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A Study Of Certified Registered Nurses Anesthetist Manpower Supply And Demand In Nebraska: Vii, Dyanna E. Swanigan, Katie L. Twomey

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Background: A shortage of healthcare professionals is a problem many hospitals may face in the era of an expanding aging population. The impact of healthcare provider shortages has proven to be detrimental. A shortage of Certified Registered Nurse Anesthetists (CRNAs) has the potential to impact the healthcare system across the United States. This research study was a continuation of a Nebraska CRNA manpower study originally conducted in 1991 by Sharon K. Loseke. This study represents the seventh Nebraska CRNA manpower study completed.

Methods: A mailed questionnaire was sent to 455 CRNAs with a Nebraska CRNA license who listed Nebraska or …

Anesthetic Management Of An Adult Brain-Dead Organ Donor: A Quality Improvement Project, Rebecca Vanwinkle

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Objective: Anesthesia plays a critical role in the management of an adult brain-dead donor. It is imperative that the anesthesia provider understand the pathophysiology of brain death and its subsequent effects on the body, hemodynamic maintenance, lung recruitment strategies, fluid and electrolyte balance, hormone replacement therapy, and the use of other pertinent medications. Failure to comprehend can result in improper management and may lead to the inability to recover and transplant organs. The purpose of this quality improvement project is to determine if an educational module to describe best practice for organ donation for certified registered nurse anesthesia providers (CRNA) …

Anesthetic Management Of Mast Cell Activation Syndrome: A Journal Course Review, Candace Glasgow

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Mast cell activation syndrome (MCAS) is a disorder that has only gained recognition in the past twelve years. Patients that are diagnosed with MCAS are plagued with abnormal acute and/or chronic mild to severe (anaphylaxis) mast cell activation (MCA) symptoms that affect two of four organ systems. Abnormal MCA has varying pathophysiology and is categorized as primary, secondary, or idiopathic. While similar in outcome, the prevention of MCA and medical management will vary by the subset of MCAS. This journal course reviews the pathophysiology behind MCAS and MCA. Different subclasses and treatment options of MCAS are clarified. Lastly, the anesthetic …

Srna Learning Preferences: A Descriptive Study, Brittney L. Schmit

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Student Registered Nurse Anesthetists (SRNAs) obtain a large portion of their required education within the clinical setting. Research suggests that learning preferences may change with exposure to certain situations, such as clinical experience. Clinical preceptors may be better prepared to educate when they know an SRNAs learning preference. Data on 22 SRNAs was collected using the Multiple Intelligences (MI) Talent Key Assessment, which scores students in seven areas to determine learning preferences. Mean scores of each intelligence were calculated for SRNAs without clinical experience (pre-clinical) and when they had at least six months of clinical experience (post-clinical), then compared using …

Perioperative Pain Management In Patients On Opioid Replacement Therapy: An Integrative Review, Meghan Boer

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Despite the lack of compelling evidence to support long-term efficacy in the treatment of opioid abuse, opioids are one of the most common classes of medications prescribed in the United States. As such, the significant increase in prescription and illicit opioid abuse since the nineties has led to a surge in patients recovering from addiction and now maintained on opioid replacement therapy (ORT). Due to this rapid growth in ORT, there has been a strong interest in utilization of opioid agonists such as methadone, and partial agonists such as buprenorphine, which have been increasingly utilized to treat severe chronic pain …

Effects Of Dexmedetomidine On Postoperative Delirium In The Older Adult Population Undergoing Cardiothoracic Surgery: An Evidence-Based Practice Analysis, Mari Fischer Vazquez

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

A PICO question was developed to provide guidance for the research/literature review process. "In the greater than 60-year-old adult population undergoing cardiac or thoracic surgery with general anesthesia (P), does the use of intraoperative dexmedetomidine (I) affect the incidence of postoperative delirium (O) when compared to placebo (C)?" A literature search was conducted and completed by searching the following databases: PubMed, Scopus, MEDLINE Complete, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Academic Search Elite. Keywords used in the search strategy include dexmedetomidine, postoperative delirium, adult, geriatric, cardiopulmonary surgery, and thoracic surgery. Inclusion criteria were studies published in …

