AANA Journal[JOURNAL]
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200 papers
An Evaluation of Commercial Payer Reimbursement and Contracting Factors for Physician Anesthesiologists and Certified Registered Nurse Anesthetists for Services Performed in 2019.
Covillo J, Poepsel MS, Skibiski J
AANA J · 2024 Feb · PMID 38289686
We sought to establish commercial rate benchmarks specific to certified registered nurse anesthetist (CRNA) anesthesia delivery models (QZ), quantify any payer disparities discovered between CRNAs and anesthesiologists,...
We sought to establish commercial rate benchmarks specific to certified registered nurse anesthetist (CRNA) anesthesia delivery models (QZ), quantify any payer disparities discovered between CRNAs and anesthesiologists, and determine payer alignment with nondiscrimination provisions of the Affordable Care Act (ACA). The Lewin Group administered the exploratory, descriptive study of QZ billing practices by surveying a targeted cross-section of 345 CRNAs known for QZ billing. Forty-one respondents reported information from 1,089 CRNAs and 351,920 cases with 127,888 commercial claims billed under 144 unique commercial contracts as performed in 2019. There was a 24% payer disparity in rates negotiated reported between anesthesia providers: CRNAs overall average of $58.62; $55.33-$64.57, compared with anesthesiologist average of $77.01 overall; $73.79-$80.76. Other findings included QZ payment adjustments, denials for reimbursement, and exclusion from plan participation. The study found disparities in rate and discriminatory payer practices specific to CRNA contracting and reimbursement, which suggests payer misalignment with nondiscrimination provisions of the ACA.
Lateral Femoral Cutaneous Nerve Cryoneurolysis for Meralgia Paresthetica: A Case Report.
Pearson L, Schmelzer V, Maye J … +1 more , Zhang SJ
AANA J · 2024 Feb · PMID 38289685
Meralgia paresthetica (MP) is a disorder of lateral femoral cutaneous nerve mononeuropathy caused by entrapment or compression of the nerve. It is characterized by numbing, tingling, and burning pain in the lateral aspec...
Meralgia paresthetica (MP) is a disorder of lateral femoral cutaneous nerve mononeuropathy caused by entrapment or compression of the nerve. It is characterized by numbing, tingling, and burning pain in the lateral aspect of the thigh. The current treatments for MP include conventional medical management, peripheral nerve blocks, and surgical interventions. Some patients who suffer from MP can experience intractable pain and medical management of MP is often inadequate to provide satisfactory pain control. Although regional anesthesia provides excellent pain relief, the analgesic effects of peripheral nerve block are short-lived. Emerging evidence suggests that cryoneurolysis has a low-risk safety profile and can provide prolonged pain relief of superficial nerves when administered appropriately. We present a successful case of a patient with intractable neuropathic pain resulting from MP treated with cryoneurolysis therapy. The patient demonstrated immediate pain relief by 100% after the procedure followed by 80% and 60% pain reduction at 1-month and 3-months follow-up, respectively. Cryoneurolysis may be an alternative modality for patients who fail at conventional medical treatments of neuropathic pain.
Redefining Competencies for Nurse Anesthesia Education--Integrating Emotional Intelligence Assessment and Training into a Nurse Anesthesia DNP Program.
Daus CS, Stein KJ, Baecht LM
AANA J · 2024 Feb · PMID 38289684
We present an overview of best practices for integrating emotional intelligence into a nurse anesthesia educational program. We first cover a brief history of the importance of emotional intelligence to the healthcare, n...
We present an overview of best practices for integrating emotional intelligence into a nurse anesthesia educational program. We first cover a brief history of the importance of emotional intelligence to the healthcare, nursing, and nurse anesthesia fields and then present the processes we undertook to integrate emotional intelligence holistically into our curriculum.
Preliminary Investigation: Pilot Study of Program Directors' Perceptions of Wellness and Suicide Prevention for Student Registered Nurse Anesthetists.
Griffis CA, Bamgbose E, Van Pelt M … +3 more , DeVon H, Wilhalme H, Choi K
AANA J · 2024 Feb · PMID 38289683
The purpose of this pilot study was to investigate wellness and student suicidality in nurse anesthesia programs. Graduate students such as student registered nurse anesthetists (SRNAs) are at increased risk of suicide f...
