AANA Journal[JOURNAL]
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200 papers
Critical Events in Patients With Alternating Hemiplegia of Childhood: A Cohort Study Subgroup Analysis.
Funk EM, Dear GL, Moya-Mendez ME … +7 more , Landstrom AP, Breglio A, Parker LE, Boggs A, Prange L, Barstow L, Mikati MA
AANA J · 2025 Feb · PMID 39945148 · Full text
People with alternating hemiplegia of childhood undergoing general anesthesia are at risk for severe complications including critical bradycardia and hemiplegic incidents. We performed a 10-year historical cohort study a...
People with alternating hemiplegia of childhood undergoing general anesthesia are at risk for severe complications including critical bradycardia and hemiplegic incidents. We performed a 10-year historical cohort study and completed a subgroup analysis of patients who specifically underwent general anesthesia. Patients with ATP1A3 positive variants were compared with those without such variants. The 14 patients reviewed underwent general anesthesia a combined total of 39 times. Two patients had a short QTc documented prior to anesthesia and presented with bradycardia in the recovery room. Two other patients experienced a suspected seizure and hemiplegic incident; one of those patients received no facility-administered medications prior to experiencing a hemiplegic incident, and the other experienced a hemiplegic incident on emergence from anesthesia with subsequent cardiac arrest and successful resuscitation. No apparent association was identified between type of anesthesia and the development of bradycardia or hemiplegic incidences. Of the four patients experiencing critical events, three had the ATP1A3-D801N variant. Although additional research is necessary to confirm such associations, patients with alternating hemiplegia of childhood, specifically the ATP1A3-D801N variant, appear to be at elevated risk for complications associated with general anesthesia, suggesting the need for an increased anticipation of complications for this population.
Sleep: Architecture, Deprivation, and Propofol-Induced Sleep.
McClintock KT, Mercurio AK, Reilly DS … +2 more , Cosgrove M, Rachler R
AANA J · 2024 Dec · PMID 39601855
The importance of sleep and its role in maintaining health and well-being has garnered much attention in recent years. A large percentage of people suffer from sleep deprivation and chronic insomnia. These derangements c...
The importance of sleep and its role in maintaining health and well-being has garnered much attention in recent years. A large percentage of people suffer from sleep deprivation and chronic insomnia. These derangements can lead to a wide range of adverse health effects. Therefore, the crucial nature of sleep health cannot be overstated. Normal sleep architecture along with adequate sleep hygiene promotes homeostasis by way of positive feedback, which in turn, maintains many crucial physiologic functions. Given their education and area of expertise, certified registered nurse anesthetists should possess a thorough knowledge of sleep, its benefits, and the detriments associated with inadequate sleep. This journal course aims to disseminate useful information regarding sleep architecture and hygiene, the sleep-health relationship, risk factors related to chronic sleep deprivation (CSD), and current treatment modalities, including a novel approach to CSD: propofol-induced sleep.
Anesthesia Management of the Patient With Pulmonary Alveolar Proteinosis Undergoing Lung Lavage.
Hall E, Hollabaugh B, Bendure J
AANA J · 2024 Dec · PMID 39601854
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disorder characterized by the accumulation of surfactant/lipoprotein material in the alveoli and subsequent hypoxemic respiratory failure. Whole lung lavage (WLL),...
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disorder characterized by the accumulation of surfactant/lipoprotein material in the alveoli and subsequent hypoxemic respiratory failure. Whole lung lavage (WLL), a procedure used to physically remove the lipoprotein material from the alveoli, is the first-line treatment for this disease process. Anesthesia providers may infrequently encounter the management of the WLL procedure due to the rarity of the underlying disease process. Pertinent anesthesia considerations for WLL are covered in the following case report. A review of the literature examines the pathophysiology of PAP, the various approaches to WLL, and the physiologic implications of WLL.
Emergency Cesarean Section With Acute Promyelocytic Leukemia and Disseminated Intravascular Coagulation-A Case Report.
