2,378 results match your criteria AANA Journal[Journal]


A Review of the Pharmacology and Anesthetic Implications of Cannabis.

AANA J 2020 Jun;88(3):237-244

has been a CRNA since graduating from Mercy College of Detroit in Detroit, Michigan, in 1988. He is a full-time faculty member at the University of Detroit Mercy Graduate Program of Nurse Anesthesiology as well as a practicing clinician. He has published articles and book chapters on the topics of substance misuse among students, pain management, academic integrity, nonsteroidal anti-inflammatory drugs, asthma, and respiratory monitoring. Email:

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. Read More

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Pharmacogenetics of Postoperative Pain Management: A Review.

AANA J 2020 Jun;88(3):229-236

is a personalized medicine nurse practitioner at the Avera Institute for Human Genetics, Sioux Falls, South Dakota. Email:

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. Read More

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Fat Embolism Syndrome Revisited: A Case Report and Review of Literature, With New Recommendations for the Anesthetized Patient.

AANA J 2020 Jun;88(3):222-228

is in the Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, and the Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.

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 manifestations of the syndrome. Read More

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Substance Abuse and Misuse Identification and Prevention: An Evidence-Based Protocol for CRNAs in the Workplace.

Authors:
Leigh Taylor

AANA J 2020 Jun;88(3):213-221

is the assistant program administrator at Middle Tennessee School of Anesthesia in Madison, Tennessee, and a staff nurse anesthetist for Anesthesia Medical Group in Nashville, Tennessee. Email:

Healthcare providers are susceptible to substance abuse, and anesthesia personnel are some of the most vulnerable. Substance abuse is the principal cause of professional impairment for Certified Registered Nurse Anesthetists (CRNAs), with 1 of 10 experiencing addiction to drugs or alcohol. Despite this problem, there is no standardized screening protocol for the identification of substance abuse or misuse for CRNAs. Read More

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Anesthesia Machine Failure: A Case Study.

AANA J 2020 Jun;88(3):209-211

is a Certified Registered Nurse Anesthetist and nurse anesthesia emphasis associate program director at the College of Nursing at University of Wisconsin Oshkosh with a clinical practice at HSHS St. Vincent Hospital and St. Mary's Hospital Medical Center, both in Green Bay, Wisconsin.

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. Read More

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Improving Endotracheal Cuff Inflation Pressures: An Evidence-Based Project in a Military Medical Center.

AANA J 2020 Jun;88(3):203-208

received his DNP from Duke University in 2015. He is an assistant professor in the Nurse Anesthesia Program at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

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 HO to protect the lung parenchyma from aspiration while also ensuring positive pressure can be generated to oxygenate/ventilate patients. Read More

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Knowledge Assessment of Military Personnel, Veterans, and Family Taking Dietary Supplements.

AANA J 2020 Jun;88(3):191-202

is the program director for the USAGPAN at Fort Sam Houston, Texas.

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. Read More

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Anesthesia Simulation in Cardiac Surgery (ASICS).

AANA J 2020 Jun;88(3):183-189

is a staff CRNA at the Mayo Clinic, Jacksonville, Florida.

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. Read More

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Sevoflurane Consumption During Inhalational Induction in Children: A Randomized Comparison of Minute Ventilation-Based Techniques With Standard Fixed Fresh Gas Flow Technique.

AANA J 2020 Jun;88(3):177-182

is an anesthesiologist in the Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.

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). Read More

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Treat COVID-19 as Though It Is Airborne: It May Be.

AANA J 2020 04;88(3):29-30

Beirut, Lebanon.

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Course: Update for Nurse Anesthetists-Optimizing Mechanical Ventilation During General Anesthesia.

AANA J 2020 Apr;88(2):149-157

is the chair of the Doctor of Nurse Anesthesia Practice Program, School of Nursing and Human Physiology, Gonzaga University. He completed a BSN at the University of Utah, Salt Lake City, Utah, and earned a Doctor of Nurse Anesthesia Practice degree from Virginia Commonwealth University, Richmond, Virginia. Dr Pettey is a clinical and didactic instructor in basic and advanced anesthesia education. Currently, he is serving on the Washington State Association of Nurse Anesthetists board of directors.

