Addressing Barriers to Implementing Problem-Based Learning.

Problem-based learning (PBL) allows students to address knowledge deficits by providing them with a clinical case so that they explore all aspects of patient care. The advantages of PBL for students include improving critical thinking skills, increased clinical reasoning, and exposure to self-directed learning. Although PBL is commonly used in medical education, it seems to be seldom used in nurse anesthesia education. An evidence-based review was conducted to identify barriers to implementing PBL and methods to address these barriers. Common barriers to PBL implementation were categorized as faculty resistance, student concerns, and resource limitations. Interventions to help address these barriers were presented to aid nurse anesthesia educators in incorporating PBL into the curriculum.

Dexmedetomidine Dosing to Prevent Pediatric Emergence Delirium.

Because of the high incidence and untoward effects of emergence delirium in the pediatric population, investigating pharmacologic measures for preventing this phenomenon is important to the anesthesia provider. Dexmedetomidine, a highly selective α2 agonist, has been shown to prevent emergence delirium in the perioperative setting; however, recommendations for best practice regarding use of this medication are not widely available. Barriers to the use of dexmedetomidine may include side effects such as bradycardia and delayed emergence, as well as limited evidence for the best practice of timing, method, and dosing of dexmedetomidine. This review of the evidence included 2,142 study participants ranging in age from 1 to 15 years. The findings suggest that administering an intravenous bolus dose of 0.5 µg/kg of body weight in the intraoperative phase demonstrated a significant reduction in the incidence of emergence delirium with minimal side effects. Administration of dexmedetomidine immediately following induction of anesthesia revealed benefit in these patients without a delay in emergence from anesthesia. Along with the benefit of preventing emergence delirium in pediatric patients, the evidence also suggests that dexmedetomidine may lower volatile-agent and analgesic requirements.