Preoperative Pre-Warming Versus No Preoperative Pre-Warming And Intraoperative Hypothermia: An Evidence-Based Practice Analysis, Heather J. Yancy

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Inadvertent perioperative hypothermia occurs in approximately 50% to 70%1 of all surgical patients, and is a risk for anyone undergoing general or neuraxial anesthesia, yet it can be prevented. Hypothermia is defined as a core body temperature of less than 36 degrees Celsius.1-10 Body temperature is regulated by the hypothalamus. Once anesthesia is induced, the body's ability to regulate temperature is reduced4 and the body's ability to produce heat is decreased. General and neuraxial anesthesia have a vasodilatory effect to the body, which causes a core-to-peripheral shift in body heat. This redistribution of heat contributes to 65%-81%4 of the total …

The Erector Spinae Plane Block For Improving Recovery After Spinal Surgery, Brooke Champane

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The literature was analyzed to determine the efficacy of ESP blocks on postoperative pain scores and postoperative total opioid consumption (TOC) in adults undergoing general anesthesia for posterior spinal surgery. Posterior spine procedures consisted of lumbar discectomies, laminoplasties, decompressions, single and multi-level fusions with and without instrumentation, and posterior internal fixation for fractures. Most studies compared the treatment (ESP block) group to the control group which consisted of no block, or a sham block performed with normal saline injection. One RCT performed in 2022, compared the ESP block group to the standard wound infiltration technique (control group) with equal doses …

Clonidine As An Adjunct To Intrathecal Bupivacaine: An Integrative Review, Jennifer Maloy

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Aims and objectives: The aim of this integrative review is to provide current, evidence-based anesthetic recommendations for the use of clonidine as an adjuvant to bupivacaine for patients undergoing total knee arthroplasty (TKA) under spinal anesthesia.

Methods: Articles published between 1993 and 2018 were critically appraised for validity and reliability of the studies. It is important to note that literature was searched for publications between 1993 and 2022, however nothing relevant to this topic was published between 2019-2022.

Results: Clonidine is a selective partial alpha 2 receptor agonist.1 When administered in the intrathecal space, clonidine has been shown to be …

The Safety And Efficacy Of Liposomal Bupivacaine Administration In Patients Undergoing Shoulder Arthroplasty: An Integrative Review, Sara Fouts

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The aim of this integrative review is to examine and report current evidence regarding the safety and efficacy of liposomal bupivacaine (LB) administration for post-operative analgesia in shoulder arthroplasty. The two administration methods examined are peri-neural and peri-articular infiltration. Articles published between 2008 and 2018 were critically appraised for validity, reliability, and rigor of study. The safety profile of subcutaneous and peri-neural administration of LB has been well documented by research. Risks of myotoxicity and neurotoxicity from LB administration are similar compared to Bupivacaine HCL when used at lower dosages (2.5-3 mg/kg). Evidence from animal studies show that peri-articular infiltration …

Prevention Of Emergence Delirium In Veteran Patients With Post-Traumatic Stress Disorder: A Descriptive Study, Andrew J. Maasdam

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Introduction: CRNAs are in a unique position to directly impact the surgical experience for veterans with PTSD during and after general anesthesia. The purpose of this descriptive study is to evaluate anesthetic management practices utilized by CRNAs for veterans diagnosed with PTSD undergoing general anesthesia using a survey approach for data collection.

Methods: Survey participants were recruited from a public membership list of the Association of Veteran Affairs Nurse Anesthetists (AVANA) website. The 10-question survey was developed through Survey Monkey to determine methods of identifying patients with PTSD, the likeliness of a change in anesthetic plan based on PTSD, whether …

Aseptic Administration Of Intravenous Medications By Anesthesia Providers; A Quality Improvement Project, Brittny Stewart

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

This quality improvement project addresses the lack of compliance by anesthesia providers in following aseptic techniques for preparing and administering IV medications. An initial 8-question survey was conducted to assess baseline knowledge of, and compliance with aseptic techniques by anesthesia providers. Following that, an educational intervention was performed and then a follow-up survey was conducted to assess changes in aseptic technique, knowledge, and compliance. The goal of the project was to improve knowledge and compliance of anesthesia providers following aseptic techniques. A Plan-Do-Study-Act Model was used for the organization and study of the overall results of this project.

