Science and Clinical Potpourri for Your Life and Your Practice.
Authors: PMID: 32718422 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Tags: AANA J Source Type: research

Pediatric Postoperative Nausea and Vomiting: Assessing the Impact of Evidence-Based Practice Change.
Abstract Postoperative nausea and vomiting (PONV) is an unpleasant complication following anesthesia and surgical procedures experienced by both adults and children. Compared with adults, children are 2 times more likely to experience PONV. Many studies have identified and independently validated risk factors associated with the development of PONV in the pediatric population. Chief among these are patient age greater than 3 years, surgical duration greater than 30 minutes, surgical type, and a history of PONV. The purpose of this evidence-based practice change was to investigate if preoperative documentation of a...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Simon RW Tags: AANA J Source Type: research

Prophylactic Tranexamic Acid in High-Risk Patients Undergoing Cesarean Delivery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Abstract Scant evidence exists regarding use of tranexamic acid (TXA) in high-risk obstetrics. The aim of this review was to evaluate the efficacy of prophylactic TXA in high-risk patients for postpartum hemorrhage. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Only studies examining the effects of TXA compared with placebo in mitigating postpartum hemorrhage were included. The primary outcomes were blood loss intraoperatively and postoperatively. The secondary outcomes were the frequency of additional uterotonic therapy and postoperat...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Stortroen NE, Tubog TD, Shaffer SK Tags: AANA J Source Type: research

Implementing Smoking Cessation Interventions in a Preoperative Clinic.
Abstract Cigarette smoking has negative health implications for surgical patients. Smoking cessation before surgery reduces complications; however, information on the risks of smoking and benefits of quitting on surgical outcomes are not regularly provided to patients. It is especially important for smokers to quit now because they are at increased risk of serious complications of coronavirus disease 2019 (COVID-19). The purpose of this project was to develop and implement a program for smoking cessation in a preanesthesia clinic associated with a southwestern medical center to increase motivation to quit smoking....
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Etteldorf JR, Robertson S, Taha A Tags: AANA J Source Type: research

Use of Computer-Assisted Instrument Guidance Technology by Student Registered Nurse Anesthetists for Simulated Invasive Procedures.
This study was conducted to determine if computer-assisted instrument guidance (CAIG, Clear Guide Medical), with an optical tracking mechanism, enhances simulated transversus abdominis plane (TAP) block performance in a porcine model by novice student registered nurse anesthetists (SRNAs) compared with standalone ultrasonography (US). In a crossover design, 26 students were randomly assigned into 2 groups: US only and CAIG. Performance was assessed using a task-specific checklist survey tool and a global rating scale to assess performance. Time to hydrodissection and number of insertion attempts were recorded. A pre-proced...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Hauglum SD, Vera C, Alves SL, Tran C Tags: AANA J Source Type: research

A Rare Case of Vincristine-Induced Neuropathy Presenting as Foot Drop in the Postoperative Period.
Abstract Patients with cancer receiving chemotherapy are at risk of neuropathy development. Many of them may have subclinical neuropathies, which may be missed before planning anesthesia, especially in emergency scenarios. This case report highlights the importance of a thorough neurologic examination in patients with subclinical neuropathy to avoid any complications and medicolegal issues. A patient with a diagnosis of diffuse large B-cell lymphoma being treated with vincristine-based chemotherapy was scheduled for an emergency laparotomy. There was no history of any neurologic deficit before surgery. The surgery...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Gupta N, Vig S, Bhan S, Bharati SJ, Mishra S Tags: AANA J Source Type: research

Methylenetetrahydrofolate Reductase Deficiency: A Case Report.
Abstract Methylenetetrahydrofolate reductase (MTHFR) deficiency is an autosomal recessive disorder that results in hyperhomocysteinemia. Elevated homocysteine levels in the blood can cause arterial and venous thrombosis, atherosclerosis, recurrent pregnancy loss, and neurologic symptoms. Emerging research suggests links to other chronic illnesses as well. Anesthetic management of patients with MTHFR deficiency should focus on decreasing the risk of arterial or venous thrombosis and minimizing elevations in homocysteine levels. Thrombosis prevention includes the use of antiembolism compression stockings, intermitte...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Hale N, Minzola D Tags: AANA J Source Type: research

