AANA Journal Issue Details

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  • Implementation of Acceleromyography to Increase Use of Quantitative Neuromuscular Blockade Monitoring: A Quality Improvement Project Residual neuromuscular blockade creates excess perioperative morbidity. Quantitative neuromuscular monitoring devices may help ensure full recovery from neuromuscular blocking agents. The authors studied the effectiveness of educational efforts to introduce quantitative monitoring at a large academic medical center, with predefined main outcome measures of self-reported familiarity with use of the device and actual device uptake. Anonymous surveys of knowledge, skills, and attitudes toward the devices were administered before and after the education effort. Monitor use rates were quantitatively assessed through data entry into the electronic medical record. Before-and-after results were compared by run charts, unpaired t tests (correcting for multiple comparisons), and examination of 99% confidence intervals.
    Keywords: Acceleromyography, clinical technology, neuromuscular blockade, postoperative complications, residual neuromuscular blockade.
    Version: 2018;86(4):269-277. Authors: Brent A. Dunworth, DNP, MBA, CRNA; Warren S. Sandberg, PhD, MD; Suzanne Morrison, DNP, CRNA; Calvin Lutz, MA; Jonathan P. Wanderer, MD, MPhil; John M. O’Donnell, DrPH, CRNA
  • High Rate of Undiagnosed Obstructive Sleep Apnea in Patients Undergoing Total Joint Arthroplasty This study described the incidence and severity of obstructive sleep apnea (OSA) and determined the sensitivity and specificity of the STOP-BANG Questionnaire in patients undergoing total joint arthroplasty (TJA) at a military academic medical center. All subjects completed the questionnaire and an unattended sleep study preoperatively. Incidence and severity of OSA (apnea-hypopnea index [AHI] ≥ 5) was calculated. Sensitivity and specificity for STOP-BANG cut scores greater than or equal to 3 and 5 for AHI of 5, 15, and 30 or more were determined. The rate of OSA was 51.2% (42/82), moderate to severe OSA was 29.3% (n = 29), and severe OSA was 7.3% (n = 6).
    Keywords: Obstructive sleep apnea, STOP-BANG Questionnaire, total joint arthroplasty, undiagnosed apnea.
    Version: 2018;86(4):282-288. Authors: CAPT Dennis Spence, PhD, CRNA, NC, USN; CAPT Tony Han, MC, USN; CDR Ted Morrison, PhD, MPH; CDR Darren Couture, PhD, CRNA, NC, USN.
  • Intravenous Fat Emulsion for Treatment of Local Anesthetic Systemic Toxicity: Best Practice and Review of the Literature Local anesthetic systemic toxicity (LAST), although rare, can be a fatal complication after regional anesthesia. The use of intravenous (IV) fat emulsion as a treatment of LAST is controversial among clinicians worldwide. This literature review aims to identify existing data supporting the use of IV lipids in the management of LAST and current best evidence-based practice by anesthesia providers during a LAST event. More than 120 articles resulted from a systematic literature search that was conducted using major search engines. Of those articles, 25 were included in this literature review. The safe use of IV lipids for the treatment of LAST is supported in the literature. Yet, there is still lack of awareness on lipid rescue therapy despite the significant evidence of its positive outcome.
    Keywords: Intravenous fat emulsion, lipid emulsion, lipid rescue, lipid sink, local anesthetic toxicity.
    Version: 2018;86(4):290-297. Authors: Ana M. Nedialkov, DNP, CRNA, ARNP; Tony Umadhay, PhD, CRNA; Jorge A. Valdes, DNP, CRNA, ARNP; Yasmine Campbell, DNP, CRNA, ARNP.
  • Reference Resource Usage Among Nurse Anesthetists: A Survey Because examination questions should be clinically applicable, the NBCRNA is interested in knowing what reference resources clinicians rely on in their work, so that questions can be based on those or similar resources. In October 2016, the NBCRNA sent an email blast for a survey on reference usage to a weighted random selection of 14,993 student and Certified Registered Nurse Anesthetists from its database. The final response rate to the survey was 21.0% (3,155). Important findings included a greater percentage acknowledging usage of web-based references than of textbooks or journals, as well as more frequent reported usage of web-based resources than textbooks.
    Keywords: Clinical resources, credentialing, evidence-based nursing, Internet, reference materials.
    Version: 2018;86(4):299-309. Authors: Matt Ferris, MA, MBA, ELS; Timothy J. Muckle, PhD,
  • A Content and Thematic Analysis of Closed Claims Resulting in Death From July 2013 to March 2014, the AANA Foundation Closed Claims Researchers evaluated 245 closed claims from the CNA Insurance Companies spanning from 2003 to 2012. An adverse event leading to death occurred in 87 of the claims. This article describes the use of content and thematic analysis in the evaluation of these closed claims. The purpose of the study was to establish themes that would provide unique insights into the events leading up to death with a focus on the role anesthesia may or may not have had in the outcome. Major themes identified include: (1) patient factors, (2) provider factors, (3) environmental factors, and (4) team/group factors.
    Keywords: Certified Registered Nurse Anesthetist, closed claims, content and thematic analysis, malpractice death.
    Version: 2018;86(4):311-318. Authors: Anne Marie Hranchook, DNP, CRNA; Lorraine Jordan, PhD, CRNA, CAE, FAAN; Marjorie Geisz-Everson, PhD, CRNA, FNAP; Maria Hirsch, DNAP, CRNA; Robert W. Matthews, PhD, CRNA. AANA Foundation Closed Claims Researchers: Rebecca Boust, MSNA, CRNA; Beth Ann Clayton, DNP, CRNA; Karen Crawforth, PhD, CRNA; Michael Kremer, PhD, CRNA, FNAP, FAAN; Patrick McElhone, MSN, CRNA; Kelly Wiltse Nicely, PhD, CRNA.
  • AANA Journal Course: Update for Nurse Anesthetists ‒ Evidence-Based Use of Nonopioid Analgesics Analgesia is a necessary component of any anesthetic technique, and can be achieved with local anesthetics, opioid and nonopioid analgesics, and inhaled anesthetic agents. Risks and benefits are associated with each of the agents and techniques described here, including local anesthetic systemic toxicity, respiratory depression, nausea, and urinary retention. Implementation of Enhanced Recovery After Surgery (ERAS) protocols, use of preemptive analgesia techniques, and the national opioid crisis are fostering increased utilization of nonopioid analgesics, including local anesthetics, nonsteroidal anti-inflammatory medications,intravenous acetaminophen, neuromodulatory agents such as gabapentin, corticosteroids, centrally acting α2 receptor agonists, and ketamine.
    Keywords: Analgesia, nonopioids, opioids.
    Version: 2018;86(4):321-327. Authors: Michael J. Kremer, PhD, CRNA, FNAP, FAAN; Charles A. Griffis, PhD, CRNA.