Reiki As A Pain Management Adjunct In The Postoperative Total Knee Arthroplasty And Surgical Obstetric Population: An Integrative Review, Allison Knopes

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Pain is an undesirable, but anticipated component of surgery. Opioids are routinely administered to manage pain for the millions of surgical procedures performed annually in the United States. Given the rising rate of opioid deaths, and undeniable fact that pain will be present with surgery, there is a need for adjunct alternative pain therapies to lessen the amount of opioids used in the surgical setting. There are many forms of alternative pain therapies such as acupuncture, massage, meditation, sound therapy, and reiki. Reiki, the focus of this integrative review, is an energetic healing technique that can promote relaxation, stress reduction, …

Perioperative Low-Dose Ketamine Infusion And Its Impact On Postoperative Pain: An Evidence Based Practice Analysis, Joseph Edward Van Den Hoven

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Acute pain after surgery is a common problem with multiple consequences. Patients, anesthesia professionals, and surgeons want adequate pain control with minimal side effects. Opioid analgesics are commonly relied upon in the perioperative and postoperative periods to provide analgesia. Large doses of opioids are associated with sedation, respiratory depression, pruritus, nausea, vomiting, and potentially opioid induced hyperalgesia (OIH).1 The use of multimodal analgesia targeted at different pain mechanisms both peripherally and centrally has been reported to decrease pain and reduce opioid consumption.

The Effect Of An Esmolol Infusion On Perioperative Opioid Use And Postoperative Pain Scores: An Integrative Review, Joey J. Chung

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Objective: The purpose of this integrative review is to investigate the effect of an esmolol infusion on perioperative opioid use and postoperative pain scores.

Methods: Articles published between 2012 and 2020 were examined and reviewed for quality, strength and relevance to the topic.

Results: Evidence suggests that an intraoperative esmolol infusion can decrease intraoperative and postoperative opioid consumption, as well as decrease postoperative pain scores.

Peripartum Pain Control In The Opioid Dependent Parturient, Jaclyn Young

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

There are several reasons practitioners prescribe opioids to pregnant women, including back pain, abdominal pain, migraine, joint pain, fibromyalgia.1 The most frequently prescribed opioids are hydrocodone, codeine, oxycodone, propoxyphene, tramadol, meperidine, hydromorphone, morphine, fentanyl, buprenorphine, methadone, pentazocine, tapentadol, and oxymorphone.1 Managing opioid dependent women’s analgesic levels during the peripartum period can be challenging for the anesthesia team.

The Use Of Thromboelastograpy Guided Transfusion Therapy In Trauma: An Integrative Review, Heidi M. Farnum

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Trauma induced mortality can often be attributed to hemorrhage in the early phase of trauma. Up to one-half of trauma deaths are due to uncontrolled bleeding within the first few hours of injury. Patient survival following a traumatic injury is reliant upon the trauma team's ability to gain early control of bleeding. Ways in which the trauma team can gain control of bleeding include rapid identification of the source of hemorrhage, applying direct pressure to the source of hemorrhage, and aggressive resuscitation. Resuscitation efforts are focused on restoring normal physiology and oxygen delivery to tissues. Resuscitation involves the use of …

Ultrasound-Assisted Neuraxial Anesthesia: An Online Education Module, Bradley J. Mack

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Because US imaging is successfully used for peripheral nerve blocks, central venous catheter placement, and other procedures, it is reasonable to suppose that it may be a solution to improve neuraxial anesthesia in challenging populations. Naturally, the next step is education and exposure for anesthesia providers to make ultrasound-assisted neuraxial anesthesia (USANA) available for the improvement of practice.

