AANA journal最新文献

Nurse anesthesiology programs continue to search for the best student traits and/or qualities to determine success in transitioning through a program of study and passing the National Certification Examination. These traits are not always quantitative in nature, but qualitative. Students face many stressors in transitioning through a nurse anesthesiology training program, and how students cope with those stressors may clue in the nurse anesthesia educators as to what determines success. This pilot study aimed to determine whether grit, or perseverance toward meeting a long-term goal, was a trait worth considering in determining student success. To that end, this cross-sectional quantitative correlational pilot study conducted in two nurse anesthesiology programs found that one grit subscale--Perseverance of Effort--was statistically significant in determining student success as defined herein.

This narrative review examines the implications of longitudinal assessment (LA) for certified registered nurse anesthetists, proposing it as an innovative method to enhance continuous professional development and maintain certification. Grounded in theoretical frameworks such as Miller's Pyramid of Clinical Competence and Moore's Expanded Outcomes Framework, this review explores how LA fosters lifelong learning in healthcare and synthesizes current evidence, detailing the integration of frequent, low-stakes assessments and targeted feedback to support knowledge retention and application. The principles of LA--flexibility, rigor, and relevance--are discussed with its potential to address the evolving demands of clinical practice, ensuring patient safety and competence. Key findings highlight the role of LA in reducing stress associated with traditional high-stakes testing while promoting engagement and critical thinking. This review highlights that LA represents a paradigm shift in healthcare education, aligning assessment methods with modern clinical and educational needs. By fostering continuous learning and adaptability, LA enhances clinician growth and improves patient outcomes. Further research is recommended to optimize LA implementation across diverse healthcare specialties.

A gap exists in the literature examining peer perception of professional impairment among certified registered nurse anesthetists (CRNAs) with and without substance use disorder (SUD) education. In addition to SUD education, personal and professional factors influencing peer perceptions were also explored. An electronic survey was sent to American Association of Nurse Anesthesiology members, and 192 participants responded to a 55-item questionnaire. An independent t-test revealed that perceptions were more positive in CRNAs who received SUD education (M, 62.44; SD, 7.124) than those who did not (M, 64.17; SD, 6.919). Similarly, a multiple regression analysis was conducted to predict perceptions of nurse impairment from personal and professional factors. The model explained 5.4% of the variance in the perception of nurse impairment, although none of the five variables added statistical significance (F[6, 165] = 1.511; P = .178; adj. R, .01). Recommendations for future studies include a qualitative study examining the lived experiences of CRNAs who suffer from SUD and sought treatment. This survey may offer the profession a unique perspective on the challenges impaired CRNAs face and the obstacles they must overcome to obtain treatment for their illness.

Multiple anatomic bedside screening tools are used in children to predict difficult laryngoscopy. Our study compared ratio of height-to-thyromental height (RHTMH) and height-to-thyromental distance (RHTMD) in forecasting children's challenging laryngoscopy grades. This was a single-center, prospective, cross-sectional study in which children aged < 5 years undergoing elective surgery were included. Age, weight, height, body mass index (BMI), TMH, TMD, RHTMH, and RHTMD were documented; Cormack-Lehane grading with Cook's modification grade of laryngoscope view was noted. The primary and secondary outcomes were to determine sensitivity and specificity as well as to determine cut-off values for RHTMH and RHTMD with the highest sensitivity to predict difficult laryngoscopy. One hundred children with a mean age of 2.1 ± 1.6 years, height of 83.17 ± 16.54 cm, weight of 10.47 ± 4.04 kg, and BMI of 14.8 ± 2.68 kg/m² were analyzed. Mean TMH, TMD, RHTMH and RHTMD were 4.43 ± 0.62 cm, 4.48 ± 0.66 cm, 18.75 ± 2.69, and 18.55 ± 2.51, respectively. At a cut-off of 19.56 (AUC, 0.714; P = .001), RHTMH showed 81.3% sensitivity and 41.2% specificity, while RHTMD had 84.4% sensitivity and 52.9 % specificity at a cut-off value of 19.14 (AUC, 0.724; P = .001) to predict laryngoscopic Grade 2b and above. In children aged < 5 years, both RHTMH and RHTMD were good predictors of difficult laryngoscopy.

The purpose of this review was to identify omissions during the informed consent process by certified registered nurse anesthetists (CRNAs) and physician anesthesiologists that were identified in malpractice claims between 1990-2022. Secondary aims included identification of injury, court ruling, and violations of patient rights and ethical principles. Abstracts of cases identified through systematic search on the Casetext database were screened for inclusion by the team's legal expert. Inclusion criteria were claims concluding between 1990-2022, failure to obtain informed consent as a primary or secondary claim, and an anesthesia provider as a defendant. Data from the included cases were extracted into a data matrix and presented in data tables to identify themes. Eighty-five cases were found on initial search, and 24 legal cases were included in the review. Defendants included CRNAs, anesthesiologists, employers of anesthesia providers, and anesthesia trainees. Risks associated with the delivery of anesthesia and failure to obtain informed consent before the delivery of anesthesia were the most frequent omissions by anesthesia providers. Patients' right to informed consent was violated in all cases, while the ethical principle of autonomy was violated in 17 cases. Anesthesia providers should consider reevaluating their communication process for informed consent because recent review of claims reveals adequate informed consent is frequently deficient.

