AANA journal
-
In the administration of anesthesia, clinicians have traditionally relied on a variety of autonomic signs to assess the pharmacologic effects of anesthetic agents on the central nervous system. As any experienced clinician knows, these signs can be misleading and lead to overdosing or underdosing of anesthetic drugs. The development of a monitor to measure the bispectral index (BIS) provides anesthetists with the first clinically tested and US Food and Drug Administration-approved monitor to assess the effects of anesthesia on the cerebral cortex. This article reviews the development of the BIS monitor, compares the BIS monitor with other commonly used clinical monitors, assesses the cost-benefit from the use of this monitor, and explores some of the possible uses for this monitor outside of the operating suite.
-
Comparative Study
Transient radiculopathy after 5% lidocaine or 0.75% bupivacaine spinal anesthesia in 3 surgical positions.
The present study was conducted to compare the incidence of transient radicular irritation (TRI) after spinal anesthesia with 5% lidocaine or 0.75% bupivacaine in the supine, prone, and lithotomy surgical positions. A non-rAndomized survey approach was used. The convenience sample consisted of 243 adults receiving spinal anesthesia for elective surgery at 1 of 3 hospitals. ⋯ The findings suggest that TRI after spinal anesthesia occurs more frequently with 5% lidocaine than with 0.75% bupivacaine only when patients undergo surgery in the lithotomy position. Providers need to consider the risks and benefits of 5% lidocaine when selecting an agent for spinal anesthesia, especially with patients undergoing surgery in the lithotomy position. When lidocaine is used, providers should discuss TRI as a risk of spinal anesthesia with patients during preanesthetic counseling.
-
Closed claims analysis of adverse anesthesia outcomes was initiated through the AANA Foundation in 1995 to examine adverse outcomes of anesthesia care provided by Certified Registered Nurse Anesthetists (CRNAs). A research team of 8 CRNAs using an instrument incorporating more than 150 variables undertook document analyses of closed claim files. All files reviewed involved incidents in which the CRNA named in the policy was potentially involved in the adverse patient outcome. ⋯ Reviewers found that respiratory claims were more likely to have involved inappropriate anesthesia management (P < .01), more likely to have involved a lack of vigilance (P < .01), and more likely to have been judged by the reviewer as preventable (P < .01). A higher percentage of respiratory incidents occurred in emergency cases (75% vs 34%, P < .01) and in cases involving general anesthesia (44% vs 17%, P < .01). Adverse respiratory incidents are largely preventable and frequently result in serious patient morbidity and mortality.
-
The significant decrease in the number of anesthesia providers during the late 1980s prompted American Association of Nurse Anesthetists (AANA) leaders to establish the National Commission on Nurse Anesthesia Education (NCNAE). The NCNAE was charged with scrutinizing all aspects of nurse anesthesia educational programs and developing strategies to reverse the critical shortage of nurse anesthetists. ⋯ Although there has been continued realization of NCNAE strategies, 10 years later the critical shortage of CRNAs has resurfaced. This 2-part article describes the commission years, the years that followed, and the current status of Certified Registered Nurse Anesthetist (CRNA) manpower.
-
Research in anesthesia risk management has focused primarily on adverse patient outcomes. Most risk management studies have evaluated the practices of the physician anesthesiologist, while minimal research has been conducted to examine anesthesia care provided by Certified Registered Nurse Anesthetists (CRNAs). For this reason, the American Association of Nurse Anesthetists Foundation supported an examination of closed malpractice claim files from St Paul Fire and Marine Insurance Company that involved insured CRNAs. ⋯ The results indicated that preoperative physical status, patient age, surgical procedure, type of anesthetic, age of anesthesia provider, and the type of anesthesia providers, (e.g., CRNA alone vs CRNA and anesthesiologist working together) did not have a statistically significant relationship with adverse anesthetic outcomes. However, providing appropriate care, being vigilant, encountering a less severe adverse outcome, and not being able to prevent the outcome were associated with smaller monetary awards. The findings of this study support those of similar studies.