Founded in 1931 and located in Park Ridge, Ill., the AANA is the professional organization for more than 90 percent of the nation’s nurse anesthetists. As advanced practice nurses, CRNAs administer approximately 32 million anesthetics in the United States each year. CRNAs practice in every setting where anesthesia is available and are the sole anesthesia providers in more than two-thirds of all rural hospitals. They administer every type of anesthetic, and provide care for every type of surgery or procedure, from open heart to cataract to pain management.

Founded in 1931 and located in Park Ridge, Illinois, the AANA Journal is the professional organization for over 90% of the nation's nurse anesthetists. As advanced practice nurses, Certified Registered Nurse Anesthetists (CRNAs) administer approximately 32 million anesthetics in the United States each year. CRNAs work in every setting where anesthesia is available and are the sole anesthesia providers in more than two-thirds of all rural hospitals. They administer every type of anesthetic and provide care for a wide range of surgeries and procedures, from open-heart surgery to cataract surgery to pain management.

AANA Journal成立于1931年，位于伊利诺伊州的公园岭，是美国超过90%的护士麻醉师的专业组织。作为高级执业护士，注册护士麻醉师（CRNA）每年在美国施行约3200万例麻醉。CRNA在所有提供麻醉的环境中工作，并且在超过三分之二的乡村医院中是唯一的麻醉提供者。他们能够施行各种类型的麻醉，并为各种手术或程序提供护理，从心脏手术到白内障手术，再到疼痛管理。

AANA Journal

Pulmonary aspiration is a potentially fatal anesthetic complication occurring when gastric contents enter the respiratory system. Fasting guidelines aim to decrease the risk of pulmonary aspiration by recommending a timeframe in which patients abstain from food and drink before surgery. Fasting guidelines recommended for healthy individuals fail to account for patients with type 2 diabetes mellitus (T2DM). Gastroparesis, a common condition associated with T2DM, is exacerbated during stress such as an impending surgery. This study sought to determine whether a relationship exists between stress levels and gastric contents in fasting patients with T2DM presenting for an elective surgical or diagnostic procedure. The quality and quantity of gastric contents and preoperative stress were evaluated using gastric ultrasonography and salivary α-amylase levels. No relationship existed between preoperative stress and gastric contents; however, glycated hemoglobin levels of 7% or greater were associated with increased gastric fluid, which was the most significant finding in this study. In addition, there was a significant difference between the mean gastric volume in healthy individuals and patients with T2DM. Performance of gastric ultrasonography preoperatively provides objective data that could influence the anesthetic plan and decrease the risk of pulmonary aspiration in patients with T2DM.

Amy M Reed

Richard E Haas

AANA journal

Type 2 Diabetes Mellitus: Relationships Between Preoperative Physiologic Stress, Gastric Content Volume and Quality, and Risk of Pulmonary Aspiration.

2型糖尿病：术前生理应激、胃内容物体积与质量及误吸风险的关系。

Simulation is an effective tool to learn or refresh skills and knowledge, but numerous barriers prevent the routine use of simulation. The purpose of this project was to assess the feasibility and acceptability of the use of a low-tech simulation kit by the hospital's personnel for overcoming those barriers. A phenomenological qualitative approach using semistructured interviews was conducted with a convenience sample of 5 Certified Registered Nurse Anesthetists (CRNAs) and a student registered nurse anesthetist at a rural community hospital. Additionally, a CRNA served as the facilitator and was interviewed. After the data were independently analyzed by 2 individuals, 6 themes emerged. A low-tech simulation was acceptable, although the sense of stress was difficult to replicate. The facilitator found that simulation preparation and execution were easier and less work than expected. A low-tech simulation kit is a viable option for increasing the frequency of simulating anesthesia emergencies and overcoming the barriers that prevent the frequent use of simulation in the clinical setting. Psychological fidelity can be enhanced through innovative methods (flip book containing screenshots of an electrocardiographic monitor, video) to overcome the limitations of a low-tech simulation.

Seth K Mogler

Joshua A Cochrane

LaChelle J Wieme

Mary E Shirk Marienau

Feasibility and Acceptability of a Low-Tech Simulation Using Local Resources in a Rural Community Hospital.

低技术模拟利用当地资源在乡村社区医院的可行性与可接受性。

Patients undergoing craniotomy are at increased risk of intravascular volume changes due to the use of mannitol. This quality improvement project was conducted to implement a standardized goal-directed fluid therapy (GDFT) protocol using a dynamic physiologic measure in an attempt to maintain euvolemia in patients undergoing craniotomy with mannitol administration. An evidence-based GDFT protocol was integrated into an existing neurosurgical protocol. Anesthesia providers were asked to implement the protocol in patients who met the screening criteria. A preimplementation and postimplementation record review was conducted to compare outcomes of the intervention with standard practice. Primary outcomes included intensive care unit (ICU) length of stay (LOS), hospital LOS, serum lactate levels, and the total amounts of intraoperative crystalloid and colloid administered between the preimplementation and postimplementation groups. Of 95 patients who met the screening criteria, 51 (54%) had full protocol compliance. There was no significant difference between groups in ICU LOS (P=.700), hospital LOS (P=.948), serum lactate levels (P=.484), or the total amount of intraoperative crystalloid administered (P=.122). The postimplementation group had significantly more colloid administered than the preimplementation group (P=.004). A lack of provider compliance with the protocol may have affected these results. Further refined quality improvement cycles are warranted.

