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Introducción: Las especialidades de posgrado constituyen la formación académica que le proporciona al profesional la actualización, profundización, perfeccionamiento o ampliación de las competencias laborales para el desempeño asistencial que requiere. Objetivo: Explorar la percepción de los enfermeros certificados para la práctica de la anestesiología sobre la necesidad de la formación de enfermeros especialistas en anestesiología y reanimación. Métodos: Se realizó un estudio cualitativo, de tipo Investigación Convergente Asistencial en el Departamento de Docencia e Investigación del Hospital Provincial Pediátrico Universitario de Villa Clara, Cuba, entre los meses de enero y marzo del año 2022. El universo estuvo compuesto por 100 profesionales de enfermería certificados en anestesiología, y la muestra seleccionada a través de un muestreo teórico quedó constituida por 80. Se realizaron entrevistas informales y ocho grupos de discusión en el proceso investigativo. Resultados: Los participantes perciben como necesaria la formación de enfermeros especialistas en anestesiología, reanimación y alivio del dolor. Las estrategias para lograr esta formación deben estar dirigidas a su aprobación por parte de las instancias de posgrado del Ministerio de Salud Pública y el Ministerio de Educación Superior. Conclusiones: Perciben como perentorio la formación de enfermeros especialistas en anestesiología y reanimación, ya que permitirá garantizar la adecuada renovación de este recurso humano, contar con enfermeras capacitadas y capaces de brindar atención anestesiológica óptima, alcanzar un nivel profesional superior que los coloque paralelos a otras áreas del cuidado y formar recursos humanos más jóvenes que tengan un nivel de preparación superior en esta especialidad.

Introduction: Postgraduate specialties constitute the academic training that provides the professional with the updating, deepening, improvement or expansion of labor competencies for the care performance that is required. Objective: to explore the perception of certified nurses for the practice of anesthesiology on the need to train specialist nurses in anesthesiology and resuscitation. Methods: A qualitative study of the Convergent Care Research type was carried out in the Teaching and Research Department of The Provincial Pediatric University Hospital of Villa Clara, Cuba between the months of January and March of the year 2022. The universe was composed of 100 nursing professionals. certificates in anesthesiology and the sample selected through a proven theory was made up of 80. Informal interviews and discussion groups were conducted as instruments in the investigative process. Results: the participants will perceive as necessary the training of specialist nurses in anesthesiology, resuscitation and pain relief. The strategies to achieve this training must be directed to its approval by the postgraduate instances of the Ministry of Public Health and the Ministry of Higher Education. Conclusions: the training of nurses specialized in anesthesiology and resuscitation is imperative, as it will guarantee the adequate renewal of this human resource, have trained nurses capable of providing optimal anesthesiological care, reach a higher professional level than place them parallel to other areas. of care and train younger human resources that have a higher level of preparation in this specialty.

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PURPOSE: This study aimed to evaluate the implementation of nursing actions in anesthesia guided by the Patient Safety Checklist: Nursing Anesthetic Procedure and the difficulties in performing patient care. DESIGN: A cross-sectional study. METHODS: Nursing actions were evaluated in 282 anesthetic procedures of adult patients undergoing general anesthesia in three periods of anesthesia in a private hospital operating room in Brazil, from January to July 2018. The evaluated outcomes were the number of items performed by nurses during anesthesia periods and limitations for applying the Patient Safety Checklist: Nursing Anesthetic Procedure instrument. FINDINGS: Execution of the nursing actions presented a mean percentage of 85.6, highlighting the anesthetic induction stage and differences between the periods before induction and reversal. The main items not performed in evaluating the nursing care in anesthesia were as follows: the anesthesia equipment test (84; 29.78%) in the preinduction period; the evaluation of adequate ventilation (132; 46.81%) in the induction period; and the tracheal aspiration assistance (62; 21.98%) during reversal. Receiving a call from another room with care interruption was highlighted among the nurses' justifications for not performing the activities and difficulty in continuing care because of shift change. CONCLUSIONS: The execution of nursing care actions in anesthesia mainly occurred during the period related to induction, with limitations because of dimensioning of operating rooms and simultaneous procedures.

