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) acqu...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.
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...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 ( = 0.57; < .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.
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...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.
One third of the population will develop atrial fibrillation in their lifetime and 12.1 million people in the United States are expected to be affected by 2030. A long-standing gap exists in traditional pharmacologic and...One third of the population will develop atrial fibrillation in their lifetime and 12.1 million people in the United States are expected to be affected by 2030. A long-standing gap exists in traditional pharmacologic and nonpharmacologic treatments for persistent atrial fibrillation. An innovative, hybrid treatment, commonly referred to as the Convergent Procedure, combines surgical ablation of the posterior left atrium through a minimally invasive subxiphoid incision with traditional endocardial ablation techniques. When the procedure includes ligament of Marshall ligation and epicardial occlusion of the left atrial appendage using a video-assisted thoracoscopic approach, it is termed the Convergent 'Plus' Procedure. Evidence indicates that the procedure is twice as effective as endocardial ablation alone, reducing the need for atrial fibrillation medications by half. Consequently, demand for the procedure has surged, and anesthesia providers are now caring for patients in cardiac operating rooms and hybrid cardiology suites nationwide. Successful execution of the Convergent Plus Procedure demands close coordination among interdisciplinary teams, including surgery, cardiology, and anesthesiology. Anesthetic management is complex, requiring certified registered nurse anesthetists to understand procedural stages, ensure proper patient positioning, manage lung isolation, and be prepared for numerous complications such as hemodynamic instability, hemorrhage, and stroke.
General anesthesia (GA) is the preferred technique in ambulatory surgery because GA is associated with a predictable recovery time. However, it carries higher risk of postoperative nausea and vomiting and drowsiness when...General anesthesia (GA) is the preferred technique in ambulatory surgery because GA is associated with a predictable recovery time. However, it carries higher risk of postoperative nausea and vomiting and drowsiness when compared with spinal anesthesia (SA). This study aimed to determine whether the recovery time in mepivacaine of 30 mg SA is noninferior when compared with GA. Our single-center retrospective study used a multivariable logistic regression to model anesthetic modality as a function of age, sex, body mass index, and American Society of Anesthesiologists physical status to generate a propensity score for each patient for matching. After screening 455 patients, 111 patients in each group were matched. SA was associated with 23.0 minutes (95% CI, -∞ to 31.0; < .0001) longer recovery time, shorter operating room time (-8.0 minutes, 95% CI -13.0 to -3.0), more likely to bypass phase 1 recovery (OR, 2.77; 95% CI, 1.20 to 6.88) and less opioid use (-0.5 mg; 95% CI, -3.7 to -0.0001) but no difference in length of stay (LOS). Spinal anesthesia was correlated with inferior recovery time. The associated phase 1 bypass and similar LOS suggest SA as a viable alternative to GA.
Point-of-care ultrasonography (POCUS) is an emerging modality that certified registered nurse anesthetists (CRNA) may consider using to augment a traditional physical assessment. The prevalence of POCUS usage by CRNAs an...Point-of-care ultrasonography (POCUS) is an emerging modality that certified registered nurse anesthetists (CRNA) may consider using to augment a traditional physical assessment. The prevalence of POCUS usage by CRNAs and the barriers to its use are unknown. A quantitative survey was sent to 2,648 CRNAs throughout the United States. Of the participants surveyed, 11.9% reported personally performing POCUS, and 90.5% thought POCUS was beneficial to nurse anesthesiology practice. The survey found that the greatest barrier to using POCUS is a need for more education or POCUS training. Respondents identified several barriers, such as lack of facility support, lack of ultrasound equipment, and a lack of perceived need to implement POCUS in clinical practice. Most CRNAs who overcame barriers and currently utilize POCUS in their practice have reported having in-person didactic and hands-on training.
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...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 ta...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 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 ( < .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 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.
Certified registered nurse anesthetists (CRNAs) regularly encounter stressful emergency situations that demand critical thinking and quick intervention; these scenarios often result in task saturation and compromised men...Certified registered nurse anesthetists (CRNAs) regularly encounter stressful emergency situations that demand critical thinking and quick intervention; these scenarios often result in task saturation and compromised mental acuity. An intervention utilizing a clinical decision support system (CDSS) with anesthesia emergency checklists built into the electronic health record (EHR) at a rural hospital in New Mexico was tested in a simulated environment. The simulation compared CRNA performance and adherence to evidence-based protocols with and without the checklists. The purpose of this study was to determine whether a CDSS built into the existing EHR could improve both CRNAs' adherence to evidence-based protocols and their documentation during an acute malignant hyperthermia (MH) emergency. Quantitative methods were used in the analysis of the data. Descriptive statistics and a paired t test were used to analyze MH evaluation tool data. Measures of central tendency were used to identify trends in the data. The study showed significant improvement ( < .05) in CRNA performance while using a CDSS during a simulated MH emergency and dramatic increases in documentation completeness.
