AANA Anesthesia E-ssential
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Patient Safety Awareness Week: CRNAs Encourage Patients to Learn about Non-Opioid Pain Relief Options

In honor of Patient Safety Awareness Week (March 12-18, 2017), CRNAs have the opportunity to discuss with their patients non-opioid options for pain relief during surgery and afterwards. Today, appropriate prescribing and use of opioids is more important than ever. Ninety-one people die every day from opioid misuse, according to the Centers for Disease Control and Prevention (CDC).

Patients are encouraged to have open and honest discussions with their families and their healthcare team members, especially their anesthesia providers, to develop an optimal plan to address pain and minimize the need for opioids. CRNAs are uniquely qualified to discuss pain management options with their patients, specifically addressing:
  • Previous experiences with pain medications
  • Current medications or illicit drug use
  • The kind of discomfort patients are experiencing or that is anticipated during and after the procedure
  • The pain management plan and realistic recovery goals
  • Patient lifestyles and how it is or may be affected by postsurgical pain
  • Patient family backgrounds and ethnicities
An initiative of the National Patient Safety Foundation, Patient Safety Awareness Week calls on patients and healthcare providers alike to be “United for Patient Safety.” Working with patients to develop their non-opioid or appropriate pain management solution engages patients in their healthcare for safe and best outcomes.

AANA resources on opioid safety, for patients and providers, can be found at Opioid Crisis Resources.  Visit United for Patient Safety for Patient Safety Awareness Week campaign logos and materials.
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Hot Topics

AANA Joins Nursing Infection Control Education Network (NICE)

The AANA is partnering with the Centers for Disease Control and Prevention (CDC) and the American Nurses Association (ANA) in the Nursing Infection Control Education (NICE) Network. The NICE Network seeks to "empower nurses to protect themselves and their patients" by providing real-time, tailored, infection control training to U.S. nurses. AANA is one of the many nursing organizations participating in the network that will provide infection control education and resources free of charge. To learn more about this initiative, visit the project webpage.
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Non-Deductible Membership Dues

As required by section 6033(e) of the Internal Revenue Code, we are required to inform you that $27 of active national membership dues are allocated towards expenses incurred by AANA for national lobbying activities. Such amount is not deductible for federal income tax purposes. All AANA members are also members of individual state associations. Please be aware that your individual state association is responsible for informing you of what amount, if any, of your state membership dues to allocated to the expenses of lobbying activities at the state or local level. All such lobbying expenditures at the state or local level are not deductible for federal income tax purposes. We encourage you to contact your individual state association if you have any questions in this regard.
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New Physician Compare Website Released

The Physician Compare Website has undergone a significant web design change. The new design has been created to make it easier for consumers to look up provider details based on specialty, practice location, group and hospital affiliation, and performance. As of December 2016, the provider search function includes over 2,500 groups and 175,000 clinicians. At the moment the website now incorporates 90 PQRS measures and 16 non-PQRS QCDR measures from the 2015 reporting year. If you have questions, suggestions, or other feedback for Physician Compare, contact the Physician Compare support team at PhysicianCompare@Westat.com.
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Calling Policy Researchers: New Research Datasets Resource

The myAANA Research website now includes a new webpage on Research Dataset Resources. This valuable resource provides aspiring and seasoned investigators with information on available datasets that can be accessed to conduct different types of healthcare analyses relating to practice and policy domains of nurse anesthesia research. Please note that this webpage only provides a general overview of common datasets and does not represent all of the possible research datasets available.
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Want to Serve on an AANA Committee?

Positions are available on AANA committees for CRNAs and student registered nurse anesthetists. Check out the committee page on the AANA website to read about the various opportunities. Deadline for submission of a committee request is May 15, 2017. Please note: If you currently serve on a fiscal year 2017 committee, you must reapply for fiscal year 2018.
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Consider Nominating a Colleague for an AANA Award

Do you know someone who has spent a lifetime advancing the practice of nurse anesthesia as a practitioner, educator, clinician, or advocate? Do you work with an outstanding program director, didactic instructor, or clinical instructor? Consider nominating your colleague for one of the national AANA recognition awards. Visit www.aana.com/awards for details on the Agatha Hodgins Award for Outstanding Accomplishment, Helen Lamb Outstanding Educator Award, Alice Magaw Outstanding Clinical Practitioner Award, Ira P. Gunn Award for Outstanding Professional Advocacy, Clinical Instructor of the Year Award, Didactic Instructor of the Year Award, and Program director of the Year Award.
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Take a Stand Against Tobacco Use on Kick Butts Day

Kick Butts Day, March 15, 2017, is sponsored by the Campaign for Tobacco-Free Kids. Aimed at America’s youth, Kick Butts Day is a national day of activism against tobacco use. Every day, more than 3,000 kids under 18 try smoking for the first time, and 700 young people become new, regular, daily smokers. Tobacco use is still the leading cause of preventable death in the United States, killing more than 480,000 people every year.