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BACKGROUND: There is a significant geographic variation in anesthesia provider supply. Lower supply in rural communities raises concerns about access to procedures that require anesthesia in rural areas. State policies related to certified registered nurse anesthetist (CRNA) practice may help to alleviate rural supply concerns. OBJECTIVES: To estimate the association between state CRNA policy and anesthesia provider supply especially in rural communities. RESEARCH DESIGN: Repeated cross-sectional design using ordinary least squares and 2-stage least squares regressions. SUBJECTS: All counties in the United States from 2010 to 2015. MEASURES: Dependent variables include anesthesia provider counts per 100,000 people, calculated separately for anesthesiologists, CRNAs, and their sum. Key variables of interest include state-level CRNA policy based on scope of practice (SOP) regulations and Medicare opt-out status. RESULTS: Opt-out status and less restrictive SOP regulations were consistently correlated with a greater supply of CRNAs, especially in rural counties. Furthermore, we found that anesthesiologists and CRNAs tend to be complements to each other, but less restrictive SOP and opt-out status tend to weaken the importance of this relationship. CONCLUSIONS: State regulations may lead to increased supply of CRNAs in rural communities. However, the design of our study makes causality difficult to assert. So, it is also possible that states set CRNA policy as a response to counts of anesthesia providers in rural areas. Furthermore, given supply of anesthesiologists and CRNAs are complementary to one another, improving access to anesthesia services may require addressing issues pertaining to the supply of all anesthesia provider types.

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BACKGROUND: Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions. METHODS: Following the 2010 earthquake in Haiti, an emergency physician was trained using the Emergency Physician's General Anesthesia Syllabus (EP GAS) to perform duties similar to those of certified registered nurse anesthetists. The emergency physician then provided anesthesia during surgical mission trips with an orthopaedic team from February 2011 to March 2017, in Milot, Haiti. This is a descriptive overview of this training program and prospectively collected data on the cohort of patients whom the surgical mission teams treated in Haiti during that time frame. RESULTS: A single emergency physician anesthetist provided anesthesia for 71 of the 172 orthopaedic surgical cases, nearly doubling the number of cases that could be performed. This also allowed the anesthesiologists to focus on pediatric and more difficult cases. Both immediately after the surgical procedure and at 1 year, there were no serious adverse events for cases in which the emergency physician provided anesthesia. CONCLUSIONS: Given emergency physicians' baseline training in airway management and sedation, well-supervised and focused extra training under the vigilant supervision of a board-certified anesthesiologist may allow emergency physicians to be able to safely administer anesthesia. Using emergency physicians as anesthetists in this closely supervised setting could increase the number of surgical cases that can be performed in a disaster setting.

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This study described the incidence and severity of obstructive sleep apnea (OSA) and determined the sensitivity and specificity of the STOP-BANG Questionnaire in patients undergoing total joint arthroplasty (TJA) at a military academic medical center. All subjects completed the questionnaire and an unattended sleep study preoperatively. Incidence and severity of OSA (apnea-hypopnea index [AHI] ≥ 5) was calculated. Sensitivity and specificity for STOP-BANG cut scores greater than or equal to 3 and 5 for AHI of 5, 15, and 30 or more were determined. The rate of OSA was 51.2% (42/82), moderate to severe OSA was 29.3% (n = 29), and severe OSA was 7.3% (n = 6). Sensitivity and specificity for a STOP-BANG score of 3 or greater were 85.7% and 43.6% for OSA, 91.7% and 36.8% for moderate OSA, and 100% and 30.7% for severe OSA. A STOPBANG score of 5 or greater increased specificity for mild, moderate, and severe OSA to 84.6%, and 78.9%, and 72%. Patients undergoing TJA have a high rate of undiagnosed OSA. It is recommended to screen these patients using the STOP-BANG, implement OSA risk reduction strategies, and refer patients postoperatively for a sleep study if their STOP-BANG score is at least 3.

