AANA journal最新文献

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disorder characterized by the accumulation of surfactant/lipoprotein material in the alveoli and subsequent hypoxemic respiratory failure. Whole lung lavage (WLL), a procedure used to physically remove the lipoprotein material from the alveoli, is the first-line treatment for this disease process. Anesthesia providers may infrequently encounter the management of the WLL procedure due to the rarity of the underlying disease process. Pertinent anesthesia considerations for WLL are covered in the following case report. A review of the literature examines the pathophysiology of PAP, the various approaches to WLL, and the physiologic implications of WLL.

Obstetric difficult airway management has emerged as a critical safety issue, and unsuccessful intubation can lead to morbidity and mortality. A literature review of difficult and failed obstetric intubations from the 1970s to 2015 shows that the incidence of failed intubation is unchanged, remaining at one per 390 anesthetics. Our obstetric case report highlights an obstetric difficult airway secondary to limited mouth opening; rescue of the airway with an i-gel®; and establishment of a definitive airway with the aid of an Aintree intubation catheter and flexible fiberoptic scope-guided intubation through the i-gel®, a second-generation supraglottic airway.

Workforce shortages influence all areas of healthcare including healthcare education. While recruitment and retention are known barriers within academia, the factors associated with the nurse anesthetist's transition from clinician to academics are unknown. The purpose of this scoping review was to identify factors that affect the transition from nurse anesthesia clinical practice to academia. A scoping review was conducted using the framework of Arksey and O'Malley. The search was performed using MEDLINE and CINAHL databases. Review selection was performed by two teams of two independent reviewers and summary of findings input into a comprehensive table. The search identified 733 articles published from 2014 to May 2023. Reviews were limited in nurse anesthesia and mainly consisted of alternate nursing specialties. Seven themes were extrapolated from the findings including mentorship (82%), orientation (47%), work-life balance (41%), early identification and empowerment (18%), formal pedagogical training (41%), faculty compensation (29%), and alternative faculty positions (23%). The review overwhelmingly revealed educator strategies available for undergraduate nursing, nurse practitioners, and midwifery, but not for nurse anesthetists. To gain a more robust knowledge of this current issue, additional research is required to educate, support, inform, and evaluate the current nurse anesthesia transition to academia process.

Acute promyelocytic leukemia (APML), a rare disease encountered during pregnancy, is associated with high mortality secondary to consumptive coagulopathy and fatal bleeding diathesis. It usually presents as a medical emergency and warrants prompt diagnosis and treatment to improve maternal survival. This case report details a 19-year-old female with new onset APML who presented for emergency cesarean section because of respiratory distress and suspected placental abruption. Antifibrinolytics, which are commonly utilized to treat postpartum hemorrhage, were contraindicated because the patient was receiving all transretinoic acid (ATRA) therapy for APML. This case adds insight into the disease and its management along with anesthesia considerations for patients undergoing emergent caesarean delivery in the setting of acute disseminated intravascular coagulation and ATRA therapy. It also highlights the importance of a multidisciplinary team approach to plan for treatment and timing of delivery that balances the risk of disease progression and fetal well-being. Such multidisciplinary care and proper planning helped in attaining the best possible outcomes for both mother and baby.

Aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted neurosurgical emergency with cardiopulmonary complications. Concurrent atrial fibrillation seen commonly in the geriatric population further challenges perioperative management. Osmotherapeutic agents such as mannitol are routinely used in SAH to decrease intracranial pressure by withdrawing water from the brain parenchyma into the intravascular space. However, mannitol also has the potential to cause myocardial dysfunction and exacerbation of arrhythmias like atrial fibrillation in geriatric patients with decreased cardiovascular reserve. The literature on goal-directed fluid therapy and transesophageal echocardiography (TEE)-guided intraoperative management of a case of atrial fibrillation is sparse. This case report highlights the role of mannitol in the potentiation of arrhythmias like atrial fibrillation which was then successfully managed using goal-directed fluid therapy and TEE leading to a favorable outcome.

A 65-year-old male patient presenting with idiopathic, intractable hiccups was to undergo bilateral thoracotomies for phrenic nerve stimulator placement but initially underwent a treatment utilizing the administration of prescriptive positive pressure ventilation as a less invasive treatment option and had successful resolution of hiccups. The patient's hiccups began after a prior hiatal hernia repair and was refractory to pharmacologic treatment and phrenic nerve blocks. Utilizing neuromuscular blockade for diaphragm paralysis and administering three vital capacity breaths to peak inspiratory pressures of 25 cm H2O via endotracheal tube, the patient had successful resolution of symptoms and further surgical intervention was not warranted.

The purpose of this study was to explore the experience of certified registered nurse anesthetists (CRNAs) choosing to quit their primary place of employment. Interpretative phenomenological analysis is the qualitative framework for this study. Ten CRNAs were interviewed about their experience of quitting their job. Interview transcripts were analyzed for common themes. Common themes were the desire for better work-life fit, the impact of stressful work intensity, and exposure to poor leadership. This study suggests that a focus on ensuring job fit for personal goals outside of work may improve CRNA retention. This study also provides practice implications for hospital leadership, as well as direction for future qualitative and quantitative research.

Pediatric patients who undergo spinal corrective surgery often require multiple blood product transfusions. The use of antifibrinolytics, especially tranexamic acid (TXA), to mitigate intraoperative blood loss has increased in popularity. The goal of this quality improvement project was to evaluate provider compliance with a TXA dosing protocol during pediatric corrective spine procedures. A retrospective chart review was conducted to compare pre- and postimplementation data on cell saver and packed red blood cell (PRBC) administration and dose of antifibrinolytic administered. A total of 486 patients (68% idiopathic and 32% neuromuscular) were evaluated over a 9-year period. Following implementation of the protocol, patients of idiopathic origin experienced a 20% reduction in cell saver administration, a 10% reduction in PRBC administration, and a 37% increase in provider compliance with the dosing protocol. Patients of neuromuscular origin experienced a 53% increase in provider compliance with the recommended TXA dosing protocol; however, this patient population did not experience a statistically significant reduction in transfusion requirements. Implementation of an antifibrinolytic protocol can facilitate compliance with recommended TXA dosing parameters and potentially decrease intraoperative blood loss, reducing blood product transfusion requirements.

The COVID-19 pandemic impacted all aspects of healthcare, including the education of certified registered nurse anesthesiologists. While the literature contains reports of the impact of COVID-19 on physician anesthesiologist faculty, there was no research identified describing the impact on nurse anesthesiologist faculty. The purpose of this study was therefore to describe and explore the impact of the COVID-19 pandemic on nurse anesthesiology faculty. This qualitative ethnographic study used small focus groups and semistructured and probing questions to examine the phenomenon of interest. Through thematic analysis of the narrative, five overarching themes were identified: 1) ability to adapt to adversity, 2) disruption leads to change, 3) perceived positive outcomes, 4) previously untapped resources, and 5) curricular innovation and integrity.