A cross-sectional study of preoperative airway assessments by certified nurse anesthetists: What do CRNAs think, read, and do?

摘要

The study was to determine what Certified Nurse Anesthetists (CRNAs) think, do, and read concerning preoperative airway assessments. The airway variables studied were those provided by the 2003 ASA Airway Assessment Guidelines plus sleep apnea because of the difficulties associated with intubations and ventilation. The participants for this study were selected using a randomized sampling method from 1,000 mailing labels obtained from the AANA. Four hundred thirty-two (N = 432) CRNAs elected to participate in the study.; Cross-sectional design methods were employed in this descriptive study. The data derived were analyzed with measures of central tendencies, descriptive and inferential statistics, independent t-tests and r regression. In addition, a focus group was conducted with five CRNAs from the Jefferson Health System, Philadelphia, PA. A content analysis were carried out on the data obtained from the focus group. Data were tallied and categorized; trends, similarities, and differences were noted across CRNA responses.; CRNAs rated the airway variables of head and neck mobility, Mallampati classification, thyromental distance, and thickness of neck as most frequently assessed and assigned the highest ranking. Variables that were ranked the lowest and assessed less frequently were jaw protrusion, interincisor gap, shape of palate, and sleep apnea. When assessing the knowledge score of CRNAs in relation to the ASA's airway assessment guidelines, the mean score was 57% (SD 17). CRNAs reported a mean of 3.6 credits during a recertification period related to airway variables and indicated "No" to mandated credits by the Council on Recertification. CRNAs indicated similar use of experience, research-based information and heuristics for airway decisions making. A majority of CRNAs never use the Internet for airway variable information, and prefer conferences and seminars to accrue continuing education credits.; There were a few significant statistics, but upon further investigation, their effect size was very small. CRNAs airway assessments were then conceptualized to theories related to tacit knowledge, habits of action, forward reasoning, situation awareness, and rapid unconscious decision making.; The content analysis of the CRNA focus group revealed similar and supported interesting findings as the CRNA questionnaire.