AANA journal最新文献

The purpose of this study was to examine the efficacy of remifentanil on external cephalic version (ECV) in breech presentation. An extensive search was conducted using PubMed, Cochrane Library, and other grey literature. Only randomized controlled trials using remifentanil for ECV were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes and quality of evidence was assessed using the Risk of Bias and GRADE system. Five studies consisting of 602 patients were analyzed. Remifentanil resulted in a moderate increase in ECV success rate (RR, 1.19; 95% CI, 1.00 to 1.43; P = .05), a large reduction of pain score (MD, -2.02; 95% CI, -2.32 to -1.72; P < .00001) with fewer transient fetal bradycardia (RR, 0.40; 95% CI, 0.19 to 0.85; P = .02). However, remifentanil did not affect cesarean section rates, (RR, 0.97; 95% CI, 0.49 to 1.93; P = .93) instrumental delivery (RR, 0.94; 95% CI, 0.41 to 2.15; P = 0.89), and spontaneous delivery rate (RR, 1.02; 95% CI, 0.78 to 1.35; P = 0.87). Mothers treated with remifentanil have a higher patient satisfaction score. The use of remifentanil may be a good strategy for ECV. However, extrapolation of this finding to clinical settings must consider the study limitations.

Emergence delirium (ED) is a significant source of both short- and long-term negative effects in the postoperative pediatric population, most notably following otolaryngology surgeries with an occurrence rate of 17.9%. Gabapentin, a gamma aminobutyric acid agonist, has been used for enhanced recovery in adult patients and for the purpose of decreasing ED in some pediatric patients undergoing strabismus surgery. This secondary analysis examined the effects of preoperative administration of gabapentin on the reduction of postoperative ED in pediatric patients between the ages of 3-18 undergoing elective tonsillectomy and adenoidectomy. The parent study randomized subjects to receive preoperative gabapentin vs placebo. Our chart review encompassed both objective and subjective measures to identify the incidence of ED. While we found no statistical significance between the treatment and control groups, there was a clinically significant reduction of ED behaviors in the gabapentin group. The limitations included nonstandardized intraoperative medication administration, small sample size, and the lack of a validated tool for documenting behaviors associated with ED in the immediate postoperative period. Based on the results of this analysis, further investigation is warranted into the potential benefit of gabapentin to reduce the incidence of postoperative ED in the pediatric patient.

Anesthesia professionals experience events resulting in psychological and physiologic implications, known as second victim experiences (SVEs). This study evaluated the impact of a peer support program on anesthesia providers' SVEs. In July 2018, a departmental peer support program was implemented. All anesthesia professionals were invited to participate in a survey, including the Second Victim Experience and Support Tool (SVEST), which evaluated SVEs and desired support, preimplementation of the program. The survey was repeated two years after program implementation. A total of 57.9% (348/601) completed the preimplementation survey; 37.6% (231/614) completed the postimplementation survey. The median SVEST scores for psychological distress (3.0 vs 2.8, P = .04) and institutional support (3.0 vs 2.3, P < .001) were significantly lower on the postimplementation survey, indicating more favorable responses. For both assessments, the most desired support option was a 'respected peer to discuss the details of what happened.' Postimplementation, 84.9% (191/225) agreed the program enhanced departmental support, 93.2% (207/222) agreed the program considered professionals' well-being, and 81.7% (183/224) agreed the program contributed to a culture of safety. A total of 99.1% (213/215) would recommend the peer support program to others. Implementation of a peer support program significantly influenced anesthesia professionals' SVE-related psychologic distress and perception of adequate institutional support.

Imposter phenomenon (IP) is an evolving, multidimensional construct defined as self-perceived intellectual phoniness and professional ineptitude frequently experienced by individuals working in high-performance or competitive environments. IP consequences include psychological distress, role underoptimization, and career dissatisfaction. As high-achieving advanced practice nurses in a profession often evaluated by peers, certified registered nurse anesthetists (CRNAs) are at risk for IP. Identifying impostorism early in the CRNA's career and adopting healthy management strategies can optimize the nurse anesthesiologist's healthcare role, lead to a more fulfilling career, and support personal wellness.

Simulation is an integral part of the healthcare educational landscape and a key element in the future of graduate professional education. For the past three decades, simulation-based educational methodology has been gaining popularity in nurse anesthesia educational programs (NAEP). There is currently limited objective evidence documenting modalities used or educational outcomes addressed through simulation in NAEPs. In 2018, the American Association of Nurse Anesthesiology (AANA) established a Simulation Subcommittee of the AANA Education Committee and tasked the group with two primary goals: 1) to gain a better understanding of the current state of simulation education and 2) to review responses with regard to how NAEPs could best incorporate simulation elements within their curriculum to meet requirements while adhering to the guidelines of the Council on Accreditation of Nurse Anesthesia Educational Programs. A survey tool was developed and distributed to all programs to assess the utilization of simulation, available simulation resources, ongoing faculty development efforts, and barriers to use of this educational approach. Survey results indicated that simulation is valued as an effective method within NAEPs for a variety of teaching and learning activities and is utilized to support achievement of both technical and nontechnical learning outcomes for student registered nurse anesthetists.