Evidence-Based Practice: Use of STOP-BANG Questionnaire to Identify Obstructive Sleep Apnea.
Abstract Certified Registered Nurse Anesthetists (CRNAs) provide care for patients with undiagnosed obstructive sleep apnea (OSA). This evidence-based practice project demonstrated that the STOP-BANG Questionnaire (SB) identified patients with OSA preoperatively and reduced hypoxemia in the postanesthesia care unit (PACU). Evidence from the literature is described; based on this evidence, a change in clinical anesthesia practice was made. Four literature databases were searched using keywords from the following PICOT (patient, intervention, comparison, outcome, time) question: Do patients (P) who have high SB scor...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Barrows LMS, Wigetman S, McCarthy CEJ Tags: AANA J Source Type: research

Evidence-Based Antiemetic Decision Tool for Management of Postoperative Nausea and Vomiting in Patients at High Risk of QT Prolongation and Patients Receiving Neurotransmitter-Modulating Medications.
Abstract Anesthesia providers have a myriad of medication options when developing and implementing a plan for the management of postoperative nausea and vomiting (PONV). However, anesthetists must be aware of the potential side effects, complications, and interactions of those medications, especially when managing high-risk populations. Although guidelines exist for the management of PONV in the general population, an evidence-based antiemetic decision support tool has not been developed for patients at risk of prolonged QT interval or for patients who are routinely receiving neurotransmitter-modulating medication...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Hymel N, Davies M Tags: AANA J Source Type: research

Comprehensive Reentry Policy for Student Registered Nurse Anesthetists With Substance Use Disorder.
Abstract Substance use disorder (SUD) is a common problem in anesthesia. Although there are SUD policies in place for practicing anesthetists, there were no known studies before this inquiry discussing reentry policies specific to the student registered nurse anesthetist (SRNA). The purpose of this research was to describe key stakeholders' knowledge and perspectives surrounding policies for reentry into academic programs in Illinois for SRNAs with SUD and to create a comprehensive structured policy template for SRNAs with SUD. The theoretical framework for this research was based on the Biopsychosocial Theory. Be...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Nigro TM, Schwartz PS, Roche BT, Tariman JD Tags: AANA J Source Type: research

Perioperative Anesthetic Techniques to Reduce Surgical Morbidity After Amputation.
Abstract Anesthetic modalities to mitigate the development of phantom limb pain have not been standardized into an evidence-based, multimodal anesthesia protocol to promote improved patient outcomes. This quality improvement project involved the implementation of a lower extremity, amputation-specific anesthesia protocol. In the postimplementation group, 94 patients were anesthetized for their amputation using an Amputation Improved Recovery Enhanced Recovery After Surgery (ERAS) protocol. Patient outcomes before and after protocol implementation were compared. The rate of continuous peripheral nerve block placeme...
Source: AANA Journal - July 30, 2020 Category: Anesthesiology Authors: Hutto EDG, Rice AN, Hopkins TJ, Muckler VC Tags: AANA J Source Type: research

Ignoring "Stay at Home!" …the Life and Times of the Frontline CRNA During a Pandemic.
Ignoring "Stay at Home!" …the Life and Times of the Frontline CRNA During a Pandemic. AANA J. 2020 Jun;88(3):171-172 Authors: Biddle C PMID: 32442092 [PubMed - as supplied by publisher] (Source: AANA Journal)
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Biddle C Tags: AANA J Source Type: research

Science and Clinical Potpourri for Your Life and Your Practice.
Authors: PMID: 32442093 [PubMed - as supplied by publisher] (Source: AANA Journal)
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Tags: AANA J Source Type: research

Sevoflurane Consumption During Inhalational Induction in Children: A Randomized Comparison of Minute Ventilation-Based Techniques With Standard Fixed Fresh Gas Flow Technique.
This study was done to ascertain the optimum fresh gas flow (FGF) offering the best balance between rapid induction and minimal waste in pediatric patients. Forty-five children (weighing 10-20 kg) undergoing elective procedures under general anesthesia were randomly assigned into 3 groups: 0.5 minute ventilation (MV), MV, and S (FGF = 6 L/min). After priming the pediatric closed circuit, anesthesia was induced using a face mask with 8% sevoflurane in 100% oxygen (Draeger Primus Vista 120 anesthesia machine) at FGF-determined MV per group allocation. After loss of eyelash reflex (time 1 [T1]), intravenous cannulation (T2) a...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Gupta A, Datta PK Tags: AANA J Source Type: research