The purpose of this pilot study was to investigate wellness and student suicidality in nurse anesthesia programs. Graduate students such as student registered nurse anesthetists (SRNAs) are at increased risk of suicide from environmental and educational stressors. Wellness interventions may help. An observational, anonymous online survey of all program directors (PDs) was conducted. Identical responses on a simultaneous pilot SRNA study were compared. Quantitative data were analyzed using Wilcoxon rank sum and Fisher's exact tests. Three PDs reported student suicides. Anxiety, depression, and emotional lability were warning signs. Student and PD responses to wellness program assessments were varied, with PD responses more positive and students more negative. PDs were as stressed as students and struggled to meet their own wellness needs. Most PDs reported no or insufficient training in suicide risk and prevention. Suggestions for improving wellness initiatives included to improve and standardize activities and make initiatives more accessible and seek innovative solutions to fit more content into an overcrowded curriculum. PDs and SRNAs need suicide prevention training and improved wellness efforts at local and national levels. Approaches are needed to counter stigma and reluctance to discuss mental health challenges. Suicide is multidimensional, but with proactive awareness, it may be preventable.
Educational Costs Expended and Career Incomes in Advanced Healthcare Professions.
Brown MM, Brown GC, Smith MR
AANA J · 2024 Feb · PMID 38289682
The financial desirability of dollar/time investments in postbaccalaureate healthcare professional education is needed. We therefore compared postbaccalaureate educational costs and career earnings for nurse anesthetists...
The financial desirability of dollar/time investments in postbaccalaureate healthcare professional education is needed. We therefore compared postbaccalaureate educational costs and career earnings for nurse anesthetists, eight other advanced degree, nonphysician professions, and 14 physician specialties with internal rate of return (IRR) and net present value (NPV) analysis. The IRR and NPV integrated educational costs (tuition, finance charges, lost salary opportunity costs), and career earnings using U.S. Bureau of Labor and Medscape 2022 Physician Compensation Report data. Costs were discounted to 2022 U.S. real dollars using the 3.97% 50-year, U.S. average inflation rate. Annual IRRs for educational investment were 1) hospital CEOs = 48.8%; 2) managed care finance directors = 48.2%; 3) Doctors of Nurse Anesthesia Practice = 26.0%; 4) specialist physicians = 20.3%; 5) primary care physicians = 19.2%; 6) Doctors of Physical Therapy = 18.8%; 7) healthcare attorneys = 18.4%; 8) Doctors of Dental Surgery (dentists) = 18.1%; 9) Doctors of Pharmacy = 17.2%; and 10) Advanced Nurse Practitioners = 10.8%. Considering the educational money/time invested for career monetary returns, the financial desirability of nurse anesthetist and nonphysician, healthcare executive education exceeded that of physicians. Lifetime earnings for nurse anesthetists exceeded those of Doctors of Dental Surgery (Doctors of Dental Medicine), Doctors of Pharmacy, Doctors of Physical Therapy, managed care MBAs, biomedical engineers, healthcare attorneys, and Advanced Nurse Practitioners.
Anesthetic Management of Patients Undergoing Electroconvulsive Therapy.
Sebastian S
AANA J · 2023 Dec · PMID 37987728
Electroconvulsive Therapy (ECT) is an effective treatment for mood disorders, particularly treatment-resistant depression, and several psychiatric illnesses. Anesthetic management of patients undergoing ECT requires an u...
Electroconvulsive Therapy (ECT) is an effective treatment for mood disorders, particularly treatment-resistant depression, and several psychiatric illnesses. Anesthetic management of patients undergoing ECT requires an understanding of ECT, the physiologic changes induced by electrical stimulus, the anesthetic agents used, and the potential complications associated with the procedure. Numerous medical and surgical conditions can impact procedural approach and anesthetic management. ECT is challenging due to its typically off-site location, fast-paced general anesthesia with bag-mask ventilation, selection of anesthetic agents that minimally affect the seizure, patient's comorbidities, and unique physiologic responses. This comprehensive review aims to update anesthetists on the periprocedural management of patients undergoing ECT.
Bilateral Erector Spinae Plane Blocks versus Bilateral Transversus Abdominis Plane Blocks in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis.
