The cost effectiveness of anesthesia workforce models: a critique.
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Anesthesia↗
Biomedical subjects
D Martin-Sheridan
Publications and source records attributed to D Martin-Sheridan.
Factors that influenced six nurse anesthesia programs to close.
The well-being of the profession of nurse anesthesia requires sound education programs to educate the cadre of providers in the specialty practice of anesthesia nursing to meet societal needs. Many factors in the environment can have an impact on a program's ability to achieve this goal. Where factors are adverse, it can force a program to close. Closure of education programs should be a matter of concern to the entire nurse anesthesia community. However, complex factors can only be understood when information about their nature and characteristics is current. Making predictions about how a system may respond based on decade-old data is neither an efficient nor effective method to develop strategy-based solutions. This study identified factors that influenced decisions to close six nurse anesthesia education programs. Armed with this information, other programs can better prepare to counter the negative influences that could lead to their closing.
Education, Nursing, Graduate↗
Comparison of ondansetron, metoclopramide, and placebo in the prevention of postoperative emesis in children undergoing ophthalmic surgery.
A common and distressing adverse effect following general anesthesia is nausea and vomiting. Pediatric ophthalmic surgery is associated with a high (50%-80%) incidence of postoperative emesis. Vomiting postoperatively may cause a prolonged hospital stay, and if it is persistent, may lead to unanticipated hospital admission after ambulatory surgery. The purpose of the present study was to compare the effectiveness of prophylactic antiemetic treatment with ondansetron, metoclopramide, and placebo in a study population of pediatric patients scheduled to undergo ophthalmic surgery. One hundred and one patients were included in this double-blinded study. The incidence of emesis and adverse effects were observed in the postanesthesia care unit and documented for 24 hours postoperatively. Analysis of variance showed that ondansetron significantly decreased (P = .05) the incidence of emesis in the postanesthesia care unit and during the first 24 hours postoperatively (P = .049). Additionally, parents of children in the ondansetron group reported a high degree (94%) of satisfaction with the experience.
Adolescent↗
AANA Journal Course: update for nurse anesthetists--management of malignant ventricular tachyarrhythmias: the role of drug therapy and surgical intervention in sudden cardiac death survivors.
The use of implantable cardioverter-defibrillators (ICDs) to treat patients with ventricular tachyarrhythmias and sudden cardiac death (SCD) has increased over the last decade. Once applied as therapy of last resort, new surgical techniques and improved technology have made the procedure relatively noninvasive. As a result, it is becoming increasingly more common for patients to undergo insertion of this life-saving device in nonoperating room locations. Because patients who require insertion of ICDs often have significant underlying cardiac disease, developing a plan of anesthesia management tailored to meet their needs and predispositions may be a challenge. This Journal Course reviews, from an historical as well as contemporary perspective, the medical and surgical management of patients with ventricular tachyarrhythmias at risk to sustain SCD. A case presentation format is utilized to illustrate an example of an anesthetic plan of care for a patient who underwent insertion of an ICD. Additional information is presented regarding the impact of the ICD on quality of life and overall healthcare costs. As our healthcare system continues to change and evolve, when treatment options are considered, quality of life and cost issues are becoming increasingly more important.
Aged↗
Postoperative nausea and vomiting after strabismus surgery: mechanisms, treatment, and implications for practice.
The occurrence of postoperative nausea and vomiting in children after strabismus surgery has historically been a challenging aspect of anesthetic management. This article provides an overview of the cause, physiology, and mechanisms of post surgical vomiting in this patient population. Current pharmacological treatment modalities and implications for future practice are examined.
Child↗
Anesthetic management for the implantable cardioverter-defibrillator.
The use of implantable cardioverter-defbrillators to treat ventricular tachyarrhythmias has increased over the last 15 years. This article presents a description of third- and fourth-generation implantable cardioverter-defibrillators (ICDs), including information concerning their use, patient selection criteria, surgical implantation techniques, and anesthetic implications. A brief history of the development of the ICD is discussed. Indications, contraindications and complications are examined.
Defibrillators, Implantable↗
Anesthesia providers, patient outcomes, and costs: a critique.
The June 1996 article in Anesthesia and Analgesia by Abenstein and Warner entitled "Anesthesia Providers, Patient Outcomes, and Costs" presents important information about anesthesia services, but it contains a number of errors and questionable interpretations that could lead to inappropriate programs and policies. Among the most important points of fact we clarify in our paper are: 1. Three organizations that accredit, certify, and govern nurse anesthetists are organized in similar fashion to three comparable bodies governing anesthesiologists. There is no justification for the implication that the AANA somehow controls the accreditation and certification of CRNAs. 2. The conclusion that anesthesiologistled care teams are the preferred model for all anesthesia services and settings because of improved patient outcomes is overly simplistic and is not borne out in the literature. 3. The attribution of reduced mortality from anesthesia over the past 40 years to the increase in numbers of anesthesiologists is not justified. Many other factors, including new anesthetic agents and improved patient monitoring, also are important. 4. The use of a hypothetical example related to Medicare reimbursement in New York to justify the implication that CRNA-delivered services are more costly than anesthesiologist-delivered services is misleading and not borne out in the literature. We hope that planners and policy makers will read the article by Abenstein and Warner with extreme caution. Taking some of their statements and conclusions seriously could lead to policies and programs that are not focused in science.
Anesthesiology↗
Discharge time in patients who receive fentanyl or alfentanil for general anesthesia.
Forty ASA I and II patients undergoing elective termination of pregnancy were studied. Patients were randomly selected to receive fentanyl or alfentanil. Patients received 1 to 2 mg midazolam, 2.0 to 2.5 mg/kg propofol, and 10 to 20 micrograms/kg alfentanil or 1 to 2 micrograms/kg fentanyl for induction and maintenance of anesthesia. In addition all patients were administered 70% N2O and 30% O2. The time from admission to the post anesthesia recovery unit until discharged home was defined as the discharge time. These times were compared using the student's t test to determine if there was a significant difference (P < .05) between the mean discharge time of the two groups. In addition, each patient's total postanesthesia recovery scores were evaluated on admission, at 15 minutes, and at discharge from the post anesthesia recovery unit. These data were analyzed using the Mann-Whitney U test to determine if there was a significant difference in the mean rate of recovery in each area observed. The data revealed no statistically significant difference between the mean discharge times of the two groups or in the total post anesthesia recovery unit recovery scores.
Adolescent↗
Outcome assessment in education programs.
This article describes the move toward outcome assessment as a tool to measure student achievement and overall program effectiveness. Methods are presented by which on-site accreditation reviewers can determine if nurse anesthesia faculty perform effective assessments and utilize the results of their findings to plan for improvement. Emphasis is placed on methods by which data from multiple sources are collected and analyzed by the faculty to enhance student learning.
Accreditation↗
Trends in higher education: preparing nurse anesthesia education for the future.
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Economics↗