSNA
  • Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: Interscalene and intersternocleidomastoid In this research article, the authors conduct a prospective, randomized study to compare differences between groups of patients given a brachial plexus block using an interscalene (IS) or an intersternocleidomastoid (ISCM) approach. The study indicated that using the ISCM approach to achieve brachial plexus blockade may offer several advantages over the IS approach. Such advantages may be beneficial, especially with the continuously increasing trend toward outpatient surgical procedures.
    Keywords: Analgesia, brachial plexus, interscalene, intersternocleidomastoid, regional implications.
    Version: 2006;74:201-206. Authors: LCDR Janet L. Dewees, CRNA, MS, NC, USN LT Cary T. Schultz, CRNA, NC, USN CDR Fred K. Wilkerson, CRNA, MS, NC, USN CDR Joseph A. Kelly, CRNA, MS, NC, USN CDR Andrew R. Biegner, CRNA, MS, NC, USN CAPT Joseph E. Pellegrini, CRNA, DNSc, NC, USN
  • Unintended subdural injection: A complication of epidural anesthesia–A case report Epidural anesthesia is practiced in virtually every clinical setting. Its safety and versatility have supported increasing use for more and varied therapies. In a healthy patient in whom near-complete left hemiparesis developed following a routine continuous epidural anesthetic for labor, subdural deposit of the local anesthetic was suspected. This case report and discussion may help illustrate the mechanism behind this complication and how it can be detected, treated, and, possibly, avoided.
    Keywords: Complications, dura-arachnoid interface, lumbar epidural, unintended subdural injection.
    Version: 2006;74:207-211. Authors: Adrian Kalil, CRNA, BSN
  • Assigning surgical cases with regional anesthetic blocks to anesthetists and operating rooms based on operating room efficiency The popularity of regional anesthesia blocks for intraoperative anesthesia and postoperative pain management supports the inclusion of the administration of regional anesthesia into discussions about operating room (OR) efficiency. This article reviews the literature on OR efficiency with a focus on day-of-surgery decision making. Vignettes show regional anesthesia block placement is a variable that can affect the efficiency of use of OR time. Clinical examples highlight OR management issues and staff assignment decisions on the day of surgery.
    Keywords: Operating room efficiency, operating room management, regional anesthesia, surgical case assignment.
    Version: 2006;74:213-218. Authors: Cormac T. O'Sullivan, CRNA, MSN Franklin Dexter, MD, PhD
  • Anesthesia concerns for children with tuberous sclerosis Tuberous sclerosis (TS) is a relatively rare, autosomal dominant syndrome that displays high genetic penetrance in affected families. In this case report, the authors describe a child with TS scheduled to receive a general anesthetic for laser treatment of facial angiofibromas. The laser procedure was performed, and there were no surgical or anesthetic complications; however, the potential for complications due to TS remained high throughout the provision of anesthesia care. Key words: Anesthesia, Bourneville, children, tuberous sclerosis.
    Keywords: Anesthesia, Bourneville, children, tuberous sclerosis.
    Version: 2006;74:219-225. Authors: Steve Septer, CRNA, MSN Edward S. Thompson, CRNA, PhD, ARNP, FAAN Ann Willemsen-Dunlap, CRNA, PhD
  • Medical therapy to reduce perioperative cardiac complications In this review article, the authors state that some 25 million people in the United States undergo noncardiac surgery each year. About 8 million of these have known cardiac disease, major cardiac risk factors, or are older than 65 years. Therefore, it is not surprising that cardiac complications occur when these patients are subjected to stress during the perioperative period. The article includes discussion of risk-reduction strategies, coronary revascularization, medical therapies, and pulmonary artery catheters.
    Keywords: Beta-blockers, perioperative cardiac complications.
    Version: 2006;74:227-232. Authors: Kevan Kemp, CRNA Darryl Potyk, MD, FACP
  • AANA Journal Course 2 Update for nurse anesthetists Eisenmenger syndrome: An anesthetic conundrum A patient with Eisenmenger syndrome (ES) presents a daunting anesthetic challenge. Already in a debilitated state, physically and emotionally, even the slightest degradations in cardiac and circulatory parameters are greatly magnified, explains the author of this AANA Journal course. The course includes discussion of history, pathophysiology, signs and symptoms, current medical management, complications, anesthetic considerations and management, and monitoring.
    Keywords: Congenital heart defect, Eisenmenger syndrome, pulmonary hypertension, right-to-left cardiac shunt, systemic vascular resistance.
    Version: 2006;74:233-239. Authors: Joseph A. Joyce, CRNA, BS