Amy E Selmer

Andi N Rice

Colleen M Naglee

Charles A Vacchiano

Optimizing Intraoperative Fluid Replacement for Patients Receiving Mannitol During Neurosurgical Procedures: A Quality Improvement Initiative.

优化神经外科手术期间接受甘露醇治疗患者的术中液体置换：一项质量改进计划。

Agatha Hodgins

AANA J

Imagining in Time.

时间中的想象。

A high prevalence of undiagnosed obstructive sleep apnea (OSA) exists in patients receiving sedation for gastrointestinal laboratory (GI lab) procedures, with potentially serious adverse events associated with untreated OSA. This quality improvement project aimed to identify patients at high risk of OSA and evaluate their risk of intraprocedure airway maneuvers and adverse events in a GI lab. In the GI lab, nurses administered and documented the STOP-BANG questionnaire as part of their pre-procedure assessment of 80 patients presenting for elective procedures. The occurrence of airway maneuvers and adverse events during the procedures was measured using a checklist given to nurse anesthetists as they brought patients to the postprocedure area. Patients with STOP-BANG scores below 5 and with scores of 5 and above were compared. Descriptive and inferential statistics were used to analyze differences in patient outcomes. Patients with high STOP-BANG scores had an increased need for airway maneuvers and higher occurrence of adverse events (P=.05). These results support the use of STOP-BANG as a pre-procedure risk assessment tool. Anesthesia professionals can anticipate intraprocedure airway interventions, consider preemptive interventions in a GI lab, and be more vigilant when caring for patients with high STOP-BANG scores at high risk of undiagnosed OSA.

Sarah Deslate

Eileen R Chasens

Cameron Yamanishi

Richard Henker

STOP-BANG as a Pre-procedure Risk Assessment Tool to Predict Intraprocedure Airway Maneuvers and Adverse Events in a Gastrointestinal Laboratory.

STOP-BANG作为术前风险评估工具预测消化内镜操作中的气道操作及不良事件。

Among anesthesia-related life-threatening complications, respiratory failure requiring reintubation is common. However, studies evaluating patient characteristics for extubation failure are scarce in the literature. Such knowledge is important to increase awareness and for the development of strategies to improve the safety of anesthesia care. We retrospectively reviewed 196 cases that were reported to our quality assurance (QA) committee from 2004 to 2014 at 3 hospitals. The reintubation rate was 0.09% (n=196). More reintubations occurred in the operating room than the postanesthesia care unit (58% vs 30%). Ninety-three reintubated patients (47%) were 65 years or older. Most patients were in ASA class 3 or 4 (76%) and had a surgical procedure lasting longer than 3 hours. Eleven reintubated patients (5%) died during the hospital course. The exact causes of reintubation could not be determined because of limited data in our QA database. We conclude that although the individual risk of reintubation for each patient is low, the reintubated patients have a higher mortality rate. The study findings emphasize the need for extra vigilance before anesthesia providers attempt extubation of a patient who is elderly, underwent surgery over 3 hours, has chronic obstructive airway disease, or has ASA class 3 or 4 status.

Ratan K Banik

Kate Honeyfield

Sana Qureshi

Shamantha G Reddy

Incidence and Mortality Rate of Perioperative Reintubation: Case Series of 196 Patients.

围手术期再插管的发生率与死亡率：196例患者病例系列研究。

Aspiration, the inadvertent introduction of fluids or solids into the trachea, is a severe risk in patients with achalasia, presenting major challenges for anesthesia providers. Achalasia is an autoimmune reaction resulting in decreased lower esophageal peristalsis and the inability of the lower esophageal sphincter to relax, preventing the passage of food and liquids. A 47-yearold woman with a history of achalasia presented to the endoscopy suite for esophagogastroduodenoscopy. The patient was admitted with complaints of dysphagia and the inability to tolerate solids and liquids. Despite the recommendation from the gastroenterology team for monitored anesthesia care, the anesthesia care team advocated for general anesthesia with rapid sequence induction to protect the airway. On introduction of the video laryngoscope (GlideScope, Verathon Inc), a pool of saliva and food particles were observed in the posterior oropharynx. This case study examines a severe case of achalasia requiring unconventional treatment. This case illustrates the need for maintaining a high index of suspicion for aspiration risk in patients with achalasia during their precarious and stressful course of management, and the importance of collaboration between the anesthesia and the gastroenterology care teams in safely managing these patients.

