AANA Journal

Certified registered nurse anesthetists (CRNAs) who are responsible for airway management, may lack adequate continuing education for emergency front of neck access (EFONA), an advanced skill necessary in situations when a patient cannot be intubated and cannot be oxygenated (CICO). The purpose of this study was to improve CRNA knowledge and confidence when performing a scalpel-bougie cricothyrotomy for EFONA in a CICO event through the implementation of a spaced learning intervention. Thirteen CRNAs at a 160-bed community hospital participated in a 3-week educational intervention...

Administration of succinylcholine to patients with a variant in the butyrylcholinesterase (BChE) gene increases the risk of anesthesia emergence prior to recovery from neuromuscular blockade (NMB). Application of quantitative neuromuscular monitoring (NMM) can identify residual NMB. We present two patients with abnormal BChE gene variants. In the first case, quantitative monitoring was applied too late to prevent awareness, but allowed diagnosis and prevented admission to the intensive care unit. In the second case, monitoring was applied prior to NMB, which enabled early diagnosis and prevented premature awakening from anesthesia...

Substance use disorder (SUD) is a persistent, relapsing condition that is present in approximately 10% of anesthesia providers, who, compared with other healthcare providers, face a greater risk of developing an SUD by virtue of constant access to medications. The ability of certified registered nurse anesthesiologists (CRNAs) to obtain or maintain employment after treatment for SUD treatment is not well documented. The purpose of this qualitative study was to explore challenges encountered by CRNAs in recovery as they attempt to reenter practice following SUD treatment...

Although some researchers have reported health-related benefits of marijuana, others have reported adverse side effects in nearly every organ system. Patterns of marijuana use are evolving, as is researchers' understanding of marijuana use for healthcare. Despite these findings and developments, nurse anesthetists are inadequately educated about marijuana's perioperative effects on endosurgical patients. As a result, many nurse anesthetists lack confidence in and knowledge of the perioperative care of endosurgical patients under the influence of marijuana...

Oropharyngeal airways (OPA) or nasopharyngeal airways (NPA) sometimes require chin-lift or jaw-thrust (CLJT) maneuvers to relieve airway obstruction which creates the burden of continuous hands-on care by the anesthesia provider. A new distal pharyngeal airway device (DPA) was used on 63 successive ambulatory surgery patients to assess the frequency of patients requiring manual CLJT maneuvers to prevent airway obstruction. Results were then compared with a contemporaneous group of patients who had used OPA or NPA devices for similar procedures...

This project sought to explore the experiences, self-perceived preparation, professional development needs, and preferred learning methods of certified registered nurse anesthetists (CRNAs) in a management role. A sample of 10 current chief CRNAs responded to a demographics survey and participated in one-on-one interviews using a 14-question, semi-structured interview framework modified from a previous study. Interview responses were deidentified and qualitatively analyzed for common themes by two content experts and one qualitative analysis expert...

Improvement to anesthesia medication safety is a useful and worthwhile area of research. Anesthesia is one of the few healthcare professions to have immediate access to compounding and label high-hazard medications at the bedside. There is a need to assess the perceptions of anesthesia medication safety and this relationship with pharmacopeia's updated recommendations for anesthesia to improve medication safety and prevent adverse drug events. Certified registered nurse anesthetist (CRNA) perceptions of medication safety climate in Florida were measured utilizing a validated Likert-scale that merged the Attitudes Questionnaire themes of teamwork, climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working...

Enhanced recovery after surgery (ERAS) is a patient-centered, evidence-based, multidisciplinary team-developed approach to a surgical stress response that is implemented to optimize physiological function and facilitate recovery for the best possible outcomes from surgery. Although there are currently well-known published guidelines for the perioperative management of patients with sickle cell disease, there are currently no specific and evidencebased ERAS protocols that address the needs of these patients...

Patients undergoing subcutaneous implantable cardioverter-defibrillator (S-ICD) placement can experience significant perioperative pain. General anesthesia is traditionally used for S-ICD placement and is associated with increased risk. Truncal plane blocks (TPBs) and sedation offer an alternative for adequate analgesia while avoiding hemodynamic compromise related to general anesthesia. A comprehensive evidence search utilized PubMed, CINAHL, Google Scholar, EBSCOhost, US National Library of Medicine Clinical Trials, and Medline Complete databases and the evidence examined the efficacy of TPBs in S-ICD placement...

Transitioning from the role of student to the professional certified registered nurse anesthetist (CRNA), as well as a CRNA transitioning to a new job can be very difficult because of uncertainty in the new environment when compounded by a lack of social support. A formal mentorship program was developed and organized by CRNA leadership to help retain and engage new employees and ensure that they assimilate to the new culture while effectively gaining institutional knowledge and clinical skills. The mentorship program consisted of structured meetings that included the newly hired cohort of CRNAs, matched mentors, and CRNA leadership at regular intervals to foster a sense of community and professional growth...

Electroconvulsive therapy (ECT) was first introduced in the late 1930s. In 2016, 1.4 million people worldwide were treated with ECT, a procedure that differs from any other. Indications for ECT include schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant syndrome, and bipolar disorder. Additionally, ECT can be beneficial for patients with autism spectrum disorder, specifically those with self-injurious behaviors and severe behaviors related to agitated or excited catatonia. As indications for ECT have grown, the results of therapy have proven beneficial...

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...

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...

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.

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...

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...

No abstract text is available yet for this article.

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...

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...

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...