Anesthesia Simulation in Cardiac Surgery (ASICS).
Abstract Nurse anesthesia programs are stressful, with routine information overload, immersion into new environments, and financial stressors. One strategy to combat this stress is to practice clinical skills in the less intimidating and safe environment of simulation. Evidence strongly suggests that simulation is an important component of a well-rounded nurse anesthesia program. However, no simulation literature was found to assist the transition of student registered nurse anesthetists (SRNAs) into their cardiac anesthesia rotations. The purpose of this evidence-based practice improvement project was to create a...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Staun J, Lanzillotta J, Rota M, Yockey M, Freed L Tags: AANA J Source Type: research

Knowledge Assessment of Military Personnel, Veterans, and Family Taking Dietary Supplements.
Abstract Dietary supplements (DS) pose many side effects and multiple interactions with perioperative medications, which may increase surgical morbidity and mortality. Descriptive empirical data are essentially nonexistent related to DS consumption and patient knowledge of DS. The aims of this study were to investigate the prevalence of use, type of supplements used, and the knowledge base among military beneficiaries and veterans consuming DS during the preoperative period. This descriptive cross-sectional study solicited data from 2,623 volunteer, preoperative patients at 6 different military medical centers thr...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Ceremuga TE, Ayala MP, Henson DT, Chicoine CRW, Celestino MJ, Chun CSM, DeGroot CJM, Glynn CAE, Randall CSA, Stanley MLR, Beaumont CDM Tags: AANA J Source Type: research

Improving Endotracheal Cuff Inflation Pressures: An Evidence-Based Project in a Military Medical Center.
Abstract Poor management of endotracheal tube cuff pressures occurs in more than 50% of all general anesthetics, leading to tracheal ischemia, tracheal rupture, sore throats, recurrent laryngeal nerve palsy, tracheal stenosis, microaspiration, and/or inadequate ventilation. General endotracheal anesthesia is common practice throughout the world. Endotracheal tube cuffs are filled with a fluid (gas or liquid) to a safe and adequate pressure of 20 to 30 cm H2O to protect the lung parenchyma from aspiration while also ensuring positive pressure can be generated to oxygenate/ventilate patients. An evidence-based proje...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Turner MA, Feeney M, Deeds LJL Tags: AANA J Source Type: research

Anesthesia Machine Failure: A Case Study.
This article examines successful management of an anesthesia machine failure with the Draeger (or Dräger) Apollo (Draeger Inc) anesthesia workstation. Approximately 45 minutes into the case, while the patient was under general anesthesia and mechanical ventilation, the anesthesia machine failed to achieve positive pressurization following a high-pressure alarm. Despite multiple maneuvers, the issue did not resolve until the machine was manually powered off and on at the main power switch. This case report emphasizes the importance of always having a backup means of patient ventilation and anesthesia administration. ...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Wren K, Condit MT Tags: AANA J Source Type: research

Substance Abuse and Misuse Identification and Prevention: An Evidence-Based Protocol for CRNAs in the Workplace.
This article addresses the need for a protocol by including occurrences of accidents and injuries, consequences to anesthesia practice and patient care, costs, and the culture in an anesthesia group or department. Components of the protocol are formation of a committee, risk assessment, clear workplace policy, annual continuing education, annual supervisor training, drug screening of anesthesia personnel, pharmacy accountability, and access to treatment. The article describes the protocol and provides supplemental information to aid in implementation at other anesthesia departments. Substance abuse among CRNAs is a complex...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Taylor L Tags: AANA J Source Type: research

Fat Embolism Syndrome Revisited: A Case Report and Review of Literature, With New Recommendations for the Anesthetized Patient.
Abstract Current criteria used to make the clinical diagnosis of fat embolism syndrome were never intended to be applied to an anesthetized, mechanically ventilated patient in the operating room and, as such, may not be applicable during intraoperative care. Because of this, confusion still exists among anesthesia providers in recognizing this potentially fatal clinical condition. Our goal was to develop and then present a more exacting and rigorous grading scale, tailored specifically for the anesthetized patient, with the hope that it will aid clinicians in recognizing and successfully managing the manifestation...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Huffman JS, Humston C, Tobias J Tags: AANA J Source Type: research

