AANA journal最新文献

Anxiety is a common preoperative occurrence in children having surgery, and it can compromise surgical results, have long-term psychological effects, and lead to future healthcare challenges. In the surgical setting, preoperative anxiety is frequently treated with a combination of pharmaceutical and nonpharmacological interventions. One nonpharmacological approach is the use of virtual reality (VR), a computer-generated environment accessed by headset or goggles. This evidence-based practice initiative utilized VR goggles to address the question: to what degree would previous research on virtual reality distraction in the preoperative area and in the operating room impact preoperative anxiety levels among pediatric patients undergoing surgery at an outpatient surgery center? A preoperative registered nurse assessed and scored the patient for preoperative anxiety utilizing the modified Yale preoperative anxiety scale (mYPAS) tool while a certified registered nurse anesthetist intraoperatively obtained a second mYPAS score. The findings demonstrated how VR goggles utilized preoperatively and intraoperatively improved patients' anxiety with innovative technology indicating that results were clinically and statistically significant.

Buprenorphine's unique pharmacologic profile and safety characteristics make it a first-line treatment for opioid use disorder (OUD). While buprenorphine is increasingly used in opioid dependence treatment, transitioning patients from full opioid agonists to buprenorphine remains a clinical challenge, particularly due to limited familiarity and complexities of induction of buprenorphine in managing OUD. Traditional clinical guidelines recommend initiating buprenorphine following a period of mild-to-moderate prerequisite opioid withdrawal. However, during the transition, inadequate equianalgesic dosing and inappropriate timing and routes of buprenorphine administration may precipitate withdrawal symptoms. Two primary induction strategies, microdosing and bridging, have currently demonstrated success in minimizing withdrawal and improving patient comfort. This journal course examines these two strategies when switching patients from common opioids to buprenorphine. Additionally, this article reviews the pharmacologic mechanisms of buprenorphine, compares the two induction techniques, and explores regulatory and practical considerations with current, evidence-based guidance on initiating buprenorphine in opioid-dependent patients for safer and more effective OUD care.

Breast cancer surgery results in significant postoperative pain. Pectoral nerve blocks (PECS I and II) may lessen the use of opioids during surgery and enhance pain management. This systematic review and meta-analysis assessed the efficacy of PECS blocks compared with placebo in breast cancer surgery. The Cochrane Collaboration, PubMed, CINAHL, Google Scholar, and grey literature were all thoroughly searched. We only included randomized controlled trials (RCTs) that compared PECS I or II blocks to a placebo. Mean differences (MD) and risk ratios (RR) were calculated for primary and secondary outcomes. Meta-analysis was conducted using RevMan 5.4, and evidence was appraised using the GRADE system. Twenty-two RCTs were included. PECS blocks significantly decreased pain scores up to 48 hours after surgery during activity (MD, -1.66) and at rest (MD, -1.38). Additionally, they decreased the use of opioids during surgery (MD, -5.28) and after surgery (MD, -9.82), extended the time until first rescue analgesia (MD, 4.95 hours), and decreased PONV (RR, 0.48) with no effect on chronic pain (RR, 0.40). PECS blocks support their role in multimodal analgesia by improving postoperative pain control, lowering the need for opioids, and promoting recovery following breast cancer surgery.

Dexmedetomidine is known to prolong sensory and motor blockade by local anesthetics. In this study we compared the efficacy of dexmedetomidine given intramuscularly and perineurally as an additive to supraclavicular brachial plexus block. Sixty-two patients requiring upper limb surgeries were randomly assigned to two groups. All patients received 2% lidocaine (10 mL) + 0.5% levobupivacaine (10 mL) + normal saline (5 mL). In the perineural group (PN), 0.5 µg/kg dexmedetomidine was administered perineurally in the block whereas in the intramuscular group (IM), 0.5 µg/kg dexmedetomidine was administered intramuscularly in the blocked arm. Onset and duration of sensory and motor blockade, time taken to request analgesia, sedation, and overall patient satisfaction were noted. Onset of sensory blockade occurred at 5 min in both groups. Onset of motor blockade (mean ± SD) occurred at 16.93 ± 6.91 min and 17.25 ± 6.93 min, in Group PN and Group IM, respectively. Sensory blockade (mean ± SD) lasted for 773.71 ± 222.6 min and 701.29±233.34 min, while motor blockade (median) lasted for 275 and 300 min in Group PN and Group IM, respectively. The onset and duration of blockade were comparable between the two groups. Onset and duration of brachial plexus block are comparable whether dexmedetomidine is given perineurally or intramuscularly as an adjunct to local anesthetic.