Smith-Steinert RM, Makkad B
AANA J · 2024 Dec · PMID 39601853
Acute promyelocytic leukemia (APML), a rare disease encountered during pregnancy, is associated with high mortality secondary to consumptive coagulopathy and fatal bleeding diathesis. It usually presents as a medical eme...
Acute promyelocytic leukemia (APML), a rare disease encountered during pregnancy, is associated with high mortality secondary to consumptive coagulopathy and fatal bleeding diathesis. It usually presents as a medical emergency and warrants prompt diagnosis and treatment to improve maternal survival. This case report details a 19-year-old female with new onset APML who presented for emergency cesarean section because of respiratory distress and suspected placental abruption. Antifibrinolytics, which are commonly utilized to treat postpartum hemorrhage, were contraindicated because the patient was receiving all transretinoic acid (ATRA) therapy for APML. This case adds insight into the disease and its management along with anesthesia considerations for patients undergoing emergent caesarean delivery in the setting of acute disseminated intravascular coagulation and ATRA therapy. It also highlights the importance of a multidisciplinary team approach to plan for treatment and timing of delivery that balances the risk of disease progression and fetal well-being. Such multidisciplinary care and proper planning helped in attaining the best possible outcomes for both mother and baby.
A Case Report of a Rescue of Unanticipated Obstetric Difficult Airway Secondary to Limited Mouth Opening With i-gel® and Establishing Definitive Airway With Aintree and Fiberscope-Guided Intubation.
Lee AI, Ortiz J, Suresh MS
AANA J · 2024 Dec · PMID 39601852
Obstetric difficult airway management has emerged as a critical safety issue, and unsuccessful intubation can lead to morbidity and mortality. A literature review of difficult and failed obstetric intubations from the 19...
Obstetric difficult airway management has emerged as a critical safety issue, and unsuccessful intubation can lead to morbidity and mortality. A literature review of difficult and failed obstetric intubations from the 1970s to 2015 shows that the incidence of failed intubation is unchanged, remaining at one per 390 anesthetics. Our obstetric case report highlights an obstetric difficult airway secondary to limited mouth opening; rescue of the airway with an i-gel®; and establishment of a definitive airway with the aid of an Aintree intubation catheter and flexible fiberoptic scope-guided intubation through the i-gel®, a second-generation supraglottic airway.
The Role of CRNAs in Reduction of Sharps Waste in the Operating Room.
Lewkovich K, Roberts K, Severance D … +4 more , Dalley CB, Cade M, Crowell N, Scott-Herring M
AANA J · 2024 Dec · PMID 39601851
The purpose of this study was to identify and explore certified registered nurse anesthetists' (CRNA) knowledge, current practices, and barriers to proper sharps waste disposal practices in the operating room. Approximat...
The purpose of this study was to identify and explore certified registered nurse anesthetists' (CRNA) knowledge, current practices, and barriers to proper sharps waste disposal practices in the operating room. Approximately 100 CRNAs who practice anesthesia in the Mid-Atlantic region at 10 different hospitals were given an electronic survey. Forty CRNAs completed the 15-question de novo quantitative descriptive survey. The survey was created by three researchers and five experts in the field to ensure validity. Data were analyzed using the chi-squared test and the Mann-Whitney U test. Thirty-seven percent of respondents reported placing unbroken vials, and 46.4% reported placing empty plastic syringes with needles still attached in sharps containers. Most survey respondents (73.7%) agreed that they had inadequate information creating a knowledge deficit on the proper disposal of sharps and that additional teaching material would be helpful.
The Role of Processed Electroencephalogram in Adult Surgical Procedures: A Retrospective Cohort Study.
Hutto K, van Pelt M, Smith MR … +3 more , Mueller A, Houle TT, Lea J
AANA J · 2024 Dec · PMID 39601850
The use of depth of anesthesia monitoring, such as a processed electroencephalogram (pEEG), can decrease the risk of awareness with recall, yet the current standards for monitoring during the administration of anesthesia...
