AANA journal最新文献

This study analyzed the relationship between aging and reported pain during the acute postoperative period in a retrospective analysis of 2,600 adult patients who underwent abdominal surgeries. Data included demographics, diagnoses, surgical, and pain assessments. Severe pain was defined as reported pain intensity ≥ 7 on the numeric rating score during the first 24 hours postsurgery. Patients were grouped into three different age categories: 18-44, 45-64, and ≥ 65 years. Comparisons among groups were performed using the Chi-square test. Multivariate logistic regression was used to estimate the likelihood of patients reporting pain intensity ≥ 7. The likelihood of reporting severe pain was significantly lower in older (> 65 years; OR, 0.48; CI, 0.39-0.60) and middle-aged (45-64 years; OR, 0.77; CI, 0.63-0.91) patients as compared with younger patients (18-44 years). Factors increasing the likelihood of reporting severe pain included female sex (OR, 1.34; CI, 1.13-1.58), history of chronic pain (OR, 2.03; CI, 1.58-2.60), and incidence of depression and/or anxiety (OR, 1.65; CI, 1.29-2.12). Findings suggest that patients ≥ 65 years are significantly less likely to experience severe acute postoperative pain following a major abdominal surgery. Nurse anesthetists' awareness of age-specific acute postoperative pain management can lead to better patient pain outcomes.

Facioscapulohumeral muscular dystrophy (FSHD), the third most common form of muscular dystrophy, is associated with a normal life expectancy, resulting in more pregnant women presenting with the condition. Pregnancy often exacerbates muscle weakness in patients with FSHD, posing unique perioperative challenges. Careful evaluation of systemic involvement is essential to minimize maternal and neonatal risks. Perioperative management is often challenging because both general and neuraxial anesthesia carry significant risks. Spinal deformities further complicate anesthesia management, requiring troubleshooting. Apart from these challenges, literature on managing FSHD during cesarean sections is limited. We report the successful anesthetic management of an elective cesarean section in a patient with FSHD and scoliosis, reviewing troubleshooting measures for neuraxial blocks in spinal deformities.

Placing patients in the prone position is required for many surgical procedures. However, once in this position, the endotracheal tube (ETT) is often inaccessible to providers and accidental removal in an anesthetized, surgical patient can pose a life-threatening emergency. This experimental study aimed to examine the effectiveness of endotracheal reintubation in the prone position using a video laryngoscope (Glidescope®) compared with an intubating laryngeal mask airway (LMA) with ETT placement assisted by fiberoptic scope on a manikin. This study was conducted using 30 anesthesia providers with varying degrees of experience. The median times to intubation were lower using the Glidescope (73.5 s vs 130 s; P < .001). Moreover, the use of the Glidescope resulted in no esophageal intubations as well as fewer attempts than when using the LMA. Most anesthesia providers found that the Glidescope was the easiest technique to perform and learn. Despite these positive outcomes for the Glidescope, most of the participants reported the use of the LMA as a safer choice because of its capability to ventilate the manikin quickly (mean time to ventilation 12.13 s). The Glidescope method was found to be more likely to cause dental damage. The most important strategy is development of a plan prior to the emergent need.

Opioid use and misuse in parturients manifests in almost six out of every 1000 births, with close to 22,000 infants born annually to women using opiates. Additionally, the associated costs in managing these pregnant patients and their infants have increased to $1.5 billion annually. The American College of Obstetricians and Gynecologists currently recommends sublingual buprenorphine and oral methadone as the two opioid pharmacotherapy options for the treatment of opioid use disorder in pregnant patients. However, the pharmacology of buprenorphine and methadone differs greatly, making initiation and management of these two medications complex. Thus, it is crucial for anesthesia providers and obstetrical teams to have a thorough understanding of these two opioids and become familiarized with the current evidence-based practice for the management of parturients undergoing medication for opioid use disorder during pregnancy. In this journal course, the differences between the pharmacology of buprenorphine and methadone are described and benefits and limitations associated with the use of methadone and buprenorphine in parturients are discussed based on the current research data.