Stress In The Student Registered Nurse Anesthetist’S Support Person: A Descriptive Study, Sarah M. Leviã„€¡

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

An understanding of the stressors affecting support persons of Student Registered Nurse Anesthetists (SRNAs) could assist in the development of an intervention to mitigate that stress. A reduction in stress in support persons could thereby reduce stress in SRNAs through a crossover effect. A survey was administered at three Midwestern entry to practice nurse anesthesia programs which award a practice doctorate to identify the causes of stress in the SRNAs' support person. Overall stress in the past month was rated moderate, with work and household management related stress rated as the most stressful. Participants did not feel they could have …

The Effect Of Preoperative Routine Cannabis Consumption Or Perioperative Administration Of Tetrahydrocannabinol (Thc) On Post Operative Nausea And Vomiting In Surgical Patients, Justin W. Graham

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

With the growing advocation for and legalization of medical and recreational marijuana, its presence in patients presenting for anesthesia is on the rise. It has been hypothesized that complications such as nausea and vomiting may be reduced with the administration of cannabis both pre-operatively and intra-operatively. The purpose of this evidence-based practice analysis is to examine current evidence to determine if pre-operative use of cannabis or the administration of cannabis versus no cannabis or administration of a placebo results in decreased post-operative nausea and vomiting.

Pulmonary Recruitment Maneuver Effects On Laparoscopic Complications: An Evidence Based Practice Analysis, Michael Feighny

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Postoperative shoulder pain is a common complication following laparoscopic surgery with an incidence as high as 80%.1 The etiology of the shoulder pain is thought to be due to residual carbon dioxide in the abdominal cavity, however the exact mechanism has not been fully elucidated.2 Anesthesia providers are challenged with providing effective postoperative pain relief while minimizing complications. Evidence in the literature suggests laparoscopic related complications such as pain and postoperative nausea and vomiting (PONV) can be reduced by implementing a pulmonary recruitment maneuver in Trendelenburg position (30°) at the end of surgery.3 The maneuver may also have an affect …

Ketorolac Use In The Pediatric Surgical Patient: An Evidence-Based Practice Analysis, Jason Beach

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Opioid-based medications are often the first medications selected for pain control in young patients; however opioids possess several unwanted side effects such as respiratory depression, nausea, vomiting and allergic reactions. Administration of medications that support a multimodal approach to pain management is imperative. It is a longstanding belief that pediatric pain is significantly undertreated due to providers' hesitance to use non-steroidal anti-inflammatory drugs (NSAIDs). Baley et al.1 cite that anesthesia providers have been challenged to eliminate the under treatment of pain in the pediatric population. The pediatric population is at high risk for inadequate pain management and providers should strongly …

Implementation Of An Orientation Seminar For Graduate Students In Nurse Anesthesia And Their Support Persons: A Program Evaluation, Stephanie Ann Ferguson

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Research has shown that support persons of graduate students may experience stress similar to their students via a crossover effect. Previous surveys of support persons of Student Registered Nurse Anesthetists (SRNAs) have shown a need for preventative interventions to mitigate their stress. An orientation seminar was developed for the primary support persons of SRNAs beginning a small Midwestern Doctor of Nurse Anesthesia Practice (DNAP) program. All support persons were invited to complete a stress survey after the orientation seminar regardless of attendance. Overall, all support persons who attended the orientation seminar reported it as helpful. No support persons of 1st …

Incorporating Dexamethasone With Local Anesthetics In Single-Shot Nerve Blocks: An Integrative Review, Kyle G. Hilsabeck

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Prolonging the duration of analgesia in single-shot nerve blocks (SNBs) continues to be a problem in regional anesthesia. Both IV and perineural dexamethasone have proven to be effective in prolonging the duration of analgesia in SNBs.

Objective: The purpose of this integrative review was to determine how IV and perineural dexamethasone effect duration of analgesia, pain scores, opioid consumption, and complications in patients undergoing SNB.

Methods: An integrative review that included 12 peer-reviewed randomized-controlled trials (RCTs) and one meta-analysis was performed.