Stewart M, Tubog TD, Johnson W … +1 more , Evans H
AANA J · 2023 Dec · PMID 37987727
Postoperative pain associated with abdominal surgeries impairs physical function, delays recovery, and decreases quality of life. Regional anesthetic techniques such as transversus abdominis plane (TAP) block and erector...
Postoperative pain associated with abdominal surgeries impairs physical function, delays recovery, and decreases quality of life. Regional anesthetic techniques such as transversus abdominis plane (TAP) block and erector spinae plane (ESP) block are used to improve patients' postoperative pain experiences. PubMed, CINAHL, Google Scholar, Cochrane Library, and gray literature were searched. Mean difference (MD) and risk ratio were used to estimate continuous and dichotomous variables. Quality of evidence was analyzed using Risk of Bias and GRADE. Sixteen studies involving 934 patients were analyzed. Compared with TAP block, ESP reduced resting (MD, -0.83; 95% confidence interval [CI], -1.02 to -0.64; < .00001) and dynamic pain intensity (MD, -0.71; 95% CI, -0.93 to -0.50; < .00001) in the first 24 hours lowered postoperative opioid consumption (MD, -4.52; 95% CI, -5.99 to -3.04; < .00001) and prolonged the time to first rescue analgesic (MD, 3.18; 95% CI, 2.43 to 3.93; < .00001). However, ESP was similar to TAP block for intraoperative opioid consumption, and the incidence of nausea or vomiting. Although the ESP block provided statistical superiority over the TAP block for acute pain management, the clinical relevance of the differences was small.
The Value of History and Physical Examination to Optimize Outcomes of Cataract Surgery: A Systematic Review.
Jackson CL, Rivers RJ, Conti ME … +4 more , Freedman LS, Song M, Lehmann JD, Pandian V
AANA J · 2023 Dec · PMID 37987726
This systematic review was conducted to examine the value of the preoperative history and physical (H&P) examination and preoperative care prior to cataract extraction and the resulting outcomes of adverse events, patien...
This systematic review was conducted to examine the value of the preoperative history and physical (H&P) examination and preoperative care prior to cataract extraction and the resulting outcomes of adverse events, patient experience, and cost. Four databases were searched using appropriate keywords from 2012 to 2022. Observational studies, randomized controlled trials, and quality improvement studies with data on the precataract H&P were included. Outcome measures were adverse events, cost, and patient experience. Of the 4,170 studies screened, 12 studies were included. Risk stratification of patients into a high-risk group with an H&P and a low-risk group without an H&P resulted in an increased incidence of minor adverse events in the low-risk group but did not increase the incidence of major adverse events or surgical adverse events. A short-term cost savings was reported, and patient experience was unchanged. In 2020, the Centers for Medicare and Medicaid Services removed the requirement for the precataract H&P within 30 days prior to ambulatory surgery, which has implications for surgery center policy. More research on the role of the preoperative H&P on patient experience, adverse events, cost, and outcomes should be conducted, given the methodological heterogeneity of this review.
A Subtle ECG Change Leading to Wolff-Parkinson-White Diagnosis Under General Anesthesia: A Case Report.
Groves C
AANA J · 2023 Dec · PMID 37987725
Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that presents with an uninhibited electrical conduction between the atria and ventricles via an accessory pathway that has the potential...
Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that presents with an uninhibited electrical conduction between the atria and ventricles via an accessory pathway that has the potential for life-threatening arrhythmias. This is a case report of an asymptomatic/undiagnosed 43-year-old female with an incidental finding of WPW pattern during hardware removal surgery of the right hip while under general anesthesia. The identification of asymptomatic patients can be difficult because there may be only subtle changes on the electrocardiogram but could still pose as life-threatening in the presence of supraventricular tachycardia. Because of the potential risks, recommendations were given to follow up with the cardiology department to establish an accurate diagnosis. After recognition, the perioperative anesthetic goal was to prepare for any potential arrhythmia, minimize triggers, and provide proper follow-up so that appropriate testing could be conducted to properly diagnose and manage WPW.
Dexmedetomidine versus Opioids on Labor Analgesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Cedeno E, Vo MAJL, Tubog TD
AANA J · 2023 Dec · PMID 37987724
Effective control of labor pain is critical to the birthing experience. Dexmedetomidine is an alternative adjunct to labor analgesia without the risk of opioid-related adverse effects. The purpose of this study was to ex...
