AANA journal最新文献

The purpose of this study was to evaluate the safety and efficacy of buprenorphine compared with placebo in prolonging the duration of analgesia in single-injection peripheral nerve block. The systematic review and meta-analysis were conducted following the PRISMA statement and Review Manager was used for meta-analysis. Outcomes were calculated using the mean difference (MD) with 95% confidence interval (CI) for continuous data. For dichotomous outcomes, effect sizes were estimated by calculating pooled risk ratio (RR) with 95% CI. Statistical heterogeneity was estimated by the I² statistic. Compared with placebo, buprenorphine prolonged the duration of analgesia by an average of 8 hours (MD, 8.01; 95% CI, 6.79 to 9.24; P < .00001). The cumulative pain scores within 24 hours (MD, -0.8; 95% CI, -1.21 to -0.40; P < .0001) and the 24-hour opioid consumption (MD, -5.56; 95% CI, -10.60 to -0.52; P = .03) after surgery was lower with buprenorphine group. Conversely, buprenorphine increased the incidence of postoperative nausea and vomiting (PONV) (RR, 1.67; 95% CI, 1.16 to 2.39; P = .006). Buprenorphine is effective in prolonging analgesia, decreasing pain scores and opioid consumption, however, it increases the risk of PONV.

Advanced practice nurses are not currently recognized in Georgia, the country intersecting Eastern Europe and Western Asia. With a critical nursing shortage and the brain-drain of graduate nurses in Georgia seeking higher pay and more respect in other countries, it is an opportune time to examine the potential for advancing nursing practice through education and professional mentorship. The aim of the study was two-fold. The first goal was to educate the local community about the profession of advanced practice nurse anesthesia and the benefits of advanced practice nursing in Georgia through a certified registered nurse anesthetist-led education session designed for a cohort of undergraduate biochemistry students. Second, a qualitative analysis identified the current state of nursing practice and directed the next steps toward nursing advancement, regulation, professionalism, access to quality care, and globally acceptable standards of practice. An education session held at San Diego State University Tbilisi, although not statistically significant, was successful in improving public knowledge. Qualitatively, the study established extreme enthusiasm for developing a nurse anesthesia program, licensure, regulation, standards of care, continuing education, and quality. In a country eager to advance, certified registered nurse anesthetists have the distinct opportunity of supporting Georgia's movement toward westernized healthcare.

Postoperative delirium is a public health and research priority. The International Perioperative Neurotoxicity Working Group recommends baseline cognitive function be assessed for older patients prior to surgery and anesthesia. Perioperative cognitive screening tools trialed in anesthesia are not routinely incorporated into clinical practice related to validity, reliability, or practicality concerns. The ideal perioperative cognitive screening tool would be rapid; easily administrable; valid; reliable; automatically scored; void of language, cultural, and education bias; and cost-efficient. No such tool currently exists. We explored baseline and postoperative neurocognitive characteristics that may help to establish predictive and trend metrics for perioperative neurocognitive assessment in older surgical patients using a novel, Food and Drug Administration-cleared point-of-care electroencephalography device (WAViMed™, Boulder, CO). To our knowledge, our study is the first to assess the device as a perioperative neurocognitive assessment tool. Although an association between P300 auditory-evoked potentials and Montreal Cognitive Assessment scores was not identified, further investigation is warranted given the magnitude of impact that such a device might have on patient outcomes and healthcare costs.

The COVID-19 pandemic strained healthcare providers, particularly certified registered nurse anesthetists (CRNAs). To date, little research has focused on the effects of the COVID-19 pandemic on CRNAs, whose unique skillset conferred on them expanded roles and responsibilities, increasing their stress load. Therefore, the purpose of this study was to utilize qualitative descriptive methodology to examine the experiences of CRNAs during the COVID-19 pandemic. Twelve CRNAs providing patient care in the US during the COVID-19 pandemic completed the interview protocol. Five key themes were identified including 1) roles of CRNAs, 2) collaboration, 3) challenges, 4) mental health implications for CRNAs, and 5) pride in profession. This study's descriptions of CRNA experiences during this unprecedented time in contemporary history identifies critical areas for further investigation and provides insights into anesthetic, mental health, and policy priorities to better support CRNAs now and through future infectious disease outbreaks.

Perioperative crisis management commonly involves both rapid generic responses and slower abstract reasoning for the successful management of adverse events. A metacognitive approach to this process offers the potential for minimizing errors and thereby improving outcomes. One such metacognitive technique uses templates that guide dynamic decisionmaking. Because stressful circumstances impair memory and cognitive function, templates may be particularly useful during crises both to improve functional recall and to provide mental constructs that compel anesthesia providers to organize their thoughts and direct approaches to problem-solving that rely on critical thinking rather than solely on heuristics. A six-step cognitive template is proposed for formulating a working diagnosis and deciding appropriate therapy during a perioperative adverse event. The template utilizes overlapping differential diagnoses organized using principles of anatomy and/or physiology. It has been effective in nurse anesthesia training to promote a metacognitive approach to decisionmaking during such events, and the template can be widely utilized in nonacademic settings for similar purposes.