Thematic Analysis of Obstetric Anesthesia Cases From the AANA Foundation Closed Claims Database.

Maternal morbidity and mortality in the United States continues to be high. Understanding parturient complications and causes of death is critical to determine corrective actions. Analysis of closed malpractice claims evaluates patient care, identifies preventable morbidity and mortality, and offers recommendations for improvement. A review of obstetric anesthesia malpractice claims filed against nurse anesthetists (N = 21), extracted from the American Association of Nurse Anesthetists Foundation Closed Claims database, was completed. The malpractice claims included 18 maternal claims and 3 neonatal claims. The most common adverse maternal outcomes were maternal death (8/18) and nerve injury (4/18). Hemorrhage accounted for the greatest number of maternal deaths (3/8) followed by cardiovascular failure, emboli, and neuraxial opioid overdose. All neonatal claims (3/3) involved hypoxic encephalopathy resulting in 1 neonatal death and 2 cases of neonatal permanent brain injury. The majority of maternal cases were identified as nonemergent (15/18) and involved relatively healthy patients (15 identified as ASA physical status 2). Qualitative analysis of closed claims provides the opportunity to identify patterns of injuries, precipitating events, and interventions to improve care. Themes related to poor outcomes in this study include care delays, failed communication, incomplete documentation, maternal hemorrhage, and lack of provider vigilance.

Shared experiences of CRNAs who were on duty in New Orleans during Hurricane Katrina.

The purpose of this focused ethnography was to describe the shared experiences of certified registered nurse anesthetists (CRNAs) who were on duty in New Orleans, Louisiana, during Hurricane Katrina as well as to elucidate the psychosocial impact the storm had on them. Ten CRNAs participated in 1 of 3 focus groups that were audio recorded. The audio recordings were transcribed and analyzed using qualitative data analysis computer software (NVivo 8, QSR International, Melbourne, Australia). Six major themes emerged from the study: caught off guard; sense of duty; uncertainty/powerlessness/frustration; group identity and cohesiveness; anger; and life-changing event. The themes represented how the CRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the CRNAs resulted mainly in short-term sleep disturbances and increased drinking. Only 2 CRNAs expressed long-term psychosocial effects from the storm. The results of this study should be used to guide policies regarding disaster activation of CRNAs, to educate CRNAs on preparing for disaster duty, and to provide a framework for future disaster studies regarding CRNAs.

Disrupted by disaster: shared experiences of student registered nurse anesthetists affected by hurricane Katrina.

The purpose of this focused ethnography was to describe the shared experiences of student registered nurse anesthetists (SRNAs) whose senior year of education and training was disrupted by Hurricane Katrina, as well as to determine the storm's psychosocial impact on them. A convenience sample of 10 former SRNAs participated in focus groups that were audiorecorded, transcribed, and qualitatively analyzed. Three major themes emerged from the study: Seriousness of Urgency, Managing Uncertainty, and Stability Equaled Relief. The themes represented how the SRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the SRNAs resulted mainly in temporary increased alcohol consumption and short-term anxiety. One person started smoking. The results of this study should serve as a guide to formulate policies regarding the education of SRNAs during and immediately after a disaster and to provide a framework for future disaster studies regarding SRNAs.

Asystole during laryngoscopy of a patient with pleural and pericardial effusions: a case report.

A 53-year-old woman presented to the operating room for surgical correction of pericardial and pleural effusions. Her history included stage IV breast cancer, well-controlled hypertension, and diverticulitis. Although her baseline blood pressure, heart rate, and respirations were normal, she was short of breath with diminished breath sounds on the left side of the lungs and required oxygen, 2 L/min via nasal cannula. The nurse anesthesia student, under the direction of the Certified Registered Nurse Anesthetist (CRNA) and anesthesiologist, induced general anesthesia with etomidate, fentanyl, lidocaine, and succinylcholine. During placement of a double-lumen endotracheal tube, the patient became asystolic. The nurse anesthesia student immediately withdrew the laryngoscope, and the patient returned to normal sinus rhythm. A second attempt at laryngoscopy produced asystole as well. Again, the laryngoscope was withdrawn, and the patient returned to normal sinus rhythm. After resuming ventilation with 100% oxygen and administering atropine, 0.4 mg, the next intubation was successful, producing no untoward effects. Reintubation at the end of the case with a single lumen endotracheal tube was uneventful. The patient was transported to the intensive care unit and mechanically ventilated overnight. The next morning, she was extubated with no further anesthetic complications.