Effective control of labor pain is critical to the birthing experience. Dexmedetomidine is an alternative adjunct to labor analgesia without the risk of opioid-related adverse effects. The purpose of this study was to examine the efficacy and safety of neuraxial dexmedetomidine versus neuraxial opioids in labor analgesia. PubMed, CINAHL, Cochrane, Google Scholar, and grey literature were searched for evidence. Risk ratio and mean difference (MD) were used to estimate outcomes. The quality of evidence was assessed using the Risk of Bias and GRADE system. Sixteen studies including 1,669 patients were analyzed. Compared with opioids, dexmedetomidine prolonged the duration of analgesia (MD, 47.58 minutes; 95% confidence interval [CI], 1.57 to 93.58; = .04), reduced pain score (MD, -0.71; 95% CI, -1.17 to -0.24; = .003), and shortened the onset of analgesia (MD, -1.14 minutes; 95% CI, -1.93 to -0.35; = .005). Dexmedetomidine did not affect the duration of first and second stages of labor, number of spontaneous, assisted, and cesarean delivery. Additionally, dexmedetomidine had little to no effects on maternal and neonatal outcomes. Neuraxial dexmedetomidine is more favorable than neuraxial opioids for labor analgesia. Extrapolation of the findings to clinical practice should take into considerations the review limitations.
A Retrospective Study: Multimodal Analgesia Quality Measure Implementation and Patient Outcome Assessment.
Lee N, Feldt J, Bowman C … +4 more , Lee B, Grass N, Crowell N, Eshkevari L
AANA J · 2023 Dec · PMID 37987723
Current research has demonstrated that nonopioid multimodal analgesia decreases perioperative opioid consumption, postoperative nausea and vomiting (PONV), and pain scores. However, no research has been conducted to exam...
Current research has demonstrated that nonopioid multimodal analgesia decreases perioperative opioid consumption, postoperative nausea and vomiting (PONV), and pain scores. However, no research has been conducted to examine the patient outcomes of Merit-based Incentive Payment System (MIPS) 477. This study evaluates those outcomes following implementation of MIPS 477. The medical records of 400 adult patients who underwent elective and urgent laparoscopic gynecological procedures at a facility in the Mid-Atlantic region were reviewed. Data collection included patient characteristics, analgesics administered, pain scores at postanesthesia care unit (PACU) arrival and discharge, and antiemetic administration in PACU. This study's primary outcomes were postoperative pain scores, total intraoperative and postoperative opioid consumption, and PONV. Twenty-nine patients (7.8%) met the criteria as a control group, and 341 patients (92.2%) met the criteria as a treatment group. Pain scores were higher upon PACU arrival among the control group ( = .001). The total intraoperative morphine milligram equivalents (MMEs) administered was less among the treatment group ( = .04). The treatment group had reduced total intraoperative MMEs and pain scores at PACU arrival. However, there was no statistical significance in PACU discharge pain score, total PACU MMEs, and PONV in both groups.
Cognitive Preference and Clinical Experience: The Relationship Between Student Nurse Anesthetists' and Certified Registered Nurse Anesthetists' Thinking Styles.
Diller TA, Haddad L, Bigger SE … +3 more , Carnevale T, Hill L, Hooper V
AANA J · 2023 Dec · PMID 37987722
This study examined the relationship between cognitive preference and clinical experience in student registered nurse anesthetists (SRNAs) and certified registered nurse anesthetists (CRNAs). Survey data was collected fr...
This study examined the relationship between cognitive preference and clinical experience in student registered nurse anesthetists (SRNAs) and certified registered nurse anesthetists (CRNAs). Survey data was collected from enrolled SRNAs and practicing CRNAs via an email link distributive through a network sampling technique. Participants completed the Rational Experiential Inventory (REI-40), which assesses individuals' preference, ability, and engagement with rational and experiential cognitive styles. Data analysis revealed that SRNAs and CRNAs have the ability and engagement preference for rational decision-making. Furthermore, there was no statistical significance in years of clinical experience to cognitive preference, nor was there a statistically significant difference between SRNA and CRNA REI-40 Inventory results. Based on these findings, the dominant cognitive preference is rational cognition and experiential thinking preference remains constant with increased experience. This knowledge contributes to our understanding of CRNAs' decision-making related to cognitive processes and provides insight into SRNA clinical education and CRNA continuing development.