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. Read More

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Prevention of Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: Are We Doing Enough?

AANA J 2020 Apr;88(2):142-147

is a professor at the University of Alabama's Capstone College of Nursing in Tuscaloosa, Alabama.

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%. Read More

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Anesthesia Implications of Patient Use of Electronic Cigarettes.

AANA J 2020 Apr;88(2):135-140

is a practicing CRNA in Maine and the director of simulation and interim assistant program director at the University of New England School of Nurse Anesthesia.

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. Read More

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Recognition and Management of Subcutaneous Emphysema as a Complication of Robotic-Assisted Laparoscopic Surgery: A Case Report.

AANA J 2020 Apr;88(2):131-134

is a 2019 graduate of the Rutgers School of Nursing Nurse Anesthesia Program. She started her career as a CRNA practicing in the state of New Jersey.

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. Read More

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Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results.

AANA J 2020 Apr;88(2):123-129

is a current resident at Southern Illinois University in Springfield, Illinois.

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. Read More

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Cut to Air.

AANA J 2020 Apr;88(2):116-120

is a staff CRNA at the R Adams Cowley Shock Trauma Center, Baltimore, Maryland.

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. Read More

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Does Ultrasonographic Measurement of Gastric Content Influence Airway Management Decisions?

AANA J 2020 Apr;88(2):107-113

is a professor of nurse anesthesia at Duke University School of Nursing.

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. Read More

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Anesthetic Considerations for Automated High-Frequency Jet Ventilation During Electromagnetic Navigation Bronchoscopy.

AANA J 2020 Apr;88(2):101-106

is employed by the University of South Alabama, Department of Orthopaedic Surgery, Mobile, Alabama.

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 anesthesia provider to achieve hands-free management. Read More

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Repeated Postanesthetic Laryngospasm in a Male Adult.

Authors:
Pamela Chambers

AANA J 2020 Apr;88(2):97-99

is an Army veteran and active consultant in healthcare law to Certified Registered Nurse Anesthetists, attorneys, administrators, and other healthcare providers. She is serving as a member of the National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA) board of directors in her second term.

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. Read More

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Science and Clinical Potpourri for Your Life and Your Practice.

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AANA J 2020 Apr;88(2):93-94

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Imagining in Time.

AANA J 2020 Apr;88(2):8-12

has worked as a CRNA practitioner, teacher, and program director. He is a professor in the Rush University College of Nursing and executive co-director of the Rush Center for Clinical Skills and Simulation. He has served as a team and chair reviewer for the Council on Accreditation of Nurse Anesthesia Educational Programs (COA), served on the COA from 2006-2012, and is also a COA consultant. He is a peer evaluator for the Higher Learning Commission, which is a regional accrediting agency for universities.

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 governmental and non-governmental organizations, meeting the goal of elevating the standards of anesthesia education and continuing this process through its commitment to promoting high-quality educational programs. Read More

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Letters.

AANA J 2020 04;88(2)

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Course: Update for Nurse Anesthetists-Enterohepatic Recirculation: From Death by Mushroom to Perioperative Pharmacokinetics.

Authors:
Chuck Biddle

AANA J 2020 Jan;88(1):71-76

is a professor and staff anesthetist at Virginia Commonwealth University, Richmond, Virginia. He is the editor-in-chief of AANA Journal and had no oversight role in the peer review of this manuscript, which was handled by other members of the editorial board.

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. Read More

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January 2020

Sustained Value of Implementation of a Flexibility-Based Compensation Structure for Nurse Anesthetists in a Large Multihospital Healthcare System.

Authors:
Brent A Dunworth

AANA J 2020 Jan;88(1):66-70

is an assistant professor of clinical anesthesiology and assistant professor of nursing at Vanderbilt University, Nashville, Tennessee. He is also the director of advanced practice and division chief of nurse anesthesia in the Department of Anesthesiology at Vanderbilt University Medical Center in Nashville, Tennessee.

