AANA journal最新文献

Certified registered nurse anesthetists (CRNAs) are essential providers of anesthesia in the United States, yet rates of burnout are alarmingly high. To further understand burnout among CRNAs, a current synthesis of the literature is warranted. The purpose of this integrative review was to identify and synthesize the prevalence, contributing factors, and associated outcomes of burnout among CRNAs. A systematic search of the PubMed, CINAHL, Scopus, and PsycINFO databases was performed. Quality appraisal was conducted using the Joanna Briggs Institute appraisal tools. A total of 15 studies were included in the review. Overall prevalence of burnout ranged from 12.5% to 72%. Significant contributing factors to burnout include lack of autonomy (n = 7), lack of leadership support (n = 4), moral distress (n = 3), and poor relations with physicians (n = 3). Intention to leave one's primary position (n = 3), decreased job satisfaction (n = 3), and fatigue (n = 1) were associated outcomes of burnout. CRNA burnout is found to have adverse individual and organizational outcomes. Contributing factors to be explored further in the CRNA population include poor CRNA-physician relations, poor CRNA-administration relations, and limited CRNA autonomy.

This study considered a cohort of 15 practicing certified registered nurse anesthetists (CRNAs) who completed a 1-day didactic and simulation-based workshop on focused transesophageal echocardiography (TEE) for noncardiac surgery. Data were acquired by survey and knowledge-based testing immediately pre- and postworkshop, and after 3 months. The primary aims of the study were to determine the extent that workshop-trained CRNAs incorporated TEE into their noncardiac surgery practice soon after program completion and to identify perceived barriers to this process. The study also evaluated both initial acquisition and short-term retention of TEE knowledge. CRNA education in focused TEE to provide entry-level skills into practice via a 1-day workshop is feasible, acceptable, and has perceived utility. Preworkshop, 33% of the cohort utilized TEE during noncardiac surgery; 13% who had not previously utilized TEE incorporated it de novo into their practices within 3 months. The most common reason for failure to use TEE during noncardiac surgery postworkshop was lack of a TEE machine or an appropriate surgical patient. Other reasons included lack of a supervising anesthesiologist agreeable to doing so or lack of TEE privileges. As assessed by written evaluation, there was both significant knowledge acquisition and short-term retention associated with this workshop.

The demand for anesthesia services continues to increase and the projected growth rate of this field may lead to increasing challenges in the future. Understanding how certified registered nurse anesthetists (CRNAs) acquire employment is important so practices can attract the CRNA workforce. It is unknown how CRNAs utilize resources to assess employment options. The aim of this survey was to determine how CRNAs acquire employment. A survey of a random sampling of 3,000 members of the American Association of Nurse Anesthesiology was conducted, 138 responses resulted in a response rate of 4.6%. Analyses were conducted using R version 4.2.2. Continuous variables were summarized using mean, standard deviation, and range. CRNAs seeking employment opportunities use on average 3.29 resources, with CRNA referrals (92.8%) and the professional association (74.6%) being most used. CRNAs ranked factors influencing employment decisions from most to least important, salary, location, and call. With the prevalence of social media use in the younger workforce, integration of this technology may become more common as an employment resource in years to come. Future research should focus on obtaining a larger sample size to ensure adequate generalizability to the CRNA population.

Autonomic dysreflexia (AD) presents a unique circumstance that many learn about in school but seldomly see in clinical practice. In this case study, AD is identified in a higher-level spinal cord injury (SCI) than what is typically imagined. In this case, physical and pharmacologic techniques are used to mitigate AD. Additionally, the procedure is still performed using various pharmacologic agents and collaborative efforts from the surgical and anesthesia team. A unique discussion on differentials and treatment options for AD is then presented. In conclusion, anesthesia providers must recognize AD such as triggers, understand signs/symptoms, and administer prompt treatment to ensure safety of SCI patients.

The Self-Evaluation Examination (SEE), an in-training examination administered by the National Board of Certification and Recertification of Nurse Anesthetists (NBCRNA), was reconfigured in 2016 to ensure fulfillment of its intended purposes, improve its utility, and augment predictive value toward a first-time pass on the National Certification Examination (NCE). The purpose of this mixed methods study was to reenvision the SEE to further enhance its value to stakeholders. A correlational quantitative analysis was conducted between the reconfigured SEE and NCE. A qualitative analysis of survey results was also performed; focus groups were undertaken among program administrators to assess utilization of the SEE. Final SEE results for 8,552 students from September 2016 through October 2023 were linked to first-time NCE results. Pearson's r correlations (r = 0.57; P < .01) represent a moderately strong positive correlation between SEE and NCE performance. Data from a survey of 107 program administrators indicated positive support for reconfigured SEE. Themes from three focus groups identified uses, best practices, and desired enhancements. Results were consistent with previously reported results, confirming the reconfigured SEE met intended goals. Future augmentations are being considered by NBCRNA to further enhance utility and value to nurse anesthesia educational programs.