Preliminary Investigation: Pilot Study of Wellness and Suicide Prevention for Student Registered Nurse Anesthetists.
Griffis CA, Bamgbose E, van Pelt M … +3 more , DeVon H, Wilhalme H, Choi K
AANA J · 2023 Dec · PMID 37987721
This pilot study investigated wellness and causes and prevention of suicide in student registered nurse anesthetists (SRNAs). A cross-sectional anonymous survey study was conducted of a sample of randomly chosen SRNAs. D...
This pilot study investigated wellness and causes and prevention of suicide in student registered nurse anesthetists (SRNAs). A cross-sectional anonymous survey study was conducted of a sample of randomly chosen SRNAs. Data were analyzed with descriptive and inferential statistics. Responses to open-ended questions were summarized and presented. Results demonstrated elevated SRNA stress levels. There was an association between suicidal ideation in SRNAs and depression, lack of perceived agency, and elevated anxiety in the classroom. SRNAs reported mental health challenges, depression, and anxiety. Sixteen percent of SRNAs felt that classmates were at risk of suicide, and two SRNAs had lost a classmate to suicide. Twenty-nine percent of SRNAs reported suicidal thoughts prior to matriculation, and 35% reported suicidal thoughts during training. Students with suicidal ideation asked for help from friends and family, but not faculty, and some did not ask for help. Students gave existing wellness initiatives low ratings, and many felt faculty did not promote wellness. Involving student group leaders and appointing a student lead wellness point person may encourage students to ask for help. Faculty should continually prioritize, check-in on, and monitor student wellness. Wellness is a never-ending, essential, and continually evolving effort. Suicide is preventable with compassionate intervention.
Assessing CRNA Knowledge of Local Anesthetic Systemic Toxicity Treatment.
Tkach L, Baillie L, Newby J … +4 more , O'Guin C, Dalley CB, Crowell N, Eshkevari L
AANA J · 2023 Oct · PMID 37788181
Local anesthetic systemic toxicity (LAST) is a rare life-threatening adverse event. Due to the potential for devastating patient outcomes, it is crucial for anesthesia providers to understand appropriate LAST management....
Local anesthetic systemic toxicity (LAST) is a rare life-threatening adverse event. Due to the potential for devastating patient outcomes, it is crucial for anesthesia providers to understand appropriate LAST management. The primary aim of this study was to assess certified registered nurse anesthetist (CRNA) knowledge of the 2020 American Society of Regional Anesthesia and Pain Medicine (ASRA) LAST treatment guidelines. The secondary aim was to determine whether there was a relationship between the frequency of CRNAs' exposure to perioperative local anesthetic use and their knowledge level. A quantitative descriptive study and national American Association of Nurse Anesthetists electronic survey solicited practicing CRNAs. Survey findings revealed knowledge scores averaging 47.3% among 184 respondents. Almost all (97.8%) recognized the importance of early lipid emulsion administration. Over half (54.3%) were unaware of the recommended epinephrine dosing during LAST. No relationship was found between knowledge level and CRNAs' exposure to local anesthetics. Those who reported having immediate access to written or electronic guidelines in the event of LAST had significantly higher knowledge scores than those without access ( = .049). Implementing cognitive aids may help bridge knowledge gaps identified in this study and ensure critical steps are not missed. Further studies examining the use of cognitive aids to improve CRNA knowledge of LAST management may be beneficial in the future.
Effects of Gabapentin on Emergence Delirium in Pediatric Tonsillectomy/Adenoidectomy Patients: A Post-Hoc Analysis.
Tuggle E, Gettis M, Brown AM … +2 more , Jeter L, Fujimoto A
AANA J · 2023 Oct · PMID 37788180
Emergence delirium (ED) is a significant source of both short- and long-term negative effects in the postoperative pediatric population, most notably following otolaryngology surgeries with an occurrence rate of 17.9%. G...