As the number of individuals identifying as transgender and gender nonbinary (TGNB) rises, the amount of TGNB patients requiring surgery increases in tandem. However, there are gaps in proficiency for certified registered nurse anesthetists and anesthesiologists which, compounded by a dearth of literature on TGNB-focused perioperative education, limit curricular implementation. Given the important need for improved perioperative care of TGNB patients, this study evaluates the impact of providing a 50-minute lecture to first-year resident registered nurse anesthetists (RRNAs) and second-year anesthesiology residents regarding their attitude, comfort, and perceived ability to care for TGNB patients. Participants completed prelecture and postlecture surveys, which were analyzed descriptively and using either chi-square tests or Fisher's exact tests. Based on our results, improvements were identified in areas such as the participants' understanding of TGNB patients' feelings, comfort interacting with TGNB patients, comfort in addressing transphobia, and perceived ability to care for TGNB patients. These results highlight the positive impact of TGNB-focused education on RRNAs and anesthesiology residents and emphasizes the importance of integrating instruction into anesthesia curricula.

The purpose of this study was to explore lived experiences of certified registered nurse anesthetists (CRNAs) regarding anesthesia provision. This was a phenomenological qualitative study conducted using a Heuristic Inquiry approach. One-on-one interviews were conducted with 17 American Association of Nurse Anesthesiology (AANA)-member CRNAs responding to an invitation sent by the AANA. The interview explored the attitudes, understandings, and opinions each CRNA held regarding their anesthesia provision behaviors. Interview questions were based on the Integrated Behavior Model (IBM). The IBM posits that intentional behaviors in a phenomenon are influenced by constructs of attitudes, beliefs, and personal agency. Analysis using the Colaizzi strategy method identified themes in three areas: 1) participant-identified important components of anesthesia provision (skills, clinical knowledge, vigilance, permeated trust); 2) feelings or attitudes experienced (performance quality, value, confidence); 3) agency beliefs held (provision ability, personal commitment, personal fulfillment). The study also revealed the theme of 'empowerment' as the meaningful essence of anesthesia provision by CRNAs. Beliefs that CRNAs hold regarding anesthesia provision, feelings about their provision of anesthesia, and beliefs about their ability to perform important anesthesia components are affected by empowerment or disenfranchisements they experience in anesthesia provision.

Obstetric anesthesia is an important subspecialty of anesthesia requiring specialized training to meet the distinctive needs of maternal care. Variations in obstetric anesthesia education create deficiencies for some nurse anesthesiologists upon graduation. The purpose of this study was to evaluate incorporating dedicated obstetric anesthesia rotation for nurse anesthesia residents at a northeastern university, focusing on training outcomes, preparedness, and perceptions of obstetric anesthesia as a subspecialty. Certified registered nurse anesthetists (CRNAs) graduated between 2018 and 2023 received a survey. Two groups were analyzed: with and without the obstetric rotation. The survey assessed clinical experience, obstetric anesthesia preparedness, and perceptions of obstetric anesthesia as a specialty using Likert-scale questions and open-ended feedback. Numerical data were analyzed using descriptive statistics, paired t-tests, and graphical representation. CRNAs with the obstetric rotation reported significantly fewer challenges meeting minimum epidural requirements, higher confidence in managing obstetric cases, and greater recognition of the importance of the training. In contrast, CRNAs without the rotation highlighted deficiencies in epidural training. An obstetric rotation is important to instill the confidence necessary for CRNAs to achieve full scope of practice capabilities. In addition to an obstetric specialty rotation, recommendations include advocacy for CRNA training, a focus on obstetric anesthesia subspecialty development, and access for educators to resources assisting in creating this rotation.