A Qualitative Description of CRNA Clinical Coordinators' and Student Registered Nurse Anesthetists' Perceptions of Clinical Readiness.

The transition from classroom academic environment to clinical patient-focused learning is a celebrated milestone, yet it is a source of stress and anxiety for student registered nurse anesthetists (SRNAs). In nurse anesthesia education, limited information exists on perceptions of clinical readiness, either from the certified registered nurse anesthetist (CRNA) clinical educators' or the SRNAs' experiences. The purpose of this study was to explore the perceptions of CRNA clinical coordinators and SRNAs regarding clinical readiness as the students transition from classroom to clinical training. A qualitative descriptive design from a postpositivist philosophical mindset was utilized and a semistructured interview guide and content analysis methodology described by Graneheim and Lundman was used. Seventeen participants were interviewed. Four themes emerged from the analysis of the CRNA clinical coordinators' perceptions: 1) going in with good attitudes and professionalism, 2) the expectation of clinical readiness, 3) mental preparedness, and 4) solid simulation experiences. Additionally, four themes emerged from the content analysis of students' perception: 1) expectations of readiness is higher than anticipated, 2) transitional orientation/adjuncts for preparedness, 3) sound didactic training, and 4) simulation and the effects of COVID-19. While prioritization is different, educators and SRNAs value knowledge, skills (including simulated), and positive attitudes as measures of clinical readiness.

Combined Forced Air Warming and Warm Intravenous Fluid Strategy for Perioperative Hypothermia in Cesarean Delivery: A Systematic Review and Meta-Analysis.

PURPOSE: Evaluate the effect of a combined forced-air warming (FAW) and warm intravenous fluid (IVF) modality on maternal and neonatal outcomes in cesarean delivery under neuraxial anesthesia. DESIGN: Systematic Review and Meta-analysis. METHODS: An extensive search was conducted using PubMed, Cochrane Library, MEDLINE, CINAHL, Google Scholar, and other grey literature. Only randomized controlled trials examining the combined modality on maternal temperatures were included. Risk ratio (RR), mean difference (MD), and standardized mean difference (SMD) were used to estimate outcomes with suitable effect models. Quality of evidence was assessed using the Risk of Bias and GRADE system. FINDINGS: Nine trials involving 595 patients were included. Combined strategy showed a smaller change in maternal temperature from baseline by 0.42°C (MD, -0.42; 95% CI, -0.62 to -0.22; P < .0001), higher temperature on PACU arrival (MD, 0.46; 95% CI, 0.11-0.82; P = .01), 15 minutes (MD, 0.43; 95% CI, 0.19-0.67; P = .0004) and 30 minutes after surgery (MD, 0.38; 95% CI, 0.12-0.64; P = .005). Combined strategy also reduced the incidence of hypothermia (RR, 0.55; 95% CI, 0.31-0.95; P = .03), and shivering (RR, 0.40; 95% CI, 0.28-0.58; P < .00001) with improvement in maternal comfort score (SMD; 0.38; 95% CI, 0.08-0.69; P = .01). However, there were no differences in clinical indicators of adverse neonatal outcomes. Lack of participants blinding, and substantial heterogeneity were limitations of this review. CONCLUSION: The use of combined FAW and warm IVF is an effective strategy in mitigating perioperative hypothermia in cesarean delivery under neuraxial anesthesia.

Supplemental Oxygen and Surgical Site Infection in Colorectal Surgery: A Systematic Review and Meta-analysis.

Surgical site infection (SSI) is a common preventable iatrogenic infection following surgery with an approximated overall occurrence of 2-4%. Despite numerous studies, controversies still exist regarding the efficacy, safety, and cost effectiveness of strategies to decrease SSI. The World Health Organization issued recommendations for the prevention of SSIs including oxygenation with 80% fraction of inspired oxygen (FiO2). The primary outcome of our systematic review and metaanalysis was the effect of high inspired FiO2 related to SSI in the colorectal surgery population. Secondary outcomes included incidence of anastomotic leaks and length of hospital stay. Eleven trials consisting of 8245 were included in the analysis. We found moderate quality of evidence that 80% FiO2 was not effective in reducing SSI (RR, 0.91; 95% CI, 0.74 to 1.13; P = .41) anastomotic leaks (RR, 0.75; 95% CI, 0.53 to 1.06; P = 0.10). Conversely, we found low quality evidence of no effect on length of stay measured in days (MD, 0.39; 95% CI -0.59 to 1.36; P = 0.44). Although additional studies are required to decrease heterogeneity of the studies, the current review showed high FiO2 does not decrease the incidence of SSI in the colorectal surgery population.

