AANA Journal Issue Details

On The Cover

Please be sure to see p. 184 for the compelling story behind this month's cover image of LTC Benjamin Riley, MNA, CRNA, ANC, USA.


  • Effects of Midazolam on Postoperative Nausea and Vomiting and Discharge Times in Outpatients Undergoing Cancer-Related Surgery Midazolam, a short-acting benzodiazepine used for preoperative anxiolysis, may also have pharmacologic properties that could further reduce the incidence of postoperative nausea and vomiting in high-risk patients when included in a multimodal antiemetic protocol. However, concerns remain that the sedating properties of midazolam will delay discharge after short outpatient procedures. A retrospective data analysis (N = 4,057) investigated effects of midazolam on postoperative antiemetic administration and length of stay following cancer-related outpatient procedures over 15 months.
    Keywords: Benzodiazepine, cancer, midazolam, outpatient, postoperative nausea and vomiting.
    Version: 2019;87(3):179-183. Authors: Jennifer R. Majumdar, MSN, CRNA; Emily Vertosick, MPH; Michael Long, DNP, CRNA; Christian Cansino, DNP, CRNA, FNP; Melissa Assel, MPH; Rebecca Twersky, MD, MPH
  • Beach Chair Position in a Patient With Subclavian Steal Syndrome and Axillary Lymph Node Dissection: A Case Report This patient’s history, combined with the necessary surgical positioning and calf blood pressure monitoring, raised the concern of decreased cerebral perfusion during a general anesthetic in the beach chair position. This report describes the management of this particular case, then reviews the relevant literature regarding cardiovascular and cerebral perfusion monitoring.
    Keywords: Axillary lymph node dissection, noninvasive cardiovascular monitoring, shoulder arthroscopy sitting position, subclavian steal syndrome.
    Version: 2019;87(3):185-191. Authors: Capt David J. Krasucki, DNP, CRNA, USAF, NC
  • Use of Near-Infrared Spectroscopy to Measure Tissue Oxygen Saturation During Total Knee Arthroplasty With Use of a Tourniquet The primary purpose of this proof-of-concept quality improvement effort was to evaluate the practicality of using near-infrared spectroscopy (NIRS) to measure tissue oxygen saturation (Sto<sub>2</sub>) during total knee arthroplasty (TKA) with use of a tourniquet. The NIRS sensors were applied to the biceps femoris and gastrocnemius muscles of both lower extremities of patients undergoing TKA procedures.
    Keywords: Near-infrared spectroscopy, tissue oxygen saturation, total knee arthroplasty, tourniquet.
    Version: 2019;87(3):192-198. Authors: Riley R. Gaines, DNP, CRNA; Andi N. Rice, DNP, CRNA; Jeffrey C. Gadsden, MD, FRCPC, FANZCA; Brett T. Morgan, DNP, CRNA; Charles A. Vacchiano, PhD, CRNA, FAAN
  • Single Dose of Ketamine During Kyphoplasty Procedures Does Not Reduce Postoperative Narcotic Consumption This study aimed to explore the study institution’s intraoperative ketamine use during kyphoplasty and compare narcotic requirements in patients who received intraoperative ketamine with those who did not.
    Keywords: Intraoperative narcotic consumption, ketamine, kyphoplasty, postoperative narcotic consumption, postoperative pain.
    Version: 2019;87(3):199-204. Authors: Seth M. Sharp, MSN, RN, CRNA; Elisha A. Chance, BSAS, CCRC; Torin Karsonovich, DO; Steven Cubbison, DO; Kene T. Ugokwe, MD
  • Burnout and the Nurse Anesthetist: An Integrative Review The rapid changes in the US healthcare system have resulted in collateral damage to many healthcare providers. Many of these changes have increased demands placed on providers, resulting in high prevalence rates of burnout throughout various healthcare specialties. The purpose of this integrated review was to examine, discuss, and synthesize the burnout construct related to CRNAs practicing in the United States.
    Keywords: Burnout, CRNA, interventions, measurement.
    Version: 2019;87(3):205-213. Authors: Brian Del Grosso, MS, CRNA; A. Suzanne Boyd, PhD, MSW
  • Role of Alveolar-Arterial Gradient in Partial Pressure of Oxygen and Pao2/Fraction of Inspired Oxygen Ratio Measurements in Assessment of Pulmonary Dysfunction Assessment of pulmonary dysfunction is vital to anesthetists. Measurements including the gradient between the alveolar partial pressure of oxygen (PAo2) and the arterial partial pressure of oxygen (Pao2), called the PAo2 - Pao2, and the ratio of the Pao2 to the fraction of inspired oxygen (FIo2) (Pao2/FIo2 ratio) are useful in determining the extent of acute lung injury.
    Keywords: PAo2 - Pao2, Pao2/FIo2 ratio, pulmonary dysfunction.
    Version: 2019;87(3):214-221. Authors: David E. Harris, PhD, RN; Maribeth Massie, PhD, MS, CRNA
  • Use of Nalbuphine for Treatment of Neuraxial Opioid-Induced Pruritus: A Systematic Review and Meta-Analysis Opioid-induced pruritus is prevalent after neuraxial administration of opioid. Although large studies are needed to decrease heterogeneity across studies, the current review showed that nalbuphine appears to reduce the incidence of opioid-induced pruritus.
    Keywords: Epidural, morphine, nalbuphine, opioid-induced pruritus, spinal.
    Version: 2019;87(3):222-229. Authors: Tito D. Tubog, DNAP, CRNA; Jennifer L. Harenberg, MS, CRNA; Kristina Buszta, MSN, CRNA; Jennifer D. Hestand, MSNA, CRNA
  • Anesthesia Exposure in the Young Child and Long-term Cognition: An Integrated Review Anesthetic agents have been shown to cause detrimental effects on brain cell survival and cognitive function in animals. As a result, the safety of general anesthetics in children is an active field of investigation. The objective of this review is to evaluate the human research on anesthesia neurotoxicity in the young child.
    Keywords: General anesthesia, neurotoxicity, pediatrics.
    Version: 2019;87(3):231-241. Authors: Audrey Rosenblatt, MSN, CRNA; Michael Kremer, PhD, CRNA, CHSE, FNAP, FAAN; Barbara Swanson, PhD, RN, FAAN; Ravi Shah, MD
  • AANA Journal Course: Update for Nurse Anesthetists—Clarifying the Confusion of Adult Emergence Delirium Researchers studying emergence delirium in adults have not adopted a consensus on the terminology for the phenomenon, a formalized definition, a measurement tool or standardized differential diagnosis to distinguish emergence delirium from postoperative delirium, anticholinergic or serotonergic toxicities, and other physiologic issues that may present on emergence from anesthesia. Information from an integrative review of the literature in conjunction with a Delphi study was used to develop a standardized differential of similarly presenting phenomena to assist clinicians.
    Keywords: Adult, differential diagnosis, emergence delirium.
    Version: 2019;87(3):243-251. Authors: Col Shawna Greiner, PhD, CRNA, USAF, NC; Michael J. Kremer, PhD, CRNA, CHSE, FNAP, FAAN