AANA Journal Issue Details

On The Cover

Jeffrey Molter, CRNA, MSN, MBA, performs a peribulbar block, while Barb Finley, RN, retracts the upper eyelid on a patient at Park West Surgical Center, Akron, Ohio. "The patient is about to undergo cataract surgery," said Molter. "Approximately 2,500 cataract and oculoplastic procedures are performed each year at the facility." (Photo taken by Wendy Corcoran, RN)


  • Isobaric Spinal Anesthesia: A Suitable Approach for a Morbidly Obese Patient Morbid obesity is a relatively common and vastly increasing condition that can have a profound impact on morbidity and mortality during the administration and maintenance of general and regional anesthesia. This case report discusses the advantages of regional versus general anesthesia in the morbidly obese patient population, in conjunction with an analysis of the various types of spinal anesthetics. This is followed by a focused discussion related to the management of a morbidly obese patient undergoing a nonelective orthopedic procedure.
    Keywords: Isobaric spinal anesthesia, morbid obesity.
    Version: 2012;80(5):341-344. Authors: Vesna Watters, CRNA, MSNA
  • Awake Video Laryngoscope Intubation: Case Report of a Patient With a Nasopharyngeal Mass Video laryngoscopes have been shown to improve visualization of the glottic opening and have become a useful aid in managing difficult airways. The purpose of this article is to summarize the use of a video laryngoscope for an awake intubation and to suggest alternative uses of these devices in other awake intubation scenarios. The case report presented offers a description of successful awake intubation using a video laryngoscope in a patient with a large pedunculated mass arising from the nasopharynx and extending down into the oropharynx.
    Keywords: Awake intubation, difficult airway, video laryngoscope.
    Version: 2012;80(5):347-353. Authors: Mitch Dotson, CRNA, MSN, ARNP, CCRN
  • Anesthetic Implications of Postpolio Syndrome: New Concerns for an Old Disease Polio vaccines have essentially eradicated the disease in the United States; however, poliovirus infection survivors who experienced a paralytic attack can see a return of some symptoms, which is postpolio syndrome. The authors conclude that the anesthetist must preoperatively assess the patient and be aware of the need to select short-acting anesthetic agents whenever possible and protect the patient because of inherent muscle weakness, painful joints and muscles, cold intolerance, and reduced protective reflexes.
    Keywords: Anesthesia, anesthesia delivery, poliomyelitis, polio virus, postpolio syndrome.
    Version: 2012;80(5):356-361. Authors: Allan Schwartz, CRNA, DDS, Lisa M. Bosch, BS, RDH
  • Ease of Intubation With the Parker Flex-Tip or a Standard Mallinckrodt Endotracheal Tube Using a Video Laryngoscope (GlideScope) Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT) and the standard Mallinckrodt. To the authors’ knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope.
    Keywords: GlideScope, intratracheal, Mallinckrodt endotracheal tube, Parker Flex-Tip endotracheal tube.
    Version: 2012;80(5):363-372. Authors: Brian P. Radesic, CRNA, DNP, MSN Chris Winkelman, RN, PhD Richard Einsporn, PhD Jack Kless, CRNA, PhD
  • A Cesarean Hysterectomy for Invading Placenta Percreta: Anesthetic Safety Considerations – A Case Report Patients presenting with abnormal placentation have a complicated surgical course and a high mortality rate. The author offers a case study of a patient with an invading placenta percreta who presented with a number of risk factors associated with this disease. A review of the current literature yields recommendations for anesthetic management of this challenging and potentially life-threatening obstetric scenario. This case underlines the importance of a well-coordinated multidisciplinary approach to a complex condition.
    Keywords: Anesthesia, cesarean hysterectomies, hemorrhage,pathophysiology, placenta accreta, placenta percreta.
    Version: 2012;80(5):373-378 Authors: Daniel Frasca, CRNA, DNAP
  • Emergency Cesarean Delivery in Primigravida With Portal Hypertension, Esophageal Varices, and Preeclampsia The incidence of cirrhosis and advanced portal hypertension during pregnancy is low, and the literature is scarce with regard to the anesthetic management of a parturient with this coexisting disease. In this case report, the authors discuss the successful perioperative management of a parturient with a history of cirrhosis and portal hypertension with esophageal varices and mild preeclampsia who presented at 38 weeks’ gestation in active labor with a breech presentation requiring emergency cesarean delivery.
    Keywords: Anesthesia, cesarean delivery, cirrhosis, portal hypertension, preeclampsia.
    Version: 2012;80(5):379-384. Authors: Puneet Khanna, MD Rakesh Garg, MD, DNB, MNAMS, FCCS, Kajari Roy, MD, Jyotsna Punj, MD, Ravindra Pandey, MD, Vanlal Darlong, MD
  • Dexmedetomidine Infusion as an Adjunct Anesthetic for Tetralogy of Fallot Repair During a Pediatric Cardiac Mission Trip in Jamaica: A Case Report This case report includes a review of the anatomy and pathophysiology of tetralogy of Fallot, medical and surgical treatments, anesthetic management, as well as global health issues involved in caring for complex cardiac patients in this underserved population. The author concludes that collaboration between pediatric cardiac surgery programs in the United States and developing programs in the Caribbean is vital to the future of a self-sustaining cardiac program that will provide the knowledge and resources to care for these complex cardiac patients.
    Keywords: Cardiac surgery, dexmedetomidine, pediatric, tetralogy of Fallot.
    Version: 2012;80(5):385-391. Authors: Kristen L. Hiscox, CRNA, DNP
  • AANA Journal Course: Update for Nurse Anesthetists – Part 4 – Is That Snoring Something to Worry About? Anesthetic Implications for Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a chronic disease that is underdiagnosed. It is characterized by repetitive pauses in breathing during sleep that can last for several seconds and can subsequently cause hypoxia-related complications. The authors state that patients having diagnostic procedures or surgeries in which sedation or anesthesia will be received should be evaluated for OSA to prevent or reduce postoperative complications. While research into the effects of surgery and anesthesia on sleep and with patients affected by OSA is ongoing, compliance with these recommendations, along with vigilance, will help ensure that many patients with OSA can be managed safely during their surgical experience.
    Keywords: Complications, obstructive sleep apnea, sleep cycle, snoring, STOP-BANG Questionnaire.
    Version: 2012;80(5):393-401. Authors: Bernadette M. Henrichs, CRNA, PhD, CCRN Robert P. Walsh, CRNA, PhD, MBA