Given the obvious connection between healthy lungs and anesthesia, CRNAs have the opportunity to reach out to their patients and advocate for “kicking butts,” stressing the importance to overall health. For more information, see these Frequently Asked Questions.
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Member Exclusive! Perioperative Delirium: The Latest Science in Anesthesia Management

Expand your knowledge of all aspects of delirium as they apply to the perianesthesia environment. You'll discover the latest in management techniques and the state of the science. Supported by an educational grant from Medtronic.
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Meetings and Workshops

Mid-Year Assembly Early Bird Registration Deadline is March 5

Join your CRNA colleagues in the heart of D.C. during the National Cherry Blossom season for the productive and exciting Mid-Year Assembly. Learn to advance CRNA policy interests on Capitol Hill and develop the skills needed to effectively advocate for your profession. Register before March 5 for early bird rates. It is strongly recommended that you make travel and hotel arrangements early. Discounted hotel rates include April 5-12 dates.
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Registration Open for these Popular Hands-On Workshops

Register now—space is limited for the Essentials of Obstetric Analgesia/Anesthesia and Spinal and Epidural workshops. Visit www.aana.com/meetings for further information and to register!

Essentials of Obstetric Analgesia/Anesthesia Workshop
AANA Foundation Learning Center
May 10, 2017
The Essentials of Obstetric Analgesia/Anesthesia Workshop will address clinical applications of obstetric analgesia/anesthesia. An excellent complement to the Spinal and Epidural Workshop, this workshop includes a lecture format that will cover normal and abnormal physiology of pregnancy, pharmacology, and techniques.

Spinal and Epidural Workshop

AANA Foundation Learning Center
May 11-13, 2017
Refresh your knowledge of clinical applications of spinal and epidural anesthesia procedures at the three-day intensive Spinal and Epidural Workshop. An excellent complement to the Essentials of Obstetric Analgesia/Anesthesia Workshop, this workshop combines expert lecture with a guided hands-on approach to learning.        
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Foundation and Research

Friends for Life Deadline is June 15

Friends for Life support the future of the nurse anesthesia profession through meaningful, lasting gifts that fund and sustain programs in anesthesia research and education.

The minimum gift commitment to join Friends for Life is $25,000. Members may fulfill this commitment through a cash gift, but there are many other ways to meet the commitment through planned gifts. Some of the most popular planned gift options for becoming a Friend for Life include:
  • A gift (bequest) in the will for a specific amount or a percentage of the total estate
  • Gift of personal property or real estate
  • Including the Foundation as a beneficiary on a retirement plan or a whole life insurance policy
Friends for Life receive a medallion at the AANA Annual Congress Opening Ceremonies, an engraved plaque in the AANA Park Ridge office, and an invitation to the Annual Awards and Recognition Event.

For further information, please contact Nat Carmichael at (847) 655-1175 or ncarmichael@aana.com. The Friends for Life submission deadline for recognition at this year’s Annual Congress in Seattle is June 15, 2017.
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AANA Foundation Student Opportunities

The Foundation offers a variety of opportunities for students—read on for more information and application deadlines. Applications are now available for the following:
  • Student Scholarship – Due March 1, 2017
  • Award Nominations – Due March 1, 2017
  • AANA Foundation Student Advocates – Due March 30, 2017
  • Board of Trustees Nominations - Student Member – Due April 1, 2017
  • “State of the Science” Oral Poster Presentation – Due April 1, 2017
  • “State of the Science” General Poster Presentation – Due May 1, 2017
If you have any questions, please contact the AANA Foundation at (847) 655-1170 or foundation@aana.com
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Visit www.crnacareers.com to view or place job postings
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Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Bradford Study Reveals Link Between Obstetric Anaesthesia and Cardiac Arrests in Pregnancy

