AANA journal最新文献

Colonoscopy procedures are common, low-risk, outpatient procedures generally performed under monitored anesthesia care. Air emboli typically occur with patients with larger high-risk surgical procedures at critical points during the case. Asystole events can occur in the operating room for various reasons based on the surgical procedure or patient comorbidities. This case report describes asystole at the end of a colonoscopy that led to the presumptive differential diagnosis of air embolism.

This integrative review evaluated current evidence on the use of lidocaine for the prevention and treatment of inflammation secondary to pulmonary aspiration of gastric contents. A comprehensive search of CINAHL, PubMed, and Embase was conducted for English-language studies published between 2014 and 2025, with the final search completed on May 5, 2025. Eligible studies included animal, human, and in vitro research that investigated the anti-inflammatory effects of intravenous lidocaine treatment for acute lung injury. Exclusion criteria were non-English publications, case reports, and studies that took place prior to 2014. Lidocaine appears to mitigate inflammatory lung injury through several mechanisms: antagonism of the P2X7 receptor, upregulation of SOCS3 protein, reduction of reactive oxygen species, and inhibition of NETosis. These effects contribute to a decrease in the inflammatory cascade following aspiration events. As research continues to expand the understanding of the different clinical applications of lidocaine, it may demonstrate promise in the prevention and treatment of pulmonary aspiration. Clinical judgment should always be used to assess patient-specific factors and ensure safe administration. Reliance on in vitro and animal studies limit the results of this review to be generalized to human subjects, therefore future research should be more inclusive of human trials.

A 10-year-old female with a history of a complete C2 fracture, tracheostomy, and ventilator dependence, presented for a T2 to pelvis posterior spinal fusion. She encountered airway obstruction causing rising end-tidal CO₂ (ETCO₂), mild oxygen desaturation, and increased peak inspiratory pressures to obtain adequate tidal volumes. Airway suctioning was not successful. A fiberoptic scope was utilized to assess the obstruction and check the position of the endotracheal tube, revealing hard secretions that were resistant to removal. A vibrating mesh nebulizer (VMN), which was already connected to the anesthesia circuit from an albuterol treatment administered to the patient shortly after intubation, was used to administer 2 cc of normal saline. The nebulized saline successfully loosened the thick secretions enough to enable suctioning of the mucous plug. The ETCO₂ and ventilation parameters normalized after intervention. This case illustrates the benefits of the fine mist generated by a VMN using only saline in managing airway secretion buildup unable to be cleared by conventional means.

Separation from cardiopulmonary bypass (CPB) is a critical phase of cardiac surgery, particularly in patients with pulmonary hypertension and right heart failure. Milrinone, a phosphodiesterase inhibitor, is often used to support right ventricular function. While intravenous milrinone improves contractility and reduces pulmonary vascular resistance, its systemic vasodilatory effects may exacerbate hypotension. Inhaled milrinone has emerged as a targeted alternative, delivering pulmonary vasodilation without systemic hypotension. We report the case of a 55-year-old male undergoing aortic valve replacement and left atrial appendage ligation who successfully separated from CPB after receiving inhaled milrinone. Improvement in pulmonary artery pressures, central venous pressure, and cardiac output contributed to a smooth postoperative course.

This study explores the clinical decision-making processes of certified registered nurse anesthetists (CRNAs) in the operating room, focusing on how their practice is shaped by clinical experience, education, interprofessional relationships, technology, psychological states, and ethical considerations. Using a qualitative, descriptive, and exploratory design, semistructured interviews were conducted with 10 CRNAs from public and private hospitals in France. Data were analyzed inductively through thematic analysis, following Braun and Clarke's framework. Six major themes emerged: clinical responsibility and patient safety, experience and intuition, collaboration with anesthesiologists, psychological and emotional influences, technology use, and ethical values. Participants emphasized that decisions are grounded in patient safety and shaped by trust-based collaboration with anesthesiologists. Experience was identified as a key factor enabling intuitive and rapid decision-making. Stress, tiredness, and emotional load were reported as affecting cognitive performance, while technology was viewed as a supportive but secondary tool. Ethical dilemmas, such as end-of-life care or treatment refusal, further influenced decision-making in complex contexts. The study concludes that CRNA decision-making is a multidimensional and context-sensitive process that relies on both individual expertise and relational dynamics. These findings support the need for continued simulation-based education, interprofessional training, and structured ethical reflection in anesthesia practice.