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 the face of recruitment challenges. Read More

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January 2020

Effect of Simulation Training on Cognitive Performance Using Transesophageal Echocardiography.

AANA J 2020 Jan;88(1):59-65

is a Certified Registered Nurse Anesthetist and program director at Middle Tennessee School of Anesthesia.

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. Read More

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January 2020

Damage Control Resuscitation of a Patient With Traumatic Aortic Rupture: A Case Report.

AANA J 2020 Jan;88(1):49-58

is the program director of the Geisinger Health System/Bloomsburg University of Pennsylvania Nurse Anesthesia Program, an assistant professor of the Bloomsburg University of Pennsylvania, and a staff CRNA at Geisinger Medical Center.

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. Read More

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January 2020

Turnover, Burnout, and Job Satisfaction of Certified Registered Nurse Anesthetists in the United States: Role of Job Characteristics and Personality.

AANA J 2020 Jan;88(1):39-48

is an associate professor at the School of Nursing and Health Studies, Georgetown University, Washington, DC. She received her PhD in technology policy and management from Westminster University.

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 positively associated with the job characteristic autonomy and the personality factor agreeableness. Read More

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January 2020

Anesthesia Challenges in the Management of Freeman-Sheldon Syndrome: Report of Two Cases and Literature Review.

AANA J 2020 Jan;88(1):35-38

is an assistant professor at All India Institute of Medical Sciences, New Delhi, India.

Freeman-Sheldon syndrome is a congenital myopathy with a reported prevalence of less than 1 per 1 million. Also known as craniocarpotarsal dysplasia, this syndrome is characterized by muscle contractures and soft-tissue dysplasia of the face, hands, and feet. The resulting musculoskeletal deformities may require multiple orthopedic, ocular, and plastic reconstructive surgeries. Read More

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January 2020

Vaping: Anesthesia Considerations for Patients Using Electronic Cigarettes.

AANA J 2020 Jan;88(1):27-34

is a clinical assistant professor in the University of Kansas Department of Nurse Anesthesia Education.

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. Read More

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January 2020

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

is an associate dean of research at Duquesne University in Pittsburgh, Pennsylvania.

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 patients at a large academic medical center from January 1, 2012, through December 31, 2017. In this cohort, 4% continued to refill opioid prescriptions more than 90 days after their surgical procedure. Read More

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January 2020

Development of a Common Clinical Assessment Tool for Evaluation in Nurse Anesthesia Education.

AANA J 2020 Jan;88(1):11-17

is chief executive officer, Council on Accreditation of Nurse Anesthesia Educational Programs, Park Ridge, Illinois.

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 make programmatic changes to ensure compliance with COA standards. Read More

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January 2020

Science and Clinical Potpourri for Your Life and Your Practice.

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AANA J 2020 Jan;88(1):9-10

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January 2020

A Review of New and Updated Professional Practice Documents.

AANA J 2020 Jan;88(1):4-6

is the AANA director of professional practice, providing staff support for Practice Committee activities.

The American Association of Nurse Anesthetists (AANA) Practice Committee, in collaboration with AANA Professional Practice staff, annually applies a standardized evidence-based process to review, evaluate, and revise clinical resource documents found in the Professional Practice Manual for the CRNA (Certified Registered Nurse Anesthetist). 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. Read More

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January 2020

Double Gloving and Infection Control.

Authors:
Archana Mane

AANA J 2020 Jan;88(1):2-3

Albany, New York.

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January 2020

Nurse Anesthesia Training in 1946.

AANA J 2020 Jan;88(1):1-2

Boise, Idaho.

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January 2020

Current Evidence-Based Practice for Pediatric Emergence Agitation.

Authors:
Kristie Hoch

AANA J 2019 Dec;87(6):495-499

is assistant clinical professor and director of the DNP-Nurse Anesthesia program at the University of Arizona College of Nursing, Tucson, Arizona.

