AANA journal最新文献_第2页

Implementation of a Perioperative Lung Protective Ventilation Protocol for Robotic-Assisted Surgeries. 为机器人辅助手术实施围手术期肺保护通气方案。

AANA journal Pub Date : 2024-10-01

Sydney A Elmore, Denise H Tola, Virginia C Simmons, Lauren A Wilson, Jessica D Szydlowski

{"title":"Implementation of a Perioperative Lung Protective Ventilation Protocol for Robotic-Assisted Surgeries.","authors":"Sydney A Elmore, Denise H Tola, Virginia C Simmons, Lauren A Wilson, Jessica D Szydlowski","doi":"","DOIUrl":"","url":null,"abstract":"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 (P < .001), respiratory rate (P = .014), and driving pressure (P < .001) within LPV limits improved with statistical significance from pre- to postimplementation. Provider confidence and knowledge increased from pre- to posteducation (P = .049). Adherence to a LPV protocol improved with education and information tools.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"92 5","pages":"337-344"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dexmedetomidine for Postoperative Delirium Prevention in the Older Adult: An Integrative Review. 右美托咪定用于预防老年人术后谵妄：综合综述。

AANA journal Pub Date : 2024-10-01

Ali Luchini Strada, Aaron Tevay, Misty Scoggins, Kimberly Gonzalez

{"title":"Dexmedetomidine for Postoperative Delirium Prevention in the Older Adult: An Integrative Review.","authors":"Ali Luchini Strada, Aaron Tevay, Misty Scoggins, Kimberly Gonzalez","doi":"","DOIUrl":"","url":null,"abstract":"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.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"92 5","pages":"383-389"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ultrasound-Guided Quadratus Lumborum Block Versus Caudal Block for Perioperative. 超声引导下腰椎四头肌阻滞与腹腔阻滞在围手术期的应用

AANA journal Pub Date : 2024-10-01

Shreya B Shah, Deepanjali Pant, Archna Koul, Anirban Roy, Jayashree Sood, Parul T Chugh

{"title":"Ultrasound-Guided Quadratus Lumborum Block Versus Caudal Block for Perioperative.","authors":"Shreya B Shah, Deepanjali Pant, Archna Koul, Anirban Roy, Jayashree Sood, Parul T Chugh","doi":"","DOIUrl":"","url":null,"abstract":"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 (P < .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 (P = .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 (P < .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.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"92 5","pages":"329-336"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of the International Scope of Practice of Nonphysician Anesthesia Providers Between 2012 and 2022. 评估 2012 年至 2022 年国际非医师麻醉提供者的执业范围。

AANA journal Pub Date : 2024-10-01

Vera Meeusen, James R Walker, Jakob Ibsen Vedtofte

{"title":"Evaluation of the International Scope of Practice of Nonphysician Anesthesia Providers Between 2012 and 2022.","authors":"Vera Meeusen, James R Walker, Jakob Ibsen Vedtofte","doi":"","DOIUrl":"","url":null,"abstract":"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.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"92 5","pages":"357-362"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predicting Intraoperative Hypotension: An Intraoperative Case Report. 预测术中低血压：术中病例报告

AANA journal Pub Date : 2024-08-01

Amy Yerdon, Katie Woodfin, Ryan Richey, Susan McMullan

引用次数: 0

Anesthetic Considerations for Gender-Affirming Airway and Facial Procedures. 性别确认气道和面部手术的麻醉考虑因素。

AANA journal Pub Date : 2024-08-01

Stephany Amendola, Nicole Stemmler, Marianne Cosgrove, Filomena Ruggiero

{"title":"Anesthetic Considerations for Gender-Affirming Airway and Facial Procedures.","authors":"Stephany Amendola, Nicole Stemmler, Marianne Cosgrove, Filomena Ruggiero","doi":"","DOIUrl":"","url":null,"abstract":"Approximately 0.6% of the United States population identifies as transgender or gender nonbinary. The term transgender refers to a person who experiences incongruence between their sex at birth and their gender identity. The care of the transgender patient is complex, often requiring the expertise of various medical and surgical specialties. The prevalence of gender-affirming surgery is increasing as societal acceptance and cultural norms are shifting. While gender-affirming procedures include a variety of body systems, airway and facial procedures are of particular importance to anesthesia providers. Anesthetic concerns for masculinization and feminization procedures of the airway and face include bleeding, injury to the airway, and other perioperative challenges. Transgender procedures of the airway and face often require advanced airway techniques. Following airway surgery, patients are at an increased risk for tracheal stenosis or perforation, glottic stenosis, vocal cord damage or dysfunction, and/or dysphagia. Additionally, transgender patients may undergo hormone therapy to achieve their gender goals. Providers should be aware of the implications associated with administration of hormones such as thromboembolic events, cardiovascular effects, and changes in various laboratory values. A knowledge of novel surgical procedures, medical therapies, and the psychosocial implications associated with transition is essential for the safe, comprehensive, and holistic care of the transgender patient.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"92 4","pages":"303-311"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of i-gel® and LMA® Supreme™ for Facilitating Fiberoptic Endotracheal Intubation: A Prospective Randomized Trial. i-gel® 和 LMA® Supreme™ 在促进纤维气管插管方面的比较：前瞻性随机试验。