According to the Centers for Disease Control and Prevention, one in four women in the United States has experienced attempted or completed rape, and over half have experienced a form of sexual violence in their lifetime. Despite this prevalence, there is currently no formal position statement regarding the role of trauma-informed care (TIC) in anesthesia. This study investigates provider knowledge and attitudes regarding TIC principles and specific applications to perioperative practices during the care of female-identifying patients. Interactive educational presentations were provided to perioperative staff in surgical centers across a large academic medical center in the Mid-Atlantic United States. Pre-post education surveys measured participant knowledge, attitudes, and practices surrounding TIC on a four-point Likert scale. Data were numerically coded and evaluated using independent t-test analysis. Results demonstrate that providers vastly underestimate the prevalence of sexual assault, do not regularly integrate TIC principles, desire additional TIC education, and are individually motivated to modify practices. Integrating universal TIC guidelines into the anesthesia care of this patient population can serve as a bridge to formal protocols, provider education, and practice integration.

The use of extracorporeal membrane oxygenation (ECMO) in surgical patients is increasing worldwide. Utilization of ECMO has nearly doubled in the past decade, enabling survival for 67% of patients in need of ECMO support. Induction and management of general anesthesia in the adult noncardiac surgical patient can present distinct challenges to the anesthesia practitioner's skill set. The need for alternative ventilatory and hemodynamic management strategies to support general anesthesia is indicated when challenges arise in the unstable surgical patient. ECMO support may be required to safely proceed with surgery in those instances. The rapid evolution of ECMO use in adult noncardiac surgical patients and a lack of updated clinical practice guidelines describing perioperative ECMO initiation and management create a knowledge gap among anesthesia practitioners. Resolving this knowledge deficit ensures efficacious care for this patient population at increased risk for perioperative complications and demise. This journal course will present evidence-based clinical practice recommendations to guide anesthesia practitioners on the initiation of elective preinduction and emergent ECMO support, and the considerations for intraoperative management of the adult noncardiac surgical patient on ECMO.

Williams syndrome is a rare congenital disorder affecting connective tissue and the cardiovascular and central nervous systems. Pediatric patients diagnosed with Williams syndrome face significant risk for cardiac collapse and death when undergoing anesthesia. We sought to evaluate our institution's historical practices, evaluate individual risk stratification, and create detailed standardized perianesthesia guidelines for management of this population, particularly during noncardiac procedures. The study included a retrospective chart review of pediatric patients with Williams syndrome who received anesthesia over a 10-year period at a single institution. A total of 23 patients underwent 46 procedures. At time of procedure, median age was 5.8 years (range, 0.4-17.6 yr), and the majority (n = 19) had a "low" Williams syndrome risk category and required anesthesia for noncardiac procedures. Most (61%) had no cardiac involvement beyond mild supravalvar or branch pulmonary artery stenosis. No intraprocedure adverse cardiac events were identified. One patient experienced an adverse cardiac event approximately 60 minutes postanesthesia emergence which included ST segment depression and development of refractory ventricular fibrillation, necessitating deployment of venoarterial extracorporeal membrane oxygenation. This patient was eventually stabilized and was taken to the operating room 3 days later for definitive severe supravalvar aortic stenosis repair. Patients with Williams syndrome have a reported risk for sudden cardiac death that is 25 to 100 times greater than that of the age-matched general population. The incidence of adverse cardiac events in our cohort of patients with Williams syndrome undergoing anesthesia was lower compared with previous studies, which reported rates ranging from 4.2% to 11%. These findings support the idea that risk stratification and institutional practice guidelines can aid anesthesia providers in making informed decisions, and standardization of pre-, intra-, and postprocedural care according to existing guidelines may further reduce risks. Our review offers valuable insight into historical anesthesia management and contributes to a broader interdisciplinary understanding of care provision for this high-risk group.

Advances in diagnosing and managing fetal anomalies have enabled the rapid evolution of maternal-fetal surgery (MFS). These surgeries are broadly categorized as minimally invasive, open, or ex utero intrapartum treatment (EXIT) procedures. A multidisciplinary team is required for these techniques with the anesthesia provider playing a pivotal role. A unique aspect of MFS is the need to manage both mother and fetus. Successful delivery of anesthesia requires knowledge of the physiologic changes of pregnancy, fetal physiology, maintenance of uteroplacental blood flow, and mitigating risk of general anesthesia. Additionally, understanding the underlying condition of the fetus and its surgical correction can ensure optimal anesthetic care. Certified registered nurse anesthetists (CRNAs) may have limited experience with MFS, but knowledge of these considerations will enable safer delivery of anesthesia. The type of anesthesia for MFS is determined by the surgical procedure. Open surgeries and EXIT procedures commonly require general anesthesia with fetal immobility, management of uterine atony, and preparation for fetal resuscitation. Minimally invasive procedures are often performed with local anesthesia and maternal sedation. MFS is a growing subspecialty with specific anesthetic considerations that CRNAs should be familiar with. This journal course aims to increase knowledge to promote safe anesthetic care for MFS.

The purpose of this toolkit is to minimize maternal health disparities by supplying obstetric anesthesia providers with evidence-based recommendations and resources that empower the provision of equitable analgesia and anesthesia. Toolkit development was accomplished through an extensive literature review and summary of evidence. The toolkit was critiqued by obstetric care experts for its relevancy, simplicity, clarity, and ambiguity. These data points were evaluated using a content validity index (CVI) process, yielding an overall CVI of 0.94. Three recommendations for improvement in obstetric analgesia and anesthesia care were identified. Recommendation 1 highlighted the need to proactively seek growth and improvement of care delivery through provider education, tracking anesthesia-specific parturient outcomes, and assessing parturient delivery experience. Recommendation 2 identified the need to strengthen parturient-provider relationships with communication, shared decision-making, and diversifying the anesthesia workforce. Recommendation 3 focused on multidisciplinary parturient management through rapid-response teams, performance of emergency drills, and implementation of crisis management checklists to standardize care. Overall, this validated toolkit offers obstetric anesthesia providers evidence-based recommendations and resources to support fair and effective pain relief and anesthesia.