This article provides a systematic review of pediatric emergence agitation, also known as emergence delirium. Major topics of this review include the incidence, risk factors, and impact of the phenomenon, in addition to current evidence-based strategies for prevention of pediatric emergence agitation. Emergence agitation causes tremendous psychological distress for the patient, family, and healthcare providers, as well as concerns for physical safety. Read More

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December 2019

Update on the Physiologic Effects of Ketamine in General Anesthesia and Spinal Blockade: A Review of the Literature.

AANA J 2019 Dec;87(6):489-494

is in the Department of Neurological Surgery at Albany Medical Center.

Ketamine, a phencyclidine analog and dissociative anesthetic, has been used in anesthesia since the 1960s. Serial subanesthetic administration has been explored for treatment of depression and chronic pain; however, there has been a recent surge in its intraoperative and perioperative use among anesthesia providers. As ketamine becomes an important addition to multimodal acute pain regimens, it important that anesthesia providers review the physiologic underpinnings of ketamine administration. Read More

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December 2019

Anesthetic Management of a Laboring Patient With a Closed-Loop Stimulation Pacemaker: A Case Report.

AANA J 2019 Dec;87(6):483-488

has been a practicing nurse anesthetist for approximately 27 years. She founded the MSMP Anesthesia Services, L.L.C. Columbia, Missouri, providing services primarily in critical access hospitals, ASCs, and office-based settings.

A new generation of cardiac implantable devices, known as Closed Loop Stimulation pacemakers, are now utilized to reduce episodes of bradycardia, syncope, and tachycardia in pregnant women. The device functions differently than conventional pacemakers by responding to changes in the patient`s cardiac output and heart rate based on physiologic demands and acute mental stress. Increased metabolic demands, including physiologic stress often accompany pregnancy, labor, and delivery. Read More

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December 2019

Operating Room Waste Reduction.

AANA J 2019 Dec;87(6):477-482

is program director of the Doctor of Nurse Anesthesia Practice Program at Mayo Clinic School of Health Sciences.

One-fourth of all operating room (OR) waste is attributed to anesthesia-related material. The goal of this project was to reduce the waste and increase cost savings of opened and unused endotracheal (ET) tubes and disposable laryngoscope handles and blades in 2 separate OR environments. The production of these unused anesthesia supplies was assessed weekly in each of 2 OR environments for 8 weeks before an educational intervention, and for 8 weeks following the intervention. Read More

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December 2019

Preventable Closed Claims in the AANA Foundation Closed Malpractice Claims Database.

AANA J 2019 Dec;87(6):468-476

is AANA chief advocacy officer and AANA Foundation chief executive officer, Park Ridge, Illinois.

Medical errors are among the top 3 causes of patient deaths in the United States, with up to 400,000 preventable deaths occurring in hospitalized patients each year. Although improvements have been made in anesthesia patient safety, adverse outcomes continue to occur. This study used thematic analysis to examine anesthesia closed claims that were associated with preventable morbidity and mortality. Read More

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December 2019

Barriers and Facilitators to Intraoperative Alternatives to Opioids: Examining CRNA Perspectives and Practices.

AANA J 2019 Dec;87(6):459-467

is a faculty member at North-Shore University HealthSystem, School of Nurse Anesthesia, and adjunct associate professor of nursing at DePaul University School of Nursing.

Opioids are the mainstay of intraoperative pain control, but they have several deleterious effects. Alternative medications and strategies to opioids, while effective in producing intraoperative analgesia, are underutilized by anesthesia providers. The purpose of this study was to examine and describe Certified Registered Nurse Anesthetists' perspectives and practices on administering opioids vs nonopioid or opioid-sparing strategies ("opioid alternatives") to treat intraoperative pain. Read More

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December 2019

Marijuana Use in the Anesthetized Patient: History, Pharmacology, and Anesthetic Considerations.

AANA J 2019 Dec;87(6):451-458

is an assistant professor in the Doctor of Nursing Practice program at Duke University, in Durham, North Carolina.