Pharmacogenetics of Postoperative Pain Management: A Review.
Abstract Despite the opioid epidemic, up to 86% of patients experience moderate to severe pain after major surgery. Although several factors influence the amount of pain patients experience postoperatively, studies have identified genetic variations that influence pain perception and response to pain medications. The purpose of this article is to examine evidence of the genetic differences that affect patients' responses to medications frequently used in postoperative pain management. Genes of interest associated with postoperative pain management include the opioid µ1 receptor (OPRM1), cytochrome P450 (CYP)...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Aroke EN, Kittelsrud JM Tags: AANA J Source Type: research

A Review of the Pharmacology and Anesthetic Implications of Cannabis.
Abstract Cannabis is now legalized, for medical and/or recreational use, in numerous states. Although the cultural shift in acceptance of cannabis is apparent in the public, that sentiment has not necessarily translated to healthcare professionals. As anesthesia providers, we must understand the pharmacology of cannabis and its effects on physiology to provide safe anesthetic care to patients who consume it. The purpose of this article is to describe cannabis and its pharmacologic and physiologic effects and to review the anesthetic implications of its short-term and long-term use. PMID: 32442102 [PubMed - as...
Source: AANA Journal - May 24, 2020 Category: Anesthesiology Authors: Teitel A, Bozimowski G Tags: AANA J Source Type: research

Treat COVID-19 as Though It Is Airborne: It May Be.
PMID: 32347791 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Eissenberg T, Kanj SS, Shihadeh AL Tags: AANA J Source Type: research

Imagining in Time.
Abstract In 1934, Gertrude Fife, president of the National Association of Nurse Anesthetists (NANA), recognized a need to elevate the standards of anesthesia practice and standardize the education of nurse anesthetists. Early members of the association responded by working to locate schools, setting education standards, and developing a school approval process, which eventually led to creation of the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) in 1975. Examination of historical documents demonstrates that COA developed into a well-known accreditation agency that is recognized by both go...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Horton B, Kremer M Tags: AANA J Source Type: research

Science and Clinical Potpourri for Your Life and Your Practice.
Authors: PMID: 32234198 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Tags: AANA J Source Type: research

Repeated Postanesthetic Laryngospasm in a Male Adult.
Abstract Laryngospasm is a potential complication after general anesthesia that is universally dreaded because the failure to act swiftly and effectively could be fatal for the patient. This case report involves a morbidly obese male patient who received his first general anesthetic and experienced 4 episodes of laryngospasm within an hour after emergence. Laryngospasm occurs when the vocal cords adduct, closing the glottis, thereby preventing gas exchange in a spontaneously ventilating individual. This patient was able to physically indicate his impending glottic closure, thus warning his caregivers of the immine...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Chambers P Tags: AANA J Source Type: research

Anesthetic Considerations for Automated High-Frequency Jet Ventilation During Electromagnetic Navigation Bronchoscopy.
Abstract Newly advanced diagnostic bronchoscopic procedures, such as electromagnetic navigation bronchoscopy using navigation system technology (superDimension, Medtronic), provides computed tomography referenced and computerized 3-dimensional imaging. To increase accuracy and higher diagnostic biopsy yield, electromagnetic navigation bronchoscopy necessitates special anesthetic and ventilation techniques providing the interventional pulmonologist minimal respiratory lung motion. This anesthetic meets 2 important goals by limiting almost all interference from diaphragmatic and lung movement while allowing the anes...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Masters R, Bechara R, Seeley NR, Parks C, Moore ZD Tags: AANA J Source Type: research

Does Ultrasonographic Measurement of Gastric Content Influence Airway Management Decisions?
Abstract The presence of gastric content before induction of general anesthesia is the primary modifiable risk factor in the prevention of pulmonary aspiration. The purpose of this project was to determine if ultrasonography could be routinely used to measure gastric content and assign aspiration risk in patients undergoing general anesthesia. Preoperative gastric ultrasonography was performed in a convenience sample of 100 patients. A group of Certified Registered Nurse Anesthetists, anesthesia residents, and anesthesiologists were asked their plan for airway management before and after receiving the results of t...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Cieslak JR, Rice AN, Gadsden JC, Vacchiano CA Tags: AANA J Source Type: research