Results: The results of the integrative review found that perineural dexamethasone prolonged the duration of analgesia, reduced pain scores, …

Norepinephrine Vs. Phenylephrine For Perioperative Hypotension Following Subarachnoid Block In Patients Undergoing Cesarean Delivery: An Evidence Based Practice Analysis, Logan Meisinger

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Subarachnoid block for patients undergoing cesarean delivery is common practice amongst anesthesia providers caring for the parturient population. Advantages of this type of anesthetic for cesarean delivery provide a number of benefits which this study will not seek to extrapolate upon. Numerous studies have looked at the variations between medications used in spinal anesthesia (isobaric, hyperbaric, local anesthetics, narcotics, etc.) and how they impact adverse effects but regardless of the drug used, they all cause some degree of sympathectomy. Because of this known side effect for this particular anesthetic, severe and sustained hypotension may result due to the sympathectomy created …

Intraoperative Lidocaine Infusion For Multimodal Pain Management In Gastrointestinal Surgeries: An Evidence-Based Practice Analysis, Shelby Sullivan

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

A population, intervention, comparison, and outcome (PICO) question was used to provide the key concepts of my search strategy. "In (P) patients undergoing gastrointestinal surgeries, what is the effect of using (I) a continuous lidocaine infusion (C) compared to normal saline (O) on the severity of postoperative pain scores?"

Indications For Hepa Filter Use In Patients Undergoing General Anesthesia With A Breathing Device: An Integrative Review, Tara Dickey

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Aim and Purpose: This integrative literature review aims to provide evidence-based recommendations for high-efficiency particulate air (HEPA) filter use within the anesthesia breathing circuit. The purpose of the recommendations is to reduce the risk of pathogen transmission to patients undergoing general anesthesia with a breathing device.

Methods: Relevant literature was critically appraised for validity and reliability. A matrix was utilized for data extraction, allowing themes to be generated as well as for categorizing findings and limitations. Inclusion criteria were current recommendations guiding filter use within the anesthesia breathing machine, indication for filter use, placement within the respiratory circuit, and recommended …

Effectiveness Of Inhaled Albuterol Delivery Methods In Adult Intubated Patients: An Integrative Review, Anthony Heidtbrink

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The purpose of this integrative review is to critically appraise the available literature related to effectiveness of albuterol delivery methods for the intubated patient undergoing general anesthesia and to make recommendations for practice. Methods of albuterol delivery commonly utilized by anesthesia providers, such as attaching a metered dose inhaler to an endotracheal tube adapter, have not been proven to reliably deliver albuterol to target tissues. The use of an in-line chambered spacer in conjunction with a metered dose inhaler improves the anesthetist's ability to reliably deliver albuterol to target tissues and achieve measurable reductions in airway resistance. Additionally, a novel …

Intraoperative Hypotension Management For Microvascular Reconstruction Surgery Using Free Tissue Transfer: An Integrative Review, Lyndsie Lafleur

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

Introduction: Anesthetic management for free flap surgery contributes to flap survival, as hypotension is an independent predictor of flap loss. The optimal blood pressure range is unknown and there are no standardized guidelines available in this area. The aim of this integrative review was to provide evidence-based recommendations for hypotension management during microvascular free flap reconstruction surgery. Methods: Articles evaluating anesthetic related predictors of flap survival were critically appraised for validity, reliability, and rigor of study. Results: Current practice favors the use of fluids over vasopressors, supported by animal studies and anecdotal evidence. Clinical data demonstrated vasopressor use does not …

The Mallampati Test Versus The Upper Lip Bite Test In Predicting Difficult Intubation, Chance Buttars

Group: Bryan College of Health Sciences Doctor of Nurse Anesthesia Practice (DNAP) Collection

The accurate assessment of the airway is one of the most important skills an anesthesia practitioner should perfect. A difficult intubation is often defined as a Cormack Lehane (CL) grade of III or IV in adult patients. The reported frequency of difficult intubation or CL grade III and IV is 12.35% and 9% in those undergoing a general anesthetic.¹ Several assessments and scoring systems are used by anesthesia providers with the goal of identifying a potentially difficult intubation.