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 c...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.
Palazi C, Sapsakos TM, Galanis P
… +8 more, Katsoulas T, Giannakopoulou M, Alexandrou E, Skepastianos G, Kopanakis N, Bastaki ME, Georgiopoulos G, Konstantinou EA
The purpose of this study was the evaluation of the pressure-volume (PV) curve and all possible complications as it appears on an anesthesia monitor and the recording of parameters such as PO and SpO intraoperatively and...The purpose of this study was the evaluation of the pressure-volume (PV) curve and all possible complications as it appears on an anesthesia monitor and the recording of parameters such as PO and SpO intraoperatively and before intubation. The study took place in the Surgery Department of a highly qualified Cancer Memorial Hospital, included 90 oncology patients diagnosed with abdominal cancer, and was divided into three groups. Patients in Group A had a normal history of pulmonary function and body mass index values; Group B included patients with a history of obstructive lung disease; and Group C comprised patients with a history of restrictive lung disease. P and P measurements at baseline were significantly higher for Group C. PO for Group A was consistently higher. FiO was higher throughout Group C. It was found that rates of cough and shortness of breath differed significantly among the groups regarding respiratory complications. The PV curve for Group A was characterized by a sigmoid form; there was a concavity in the curve primarily in the final part for Group B; and there was a steep slope of the flow-volume curve and decreased forced vital capacity in Group C. Monitoring lung function during general anesthesia may provide useful information to anesthetists and allow the quantification of the severity of respiratory disease. The creation of PV curves and the evaluation of its data presents valuable information about lung mechanics and ventilator setup and can be an ideal postoperative tool as well as during general anesthesia.
Anesthesia-related studies have found that many adverse events are related to human factors including occupational burnout, safety culture, and production pressure. The purpose of this study was to explore the relationsh...Anesthesia-related studies have found that many adverse events are related to human factors including occupational burnout, safety culture, and production pressure. The purpose of this study was to explore the relationships between those factors to identify potential interventions to improve patient safety and anesthesia practice. This exploratory study used a cross-sectional design with a survey administered via e-mail to nurse anesthetists. The survey consisted of the Survey on Patient Safety, Maslach's Burnout Inventory, and the NASA task-load-index. Data analysis included linear mixed regression models, Spearman correlations, and Cronbach's alpha. Covariates included age, years of clinical experience, zip codes, and gender. We found that the best predictors of patient safety are hospitals' culture of safety and staffing patterns. Adequate staffing had the largest impact on reducing occupational burnout and nurse anesthetists' intentions to leave their jobs. Less experienced nurse anesthetists reported lower patient safety scores. Successful interventions to improve institutional factors need to be implemented and supported by management with an emphasis on open communication among all team members to elicit lasting changes. Additionally, interventions should focus on appropriate staffing, team training, and resilience training because these have the greatest impact.
Hypoxemia and related complications are the leading adverse events during an anesthetic in neonates and infants younger than 60 weeks postconceptual age. This risk is more prominent during induction of anesthesia. A preo...Hypoxemia and related complications are the leading adverse events during an anesthetic in neonates and infants younger than 60 weeks postconceptual age. This risk is more prominent during induction of anesthesia. A preoperative assessment and plan should be made for both management of an uncomplicated anesthesia induction and the unexpectedly difficult airway. Developmental anatomy and physiology contribute to a higher incidence of unexpected difficult bag mask ventilation, intubation, and cannot intubate, cannot oxygenate situations. This has driven the advancement of oxygen delivery methods, size-specific airway equipment, and comprehensive pediatric-based difficult airway algorithms and cognitive aids. Recommendations for the future include increased education, training, and standardization of care. A specialized clinical approach to efficiently secure the infant airway and mitigate rapid onset of hypoxemia is key. Limitations to our study results include cost of equipment and implementation, but quality and strength of supporting evidence is robust.
