AANA journal最新文献

The U.S. was at war for nearly two decades, supporting unprecedented survival on the battlefield. As the nation pivots to a relative peace, it is critical that U.S. Army certified registered nurse anesthetist (CRNA) leaders mitigate the loss of lessons learned and prepare future Army CRNAs for war. This article describes the U.S. Army CRNA Readiness Model that incorporates the knowledge, skills, and abilities required to sustain readiness. This model will provide U.S. Army nursing leaders with the framework to implement and evaluate solider readiness to provide anesthesia in operational environments.

High-fidelity simulation scenarios provide trainees the opportunity to demonstrate foundational anesthesia skills, complex prioritization, and decision making. One strategy used in trainee assessment is an objective structured clinical examination (OSCE). The purpose of this study was to design an OSCE with a reliable, quantitative grading rubric that could be used as part of a comprehensive assessment strategy to determine readiness for entry into clinical training for nurse anesthesia residents. An observational correlational study was developed to validate four high-fidelity simulation scenarios and accompanying quantitative grading rubrics. The rubrics were tested on junior nurse anesthesia residents and graded by program faculty members. Interrater reliability was tested using Krippendorff's alpha. Three cohorts of nurse anesthesia residents (n = 83) were assessed yielding 330 unique observations. Interrater reliability increased over the duration of the study with an overall reliability coefficient of 0.9092 (95% CI, 0.8509-0.9062), indicating a very high degree of interrater reliability among a variety of raters in complex simulated environments. Development of a quantitative rubric for high-fidelity simulation is achievable and should be considered as part of a summative assessment to differentiate individual student performance and readiness to proceed to clinical training within a front-loaded nurse anesthesia program.

A nurse anesthesia educator shortage exists that is attributed to factors such as a lack of financial incentive and proper training to be an educator. Due to the faculty shortage, nurse anesthesia programs (NAPs) are forced to defer admission to qualified applicants which reduces the number of certified registered nurse anesthetists (CRNAs) that NAPs can produce. Research regarding students as teaching assistants (TAs) at the university level has shown benefits and challenges to students, professors, and the TAs themselves as well as the impact on the overall faculty capacity. Current research regarding TA programs does not pertain to NAPs, therefore, research regarding the impact of TA programs on increasing nurse anesthesia faculty merits further work. This study was conducted using quantitative surveys and qualitative interviews to bridge the gap in the literature on the potential impact of TA programs on NAP faculty shortages. A survey was sent via email to former TAs (n = 44) of the Georgetown University NAP to assess the impact that the TA program had on their decision to enter a role in academia after graduation. Interviews were then conducted on a voluntary basis via a video conferencing platform to add qualitative data to the survey results. The survey response rate was 45% (n = 20). Following proportional analysis, 80% of the survey respondents indicated that they participated in the education of student registered nurse anesthetists in the clinical or didactic setting as a CRNA. Eighty percent of respondents indicated that being a TA positively influenced their desire to become a faculty member. One hundred percent of CRNAs interviewed reported that the biggest barrier to becoming fulltime faculty was the lack of financial incentives offered by NAPs. Interviewees recalled their TA experience as the foundation for their enjoyment of teaching anesthesia. The results of this study indicate that TA programs in NAPs can be used as a method to increase faculty capacity.

To our knowledge, there are currently no published articles discussing the use of 2-chloroprocaine plus dexmedetomidine in women undergoing cesarean section and only one article published on spinal anesthesia with these two medications for other types of surgery. 2-Chloroprocaine is a short-acting local anesthetic that helps patients ambulate more quickly after surgery due to its 60-minute average duration of action. Dexmedetomidine, when given in combination with local anesthetics, in spinal anesthesia, prolongs the effects of the local anesthetic. It is especially advantageous in obstetric anesthesia because of its wide safety margin, minimal ability to cross the placenta, and benefits that are unique to the parturient: dense visceral analgesia, anxiolysis without amnesia, reduced shivering, and lack of respiratory depression, nausea, and pruritis. We report a case of spinal anesthesia for cesarean section with 2-chloroprocaine plus dexmedetomidine and were able to achieve excellent surgical conditions and a more rapid recovery of motor function than with bupivacaine plus dexmedetomidine.

No clear policy on administration methods for small-volume intravenous antibiotic bags (≤ 100 mL) for surgical prophylaxis lead to wide variation in anesthesia provider practice at a large academic medical center. Administration via secondary tubing is the recommended practice to minimize significant medication losses from dead volumes. An observation of current practice and measurements of dead volumes was followed by an educational intervention on best practices for administration of small-volume antibiotics. Three postintervention cycles were conducted to evaluate change in practice and reductions in dead volumes over a 6-week period. Mean dead volume losses were evaluated using one-way ANOVA. Statistically significant (P = .0012) decreases in dead volume losses were observed postintervention, from 8.48 mL (SD 6.80) to 0.93 mL (SD 1.46). The most common pre- and postintervention tubing sets used were primary tubing (pre) and secondary tubing (post). Mean dead volume losses for these respective tubing sets were 13.45 mL (SD 4.74) and 0.79 mL (SD 1.40) (P < .0001). Preintervention administration methods resulted in incomplete antibiotic administration. Overall, there was a significant reduction in dead volumes of antibiotic by changing practice to secondary tubing. With strong provider acceptance and sustained reduction in medication wastage, this intervention has shown to be a beneficial new practice moving forward.

Current research on the optimal amount of oxygen delivery during general anesthesia is controversial. It is well described that anesthesia providers create supraphysiological arterial oxygen levels in patients with the delivery of supplemental oxygen. Over the past 20 years, hyperoxia has been studied more thoroughly and potential consequences are better understood. Atelectasis and radical oxygen species can lead to postoperative complications such as infection, prolonged respiratory support, and increased length of hospital stay. Anesthetists should consider the risk and benefit, potential effects, and differentiate the amount of oxygen dependent on the clinical situation. More research is needed in varying patient populations and surgical procedures to better understand the implications of hyperoxia in patients requiring general anesthesia.