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AANA J [journal]
- A call for change: clinical evaluation of student registered nurse anesthetists. [Journal Article, Validation Studies]
- AANA J 2014 Feb; 82(1):65-72.
The ability to integrate theory with practice is integral to a student's success. A common reason for attrition from a nurse anesthesia program is clinical issues. To document clinical competence, students are evaluated using various tools. For use of a clinical evaluation tool as possible evidence for a student's dismissal, an important psychometric property to ensure is instrument validity. Clinical evaluation instruments of nurse anesthesia programs are not standardized among programs, which suggests a lack of instrument validity. The lack of established validity of the instruments used to evaluate students' clinical progress brings into question their ability to detect a student who is truly in jeopardy of attrition. Given this possibility, clinical instrument validity warrants research to be fair to students and improve attrition rates based on valid data. This ex post facto study evaluated a 17-item clinical instrument tool to demonstrate the need for validity of clinical evaluation tools. It also compared clinical scores with scores on the National Certification Examination.
- Intravenous acetaminophen and intravenous ketorolac for management of pediatric surgical pain: a literature review. [Journal Article, Review]
- AANA J 2014 Feb; 82(1):53-64.
Pediatric surgical patients are a population at risk of inadequate pain management. The American Society of Anesthesiologists' 2012 Practice Guidelines for Acute Pain Management in the Perioperative Setting recommend a multimodal approach as the most effective way to prevent and treat pain in children. A multimodal approach entails the use of 2 or more analgesic medications that act by different mechanisms, to maximally target a variety of pain receptors and reduce the potential for side effects. One method for incorporating a multimodal approach is to augment intravenous (IV) opioids with nonopioid IV analgesics. Ketorolac and acetaminophen are the 2 nonopioid IV analgesics currently available for use in the United States. This article provides a review of the literature of IV ketorolac and IV acetaminophen regarding their pharmacology, analgesic efficacy, limitations, and practical considerations, with a focus on patients 16 years of age and younger.
- Early percutaneous pinning of hip fracture using propofol-ketamine-lidocaine admixture in a geriatric patient receiving dabigatran: a case report. [Case Reports, Journal Article]
- AANA J 2014 Feb; 82(1):46-52.
Hip fractures occur commonly in elderly patients. Many of these patients have multiple comorbidities requiring the use of anticoagulants. Some of the newer anticoagulants have no reliable method for reversal. This case report discusses the advantages and pitfalls of the selection of local anesthetic and monitored anesthesia care using a propofol-ketamine-lidocaine admixture for an elderly patient with a femoral neck fracture who was receiving dabigatran etexilate (Pradaxa). This case illustrates the potential for sedation during monitored anesthesia care to progress to general anesthesia and its associated risks as well as special considerations for anesthesia in geriatric patients.
- Utility of the Berlin Questionnaire to screen for obstructive sleep apnea among patients receiving intravenous sedation for colonoscopy. [Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't, Validation Studies]
- AANA J 2014 Feb; 82(1):38-45.
Obstructive sleep apnea (OSA) affects approximately 20% of Americans. Patients with undiagnosed OSA may experience obstructive episodes during conscious sedation for colonoscopy. The purpose of this investigation was to describe the risk of undiagnosed OSA using the Berlin Questionnaire and to identify the relationship between OSA risk and the number of provider interventions performed to relieve obstructive symptoms during sedation for colonoscopy.Adult patients were enrolled from the gastroenterology clinic at the National Military Medical Center (N = 99). The Berlin Questionnaire was delivered and a brief health history obtained. Patients were observed for obstructive symptoms during sedation. Provider interventions were counted. 18 patients were monitored during their first night of sleep using a portable sleep monitor. Data were analyzed using the independent samples t-test, Chi-square, and Chi-square test for trend.The incidence of undiagnosed OSA was 40.4%. Patients with hypertension had a higher rate of a positive screen for OSA (70%) than those without hypertension (20.3%), chi2(1) = 3.87, P < .05. There was no statistical difference in the number of provider interventions between the 2 groups. Risk of undiagnosed OSA in this sample is large but it does not appear to be associated with episodes of obstructive symptoms requiring provider intervention.
