AANA journal最新文献

Hypoxemia and related complications are the leading adverse events during an anesthetic in neonates and infants younger than 60 weeks postconceptual age. This risk is more prominent during induction of anesthesia. A preoperative assessment and plan should be made for both management of an uncomplicated anesthesia induction and the unexpectedly difficult airway. Developmental anatomy and physiology contribute to a higher incidence of unexpected difficult bag mask ventilation, intubation, and cannot intubate, cannot oxygenate situations. This has driven the advancement of oxygen delivery methods, size-specific airway equipment, and comprehensive pediatric-based difficult airway algorithms and cognitive aids. Recommendations for the future include increased education, training, and standardization of care. A specialized clinical approach to efficiently secure the infant airway and mitigate rapid onset of hypoxemia is key. Limitations to our study results include cost of equipment and implementation, but quality and strength of supporting evidence is robust.

Previous studies have shown that higher emotional intelligence (EI) leads to lower incidence of burnout in clinical healthcare workers. However, there are currently no published studies that explore this relationship in anesthesia providers. This study aimed to investigate 1) whether anesthesia providers with higher EI were less likely to meet burnout criteria, and 2) whether demographic factors played a role in likelihood of burnout. In this study, 21 certified registered nurse anesthesiologists, 23 physician anesthesiologists, and six anesthesiologist assistants completed the 16-item Wong and Law Emotional Intelligence Score and the 16-item Oldenburg Burnout Inventory. T-test analysis was used for data interpretation to answer the emotional intelligence and burnout relationship proposed by the study. A statistically significant correlation was found between higher EI and lower incidence of burnout (P = .022). No statistically significant relationships were found between demographic variables and rates of burnout. Burnout is a tremendous issue among anesthesia providers, and further exploration into the influence of emotional intelligence on burnout may be instrumental to decreasing burnout incidence.

This research focused on the perspectives of certified registered nurse anesthetists on practice within the anesthesia care team (ACT) model. This narrative, qualitative study examined participants' perspectives on the strengths, challenges, conflict resolutions, and any other information they provided about working in the ACT model. The participants drew sharp distinctions between the supervision requirement of the ACT and that of collaboration with a team approach. The participants reported that they enjoyed and supported collaboration and found that the team approach led to efficient patient care while having extra hands to help and minds to problem-solve complicated patient scenarios. They did not believe physician supervision over their practice was necessary and proved burdensome. They further reported that they often relied on collaboration, accommodation, or compromise to resolve decision-making conflicts when they practiced within the ACT. However, several reported avoiding or leaving the ACT care model for independent practice. Participants who left ACTs reported that they were much happier with their profession and would never return to the ACT model. The recommendations from this study include discontinuing supervision of their practice while strengthening collaboration, a change in payment structure for anesthesia services, and reformed hospital credentialing. They believe that these recommendations would facilitate the full scope of practice and work independently to deliver the high-quality anesthesia care they trained for.

Anesthesia-related studies have found that many adverse events are related to human factors including occupational burnout, safety culture, and production pressure. The purpose of this study was to explore the relationships between those factors to identify potential interventions to improve patient safety and anesthesia practice. This exploratory study used a cross-sectional design with a survey administered via e-mail to nurse anesthetists. The survey consisted of the Survey on Patient Safety, Maslach's Burnout Inventory, and the NASA task-load-index. Data analysis included linear mixed regression models, Spearman correlations, and Cronbach's alpha. Covariates included age, years of clinical experience, zip codes, and gender. We found that the best predictors of patient safety are hospitals' culture of safety and staffing patterns. Adequate staffing had the largest impact on reducing occupational burnout and nurse anesthetists' intentions to leave their jobs. Less experienced nurse anesthetists reported lower patient safety scores. Successful interventions to improve institutional factors need to be implemented and supported by management with an emphasis on open communication among all team members to elicit lasting changes. Additionally, interventions should focus on appropriate staffing, team training, and resilience training because these have the greatest impact.

To improve dynamic needle-tip visualization, nurse anesthesiology students were evaluated during simulated ultrasound-guided procedures. This quasiexperimental study utilized two computed tomography 3D printed models. Thirty-two students performed each procedure twice, once without and once with needle guidance. Measures focused on accuracy and procedural performance to determine the impact that guidance versus no guidance had on attempts. Students evaluated their experiences, self-confidence, feasibility, and usability using needle guidance technology. Needle guidance improved the distance to target, total procedure time, phantom penetration time, number of attempts, completion rate, and effectiveness in both procedures. Overall, a decrease in distance to target in millimeters was uncovered when needle guidance was utilized (Z = -5.723, P < .001). Needle guidance showed a decrease of 3.96 attempts when guidance was utilized for the infraclavicular (F[1, 22] = 51.79, P < .001) and 0.96 attempts during the thoracic paravertebral procedure (F[1, 22] = 6.02, P = .023). Students found that needle guidance enhanced ease, speed, and overall performance, while feeling significantly more confident performing the infraclavicular (P < .001) and thoracic paravertebral (P < .001) procedures. The use of needle guidance technology showed improvement in accuracy comparable with results obtained using external tracking technology.

People with alternating hemiplegia of childhood undergoing general anesthesia are at risk for severe complications including critical bradycardia and hemiplegic incidents. We performed a 10-year historical cohort study and completed a subgroup analysis of patients who specifically underwent general anesthesia. Patients with ATP1A3 positive variants were compared with those without such variants. The 14 patients reviewed underwent general anesthesia a combined total of 39 times. Two patients had a short QTc documented prior to anesthesia and presented with bradycardia in the recovery room. Two other patients experienced a suspected seizure and hemiplegic incident; one of those patients received no facility-administered medications prior to experiencing a hemiplegic incident, and the other experienced a hemiplegic incident on emergence from anesthesia with subsequent cardiac arrest and successful resuscitation. No apparent association was identified between type of anesthesia and the development of bradycardia or hemiplegic incidences. Of the four patients experiencing critical events, three had the ATP1A3-D801N variant. Although additional research is necessary to confirm such associations, patients with alternating hemiplegia of childhood, specifically the ATP1A3-D801N variant, appear to be at elevated risk for complications associated with general anesthesia, suggesting the need for an increased anticipation of complications for this population.

Fetomaternal outcomes and anesthetic management of pregnancy have rarely been described in a prospective cohort of women with Ebstein's anomaly. Therefore, due to the scarcity of data, diagnostic approaches and obstetric and anesthetic management plans are still evolving. In this prospective observational study, we describe the anesthetic management and fetomaternal outcomes of seven women with different grades of unrepaired Ebstein's anomaly. All women were in NYHA (New York Heart Association) Class II, none had cyanosis or cardiac decompensation at the time of admission during pregnancy. Pregnancy was uneventful except in one woman who developed pulmonary oedema. Two women developed supraventricular arrhythmia in the postpartum period. Six women underwent vaginal or assisted vaginal delivery, while one woman underwent cesarean delivery due to the transverse lie of the fetus. All mothers returned to NYHA Class I at 6 weeks follow up. In conclusion, pregnancy increases the risk of maternal complications in asymptomatic women with Ebstein's anomaly. Therefore, preoperative functional and echocardiographic risk stratification is crucial for prepregnancy counseling. Intrapartum and postpartum surveillance, prompt diagnosis of complications, and appropriate management in multidisciplinary hospital settings are associated with favorable fetomaternal outcomes.

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.