The Training and Performance of Emergency Physicians as Anesthetists for International Medical Surgical Response Teams: The Emergency Physician’s General Anesthesia Syllabus (EP GAS)

Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.

A survey of moral distress in certified registered nurse anesthetists:A theoretical perspective for change in ethics education for advance practice nurses

Objective:The aim of this study was to examine the relationship between moral distress that may affect patient safety,and the clinical practice model,assessing ethical decision-making skills of certified registered nurse anesthetists(CRNAs).Methods:A survey using the Ethical Stress Scale(ESS)and the Ethical Assessment Skills Survey(EASS)was conducted with 134 CRNAs.Results:Results indicated no significant effect of practice model on level of moral distress or perceived ethical assessment skill knowledge[Wilks's lambda=0.952,F(6,256)=1.068,P=0.382,n^(2)=0.02].A statistically significant positive correlation existed between importance and skill(r=0.275,P=0.001).CRNAs felt skilled to manage the actions or activities they deemed important.Conclusion:CRNAs who perceived a higher skill level in addressing ethical issues experienced lower levels of moral distress.Findings indicate content-specific curricula for the CRNAs need to be evaluated for ethical decision-making skill assessment content.

Obstetric Anesthesia Practice Significantly Evolved: A Field for Cesarean Delivery Parturient for the Provision of Safe Anesthesia in Urgent Circumstances

General anesthesia and Obstetric Anesthesia is the gold standard for a cesarean section but there are some cases where general anesthesia is unavoidable. The use of general anesthesia for cesarean delivery has decreased in recent years due to the widespread use of neuraxial techniques. The choice of anesthesia techniques for cesarean delivery depends on several factors, including the patient’s psychology and the attending physician’s experience. It is chosen because of its safety profile and its benefits to the mother and fetus. It may be indicated due to emergency, maternal refusal of regional techniques, or regional contraindications. Major complications include failed intubation, gastric content aspiration, and increased bleeding risk. This study aims to evaluate the impact of a newly launched team on obstetric anesthesia practice.

The development and evaluation of a nurse anaesthesia model for practice in South Africa

Objective This article aimed to present a developed model for nurse anaesthesia practice in South Africa and then to evaluate the model by national and international anaesthetist experts.Methods For the model development,a theory-generative research design was used as guided by Chinn&Kramer.The study included four steps to develop and evaluate the model:step one,concept analysis;step two,placing the concepts into relationships;step three,description and critical reflection of the model;step four,evaluation of the model.For evaluation of the model,data were collected using individual,in-depth interviews.Four South African medical specialist anaesthesiologists and four international nurse anaesthetists were interviewed.Transcribed interviews were analyzed using Tesch’s eight steps of thematic data analysis.Results The model was described in four phases:relationship phase,working phase,termination phase,and independent phase.The model shows a development process of a student nurse anaesthetist by a nurse anaesthetist facilitator to the mastery of the scope of practice of a nurse anaesthetist.Two themes(six categories)emerged through thematic analysis:the model and guidelines for implementation were found to be appropriate(model and guidelines for implementation are important because of the need for nurse anaesthetist,the model is applicable because it is described as comprehensive,the relationship phase was found to be important and the interdependence between disciplines is imperative,the affirmation that mastery has to be attained by nurse anaesthetists due to the complexity of services rendered),anticipated limitations to the South African nurse anaesthetist(the need to identify complex patients and limitations on the setting and refer to higher level of care,limitations due to red tape).Conclusions This model provides fertile soil to inform and outline the education(curriculum)and practice(scope of practice)and research for nurse anaesthesia practice in South Africa.