The use of depth of anesthesia monitoring, such as a processed electroencephalogram (pEEG), can decrease the risk of awareness with recall, yet the current standards for monitoring during the administration of anesthesia do not include the use of brain monitoring for anesthetic depth. This retrospective cohort study describes the frequency of use and explores the characteristics of utilization of pEEG monitoring by anesthesia professionals during the administration of general anesthesia in the adult patient population at a large academic medical center. Descriptive associations with pEEG monitoring were confirmed in both univariate and multivariable analyses with multiple patient, anesthetic, and surgical characteristics. After taking anesthesia provider, patient, anesthetic, and surgical characteristics into consideration, 38.0% of the variability in pEEG use was accounted for. Although these data suggest recommended guidelines are being followed, further analyses should examine explicit relationships and differences in pEEG use.
Implementing A Surgical Safety Checklist for In-Office Procedures.
Kaiser JR, Hayth T, DeBlieck C
AANA J · 2024 Dec · PMID 39601849
There has been a notable movement in performing procedures in the office setting. With this new shift, the utilization of proven safety measures would be beneficial to mirror. The utilization of a surgical safety checkli...
There has been a notable movement in performing procedures in the office setting. With this new shift, the utilization of proven safety measures would be beneficial to mirror. The utilization of a surgical safety checklist (SSC) has become an essential part of safety measures instituted to mitigate preventable errors in the operating room (OR). This measure is equally important to institute for non-OR procedures. The purpose of this project was to implement a SSC protocol as a standard of care at a clinic that newly adopted in-office surgical procedures with anesthesia. The project focused on developing and disseminating a SSC educational program for the procedural staff that included: three surgeons, three medical assistants, and one anesthesia provider. The staff were assessed on their ability to successfully implement the SSC over a 3-month period with a goal of 90% compliance. The result of the project was that the staff exceeded the compliance goal by successfully completing the SSC on 28 of the 29 procedures performed with anesthesia, meeting a 96% compliance. Overall, the implementation was embraced and effectively incorporated into the workflow. Comments received revealed that three staff have now adopted using the SSC beyond the project and utilize it for all procedures and injections they perform, making this implementation successful.
Factors Affecting Nurse Anesthetists' Transition from Clinical Practice to Academia: A Scoping Review.
Stuit DJ, Chabo TL, Hart D … +2 more , Sewell K, McMullan SP
AANA J · 2024 Dec · PMID 39601848
Workforce shortages influence all areas of healthcare including healthcare education. While recruitment and retention are known barriers within academia, the factors associated with the nurse anesthetist's transition fro...
Workforce shortages influence all areas of healthcare including healthcare education. While recruitment and retention are known barriers within academia, the factors associated with the nurse anesthetist's transition from clinician to academics are unknown. The purpose of this scoping review was to identify factors that affect the transition from nurse anesthesia clinical practice to academia. A scoping review was conducted using the framework of Arksey and O'Malley. The search was performed using MEDLINE and CINAHL databases. Review selection was performed by two teams of two independent reviewers and summary of findings input into a comprehensive table. The search identified 733 articles published from 2014 to May 2023. Reviews were limited in nurse anesthesia and mainly consisted of alternate nursing specialties. Seven themes were extrapolated from the findings including mentorship (82%), orientation (47%), work-life balance (41%), early identification and empowerment (18%), formal pedagogical training (41%), faculty compensation (29%), and alternative faculty positions (23%). The review overwhelmingly revealed educator strategies available for undergraduate nursing, nurse practitioners, and midwifery, but not for nurse anesthetists. To gain a more robust knowledge of this current issue, additional research is required to educate, support, inform, and evaluate the current nurse anesthesia transition to academia process.
Perioperative Management of Atrial Fibrillation In a Geriatric Neurosurgical Patient With Acute Aneurysmal Subarachnoid Hemorrhage.
Reddy A, Mahajan S, Panda N … +1 more , Kumar S
AANA J · 2024 Dec · PMID 39601847
Aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted neurosurgical emergency with cardiopulmonary complications. Concurrent atrial fibrillation seen commonly in the geriatric population further challenges p...
Aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted neurosurgical emergency with cardiopulmonary complications. Concurrent atrial fibrillation seen commonly in the geriatric population further challenges perioperative management. Osmotherapeutic agents such as mannitol are routinely used in SAH to decrease intracranial pressure by withdrawing water from the brain parenchyma into the intravascular space. However, mannitol also has the potential to cause myocardial dysfunction and exacerbation of arrhythmias like atrial fibrillation in geriatric patients with decreased cardiovascular reserve. The literature on goal-directed fluid therapy and transesophageal echocardiography (TEE)-guided intraoperative management of a case of atrial fibrillation is sparse. This case report highlights the role of mannitol in the potentiation of arrhythmias like atrial fibrillation which was then successfully managed using goal-directed fluid therapy and TEE leading to a favorable outcome.
Educating the Next Generation of CRNAs.
Durbin T, Moore E, Everson M … +3 more , Sareerak J, Morgan B, Pantone G
AANA J · 2024 Dec · PMID 39601846
Abstract loading — click title to view on PubMed.
Optimizing Workplace Wellness for Nurse Anesthetists: Key Benefits to Consider When Choosing Employment.
Evans HD, Hooge NB, Keeney D
AANA J · 2024 Dec · PMID 39601845
Abstract loading — click title to view on PubMed.
Dexmedetomidine for Postoperative Delirium Prevention in the Older Adult: An Integrative Review.
Strada AL, Tevay A, Scoggins M … +1 more , Gonzalez K
AANA J · 2024 Oct · PMID 39361485
The brain and cognition are particularly vulnerable to anesthetic and surgical insults, with postoperative delirium being the most common postoperative complication in patients aged ≥ 65 years. The body releases psychoac...
The brain and cognition are particularly vulnerable to anesthetic and surgical insults, with postoperative delirium being the most common postoperative complication in patients aged ≥ 65 years. The body releases psychoactive proinflammatory cytokines in response to surgical trauma, including interleukin-1β, interleukin-6, and tumor necrosis factor-α. This promotes a porous blood-brain barrier, promoting postoperative cognitive dysfunction. Aging adults lose brain volume, cerebrospinal fluid, and dendritic synapses, thereby increasing neurologic stress and vulnerability to these surgical changes. Anesthetic technique influences the process, necessitating the importance of educated certified registered nurse anesthetists. Dexmedetomidine, a nonspecific α2-adrenergic receptor agonist, exhibits anti-inflammatory properties that counteract the proinflammatory mechanisms initiated by surgical insult. Additionally, dexmedetomidine mimics natural sleep pathways and reduces opioid dosing requirements, promoting cognitive preservation. While further research is required to establish an association with long-term effects, current literature indicates that dexmedetomidine may reduce postoperative delirium and cognitive dysfunction in older adults through various dosing regimens. This journal course reviews the pathophysiology of postoperative neurocognitive dysfunction and delirium, dexmedetomidine as an adjunct to mitigate these pathologic changes, and the current literature on dexmedetomidine's impact on postoperative delirium in older adults.
Shared Experiences of Nurse Anesthesiology Faculty During the COVID-19 Pandemic.
Wilbanks B, Hranchook A, Callan V … +4 more , Everson M, Clayton BA, Hirsch M, Jordan L
AANA J · 2024 Oct · PMID 39361484
The COVID-19 pandemic impacted all aspects of healthcare, including the education of certified registered nurse anesthesiologists. While the literature contains reports of the impact of COVID-19 on physician anesthesiolo...
The COVID-19 pandemic impacted all aspects of healthcare, including the education of certified registered nurse anesthesiologists. While the literature contains reports of the impact of COVID-19 on physician anesthesiologist faculty, there was no research identified describing the impact on nurse anesthesiologist faculty. The purpose of this study was therefore to describe and explore the impact of the COVID-19 pandemic on nurse anesthesiology faculty. This qualitative ethnographic study used small focus groups and semistructured and probing questions to examine the phenomenon of interest. Through thematic analysis of the narrative, five overarching themes were identified: 1) ability to adapt to adversity, 2) disruption leads to change, 3) perceived positive outcomes, 4) previously untapped resources, and 5) curricular innovation and integrity.
Impact of a Tranexamic Acid Dosing Practice Guideline in Reducing Blood Product Administration in Pediatric Scoliosis Surgery.