Cut to Air.
Abstract A "cannot ventilate, cannot intubate" scenario is a rare, high-risk anesthesia event. Cricothyrotomy is the final step, but anesthesia training and maintenance of surgical airway skills is variable. The ability to "cut to air" when one performs a cricothyrotomy may be all that prevents a patient from experiencing anoxic brain injury or death. Forty-three Certified Registered Nurse Anesthetists (CRNAs) performed emergency cricothyrotomies on a simulation manikin. Three techniques were available: (1) cricothyrotomy kit, (2) scalpel and tracheostomy, and (3) scalpel/bougie/endotracheal tu...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Scott-Herring M, Morosanu I, Bates J, Batoon B Tags: AANA J Source Type: research

Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results.
Abstract Using deep sedation, adjunct airway devices such as oral or nasal airways are frequently required to maintain airway patency. Traditional oral airways (TOAs, made of rigid plastic) or nasal airways (made of pliable materials) can be associated with adverse effects, contributing to a trend of anesthesia providers placing nasal airways orally. A clinical observational study and an electronic provider survey were conducted to examine this emerging practice. The observation study objective was to investigate reported postoperative sore throat occurrence associated with use of either a nontraditional airway (n...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: McMurray R, Becker L, Olsen KF, McMurray M Tags: AANA J Source Type: research

Recognition and Management of Subcutaneous Emphysema as a Complication of Robotic-Assisted Laparoscopic Surgery: A Case Report.
Abstract This case report discusses an unlikely occurrence of massive subcutaneous emphysema in an elective robotic-assisted laparoscopic total hysterectomy in a 45-year-old, ASA class 1 woman. The patient's perioperative course was otherwise uncomplicated, with the subcutaneous emphysema developing at surgical closure. The patient presented with substantial crepitus spanning from her face to her lower extremities and hypercarbia with end-tidal carbon dioxide readings persistent between 60 and 70 mm Hg. This case did not result in clinically significant airway obstruction because of provider vigilance. However, un...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Pallaria TJ, McLaughlin M, Diskerud L Tags: AANA J Source Type: research

Anesthesia Implications of Patient Use of Electronic Cigarettes.
Abstract Electronic cigarettes are essentially electronic nicotine delivery systems (ENDS). Use of ENDS has increased sharply in the United States in recent years, particularly among youth. We reviewed the literature on ENDS use, based on a PubMed search, with a focus on effects that could influence anesthetic and surgical outcomes. We also included a meta-analysis of articles published between 2016 and 2018 reporting injuries from exploding ENDS. These devices deliver nicotine, which is addictive and a cardiac stimulant. The nicotine in ENDS has been linked to increased risk of heart disease and myocardial infarc...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Harris DE, Foley EM Tags: AANA J Source Type: research

Prevention of Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: Are We Doing Enough?
Abstract The worldwide obesity epidemic has led to an increase in the number of bariatric procedures for treatment. Currently, the most commonly performed bariatric surgical operation in the United States is the laparoscopic sleeve gastrectomy (LSG). The risk of postoperative nausea and vomiting (PONV) is exceptionally high following the LSG: as much as 65%. Anesthesia providers should be mindful of this elevated risk and stay up to date on evidence-based techniques that help to mitigate the incidence of PONV related to this specific procedure. The purposes of this clinical review are to increase provider awarenes...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Varner KL, March AL Tags: AANA J Source Type: research

AANA Journal Course: Update for Nurse Anesthetists-Optimizing Mechanical Ventilation During General Anesthesia.
Abstract Optimal mechanical ventilatory support is a vital component of intraoperative anesthesia care, lung protection, and minimizing postoperative pulmonary sequela. Although concepts surrounding ventilation can be multifaceted and ambiguous, a pragmatic approach coupled with contemporary evidence and skilled assessments will facilitate ideal intraoperative management. Effective mechanical ventilation is dependent on obtaining the best pulmonary mechanics, including compliance, resistance, and gas exchange. Optimally titrated positive end-expiratory pressure is the foundation for ideal pulmonary mechanics, prev...
Source: AANA Journal - April 1, 2020 Category: Anesthesiology Authors: Wright GT, Ashworth L, Pettey S Tags: AANA J Source Type: research