Simulation is a valuable tool for developing technical skills and self-efficacy for high-risk, low-frequency events such as cannot intubate, cannot oxygenate (CICO) scenario. There is a deficiency of evidence regarding CICO events and emergency front of neck access training for resident registered nurse anesthetists (RRNAs). This study explored whether a low-fidelity simulation training utilizing a 3D-printed cricothyrotomy task trainer and educational intervention increased self-efficacy, improved performance measures (performance time, performance checklist scores), and increased expert performance levels (performance time, performance checklist score, completion of critical performance checklist steps) regarding scalpel-bougie-tube surgical cricothyrotomy (SBT-SC) among RRNAs. This pilot study utilized a quasiexperimental pretest-posttest design. Ten RRNAs participated in the study. Statistical analysis with paired t-tests demonstrated statistically significant improvement in mean self-efficacy scores (3.13 to 4.5 out of 5, P < .001), mean performance completion time (103.5 seconds (SD, 34.5) to 55.9 (SD, 17.9) seconds [P < .001]), mean performance checklist scores (5.5 to 9.1 out of 10, [P < .001]), and completion of critical checklist steps. Six participants completed the postintervention SBT-SC in under 60 seconds while completing all critical checklist steps. One participant met expert performance benchmark criteria following the intervention. This study supports low-fidelity simulation for SBT-SC education and training for RRNAs.

Postpartum hemorrhage (PPH) remains one of the leading causes of maternal death in the United States. There are several risk factors known to increase the risk of PPH and the use of tranexamic acid (TXA) has been widely researched in clinical situations with high bleeding risk. This retrospective observational study of the role of TXA and PPH in 418 high-risk obstetric patients was completed at a community hospital, and information on TXA administration, blood/colloid administration, and intraoperative and 24-hour estimated blood loss was evaluated for all patients who had a cesarean section within the study parameters. TXA doses ranged from .001 g to 2 g with a mean of 1.03 g (SD = 0.21). Using Games-Howell post-hoc testing, mean 24-hour EBL differed significantly among all groups except the uterotonics only group, which did not differ significantly from any other group. Twenty four-hour estimated blood loss was highest in those receiving both TXA and other uterotonic agents and lowest in those receiving neither.

Proficiency in epidural placement remains a challenging skill for anesthesia providers, requiring the ability to discern loss of resistance (LOR) when entering the epidural space. Current educational manikins lack the tactile feedback required for realistic epidural training. This descriptive pilot study aimed to compare an ex vivo porcine spine model with the M43B manikin model for simulation of clinical epidural placement. Expert anesthesia providers (n = 10) evaluated physical characteristics of each model using a survey comprised of a visual analog scale (0-100) and qualitative open-ended questions. Continuous data were analyzed using paired two-tailed Student's t tests, while qualitative open-ended narrative responses were reported by response frequency. Epidural simulation with the porcine spine demonstrated significantly higher clinical similarity scores (P < .001) for ligamentum flavum feel (85 ± 4.5 vs. 32 ± 8.1), LOR (93.5 ± 3.0 vs. 42.5 ± 10.7), catheter insertion (92.3 ± 3.9 vs. 48.8 ± 8.0), and novice training utility (92.5 ± 3.3 vs. 41.5 ± 7.7), while landmark identification (iliac crest/spinous processes) was comparable between models. Providers unanimously preferred the porcine model for epidural simulation. Simulation using an ex vivo porcine spine model enhances the realism of epidural training and underscores the importance of utilizing clinically relevant models for anesthesia procedural skill acquisition and maintenance.

Corrosive ingestion remains a common problem in developing countries such as India due to the lack of strict laws that regulate the sale of caustics. Corrosives can damage any segment of the gastrointestinal tract. The chronic phase of corrosive injuries may result in several complications, with the most common among them being stricture. These chronic sequelae are frequently managed by esophageal replacement. Due to the associated injury to the larynx and the trachea, the airway management is complicated in the late phase when fibrosis and strictures distort the anatomy. We present a case of a patient with corrosive esophageal injury scheduled for a colonic pullup. Pneumothorax is a recognized complication of esophageal replacement. In this case, the scarred airway with a delayed postoperative pneumothorax created a catastrophic situation. This case report draws attention to the possibility of a disaster following esophageal replacement in patients with corrosive injury when postoperative lung complications compound a distorted airway. During such an emergency, strict vigilance and proper planning with early corrective measures is imperative.