Jones KD, Hatlevig C, Thompson JA … +3 more , Rowe B, Einhorn LM, Funk EM
AANA J · 2024 Oct · PMID 39361483
Pediatric patients who undergo spinal corrective surgery often require multiple blood product transfusions. The use of antifibrinolytics, especially tranexamic acid (TXA), to mitigate intraoperative blood loss has increa...
Pediatric patients who undergo spinal corrective surgery often require multiple blood product transfusions. The use of antifibrinolytics, especially tranexamic acid (TXA), to mitigate intraoperative blood loss has increased in popularity. The goal of this quality improvement project was to evaluate provider compliance with a TXA dosing protocol during pediatric corrective spine procedures. A retrospective chart review was conducted to compare pre- and postimplementation data on cell saver and packed red blood cell (PRBC) administration and dose of antifibrinolytic administered. A total of 486 patients (68% idiopathic and 32% neuromuscular) were evaluated over a 9-year period. Following implementation of the protocol, patients of idiopathic origin experienced a 20% reduction in cell saver administration, a 10% reduction in PRBC administration, and a 37% increase in provider compliance with the dosing protocol. Patients of neuromuscular origin experienced a 53% increase in provider compliance with the recommended TXA dosing protocol; however, this patient population did not experience a statistically significant reduction in transfusion requirements. Implementation of an antifibrinolytic protocol can facilitate compliance with recommended TXA dosing parameters and potentially decrease intraoperative blood loss, reducing blood product transfusion requirements.
Evaluation of the International Scope of Practice of Nonphysician Anesthesia Providers Between 2012 and 2022.
Meeusen V, Walker JR, Vedtofte JI
AANA J · 2024 Oct · PMID 39361482
In 2012, representatives of the 44 International Federation of Nurse Anesthetists (IFNA) member countries were surveyed about their scope of practice. Ten years later, the researchers repeated the study to evaluate the p...
In 2012, representatives of the 44 International Federation of Nurse Anesthetists (IFNA) member countries were surveyed about their scope of practice. Ten years later, the researchers repeated the study to evaluate the professional development of nonphysician anesthesia providers. The survey was prepared by the IFNA Practice Committee and explored demographics, training, anesthesia team members, and daily activities of the nonphysician anesthesia providers (NPAPs). The online survey was sent to all IFNA Country National Representatives. In 2022, 22 out of 44 countries had more than one type of NPAP including five countries that had anesthesia technicians. NPAPs work in operating theatres (94.4%), postanesthesia care units (81.9%), intensive care units (46%), acute (51%), chronic pain (28%), air ambulance (28%), resuscitation (69%), or trauma team (42%), preoperative screening (57%). Formal recognition of the profession and the requirement of licensure to practice has increased. Education levels have increased substantially, which resulted in more indirect supervision. Direct supervision by physicians is related to education levels and limited scope of practice. The NPAP workforce is growing toward IFNA standards, but it has become a more diversely educated workforce. NPAPs who are educated at a bachelor or higher level and require officially recognized licensure to practice, have an extensive scope of practice.
Exploring the Experience of CRNAs Choosing to Quit Their Jobs: A Qualitative Study.
Lambert MC, Ward R, Riddle D
AANA J · 2024 Oct · PMID 39361481
The purpose of this study was to explore the experience of certified registered nurse anesthetists (CRNAs) choosing to quit their primary place of employment. Interpretative phenomenological analysis is the qualitative f...
The purpose of this study was to explore the experience of certified registered nurse anesthetists (CRNAs) choosing to quit their primary place of employment. Interpretative phenomenological analysis is the qualitative framework for this study. Ten CRNAs were interviewed about their experience of quitting their job. Interview transcripts were analyzed for common themes. Common themes were the desire for better work-life fit, the impact of stressful work intensity, and exposure to poor leadership. This study suggests that a focus on ensuring job fit for personal goals outside of work may improve CRNA retention. This study also provides practice implications for hospital leadership, as well as direction for future qualitative and quantitative research.
Successful Treatment of Idiopathic, Intractable Hiccups With Prescriptive Positive Pressure Ventilation-A Case Report.