Nurse Anesthesia Training in 1946.
PMID: 32008608 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Richart MG, Coonse RK Tags: AANA J Source Type: research

NVM for Prevention of Upper Airway Obstruction.
PMID: 32008609 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Willard CE, Rice AN, Broome ME, Silva SG, Muckler VC Tags: AANA J Source Type: research

Double Gloving and Infection Control.
PMID: 32008610 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Mane A Tags: AANA J Source Type: research

A Review of New and Updated Professional Practice Documents.
This article highlights several revised and newly developed documents, which include topics such as the standards for nurse anesthesia practice, office-based anesthesia practice, anesthesia for patients with substance use disorder, clinical privileges for CRNAs, ketamine infusion therapy, postanesthesia care, and medication-assisted therapy. The full versions of each document can be accessed at www.aana.com/PracticeManual. PMID: 32008611 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Poole J, Greenier E Tags: AANA J Source Type: research

Science and Clinical Potpourri for Your Life and Your Practice.
Authors: PMID: 32008612 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Tags: AANA J Source Type: research

Development of a Common Clinical Assessment Tool for Evaluation in Nurse Anesthesia Education.
Abstract There is a lack of standardization among evaluations completed by clinical educators of student registered nurse anesthetists (SRNAs) during their clinical education as reported by nurse anesthesia program administrators and students. To address this issue, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) Board created the Common Clinical Assessment Tool (CCAT) Special Interest Group to develop a standardized clinical evaluation instrument. The goal was to improve the consistency of clinical evaluation across nurse anesthesia programs while assisting program administrators to ma...
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Elisha S, Bonanno L, Porche D, Mercante DE, Gerbasi F Tags: AANA J Source Type: research

Association of Prescription Opioid Exposure and Patient Factors With Prolonged Postoperative Opioid Use in Opioid-Na ïve Patients.
Association of Prescription Opioid Exposure and Patient Factors With Prolonged Postoperative Opioid Use in Opioid-Naïve Patients. AANA J. 2020 Jan;88(1):18-26 Authors: Lanzillotta-Rangeley J, Clark A, Christianson A, Kalarchian MA Abstract The purpose of this research study was to identify factors associated with prolonged postoperative opioid use in opioid-naïve patients in 2 domains: specific patient characteristics and exposure through postoperative opioid prescriptions. A retrospective analysis was conducted of electronic medical records of opioid-naïve adult orthopedic surgical pat...
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Lanzillotta-Rangeley J, Clark A, Christianson A, Kalarchian MA Tags: AANA J Source Type: research

Vaping: Anesthesia Considerations for Patients Using Electronic Cigarettes.
Abstract Anesthetists are generally familiar with the perioperative implications of patients' cigarette smoking. Electronic cigarettes are, however, a relatively newly popular phenomenon among adolescents and young adults. There is a generalized lack of knowledge among healthcare providers regarding the overall health effects of electronic cigarettes, which often are advertised as a harmless smoking-cessation tool. US health protection agencies have reported that electronic cigarettes contain cytotoxic compounds and harmful byproducts such as nicotine, heavy metals, propylene glycol, diacetyl, and other impurities...
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Hobson A, Arndt K, Barenklau S Tags: AANA J Source Type: research

Anesthesia Challenges in the Management of Freeman-Sheldon Syndrome: Report of Two Cases and Literature Review.
This report of the anesthetic management of 2 children with Freeman-Sheldon syndrome emphasizes the anesthetic considerations for the successful management of patients with this syndrome. PMID: 32008616 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Kamal G, Shah SB, Gupta A Tags: AANA J Source Type: research

Turnover, Burnout, and Job Satisfaction of Certified Registered Nurse Anesthetists in the United States: Role of Job Characteristics and Personality.
This study, designed to identify the determinants of job satisfaction, employee burnout, and turnover intentions, was based on data derived from a survey of members of the American Association of Nurse Anesthetists (AANA) who were active Certified Registered Nurse Anesthetists (CRNAs). The relationships explored, using structural equation models, were job satisfaction as a function of job characteristics and personality factors; employee burnout as a function of job characteristics, personality factors, and demographic characteristics; and turnover as a function of job satisfaction and burnout. Job satisfaction was positiv...
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Mahoney CB, Lea J, Schumann PL, Jillson IA Tags: AANA J Source Type: research