Emergence delirium (ED) is a significant source of both short- and long-term negative effects in the postoperative pediatric population, most notably following otolaryngology surgeries with an occurrence rate of 17.9%. Gabapentin, a gamma aminobutyric acid agonist, has been used for enhanced recovery in adult patients and for the purpose of decreasing ED in some pediatric patients undergoing strabismus surgery. This secondary analysis examined the effects of preoperative administration of gabapentin on the reduction of postoperative ED in pediatric patients between the ages of 3-18 undergoing elective tonsillectomy and adenoidectomy. The parent study randomized subjects to receive preoperative gabapentin vs placebo. Our chart review encompassed both objective and subjective measures to identify the incidence of ED. While we found no statistical significance between the treatment and control groups, there was a clinically significant reduction of ED behaviors in the gabapentin group. The limitations included nonstandardized intraoperative medication administration, small sample size, and the lack of a validated tool for documenting behaviors associated with ED in the immediate postoperative period. Based on the results of this analysis, further investigation is warranted into the potential benefit of gabapentin to reduce the incidence of postoperative ED in the pediatric patient.
Use of the Second Victim Experience and Support Tool (SVEST) to Assess the Impact of a Departmental Peer Support Program on Anesthesia Professionals' Second Victim Experiences (SVEs) and Perceptions of Support Two Years After Implementation.
Pelikan M, Finney RE, Jacob A
AANA J · 2023 Oct · PMID 37788179
Anesthesia professionals experience events resulting in psychological and physiologic implications, known as second victim experiences (SVEs). This study evaluated the impact of a peer support program on anesthesia provi...
Anesthesia professionals experience events resulting in psychological and physiologic implications, known as second victim experiences (SVEs). This study evaluated the impact of a peer support program on anesthesia providers' SVEs. In July 2018, a departmental peer support program was implemented. All anesthesia professionals were invited to participate in a survey, including the Second Victim Experience and Support Tool (SVEST), which evaluated SVEs and desired support, preimplementation of the program. The survey was repeated two years after program implementation. A total of 57.9% (348/601) completed the preimplementation survey; 37.6% (231/614) completed the postimplementation survey. The median SVEST scores for psychological distress (3.0 vs 2.8, = .04) and institutional support (3.0 vs 2.3, < .001) were significantly lower on the postimplementation survey, indicating more favorable responses. For both assessments, the most desired support option was a 'respected peer to discuss the details of what happened.' Postimplementation, 84.9% (191/225) agreed the program enhanced departmental support, 93.2% (207/222) agreed the program considered professionals' well-being, and 81.7% (183/224) agreed the program contributed to a culture of safety. A total of 99.1% (213/215) would recommend the peer support program to others. Implementation of a peer support program significantly influenced anesthesia professionals' SVE-related psychologic distress and perception of adequate institutional support.
Nurse Anesthetist Practice Over 40 Years: A Repeated Cross-Sectional Study in Norway.
Leonardsen AL, Drageset S, Ellingsen S … +3 more , Finjarn TJ, Sandvik L, Olsen MV
AANA J · 2023 Oct · PMID 37788178
Research focusing on the scope of practice by nurse anesthetists (NAs) is limited. The purpose of this study was to examine NAs' scope of practice in Norway, and to explore whether and how this has changed during the per...
Research focusing on the scope of practice by nurse anesthetists (NAs) is limited. The purpose of this study was to examine NAs' scope of practice in Norway, and to explore whether and how this has changed during the period from 1979 to 2018. The study had a repeated crosssectional design. All members of the Norwegian Association of Nurse Anesthetists at the four time-points (1979, 1989, 1999 and 2018) were invited to participate in a questionnaire study. Inclusion criteria were education and work as an NA and currently working in Norway. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Findings indicate that the scope of NAs' practice in Norway has been increasingly restricted from 1979 to 2018 (N = 2171, < .001). Additionally, the presence of an anesthesiologist when performing anesthesia had significantly increased during that time (39% in 1979 vs 90% in 2018). However, NAs' independent practice significantly increased in some areas, such as handling of acute situations, (i.e., handling of laryngospasm/bronchospasm [41% in 1979 versus 54% in 2018]). International and national standards underline the independent role of NAs. The development shown in our results should be addressed to avoid further restrictions of NAs' scope of practice.
Remifentanil for External Cephalic Version: A Systematic Review and Meta-Analysis.
Koonce BT, Castillo JDD, Tubog TD … +1 more , Hestand JD
AANA J · 2023 Oct · PMID 37788177
The purpose of this study was to examine the efficacy of remifentanil on external cephalic version (ECV) in breech presentation. An extensive search was conducted using PubMed, Cochrane Library, and other grey literature...