Ureteroscopy for Urinary Calculi with or Without Ureteral Stents.

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.

The Use of Coffee to Decrease the Incidence of Postoperative Ileus: A Systematic Review and Meta-Analysis.

PURPOSE: To investigate the efficacy of providing coffee to elective abdominal surgery patients, immediately postoperatively, to lessen postoperative ileus. DESIGN: A systematic review with meta-analysis of six randomized controlled trials published since 2012. METHODS: Methodological quality was evaluated using the Cochrane guidelines. The Grading of Recommendations, Assessment, Development, and Evaluations assessment tool evaluated the quality of the evidence. Subgroup analyses were completed if the I2 statistic demonstrated heterogeneity (greater than 50%). FINDINGS: Coffee was statistically significant in shortening the time between surgery and the first passage of stool (mean difference, -9.38; 95% confidence interval, -17.60 to -1.16; P = .03). Although not statistically significant (P = .20), the overall effect favored shorter hospital stays for those patients receiving coffee. CONCLUSIONS: The current systematic review and meta-analysis suggests that coffee given as early as 2 hours postoperatively decreases time to first bowel movement. In addition, patients tolerated solid food faster and were discharged sooner when given coffee immediately postoperatively.

Perioperative Management of the Direct-Acting Oral Anticoagulants.

Since the 1950s, warfarin has been the most commonly prescribed anticoagulant in the prevention of stroke-related thromboembolism. Beginning in 2008, direct-acting oral anticoagulants (DOACs) began to replace warfarin. Although the DOACs had a greater safety profile, approved reversal agentsfor use in emergent/excessive hemorrhage did not exist. This course reviews the perioperative management of the DOACs.

Opioid-Sparing Effects of Transversus Abdominis Plane Block in Elective Hysterectomy: A Systematic Review and Meta-Analysis.

Posthysterectomy pain is caused by abdominal incision and traumatic manipulation of the intra-abdominal structures. Optimal pain management consists of a multimodal pain regimen combined with transversus abdominis plane (TAP) block. We searched PubMed, EMBASE, and Cochrane Database for randomized controlled trials evaluating the opioid-sparing effects of TAP block in patients undergoing hysterectomy. The primary outcome was morphine consumption in the perioperative phase extending to 48 hours after surgery. The secondary outcomes were pain scores at rest and during coughing, time of first postoperative analgesia, and incidence of postoperative nausea and vomiting (PONV) and sedation. Twenty-three trials were selected consisting of 1,554 patients. Morphine consumption showed a reduction of 3.6 mg intraoperatively (mean difference [MD], -3.57; 95% CI, -6.88 to -0.25); 2.9 mg in the recovery room (MD, -2.86; 95% CI, -5.55 to -0.15); 3.4 mg at 24 hours (MD, -3.43; 95% CI, -6.77 to -0.09), and 29 mg at 48 hours (MD, -28.68; 95% CI, -44.35 to -13.01) after surgery in favor of TAP block. Pain scores were lower at rest, and the incidence of PONV and sedation were reduced. Although opioid-sparing effects of TAP block were significant perioperatively, its clinical application is debatable because of substantial heterogeneity across studies.

Effects of Ondansetron on Attenuating Spinal Anesthesia­Induced Hypotension and Bradycardia in Obstetric and Nonobstetric Subjects: A Systematic Review and Meta-Analysis.

Hypotension and bradycardia are common adverse effects following spinal anesthesia. Ondansetron has been studied in the attenuation of spinal anesthesia­ induced hypotension (SIH) and bradycardia because of its antagonistic effect on the Bezold-Jarisch reflex. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to determine the efficacy of intravenous (IV) ondansetron in reducing the incidence of SIH and bradycardia. Thirteen RCTs were included in this analysis, totaling 1,225 subjects. Hypotension and bradycardia were summarized using a risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was summarized using randomeffects model for I(2) greater than 50%; otherwise, a fixed-effects model was performed. Intravenous ondansetron reduced the incidence of hypotension in both the all-procedure analysis group (RR, 0.64; CI, 0.45-0.90) and cesarean delivery group (RR, 0.63; CI, 0.45-0.88). For bradycardia, IV ondansetron resulted in reduced risk (RR, 0.31; CI, 0.19-0.50). Findings of our meta-analysis suggest that IV ondansetron may mitigate the risks of SIH and bradycardia following spinal anesthesia.