The use of Pre-Exposure Prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention has increased significantly, with approximately 30% of eligible individuals in the U.S. receiving a prescription by 2021, up from 13% in 2017. As more patients on PrEP undergo surgical procedures, understanding the perioperative implications of these medications is crucial for anesthesia providers. This review aims to summarize current literature on the perioperative considerations for patients on PrEP and provide anesthesia providers with key recommendations to optimize patient safety and outcomes. It examines the pharmacology, side effects, and perioperative considerations of current PrEP formulations: Truvada, Descovy, and Apretude. We conducted a broad literature search focusing on publications from 2013 through 2024. The review identifies potential nephrotoxicity with tenofovir-based formulations, particularly when combined with nephrotoxic agents such as nonsteroidal anti-inflammatory drugs. Emtricitabine/tenofovir alafenamide use is associated with an increased risk of hypertension and hypercholesterolemia. No specific anesthetic agents are contraindicated, but dose adjustments for renally excreted drugs may be necessary. Current evidence supports continuing PrEP throughout the perioperative period, with strategies provided for managing different formulations during surgery. As PrEP use expands, anesthesia providers must balance safe, effective care with contributing to HIV prevention efforts. Future research should focus on long-term anesthetic implications of PrEP and optimal perioperative management strategies. By implementing informed practices, anesthesia providers can significantly enhance the care of patients on PrEP and support broader public health goals in HIV prevention.

Video laryngoscopes (VLs) offer benefits by improving visualization and first-attempt success and decreasing failed intubations. This study examined the perceived usefulness and perceived ease of using VLs by certified registered nurse anesthetists (CRNAs) utilizing the Technology Acceptance Model published by Fred Davis in 1989. The study further investigated the influence of patient airway types, provider characteristics (age, years of practice, intubation frequency), and clinical factors (hospital size and technology availability) on subsequent selection and usage. The cross-sectional design included a one-time national survey using a purposive 3,000-CRNA sample. Data analysis included univariate, bivariate, and multivariate methodologies with multiple linear and binary logistic regression models. Approximately 71% of CRNAs were extremely likely to find VLs useful and easy to use and approximately 60% reported their selection and use when confronting difficult airways. Additionally, CRNAs selecting VLs for routine airways 50% to 100% of the time reported 4.49 times greater odds of always using VLs (100%) for difficult airways compared with CRNAs using this technology infrequently. This study provides current usage data by CRNAs and represents a first-ever assessment exploring CRNA perceptions of usefulness and ease in utilizing VLs in the operating room setting.

Point-of-care ultrasound (POCUS) is an inexpensive and often readily available tool for anesthesia providers to utilize to assess gastric content, both qualitatively and quantitatively, in the perioperative arena. Gastric POCUS requires the anesthesia provider to be trained and proficient in technique and interpretation of findings to accurately guide decision-making for patient care. The American Association of Nurse Anesthesiology, the American Society of Anesthesiologists, and the American Society of Regional Anesthesia have established guidelines supporting the use of gastric POCUS. This article aims to provide an integrative review of the literature surrounding current strategies in education and assessment of anesthesia provider competency in the perioperative utilization of gastric POCUS. Strict inclusion and exclusion criteria were used yielding eight articles in an effort to help determine feasible, efficient, reliable, and beneficial educational strategies to improve anesthesia provider competency. Findings suggest success with various educational strategies, including didactic, hands-on, electronic, and self-directed courses on gastric POCUS, supported by improved postintervention analyses of provider competency.

Peripartum cardiomyopathy (PPCM) complicated by pulmonary arterial hypertension (PAH) is an uncommon and high-risk condition that presents significant anesthetic and obstetric challenges. This case report contributes to the limited literature by describing the successful anesthetic management of a parturient with severe cardiac dysfunction and PAH, emphasizing the importance of a multidisciplinary approach. A 30-year-old pregnant woman with newly diagnosed dilated cardiomyopathy of unknown etiology and PAH was admitted for elective cesarean delivery. The diagnosis was established in the second trimester following symptoms of dyspnea at rest. Transthoracic echocardiography revealed severe left ventricular systolic dysfunction and elevated pulmonary artery pressures. A combined spinal-epidural technique was selected to allow for gradual onset of anesthesia and tight hemodynamic control. The patient was managed in a multidisciplinary setting involving anesthesiology, cardiology, obstetrics, and intensive care. Intraoperative and postoperative periods were uneventful, with no signs of pulmonary edema or right ventricular failure. The patient was discharged in stable condition on postoperative day 7. This case highlights the critical importance of individualized anesthetic planning and collaborative multidisciplinary care in the management of high-risk obstetric patients with PPCM and PAH. Early diagnosis, careful monitoring, and tailored interventions are key to optimizing maternal and neonatal outcomes in such complex scenarios.