The purpose of this study was to examine the efficacy of remifentanil on external cephalic version (ECV) in breech presentation. An extensive search was conducted using PubMed, Cochrane Library, and other grey literature. Only randomized controlled trials using remifentanil for ECV were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes and quality of evidence was assessed using the Risk of Bias and GRADE system. Five studies consisting of 602 patients were analyzed. Remifentanil resulted in a moderate increase in ECV success rate (RR, 1.19; 95% CI, 1.00 to 1.43; = .05), a large reduction of pain score (MD, -2.02; 95% CI, -2.32 to -1.72; < .00001) with fewer transient fetal bradycardia (RR, 0.40; 95% CI, 0.19 to 0.85; = .02). However, remifentanil did not affect cesarean section rates, (RR, 0.97; 95% CI, 0.49 to 1.93; = .93) instrumental delivery (RR, 0.94; 95% CI, 0.41 to 2.15; P = 0.89), and spontaneous delivery rate (RR, 1.02; 95% CI, 0.78 to 1.35; = 0.87). Mothers treated with remifentanil have a higher patient satisfaction score. The use of remifentanil may be a good strategy for ECV. However, extrapolation of this finding to clinical settings must consider the study limitations.
Hemostatic Spray TC-325 (Hemospray®) and Unexpected Esophageal Entrapment of Gastroscope With Airway Management Considerations: A Case Report.
Crowley JM
AANA J · 2023 Oct · PMID 37788176
Bleeding from the upper gastrointestinal tract is responsible for approximately 2% of all hospital admissions annually, with an up to 17% mortality rate. Therapeutic endoscopic interventions are often indicated for estab...
Bleeding from the upper gastrointestinal tract is responsible for approximately 2% of all hospital admissions annually, with an up to 17% mortality rate. Therapeutic endoscopic interventions are often indicated for establishing hemostasis. These interventions include but are not limited to thermal coagulation with cautery, mechanical methods using band ligation or hemostatic clips, and hemostatic spray. Anesthesia providers are frequently involved in providing sedation for those endoscopic procedures. In 2018, the United States Food and Drug Administration approved a hemostatic spray, Hemospray® TC-325 (Cook Medical, Winston- Salem, NC, USA) for controlling nonvariceal upper gastrointestinal bleeding. The inorganic, mineral-based powder forms a mechanical tamponade by absorbing water and attracting clotting factors to the bleeding site. Adverse events associated with using the product are reported as rare but have included perforation and difficulty in removing the gastroscope. This case presents unexpected entrapment of the gastroscope in a patient's esophagus after the bleeding site was treated with Hemospray. Potential difficulties with airway management strategies are discussed.
A Qualitative Description of CRNA Clinical Coordinators' and Student Registered Nurse Anesthetists' Perceptions of Clinical Readiness.
Tubog TD, Shaffer SK, Kane TD … +1 more , Hestand JD
AANA J · 2023 Oct · PMID 37788175
The transition from classroom academic environment to clinical patient-focused learning is a celebrated milestone, yet it is a source of stress and anxiety for student registered nurse anesthetists (SRNAs). In nurse anes...
The transition from classroom academic environment to clinical patient-focused learning is a celebrated milestone, yet it is a source of stress and anxiety for student registered nurse anesthetists (SRNAs). In nurse anesthesia education, limited information exists on perceptions of clinical readiness, either from the certified registered nurse anesthetist (CRNA) clinical educators' or the SRNAs' experiences. The purpose of this study was to explore the perceptions of CRNA clinical coordinators and SRNAs regarding clinical readiness as the students transition from classroom to clinical training. A qualitative descriptive design from a postpositivist philosophical mindset was utilized and a semistructured interview guide and content analysis methodology described by Graneheim and Lundman was used. Seventeen participants were interviewed. Four themes emerged from the analysis of the CRNA clinical coordinators' perceptions: 1) going in with good attitudes and professionalism, 2) the expectation of clinical readiness, 3) mental preparedness, and 4) solid simulation experiences. Additionally, four themes emerged from the content analysis of students' perception: 1) expectations of readiness is higher than anticipated, 2) transitional orientation/adjuncts for preparedness, 3) sound didactic training, and 4) simulation and the effects of COVID-19. While prioritization is different, educators and SRNAs value knowledge, skills (including simulated), and positive attitudes as measures of clinical readiness.
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