Marijuana consumption is growing in the United States because of state legalization for recreational and medical use. However, many anesthesia practitioners are unaware of the potential adverse effects that may occur if marijuana is taken before the administration of an anesthetic. This review provides a history of marijuana use, the current laws and regulations, the pharmacology of marijuana, and best evidence-based practices related to anesthetic care of the marijuana user. Read More

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December 2019

Preliminary Psychometric Evaluation of the Nurse Anesthesia and the Aftermath of Perioperative Catastrophes Survey and the Ways of Coping Questionnaire.

AANA J 2019 Dec;87(6):441-450

is associate dean for practice and professor of pain practice, University of Pennsylvania School of Nursing and professor of anesthesiology and critical care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

The National Academy of Medicine recognizes medical errors as a leading cause of death in the United States. Hospitals nationwide have acted to improve patient safety, quality of care, and system processes; however, no standards mandate assessment of the emotional impact of perioperative catastrophes on healthcare professionals. A cross-sectional descriptive study using a sample of 196 Certified Registered Nurse Anesthetists (CRNAs) tested the psychometric properties of an adapted version of the Perioperative Catastrophes Survey and administered this survey along with the Ways of Coping Questionnaire to measure CRNAs' perceptions, experiences, and responses associated with perioperative catastrophes. Read More

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December 2019

Combined General and Epidural Anesthesia for Emergency Cesarean Delivery of Twins in a Parturient With Coarctation of Aorta.

AANA J 2019 Dec;87(6):437-440

is professor and head, Department of Anesthesiology, Lokmanya Tilak Municipal Medical College and General Hospital.

Pregnancy is associated with increased coarctation-associated complications. 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. Read More

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December 2019

Science and Clinical Potpourri for Your Life and Your Practice.

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AANA J 2019 Dec;87(6):435-436

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December 2019

Ketamine and Treatment-Resistant Depression.

AANA J 2019 Oct;87(5):411-419

is a professor and the coordinator of the Research and Anesthesia Curriculum for the Doctor of Nurse Anesthesia Practice program at Texas Wesleyan University.

Major depressive disorder affects tens of millions of people each year. One-third of those affected have depression that is resistant to conventional pharmacologic, psychologic, or somatic treatments. Patients with treatment-resistant depression have few remedies other than electroconvulsive therapy or transcranial magnetic stimulation. Read More

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October 2019
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Characterizing Anesthetic Management and Perioperative Outcomes Associated with a Novel, Fusionless Scoliosis Surgery in Adolescents.

AANA J 2019 Oct;87(5):404-410

is an assistant professor of anesthesiology at the Geisel School of Medicine at Dartmouth, and an attending physician in the Department of Anesthesiology at Dartmouth-Hitchcock Medical Center.

Anterior vertebral tethering (AVT) is a novel "fusionless" surgical approach to correct scoliosis. This study aims to characterize the anesthetic management and perioperative outcomes of AVT and traditional posterior spinal fusion (PSF) after establishing the technique at our institution. Scoliosis correction procedures performed in patients aged 10 to 21 years between January 2014 and August 2017 were identified in the electronic medical record. Read More

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October 2019
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Nasal Ventilation Mask for Prevention of Upper Airway Obstruction in Patients With Obesity or Obstructive Sleep Apnea.

AANA J 2019 Oct;87(5):395-403

is an associate clinical professor of nurse anesthesia at Duke University School of Nursing and a National League for Nursing simulation leader.

This project aimed to develop and implement a nasal ventilation mask (NVM) guideline to reduce the incidence of airway obstruction in outpatients undergoing endoscopy procedures. An observational design was used to evaluate implementation of an NVM guideline as the oxygen delivery method for this patient population. An evidence-based guideline for NVM use was developed for patients with obstructive sleep apnea (OSA) and/or an elevated body mass index (BMI) above 35 kg/m² undergoing esophagogastroduodenoscopy and/or colonoscopy procedures at an outpatient endoscopy clinic. Read More

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October 2019
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