AANA journal
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The AANA determines the scope of nurse anesthesia practice. It is important for all members to understand the scope of practice that governs their work to better practice their profession and mentorship. In January 2013, the AANA Board of Directors charged the Practice Committee to revise the Scope of Nurse Anesthesia Practice. ⋯ Focus group themes include: (1) elements of nurse anesthesia practice; (2) future practice opportunities; (3) interprofessional collaboration; (4) full scope of practice; (5) autonomous practice; and (6) barriers to practice and recommendations. Of the 4,200 CRNA survey respondents, 44.6% are not permitted to practice to their full scope of practice. The revised Scope of Nurse Anesthesia Practice embodies the comprehensive span of nurse anesthesia practice.
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The anesthesiology field has recently embraced the use of checklists to obviate the need for long-term memory, improve safety, and achieve goals and tasks. These checklists serve to increase safety, improve consumer satisfaction, and reduce mortality and morbidity. Spinal surgery with the patient lying prone is associated with complex morbidities when there is inattention to proper positioning technique. ⋯ The purpose of this research project was to examine the use of a checklist for nurse anesthetists who provide care for patients undergoing spinal surgery. The checklist addressed specific positioning needs as a means of decreasing mortality and morbidity. It is theorized that the use of a checklist will serve as a systematic aid to memory and enable the anesthetist to adhere to proper positioning techniques in this patient population and thereby improve outcomes.
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Guidelines for the perioperative administration of fluid are often based on static hemodynamic targets such as central venous pressure, and delayed volume status indexes such as blood pressure, heart rate, capillary refill, and urine output. Traditional fluid management protocols also rely heavily on algorithmic estimates of fluid deficit, intravascular fluid volume status, fluid loss, and basal fluid requirements to guide perioperative fluid administration. Such formulaic approaches lack definitive physiologic endpoints for determining fluid optimization and fail to address the roles of tissue oxygenation and end-organ perfusion in achieving positive long-term patient outcomes. ⋯ A broad literature search was conducted, and 12 studies met the inclusion criteria. Studies were evaluated for design, population, goal-directed therapy targets, monitoring devices used, clinical endpoints, methods, and results. Goal-directed therapy was associated with decreased hospital stay compared with the control group (in 7 studies) and reduced number of postoperative complications (7 studies).