Damage Control Resuscitation of a Patient With Traumatic Aortic Rupture: A Case Report.
Abstract Traumatic aortic rupture (TAR) is a highly fatal injury mechanism resulting from blunt deceleration forces against the descending aorta. The mechanism of TAR is directly attributed to the aorta suffering damage by indirect shearing forces. The descending aorta remains fixed to the posterior chest wall, while the heart and ascending aorta are exerted forward, thus causing the intimal tear. A characteristic triad presents as increased blood pressure in the upper extremities, decreased blood pressure in the lower extremities, and a widened mediastinum on radiography. Early recognition of signs and symptoms o...
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Heiss C, Foernges L, Minzola D Tags: AANA J Source Type: research

Effect of Simulation Training on Cognitive Performance Using Transesophageal Echocardiography.
Abstract Simulation is used in anesthesia training to reinforce didactic learning. The authors hypothesized that knowledge acquisition in the use of transesophageal echocardiography (TEE) could be accomplished better through the use of a simulator than with online or web-based learning. A total of 71 student registered nurse anesthetists were randomly assigned to either web-based or simulator-based TEE training. Using the same rubric, each group was instructed to use 11 views to identify 12 different cardiac structures. In addition, 15 cardiac abnormalities ("pathologies") were identified through either ...
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Shields JA, Gentry R Tags: AANA J Source Type: research

Sustained Value of Implementation of a Flexibility-Based Compensation Structure for Nurse Anesthetists in a Large Multihospital Healthcare System.
Abstract Nurse anesthetists can use their creative problem-solving abilities to benefit both their employers and themselves. In an era when healthcare dollars are in short supply and patients who require anesthesia care are living longer (and requiring more procedures with anesthesia), innovative strategies are needed to achieve value and access to anesthesiology services. Leveraging the professional interests of Certified Registered Nurse Anesthetists (CRNAs), the implementation of a flexibility-based compensation structure can optimize overall staffing requirements to meet patient care demands, particularly in t...
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Dunworth BA Tags: AANA J Source Type: research

AANA Journal Course: Update for Nurse Anesthetists-Enterohepatic Recirculation: From Death by Mushroom to Perioperative Pharmacokinetics.
Abstract Enterohepatic recirculation (EHRC) is a multistaged process with the following sequence: liver metabolism, bile secretion, gut metabolism, and reabsorption from the gut back to the systemic circulation. Enterohepatic recirculation prolongs drug half-lives and may be associated with the generation of 1 or more secondary plasma peaks. For EHRC to occur, there is substantial dependence on the flora residing in the gastrointestinal (GI) tract. The role of gut microflora is so essential to our overall homeostasis that it is referred to by some authorities as an endocrine organ or "a second brain." He...
Source: AANA Journal - January 1, 2020 Category: Anesthesiology Authors: Biddle C Tags: AANA J Source Type: research

Science and Clinical Potpourri for Your Life and Your Practice.
Authors: PMID: 31920195 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - December 1, 2019 Category: Anesthesiology Tags: AANA J Source Type: research

Combined General and Epidural Anesthesia for Emergency Cesarean Delivery of Twins in a Parturient With Coarctation of Aorta.
We report the successful management of emergency lower-segment cesarean delivery in a patient with coarctation of aorta. A parturient at 34 weeks of gestation of a twin pregnancy with uncorrected coarctation of aorta was taken for emergency lower-segment cesarean delivery to be performed using epidural anesthesia. A mixture of lignocaine (lidocaine), bupivacaine, and fentanyl was administered epidurally. In view of unsatisfactory motor action, general anesthesia had to be administered. However, because of sufficient analgesia due to the epidural drugs, optimal hemodynamic control was achieved. A combination of general and ...
Source: AANA Journal - December 1, 2019 Category: Anesthesiology Authors: Thakur D, Modak S, Rayadurg V, Tendolkar BA Tags: AANA J Source Type: research