Despite rising numbers of certified registered nurse anesthetists and student registered nurse anesthetists (SRNAs) in the United States, engagement in state professional organizations has declined. To address this problem, the diffusion of innovation theory was applied to a quality improvement project. The student representative role within the state professional organization was enhanced by developing a toolkit and explicit expectations for the role. A pretest/posttest survey was distributed via email to SRNAs from three SRNA university programs within the state. SRNAs were assessed through the survey on engagement, beliefs, and attitudes. Additionally, engagement metrics including meeting attendance, and Midyear Assembly sponsorship applications were assessed. Utilizing Microsoft Excel for data analysis, we observed an increase in SRNA understanding of the professional organization's purpose (P = .02). Increased attendance at organizational events and sponsorship applications were shown. Our findings also highlight key barriers to engagement among SRNAs, including time conflicts (22.6%), cost (20.2%), and limited interest in the types of organizational events offered (20.8%). Enhancing the student representatives' role through explicit expectations and a toolkit successfully resulted in boosting SRNA engagement.

Adverse events may cause emotional distress among clinicians. Negligence claims compound this stress, leading to emotional effects such as litigation stress syndrome. Repercussions of being named in a claim extend beyond the individual, affecting interpersonal relationships. There is a notable gap in research regarding the lived experiences of certified registered nurse anesthetists named in negligence claims. Eleven participants were recruited via social media who completed a demographic survey and were interviewed for up to 60 minutes. Data were coded through in vivo coding using thematic analysis. Forty six percent reported experiencing a patient death, 18% encountered a major event, and 36% faced a minor event. Participants described a range of emotions including "stressful, angry, suicidal, confident, and fearful." All participants were instructed to not discuss the claim, leading to feelings of isolation and loneliness. Additionally, none of the participants were aware of the resources provided by the American Association of Nurse Anesthesiology, indicating a lack of awareness regarding available support for addressing litigation stress syndrome. Due to significant feelings of isolation, the emotional toll of a negligence claim can affect an individual's mental health, leading to anxiety, depression, or anger that can affect their relationships with others.

The purpose of this pilot educational program evaluation was to explore the integration of the American Association of Nurse Anesthesiology (AANA) Wellness Ambassador Microcredential (MC) into a nurse anesthesiology educational program's (NAEP) curriculum and evaluate its impact on resident registered nurse anesthetists' (RRNAs) wellness-related knowledge and competencies. Eighteen third-year RRNAs enrolled in a Professional Aspects of Anesthesia course completed the MC. Following completion, the RRNAs completed a 39-item survey assessing satisfaction, perceived relevance, and self-reported competency gains developed using the Kirkpatrick Model of instructional design. Results indicated high satisfaction, with 89.5% finding the content engaging and over half rating the quality as excellent. Self-reported improvements were observed across all nine wellness competencies, particularly in knowledge of wellness resources and application of holistic health principles. The interactive format and real-world applicability were especially valued. Participants reported increased confidence in addressing wellness-related challenges and a greater likelihood of utilizing and recommending wellness resources such as the AANA Helpline (800-654-5167). Findings support early and longitudinal integration of wellness education within the NAEP to foster resilience, reduce burnout, and promote a culture of well-being in nurse anesthesiology. While limited by sample size and self-reported data, this pilot project demonstrated the potential use of MC as scalable, competency-based tools for enhancing wellness education. Future research should include longitudinal and multisite evaluations to further validate outcomes and inform broader implementation strategies.

Hospitals rank among the most hazardous workplaces in the U.S. In 2011, healthcare institutions in the U.S. reported 253,700 work-related injuries and illnesses, surpassing those in traditionally high-risk industries like construction and manufacturing. Occupational hazards are prevalent in the operating room, contributing to injury, illness, and reduced employee productivity. Various occupational risks are encountered in this environment, including physical hazards such as radiation and noise; chemical hazards like waste anesthetic gases and methyl methacrylate; and biological hazards such as surgical smoke, which may contain viruses, bacteria, and carcinogens. Anesthesia providers, who primarily work in this high-risk setting, are regularly exposed to these dangers. Prolonged exposure is linked to a range of short- and long-term health effects, including skin conditions, reproductive issues such as miscarriage, and even cancer. Despite the seriousness of these risks, many anesthesia providers report a lack of knowledge about occupational health hazards and the necessary mitigation strategies. Raising awareness and implementing preventive measures are essential to reducing work-related illnesses and fostering a safer, more productive work environment.