Abner Perez

Anesthesia Considerations for Patients With Severe Achalasia.

严重贲门失弛缓症患者的麻醉注意事项。

Enhanced Recovery After Surgery (ERAS) protocols have been implemented in many institutions to attenuate the stress of surgery and facilitate early recovery. Careful selection of multimodal analgesic medication plays an essential role in achieving the goals of ERAS protocols. Clonidine and dexmedetomidine are α2-adrenergic receptor (α2-AR) agonists that can greatly enhance various ERAS components owing to their unique pharmacologic properties: antinociception, anxiolysis, anti-inflammation, and renal protection. The α2-AR agonists exert supraspinal and spinal antinociceptive effects by potentiating descending pain modulatory pathways and inhibiting peripheral C fibers. These antinociceptive effects of α2-AR agonists are independent of opioid receptors and result in analgesic synergy with opioid agonists. Several meta-analyses and systematic reviews have reported that α2-AR agonists decrease opioid consumption and side effects in adult and pediatric surgical patients. Given the wide distribution of α2-ARs in the body, α2-AR agonists have been associated with a reduction in anxiety, perioperative stress, inflammation, postoperative nausea and vomiting, shivering, and cognitive dysfunction. This course describes the basic and applied pharmacology of the α2-AR agonists and provides emerging evidence to support their utility in acute pain management and ERAS protocols. Perioperative administration of α2-AR agonists can enhance pain management, decrease adverse effects, and promote surgical recovery.

Sarah Jingying Zhang

Gloria Lai

Charles A Griffis

Michelle Schiltz

Edwin N Aroke

α 2-Adrenergic Receptor Agonist, an Attractive but Underused ERAS Component in Improving Fast-Track Recovery and Surgical Outcomes

α2-肾上腺素受体激动剂：改善快速康复和手术结果的有吸引力但未充分利用的ERAS组成部分

Double-outlet right ventricle (DORV) is a rare cardiac condition in which both the aorta and pulmonary artery arise from the right ventricle, resulting in parallel systemic and pulmonary circulations. Usually, DORV is present with ventricular septal defect; however, the location of the ventricular septal defect and presence of pulmonary stenosis (PS) result in various physiological features and subtypes of DORV. Because DORV without PS causes congestive cardiac failure and DORV with PS results in cyanotic heart disease, anesthesia management varies widely according to the resultant physiological characteristics. Reports of anesthesia management in a parturient with DORV undergoing cesarean delivery is scarce because of the low incidence of DORV and the discouragement of these patients to conceive. Only 8 known previous such cases are reported, and almost all these patients were administered regional anesthesia. Here we describe a parturient with DORV, to whom general anesthesia was administered because of incidental antiphospholipid syndrome with low platelets. To the best of our knowledge, this scenario has not been described previously.

Apala R Chowdhury

Jyotsna Punj

Choro Athiphro Kayina

Abhishek Singh

Joel G Jasiel

Anesthetic Management of a Parturient With Double-Outlet Right Ventricle Obstruction and Pulmonary Stenosis Scheduled for Cesarean Delivery: Case Report and Review of Literature.

双出口右心室梗阻和肺动脉狭窄孕妇拟行剖宫产的麻醉管理：病例报告与文献综述。

Many nurse anesthetists changing positions or considering leaving their positions can give the impression that suboptimal quality of anesthesia department leadership exists. To provide nationally accurate benchmark data on annual turnovers of nurse anesthetists to assist chief nurse anesthetists who may be scrutinized for the resignation rate of nurse anesthetists at their hospital, we used the 2018 US National Sample Survey of Registered Nurses. Analyses show that, during 2017, approximately 13.6% (99% CI, 6.6%-25.8%) of survey respondents left the positions that they held as of December 31, 2016. Approximately 37.6% considered leaving but did not resign as of December 31, 2017 (CI, 26.2%-50.6%). Estimates for nurse anesthetists were comparable to those for registered nurses (ie, not unique to nurse anesthetists). With both estimates combined, approximately 53% of nurse anesthetists changed or considered leaving their primary position (CI, 37.3%-68.0%, P=.62 compared with half). The most commonly reported reason was better pay/benefits (P≤.0064 vs all other reasons, including burnout). Applying the results, in a department with 37 nurse anesthetists, the national incidence of 13.6% would represent a turnover of 5.0 per year. The 13.6% incidence could also result in 1 of 5 years having as many as 11 nurse anesthetists (30%) leaving.

Franklin Dexter

Richard Epstein

Mohamed Elhakim

Cormac O'Sullivan

US Survey of Incidence of and Reasons for Nurse Anesthetists Leaving or Having Considered Leaving Their Jobs.

美国护士麻醉师离职或考虑离职的发生率及原因调查。

ISSN	0094-6354, 2162-5239
h-index	36

Publication Information	Publisher: AANA Publishing Inc.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1973，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%

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