暂无摘要。

The American Association of Nurse Anesthesiology (AANA) Practice Committee, in collaboration with AANA Professional Practice staff, advisory panels, and subject matter experts, annually applies a standardized evidence-based process to review, evaluate, and revise clinical resource documents found in the Professional Practice Manual for the CRNA (Certified Registered Nurse Anesthetist) and on the AANA website. This article highlights several revised and newly developed documents, which include topics such as diversity, equity, and inclusion, anesthesia and analgesia for obstetric patients, and safe injection guidelines.

Anesthesia providers must be experts in advanced airway management techniques such as laryngeal mask airway and endotracheal tube insertion. However, practicing anesthesia providers may work in clinical settings where advanced airway management techniques are rarely required. Infrequent advanced airway skill performance in these clinical settings can lead to skill decay, which is the gradual loss of acquired skills through infrequent practice or extended periods of skill nonuse. This literature review synthesizes available evidence regarding advanced airway management skill decay. Themes emerging from the literature review include skill decay association with decreased endotracheal intubation success rates, a timeframe within which advanced airway management skill decay may begin to occur, and recommendations for preventing decay of advanced airway management skills. With infrequent use of advanced airway skills in clinical settings, routine practice is crucial for skill maintenance. Clinical simulation could play a role in mitigating skill decay among practicing anesthesia providers at risk for decay in advanced airway management skills resulting from skill nonpractice.

OBJECTIVE: The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists\' (SNAs\') learning in the operating room during clinical practice, from students\' and supervisors\' perspectives.
METHODS: An integrative review.
METHODS: Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method.
RESULTS: Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment.
CONCLUSIONS: SNAs\' learning situation in the operating room resembles undergraduate nurses\' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs\' learning. Further research is warranted on the effect of teamwork on SNAs\' learning.

We performed a narrative review of articles applicable to anesthesiologists\' and nurse anesthetists\' choices of who works each statutory holiday for operating room and non-operating room anesthesia. We include search protocols and detailed supplementary annotated comments. Studies showed that holiday staff scheduling is emotional. Working on holidays often is more stressful and undesirable than comparable workdays. Intrinsic motivation may overall, among practitioners, be greater by preferentially scheduling practitioners who choose to work on holidays, for compensation, before mandating that practitioners who would prefer to be off must work on holidays. Granting each practitioner (who so desires) at least one major holiday off can depend on identifying and scheduling other clinicians who want to work holidays for monetary compensation or extra compensatory time off. Scheduling holidays by random priority (i.e., a lottery choosing who gets to pick their holiday[s] first, second, etc.) is inefficient, resulting in fewer practitioners having their preferences satisfied, especially for small departments or divisions (e.g., cardiac anesthesia). No article that we reviewed implemented a random priority mechanism for staff scheduling. The selection of practitioners to take turns in choosing their holidays is perceived to have less fairness than a selection process that collects each participants\' preferences. Although holidays often are scheduled separately from regular workdays and weekends, doing so will not increase efficiency or fairness. Holidays can, in practice, be scheduled simultaneously with non-holidays. Models can explicitly include fairness as an objective. For example, fairness can be based on the difference between the maximum and minimum number of holidays for which practitioners of the same division are scheduled. Holidays can be given greater weights than other shifts when estimating fairness. Staff scheduling for holidays, when done simultaneously with regular workdays, nights, and weekends, can also use personalized weights, specifying practitioners\' preferences to be satisfied if possible.

Nurse anesthesiologists have successfully influenced legislative change to include full practice authority across the United States. These legislative changes directly impact the scope of practice as well as patient care and the advancement of the nursing profession. However, nurse anesthesiologists remain hesitant to embrace health policy advocacy as a professional responsibility. To act as advocates, awareness must exist around professional responsibility to engage in political advocacy, and how to engage in this role. We describe successful statewide strategies involving members of a professional state organization for nurse anesthesiologists. Leaders from the state organization incorporated clinical site visits to create a shared vision and inform legislators about their role and its influence on providing safe, quality, cost-effective care to patients. These efforts were effective in moving the policy agenda forward. Additionally, this process of educating legislators within the hospital has empowered a new generation of nurse anesthesiology advocates.

The clinical learning environment is essential for student registered nurse anesthetists (SRNAs) to develop intricate clinical knowledge and acquire proficiency in technical skills required for anesthetic care. The perioperative experience of an SRNA can differ greatly based on the program, preceptor, hospital rotation, or geographic location. This literature review synthesizes the historical and current state of certified registered nurse anesthetist (CRNA)/SRNA preceptorship in the clinical setting. Themes analyzed include the current CRNA/SRNA learning and teaching environment, student perceptions of effective CRNA preceptors, evaluation tools and feedback practices, and overall CRNA preceptor preparedness as well as the availability and effectiveness of preceptor training programs. We compare their findings to best practices seen in the United States Air Force (USAF) pilot training program because of its similar \"high stakes\" learning environment and utilization of a preceptor teaching model. Actionable recommendations, based on CRNA preceptorship data, preceptorship theory, and the USAF pilot training model are presented in the effort to improve preceptor transfer of knowledge and SRNA clinical competence.

The enactment of the Affordable Care Act in 2010 prompted the Institute of Medicine to release The Future of Nursing report to help guide the necessary changes in nursing to accommodate millions of newly insured individuals. A key point of the campaign was for advanced practice registered nurses (APRNs) to practice at the fullest extent of their licensure to meet the needs of the newly insured population. Certified Registered Nurse Anesthetists (CRNAs) experience the most restricted scope of practice among APRNs. An integrative review was conducted to examine CRNA practice and policy since The Future of Nursing was released. Ten research articles were included in the final review. Key findings related to CRNA practice and policy that emerged from the review were (1) patient complications and mortality rates are no different under the care of CRNAs compared with anesthesiologists; (2) CRNAs are more accessible to vulnerable populations and rural areas; and (3) state legislators are being influenced by factors other than evidence, such as strong professional group influence, to make policy decisions for CRNAs. Future interdisciplinary research investigating outcomes from the patients\' perspectives could help remove bias and strengthen the evidence of the quality of care given by CRNAs.

Current criteria used to make the clinical diagnosis of fat embolism syndrome were never intended to be applied to an anesthetized, mechanically ventilated patient in the operating room and, as such, may not be applicable during intraoperative care. Because of this, confusion still exists among anesthesia providers in recognizing this potentially fatal clinical condition. Our goal was to develop and then present a more exacting and rigorous grading scale, tailored specifically for the anesthetized patient, with the hope that it will aid clinicians in recognizing and successfully managing the manifestations of the syndrome. A thorough review of the proposed mechanisms of fat embolism syndrome is provided, as well as a brief case report detailing a pediatric patient who experienced cardiovascular collapse during intramedullary nailing of a femur fracture. Also included is a proposal for new clinical guidelines for the intraoperative diagnosis of fat embolism.

Freeman-Sheldon syndrome is a congenital myopathy with a reported prevalence of less than 1 per 1 million. Also known as craniocarpotarsal dysplasia, this syndrome is characterized by muscle contractures and soft-tissue dysplasia of the face, hands, and feet. The resulting musculoskeletal deformities may require multiple orthopedic, ocular, and plastic reconstructive surgeries. The anesthetic challenges include a potentially difficult airway and intravenous access, susceptibility to malignant hyperthermia, and an unpredictable response to muscle relaxants. This report of the anesthetic management of 2 children with Freeman-Sheldon syndrome emphasizes the anesthetic considerations for the successful management of patients with this syndrome.