Previous studies have shown that higher emotional intelligence (EI) leads to lower incidence of burnout in clinical healthcare workers. However, there are currently no published studies that explore this relationship in...Previous studies have shown that higher emotional intelligence (EI) leads to lower incidence of burnout in clinical healthcare workers. However, there are currently no published studies that explore this relationship in anesthesia providers. This study aimed to investigate 1) whether anesthesia providers with higher EI were less likely to meet burnout criteria, and 2) whether demographic factors played a role in likelihood of burnout. In this study, 21 certified registered nurse anesthesiologists, 23 physician anesthesiologists, and six anesthesiologist assistants completed the 16-item Wong and Law Emotional Intelligence Score and the 16-item Oldenburg Burnout Inventory. T-test analysis was used for data interpretation to answer the emotional intelligence and burnout relationship proposed by the study. A statistically significant correlation was found between higher EI and lower incidence of burnout ( = .022). No statistically significant relationships were found between demographic variables and rates of burnout. Burnout is a tremendous issue among anesthesia providers, and further exploration into the influence of emotional intelligence on burnout may be instrumental to decreasing burnout incidence.
This research focused on the perspectives of certified registered nurse anesthetists on practice within the anesthesia care team (ACT) model. This narrative, qualitative study examined participants' perspectives on the s...This research focused on the perspectives of certified registered nurse anesthetists on practice within the anesthesia care team (ACT) model. This narrative, qualitative study examined participants' perspectives on the strengths, challenges, conflict resolutions, and any other information they provided about working in the ACT model. The participants drew sharp distinctions between the supervision requirement of the ACT and that of collaboration with a team approach. The participants reported that they enjoyed and supported collaboration and found that the team approach led to efficient patient care while having extra hands to help and minds to problem-solve complicated patient scenarios. They did not believe physician supervision over their practice was necessary and proved burdensome. They further reported that they often relied on collaboration, accommodation, or compromise to resolve decision-making conflicts when they practiced within the ACT. However, several reported avoiding or leaving the ACT care model for independent practice. Participants who left ACTs reported that they were much happier with their profession and would never return to the ACT model. The recommendations from this study include discontinuing supervision of their practice while strengthening collaboration, a change in payment structure for anesthesia services, and reformed hospital credentialing. They believe that these recommendations would facilitate the full scope of practice and work independently to deliver the high-quality anesthesia care they trained for.
Fetomaternal outcomes and anesthetic management of pregnancy have rarely been described in a prospective cohort of women with Ebstein's anomaly. Therefore, due to the scarcity of data, diagnostic approaches and obstetric...Fetomaternal outcomes and anesthetic management of pregnancy have rarely been described in a prospective cohort of women with Ebstein's anomaly. Therefore, due to the scarcity of data, diagnostic approaches and obstetric and anesthetic management plans are still evolving. In this prospective observational study, we describe the anesthetic management and fetomaternal outcomes of seven women with different grades of unrepaired Ebstein's anomaly. All women were in NYHA (New York Heart Association) Class II, none had cyanosis or cardiac decompensation at the time of admission during pregnancy. Pregnancy was uneventful except in one woman who developed pulmonary oedema. Two women developed supraventricular arrhythmia in the postpartum period. Six women underwent vaginal or assisted vaginal delivery, while one woman underwent cesarean delivery due to the transverse lie of the fetus. All mothers returned to NYHA Class I at 6 weeks follow up. In conclusion, pregnancy increases the risk of maternal complications in asymptomatic women with Ebstein's anomaly. Therefore, preoperative functional and echocardiographic risk stratification is crucial for prepregnancy counseling. Intrapartum and postpartum surveillance, prompt diagnosis of complications, and appropriate management in multidisciplinary hospital settings are associated with favorable fetomaternal outcomes.
To improve dynamic needle-tip visualization, nurse anesthesiology students were evaluated during simulated ultrasound-guided procedures. This quasiexperimental study utilized two computed tomography 3D printed models. Th...To improve dynamic needle-tip visualization, nurse anesthesiology students were evaluated during simulated ultrasound-guided procedures. This quasiexperimental study utilized two computed tomography 3D printed models. Thirty-two students performed each procedure twice, once without and once with needle guidance. Measures focused on accuracy and procedural performance to determine the impact that guidance versus no guidance had on attempts. Students evaluated their experiences, self-confidence, feasibility, and usability using needle guidance technology. Needle guidance improved the distance to target, total procedure time, phantom penetration time, number of attempts, completion rate, and effectiveness in both procedures. Overall, a decrease in distance to target in millimeters was uncovered when needle guidance was utilized (Z = -5.723, < .001). Needle guidance showed a decrease of 3.96 attempts when guidance was utilized for the infraclavicular (F[1, 22] = 51.79, < .001) and 0.96 attempts during the thoracic paravertebral procedure (F[1, 22] = 6.02, = .023). Students found that needle guidance enhanced ease, speed, and overall performance, while feeling significantly more confident performing the infraclavicular ( < .001) and thoracic paravertebral ( < .001) procedures. The use of needle guidance technology showed improvement in accuracy comparable with results obtained using external tracking technology.