- Sevoflurane induction procedure: cost comparison between fixed 8% versus incremental techniques in pediatric patients. [Comparative Study, Journal Article]
- AANA J 2014 Feb; 82(1):32-7.
This study compared 2 well-accepted and safe methods of pediatric inhalation induction using sevoflurane. Incremental and fixed 8% induction methods were evaluated for economic outcomes by comparing the amount of liquid sevoflurane consumed. We also tried to establish the relation between cost of induction and demographic parameters in both groups. One hundred pediatric patients scheduled for ophthalmologic examination under anesthesia were randomly divided into 2 equal groups. The amount of sevoflurane consumed in both groups was computed using the Dion method. Although the time to loss of consciousness was significantly lower using the 8% method (75.98 vs 135 seconds), the liquid sevoflurane consumption using the incremental method (2.25 mL) was almost half that of the fixed 8% method (4.46 mL). The overall procedural cost of induction (loss of consciousness plus intravenous cannulation and insertion of a laryngeal mask airway) was also almost double using the fixed 8% method. Use of the incremental method preferably over the fixed 8% method could save almost $18 US for each procedure. The volume of sevoflurane consumed during anesthesia induction was found to be independent of age, weight, or sex of pediatric patients. Both induction methods proved to be equally safe and acceptable to the patients.
- Cost of education and earning potential for non-physician anesthesia providers. [Journal Article]
- AANA J 2014 Feb; 82(1):25-31.
Potential non-physician anesthesia students gauge many different aspects of a graduate program prior to applying, but cost of education and earning potential are typically high priorities for students. Our analysis evaluated the cost of tuition for all certified registered nurse anesthetist (CRNA) and anesthesiologist assistant (AA) programs in the United States, as well as earning potential for both professions. We collected educational cost data from school websites and salary data from the Medical Group Management Association's Physician Compensation and Production Survey: 2012 Report in order to compare the two groups. We found that the median cost of public CRNA programs is $40,195 and the median cost of private programs is $60,941, with an overall median of $51,720. Mean compensation for CRNAs in 2011 was $156,642. The median cost of public AA programs is $68,210 compared with $77,155 for private AA education, and an overall median cost of $76,037. Average compensation for AAs in 2011 was $123,328. Considering these factors, nurse anesthesia school is a better choice for candidates who already possess a nursing license; however, for those prospective students who are not nurses, AA school may be a more economical choice, depending on the type and location of practice desired.
- Bilateral tension pneumothorax following equipment improvisation. [Case Reports, Journal Article]
- AANA J 2014 Feb; 82(1):20-4.
This case report describes an unexpected event that took place as a result of using improvised equipment. The patient, a 16-year-old female undergoing complex oral surgery, suffered bilateral pneumothorax following the improper use of an airway support device. During the immediate postoperative period with the patient still intubated, oxygen tubing was attached to a right angle elbow connector with the port closed and 10 L/minute oxygen flow was administered to the patient in a manner that did not allow the patient to exhale. Within seconds, pneumothorax was apparent as the patient's vital signs deteriorated, visible swelling was noted in the shoulders and neck, and there was an absence of breath sounds on auscultation. This case study has application beyond the immediate discussion of bilateral pneumothorax, serving as a caution about the unintended consequences of equipment improvisation. In addition to highlighting the hazards of providing patient care with a non-standard device, this study also provides a powerful example of the human factors that can contribute to medical errors in the healthcare setting.
- Strategic planning for curricular excellence: anesthesia and comprehensive care. [News]
- AANA J 2014 Feb; 82(1):13-8.
- False Claims Act liability for CRNAs related to medical direction. [Journal Article, Legal Cases]
- AANA J 2014 Feb; 82(1):10-2.
- Response. [Comment, Letter]
- AANA J 2014 Feb; 82(1):9.