Nurse anesthetist training Center on IFNA standards in Mainland China.

AIM: The first training center for nurse anesthetists in Jiangsu Province, China was established. The aim of this study is to understand the status of and effectiveness of a training program based on International Federation of Nurse Anesthetists (IFNA) standards for nurse anesthetists in China. BACKGROUND: China recently issued a clear policy to improve the quality of anesthesia care and to ensure the safety and comfort of patients. As a result, the roles of nurse anesthetists have received more attention, highlighting the importance of the development and implementation of relevant training. INTRODUCTION: IFNA standards were applied to the development of a specialized training program for nurse anesthetists, which is expected to serve as a reference for various medical institutions and to lead to increased uniformity and improvement in the quality and efficiency of care. METHODS: These standards are divided into two indicators: curriculum and core competencies. Through questionnaires, course evaluations, and satisfaction surveys before and after the implementation of the training program, the effectiveness of the training program was analyzed. RESULTS: Theoretical assessment of the program was higher after its completion than before and the core competencies of nurse anesthetists significantly improved. Overall, the curriculum was highly satisfactory and important. DISCUSSION: Curriculum design was based on IFNA standards. Nurse anesthetists who are trained in a systematic way can work better with other professionals in providing anesthesia care. The objectives are to improve anesthesia care, reduce errors, improve physician satisfaction, and allow nurse anesthetists to realize their value. Overall, quality of anesthesia care improved after implementation of IFNA-standard training.

Postoperative reintubation after planned extubation: a review of 137,866 general anesthetics from 2005 to 2007 in a Medical Center of Taiwan.

BACKGROUND: regarding general anesthesia, postoperative reintubation after planned extubation (RAP) is needed when circumstances compel us to do so, irrespective of prolongation of hospital stay and increase of medical expenditure. We describe here our implementation of a case-controlled model to identify the risk factors of RAP. METHODS: patients who saw RAP in the space from January 1, 2005 to December 31, 2007 were retrospectively sorted out from the Quality Assurance (QA) database of the Department of Anesthesiology. We compared RAP cases with the control group and analyzed the factors using descriptive statistics and logistic regression. Reintubation was defined as intubation after the extubation for the initial endotracheal intubation, for general anesthesia, at the time period before departure from the post-anesthesia care unit. RESULTS: of the 137,866 patients who underwent endotracheal intubation for general anesthesia, 83 (0.06%) sustained RAP. The control group included 249 patients randomly selected for endotracheal intubation without RAP. Twenty-two variables, including demographic, operative and anesthetic data, were analyzed. We found that patients with preoperative COPD (odds ratio: 7.17, 95% CI: 1.98-26.00), pneumonia (odds ratio: 7.94, 95% CI: 1.93-32.78), ascites (odds ratio: 13.76, 95% CI: 1.08-174.74) and systemic inflammatory response syndrome (SIRS) (odds ratio: 11.90, 95% CI: 2.63-53.86) were more likely to be subjected to RAP. Airway surgery and head-neck surgery also predisposed patients to reintubation. However, administration of both an extra dose of opioid and neuromuscular blocker at the end of surgery proved irrelevant to RAP. CONCLUSIONS: risk factors for RAP are clear and unambiguous. This study will prompt further studies on preventative measures or evaluation of how to improve outcome.