Ketamine is a multimodal dissociative anesthetic, which provides powerful analgesia for victims with traumatic injury. However, the impact of ketamine administration in the peri-trauma period on the development of post-traumatic stress disorder (PTSD) remains controversial. Moreover, there is a major gap between preclinical and clinical studies because they utilize different doses and routes of ketamine administration. Here, we investigated the effects of sub-anesthetic doses of intravenous (IV) ketamine infusion on fear memory and brain glucose metabolism (BGluM) in rats. Male Sprague-Dawley rats received an IV ketamine infusion (0, 2, 10, and 20 mg/kg, 2 h) or an intraperitoneal (IP) injection (0 and 10 mg/kg) following an auditory fear conditioning (3 pairings of tone and foot shock [0.6 mA, 1 s]) on day 0. Fear memory retrieval, fear extinction, and fear recall were tested on days 2, 3, and 4, respectively. The effects of IV ketamine infusion (0 and 10 mg/kg) on BGluM were measured using 18F-fluoro-deoxyglucose positron emission tomography (FDG-PET) and computed tomography (CT). The IV ketamine infusion dose-dependently enhanced fear memory retrieval, delayed fear extinction, and increased fear recall in rats. The IV ketamine (10 mg/kg) increased BGluM in the hippocampus, amygdala, and hypothalamus, while decreasing it in the cerebellum. On the contrary, a single ketamine injection (10 mg/kg, IP) after fear conditioning facilitated fear memory extinction in rats. The current findings suggest that ketamine may produce differential effects on fear memory depending on the route and duration of ketamine administration.

Screen-based simulation (SBS) using digital technology has been demonstrated to improve the cognitive and psychomotor skills of anesthesia trainees. As a method of education and evaluation, this form of simulation offers multiple advantages related to cost, availability, simplicity, repeatability, and scorability. Online use of SBS with software employing standard cloud-based peer-to-peer platforms allows for instruction at a distance of important anesthesia-related critical thinking skills including crisis management. Despite the fact that there are no studies concerning the application of SBS in anesthesia distance education, this form of instruction has increased as a result of quarantine measures associated with the coronavirus-2 pandemic that have disrupted traditional in-person mannequin-based simulation, and its usage likely will continue through the post-pandemic era for multiple reasons. Several options exist for asynchronous and synchronous teaching of anesthesia skills at a distance with SBS, and there are useful techniques that can assist in achieving these educational goals with this process.

Ideal and effective communication consists of a clear, audible, and focused message from a transmitter that is delivered to an attentive, undistracted receiver, and consists of both verbal and nonverbal types. Communication in the health care setting is highly complex and dynamic, involving multiple settings, participants, and unique challenges. Effective communication in the perioperative environment is a requirement for safe patient care delivery and an important element of teamwork. A message must be accurately delivered in a uniquely high-risk and time-sensitive location, beset with numerous distractions, barriers, and challenges. Surgical checklists and time-out procedures have promoted a standardized, "all-hands" approach to addressing some of the challenges to effective communication in the perioperative environment. Postoperative debriefing sessions have demonstrated effectiveness in improving team functioning in the simulated learning environment and hold promise as another strategy to address these challenges, but require further research and development. Other promising strategies to improve effective perioperative communication are focused on team building activities and minimizing distractions at critical time points within patient care delivery, but to date are not substantiated by evidence. Future research is necessary to examine these novel approaches to improving communication in the perioperative environment to influence the safety of patient care delivery in this highly challenging health care setting. Wise men speak because they have something to say; Fools because they have to say something. Plato.

Background: Despite its widespread use in anesthesia residency training, mock oral board examinations (MOBEs) are not included in the pedagogy of most nurse anesthesia programs (NAPs). A small-scale study was conducted to assess the use of MOBEs in this setting. Method: The investigational cohort consisted of 10 second-year students in a master's program in nurse anesthesia. MOBEs were scored according to a common rubric, and final scores were reconciled by raters. Responses from pretest and posttest questionnaires, as well as scoring data, were analyzed. Results: MOBEs were administered in a problem-free manner to nurse anesthesia students and was perceived by these students as a valuable addition to their curriculum. There was pass–fail agreement among the raters related to clinical analysis, fund of knowledge, and communication skills, and the scoring was characterized by elements of internal consistency. Conclusion: MOBEs are feasible in an NAP, and well accepted by students. MOBEs have significant evaluative potential in this setting. [ J Nurs Educ . 2021;60(4):229–234.]

Purpose The aim of the present study was to evaluate the feasibility, acceptability, and utility of synchronous online screen-based simulation (SBS) in anesthesia education. Methods The investigational cohort consisted of 12 second-year nurse anesthesia students enrolled in a Doctor of Nursing Practice (DNP) program. Pairs of students worked with a single instructor online using the same SBS employing a cloud-based peer-to-peer platform and high-fidelity software involving a graphical avatar. During each session, the instructor initially manipulated the avatar through the software scenario with educational pauses to communicate learning content. Thereafter, students proceeded through the same SBS by stating their desired actions, which were then implemented by the instructor. At the conclusion of each session, students were evaluated by an integrated software scoring system, and thereafter they completed a questionnaire rating their distance SBS experience. Results Synchronous online SBS was performed in this manner without difficulty; it was accepted by students as a valuable adjunct to their in-person mannequin-based simulation (MBS) training; and it was perceived as a useful addition to their anesthesia education. Students identified significant value in the isolation of the cognitive component of learning by this teaching methodology. Lack of haptic learning, however, also was seen as a disadvantage of SBS compared to MBS. Students’ criticisms of SBS were largely unrelated to use of this technique with synchronous online education, but rather related to general limitations associated with SBS technology. There was a positive correlation between the students’ mean post-SBS rating and the automated SBS score (r = 0.832). Conclusion Synchronous online SBS can effectively supplement MBS in an anesthesia training program. Its major perceived advantage appears to be an ability to isolate and reinforce appropriate cognitive skills related to intraoperative care including crisis management. Students who had higher mean post-SBS ratings also had higher automated SBS scores.

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Anesthesiologists do not participate regularly in the preclinical portion of nurse anesthesia training programs (NAPs). This practice is predicated on a historical separation of the early educational tracks of physicians and advanced practice nurses whose professions ultimately came to occupy overlapping niches within the field of anesthesia. The state of affairs has been bolstered by territorial friction between professional organizations, and by the lack of a perceived need for anesthesiologists to become involved at an early stage of nurse anesthesia education given the large number of qualified certified registered nurse anesthesia instructors available to perform this role. Anesthesiologists, however, have significant pedagogical assets to offer NAPs, including expertise in critical analysis and decision-making skills related to perioperative adverse events. In addition, introduction of anesthesiologists into preclinical NAP education has the potential to inject added academic rigor into NAPs currently transitioning to Doctor of Nursing Practice programs. Likewise, NAPs offer a professional haven for those anesthesiologists seeking new challenges in education, and a unique opportunity to shape the future of anesthesia. Most importantly, introducing anesthesiologists into the initial educational phases of the nurse anesthesia profession provides an opportunity to grow trust and understanding between these two professions that are critical for safe, healthy, and lasting partnerships in future years.