AANA journal Pub Date : 2024-06-01

Ryan J Lefevre, Christina A Jelly, Cynthia Schmelz, Jeremy Bennett, Yaping Shi, Matthew Shotwell, Jeffrey Ford, Antonio Hernandez

{"title":"Comparison of i-gel® and LMA® Supreme™ for Facilitating Fiberoptic Endotracheal Intubation: A Prospective Randomized Trial.","authors":"Ryan J Lefevre, Christina A Jelly, Cynthia Schmelz, Jeremy Bennett, Yaping Shi, Matthew Shotwell, Jeffrey Ford, Antonio Hernandez","doi":"","DOIUrl":"","url":null,"abstract":"Supraglottic airway (SGA) is an alternative to endotracheal intubation, however endotracheal intubation is often essential. One method to convert from an SGA to an endotracheal tube (ETT) is utilizing the SGA as a conduit for fiberoptic-guided advancement of an Aintree catheter (airway exchange catheter), and exchange of the SGA for an ETT. In this prospective randomized study, we compared two SGA devices in facilitating this exchange. Subjects were randomized to receive either the i-gel® or LMA® Supreme™ SGA. The SGA was placed and an Aintree intubation catheter was inserted through the SGA over a fiberoptic bronchoscope. Next, the SGA was removed, leaving the Aintree within the trachea, and an ETT was placed over the Aintree catheter and advanced into the trachea. The i-gel group exhibited shorter time to successful intubation (median, 191 vs. 434 seconds; P = .002). The i-gel group also had fewer study subjects requiring more than one attempt for successful Aintree placement (33% vs. 75%, P = .02). The i-gel group showed superior laryngeal view score (LVS) (6 vs. 4; P = .003). The i-gel SGA achieved a faster time to successful intubation, higher rate of first attempt Aintree placement, and superior LVS.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"92 3","pages":"197-205"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Widening the Definition of Research-Let's Be Inclusive. 拓宽研究的定义--让我们兼容并包。

AANA journal Pub Date : 2024-06-01

Charles A Griffis

引用次数: 0

Airway Complications in a Patient With Ehlers-Danlos Syndrome: A Case Report. 埃勒斯-丹洛斯综合征患者的气道并发症：病例报告

AANA journal Pub Date : 2024-06-01

Vera Meeusen, Ante Lemic

{"title":"Airway Complications in a Patient With Ehlers-Danlos Syndrome: A Case Report.","authors":"Vera Meeusen, Ante Lemic","doi":"","DOIUrl":"","url":null,"abstract":"A female patient, known to have hypermobile Ehlers-Danlos syndrome (hEDS), underwent several elective gastroscopies under sedation in different hospitals. Except for a single incident of mild laryngospasm during emergence, all procedures were uneventful. On that occasion, following the procedure in the postanesthesia care unit, the patient suffered severe airway obstruction, and standard airway rescue techniques exacerbated adequate ventilation. After the removal of all stimuli and maintaining only an indirect oxygen supply via a mask in front of her face, her airway improved, and the patient fully recovered after 17 minutes. After the gastroscopy, physical examination revealed that the patient had an extremely flexible trachea that could be completely moved outside the midline to the extreme right and left. For the subsequent procedures, an airway plan was developed in conjunction with the patient and resulted in uncomplicated perianesthetic care. This case report serves to alert readers to the risk of adverse airway events in patients with EDS and suggests an alternative approach to avoid such complications. When patients receive care in different hospitals, adequate documentation is essential and adequate preoperative assessment is crucial. This case study demonstrates the value of patient-coproduction care plans.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"92 3","pages":"189-195"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving CRNAs' Confidence and Perceived Knowledge of Endosurgical Patients Who Use Marijuana: A Quality Improvement Project. 提高 CRNA 对使用大麻的内外科患者的信心和认知：质量改进项目。

AANA journal Pub Date : 2024-04-01

Janice Cain, Teri Lindgren, Alexandra Duke

{"title":"Improving CRNAs' Confidence and Perceived Knowledge of Endosurgical Patients Who Use Marijuana: A Quality Improvement Project.","authors":"Janice Cain, Teri Lindgren, Alexandra Duke","doi":"","DOIUrl":"","url":null,"abstract":"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. This lack of confidence and knowledge limits the ability of nurse anesthetists to provide optimal care, threatens patient safety, and potentially impairs surgical outcomes. To improve the confidence and perceived knowledge of certified registered nurse anesthetists (CRNAs) regarding perioperative care of endosurgical patients who use marijuana, a quality improvement project was conducted in a metropolitan endosurgical center in California. After the project, participating CRNAs (N = 15) reported increased confidence (z = -0.982; P = .325, > .05) and significantly improved perceived knowledge (z = -3.04; P = .002, < .05) regarding care of patients who use marijuana. For endosurgical patients who used marijuana prior to their procedure, knowledgeable and confident anesthesia care for the side effects of marijuana substantially improved the quality of care, communication, and reduced cancellations.","PeriodicalId":7104,"journal":{"name":"AANA journal","volume":"92 2","pages":"121-130"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0