Rampersad D, Slaven J
AANA J · 2024 Oct · PMID 39361480
A 65-year-old male patient presenting with idiopathic, intractable hiccups was to undergo bilateral thoracotomies for phrenic nerve stimulator placement but initially underwent a treatment utilizing the administration of...
A 65-year-old male patient presenting with idiopathic, intractable hiccups was to undergo bilateral thoracotomies for phrenic nerve stimulator placement but initially underwent a treatment utilizing the administration of prescriptive positive pressure ventilation as a less invasive treatment option and had successful resolution of hiccups. The patient's hiccups began after a prior hiatal hernia repair and was refractory to pharmacologic treatment and phrenic nerve blocks. Utilizing neuromuscular blockade for diaphragm paralysis and administering three vital capacity breaths to peak inspiratory pressures of 25 cm H2O via endotracheal tube, the patient had successful resolution of symptoms and further surgical intervention was not warranted.
Implementation of a Perioperative Lung Protective Ventilation Protocol for Robotic-Assisted Surgeries.
Elmore SA, Tola DH, Simmons VC … +2 more , Wilson LA, Szydlowski JD
AANA J · 2024 Oct · PMID 39361479
This project sought to educate providers on the benefits of lung protective ventilation (LPV), implement a LPV protocol in robotic surgery, and evaluate adherence to the protocol in the adult (≥ 18 years) robotic-assiste...
This project sought to educate providers on the benefits of lung protective ventilation (LPV), implement a LPV protocol in robotic surgery, and evaluate adherence to the protocol in the adult (≥ 18 years) robotic-assisted surgery population. This project used a pre/post quality improvement design with a retrospective chart review and periodic knowledge, attitude, and practice surveys over the course of 6 months. This project retrospectively reviewed electronic medical records to assess adherence to the LPV protocol. The type of surgery; ventilator settings including positive end-expiratory pressure, FiO2, tidal volume, SpO2, ventilator mode, compliance, driving pressure and peak pressure; patient height and weight; patient body mass index; and American Society of Anesthesiologists physical status classification were collected. Analyzed results compared baseline preeducation data and data collected at 3- and 6-months postimplementation. Adherence to the LPV protocol parameters of tidal volume ( < .001), respiratory rate ( = .014), and driving pressure ( < .001) within LPV limits improved with statistical significance from pre- to postimplementation. Provider confidence and knowledge increased from pre- to posteducation ( = .049). Adherence to a LPV protocol improved with education and information tools.
Ultrasound-Guided Quadratus Lumborum Block Versus Caudal Block for Perioperative.
Shah SB, Pant D, Koul A … +3 more , Roy A, Sood J, Chugh PT
AANA J · 2024 Oct · PMID 39361478
Quadratus lumborum block is an effective truncal block for postoperative analgesia in patients undergoing abdominal surgeries. We aimed to compare the analgesic efficacy of caudal block versus ultrasonography-guided quad...
Quadratus lumborum block is an effective truncal block for postoperative analgesia in patients undergoing abdominal surgeries. We aimed to compare the analgesic efficacy of caudal block versus ultrasonography-guided quadratus lumborum block in pediatric patients undergoing open pyeloplasty. Fifty patients weighing ≤ 16 kg (age ≤ 4 years) with ASA physical status I-II scheduled for elective open pyeloplasty under general anesthesia were randomized into caudal block or transmuscular quadratus lumborum block groups. Fifty patients were included in the analysis. The mean duration of postoperative analgesia in the caudal group was 6.85 ± 1.99 hr, and for the quadratus lumborum block group it was 11.27 ± 3.74 hr ( < .001). There was no significant difference between the groups in terms of perioperative fentanyl requirement. However, there was a significant difference in postoperative paracetamol requirement between the groups ( = .005). There was a significant difference in postoperative pain score between the groups at 30 min, 1 hr, 1.5 hr, 2 hr, 8 hr, and 24 hr ( < .05). Mean heart rate and mean arterial pressure were comparable. No complications were recorded. Quadratus lumborum block was more effective than caudal block in terms of duration of postoperative analgesia and postoperative analgesic consumption.
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