Anesthesia delivery models have long been shaped by workforce trends, state and federal regulations, economic incentives driven by reimbursement, and the normative preferences of provider and facility organizations. In recent years, there has been a significant shift toward greater use of more efficient certified registered nurse anesthetist (CRNA)-oriented delivery models observed at the national level Medicare data. However, given the wide range of these factors across states and regions, this shift has likely occurred at an uneven pace. This study analyzes the influence of provider workforce composition and CRNA scope of practice (SOP) regulations on usage of competing types of anesthesia delivery models, including anesthesiologist alone, care team, and undirected CRNA models. Results show that over the period from 2010-2019, anesthesia delivery models utilized under Medicare Part B have become increasingly oriented around the use of CRNAs. However, increases in the care team vs undirected CRNA model are highly uneven and inconsistent across states, even after adjusting for workforce and SOP. Speculation on additional normative or organization-driven reasons for persistent use of inefficient delivery models in some places is offered.

Bleeding from the upper gastrointestinal tract is responsible for approximately 2% of all hospital admissions annually, with an up to 17% mortality rate. Therapeutic endoscopic interventions are often indicated for establishing hemostasis. These interventions include but are not limited to thermal coagulation with cautery, mechanical methods using band ligation or hemostatic clips, and hemostatic spray. Anesthesia providers are frequently involved in providing sedation for those endoscopic procedures. In 2018, the United States Food and Drug Administration approved a hemostatic spray, Hemospray® TC-325 (Cook Medical, Winston- Salem, NC, USA) for controlling nonvariceal upper gastrointestinal bleeding. The inorganic, mineral-based powder forms a mechanical tamponade by absorbing water and attracting clotting factors to the bleeding site. Adverse events associated with using the product are reported as rare but have included perforation and difficulty in removing the gastroscope. This case presents unexpected entrapment of the gastroscope in a patient's esophagus after the bleeding site was treated with Hemospray. Potential difficulties with airway management strategies are discussed.

An artery may be entered on the dorsum of the hand with the mistaken belief that it is a vein. Intraarterial injection of drugs is one of the dreadful consequences of accidental intraarterial cannulation. In this case of a 3-month-old infant, we emphasize the fact that careful observation can prevent unintentional intraarterial drug injection via an 'assumed intravenous' cannula and prevent the associated morbidity. When there is a suspicion of an intraarterial placement of venous cannula, it is of paramount significance to confirm before the injection of medications. Aberrant arterial anatomy should be kept in mind, particularly in children on the dorsum of the hand, where placement of an intravenous cannula is usually considered safe.

Spinal anesthesia is an option for patients during total knee arthroplasty (TKA) procedures. Spinal anesthesia can offer advantages and disadvantages to the patient's experience and outcomes. We conducted an evidence-based, quality improvement project comparing mepivacaine 2% and isobaric bupivacaine 0.5% and retrospectively assessed specific intraoperative and postoperative outcomes that were of interest to the staff at the hospital where the project was completed. Primary outcome measures of interest included intraoperative heart rate, blood pressure, vasopressor use, fluid resuscitation, postoperative pain scores, use of opioid analgesic medications, and time to ambulation after administration of the spinal anesthetic. Compared with patients receiving isobaric bupivacaine 0.5% (n = 30), patients receiving mepivacaine 2% (n = 30) had greater intraoperative hemodynamic stability (defined as heart rate and blood pressure maintained within 20% of baseline values) during the first 30 minutes after anesthetic administration (P < .05 for multiple time points). They also required less opioid medication for postoperative pain management (25 vs 50 mcg fentanyl) and were able to ambulate sooner after the procedure (mean [standard deviation], 452.2 [218.5] vs 681.0 [476.6] minutes; P = .006). In conclusion, mepivacaine 2% was the higher-performing local primary spinal anesthetic for patients undergoing TKA.

Organ procurement is a complex and unique procedure that warrants the creation of an evidence-based practice guideline. Anesthesia care of the donor may adversely impact the fate of organs once transplanted. The following article gives a brief review of the literature, and a guideline for providing anesthesia during an organ procurement which was created for a large, level-one, academic facility. Care of the organ donor during the preoperative phase is frequently discussed in the literature; however, there remains a need for further information on the care of the organ donor intraoperatively.