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INTRODUCTION: Management of critical events requires teams to employ nontechnical skills (NTS), such as teamwork, communication, decision making, and vigilance. We sought to estimate the reliability and provide evidence for the validity of the ratings gathered using a new tool for assessing the NTS of anesthesia providers, the behaviorally anchored rating scale (BARS), and compare its scores with those of an established NTS tool, the Anaesthetists' Nontechnical Skills (ANTS) scale. METHODS: Six previously trained raters (4 novices and 2 experts) reviewed and scored 18 recorded simulated pediatric crisis management scenarios using a modified ANTS and a BARS tool. Pearson correlation coefficients were calculated separately for the novice and expert raters, by scenario, and overall. RESULTS: The intrarater reliability of the ANTS total score was 0.73 (expert, 0.57; novice, 0.84); for the BARS tool, it was 0.80 (expert, 0.79; novice, 0.81). The average interrater reliability of BARS scores (0.58) was better than ANTS scores (0.37), and the interrater reliabilities of scores from novices (0.69 BARS and 0.52 ANTS) were better than those obtained from experts (0.47 BARS and 0.21 ANTS) for both scoring instruments. The Pearson correlation between the ANTS and BARS total scores was 0.74. CONCLUSIONS: Overall, reliability estimates were better for the BARS scores than the ANTS scores. For both measures, the intrarater and interrater reliability was better for novices compared with domain experts, suggesting that properly trained novices can reliably assess the NTS of anesthesia providers managing a simulated critical event. There was substantial correlation between the 2 scoring instruments, suggesting that the tools measured similar constructs. The BARS tool can be an alternative to the ANTS scale for the formative assessment of NTS of anesthesia providers.

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Because of a critical shortage of anesthesia providers in Belize, the Belize Ministry of Health initiated support for the creation of a nurse anesthesia education program. Developed in collaboration with Health Volunteers Overseas and the University of Belize, the nurse anesthesia education program graduated 10 nurse anesthetists. This article describes the 24-month nurse anesthesia education program's design, implementation, and evaluation. Challenges and opportunities experienced during the program are outlined as lessons learned for planning similar programs.

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ABSTRACT BACKGROUND AND OBJECTIVE: To evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view. METHODS: Eighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack-Lehane classification of the laryngeal view were recorded. RESULTS: The anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p = 0.001). However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively) and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively). The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p = 0.03). There were no significant differences in the Cormack-Lehane view between both groups. CONCLUSION: The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure.

RESUMO JUSTIFICATIVA E OBJETIVO: Avaliar a capacidade de residentes em anestesiologia em comparação com enfermeiros assistentes de enfermagem para identificar a cartilagem cricoide, aplicar a pressão cricoide adequada e produzir uma vista adequada da entrada da laringe. MÉTODOS: Foram convidados 85 participantes, 42 residentes em anestesiologia e 43 enfermeiros assistentes de enfermagem a responder questionários sobre a quantidade correta de força a ser aplicada na cartilagem cricoide. Os participantes deviam identificar a cartilagem cricoide e aplicar a pressão cricoide em modelos de vias aéreas superiores colocados sobre uma balança de pesagem e a pressão era registada. Posteriormente, aplicaram pressão cricoide em pacientes anestesiados reais após a indução de sequência rápida. Os detalhes sobre a aplicação de pressão cricoide e a classificação de Cormack-Lehane da visibilidade da laringe foram registrados. RESULTADOS: Os residentes em anestesiologia foram significativamente melhores do que os enfermeiros assistentes de enfermagem na identificação da cartilagem cricoide (95,2% vs. 55,8%, p = 0,001). No entanto, o conhecimento de ambos os grupos era precário sobre a quantidade de força necessária para aplicar a pressão cricoide (11,9% vs. 9,3%, respectivamente) e a correta aplicação da pressão cricoide (16,7% vs. 20,9%, respectivamente). A técnica de três dedos foi aplicada por 85,7% dos residentes em anestesiologia e 65,1% dos enfermeiros assistentes de enfermagem (p = 0,03). Não houve diferença significativa entre os dois grupos em relação à classificação de Cormack-Lehane para a visão. CONCLUSÃO: Os residentes em anestesiologia foram melhores do que os enfermeiros assistentes de enfermagem para identificar a cartilagem cricoide, mas ambos os grupos apresentaram um conhecimento igualmente precário sobre a aplicação de pressão cricoide.

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BACKGROUND AND OBJECTIVE: To evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view. METHODS: Eighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack-Lehane classification of the laryngeal view were recorded. RESULTS: The anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p=0.001). However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively) and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively). The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p=0.03). There were no significant differences in the Cormack-Lehane view between both groups. CONCLUSION: The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure.

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