While cardiac arrest during pregnancy is relatively uncommon in the United Kingdom, the primary reason when it does occur is complication from obstetric anesthesia, researchers report. Led by Virginia Beckett, MD, of Bradford Teaching Hospitals NHS Foundation Trust, the investigators identified just 66 instances of cardiac arrest out of 2.3 million women who delivered between 2011 and 2014. Anesthesia—administered as an epidural, spinal, or combined spinal-epidural—played a prominent role in nearly a quarter of those cases. All 16 patients who went into cardiac arrest following obstetric anesthesia survived, however, as did 58 percent of the general obstetric population who suffered cardiac arrest. Beckett credited timely resuscitation and swift perimortem caesarean section for the favorable survival rate. The study also underscored the importance of maintaining healthy pregnancy weight. Although all of the women who suffered cardiac arrest after anesthesia survived, most also were obese.

From "Bradford Study Reveals Link Between Obstetric Anaesthesia and Cardiac Arrests in Pregnancy"
Telegraph & Argus (02/23/17) Mason, Vivien

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Pain Research Moving at Snail's Pace

The medical community is excited and encouraged by the pain-killing power of a compound found in the deadly venom of the marine cone snail. When researchers from the University of Utah tested lab animals, Rg1A4 cleared from the bodies of rodents injected with the compound in just four hours but its analgesic effects lasted 72 hours—much longer than opioids. The prolonged duration of analgesia raises the prospect that Rg1A4 may have a restorative relationship on some compounds in the nervous system. "Once chronic pain has developed, it is difficult to treat," notes psychiatry professor J. Michael McIntosh, MD, at the University of Utah Health Sciences. "This compound offers a potential new pathway to prevent pain from developing in the first place and offer a new therapy to patients who have run out of options. . We feel that drugs that work by this pathway may reduce burden of opioid use." And unlike narcotic painkillers, German investigators discovered separately, peptides in Rg1A4 decompose rapidly and are not likely to trigger dependency. Scientists worldwide are exploring the potential benefits of cone snail venom, with one drug already on the market to treat severe pain like that from cancer and AIDS.

From "Pain Research Moving at Snail's Pace"
Pain News Network (02/22/17) Anson, Pat

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Phantom Limb Pain Managed Effectively by Transcranial Magnetic Stimulation

New evidence supports the use of repetitive transcranial magnetic stimulation (rTMS) to alleviate phantom limb pain. The trial randomized 54 participants, all of whom lost lower extremities in land mine explosions, to real intervention or sham rTMS for a period of 10 days. The 20-minute treatments were applied once daily over the area corresponding to the motor cortex contralateral to the amputated limb. Among participants who received actual rTMS, 70 percent saw a 30 percent or greater reduction in pain scores; and 63 percent lowered their scores by more than half. By comparison, only 40 percent of those who received sham treatments realized pain relief of 30 percent or more. The benefits of rTMS lasted up to 15 days, with no severe adverse effects, but were no longer clinically meaningful after 30 days. "We still need to identify appropriate stimulation protocols—frequency and number of stimulation sessions—associated with a more long-lasting response," admitted study author Ronald Garcia, MD, of Harvard Medical School and Massachusetts General Hospital. The findings are published in the Journal of Pain.

From "Phantom Limb Pain Managed Effectively by Transcranial Magnetic Stimulation"
Anesthesiology News (02/17/17) Holzman, David C.

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Achieving Ecological Sustainability in Anesthesiology

With anesthesia providers in a strongly supportive role, a movement is underway to advance the healthcare sector toward a state of ecological sustainability. The medical field is one of the biggest perpetrators of environmental pollution, notes Yale School of Medicine assistant anesthesiology professor Jodi Sherman, MD—especially by way of inhaled anesthetics in the operating room (OR). However, she adds, opportunities to reduce the footprint abound; and they are generally simple and painless. Whenever clinically possible, for example, providers should choose regional anesthesia or non-inhaled intravenous options in the OR. In cases where inhaled anesthetics cannot be avoided, she recommends prioritizing sevoflurane or isoflurane over higher-impact desflurane and nitrous oxide and routinely using low fresh gas flows. Other changes include reducing waste, using more reusable devices, and switching to prefilled syringes, according to Sherman, who also co-chairs the American Society of Anesthesiologists Environmental Task Force. The panel assembled a sustainability checklist including these and other measures toward reducing ecological harm from the profession.

From "Achieving Ecological Sustainability in Anesthesiology"
Anesthesiology News (02/16/17)

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Does Standing or Sitting Position of the Anesthesiologist in the Operating Theatre Influence Sevoflurane Exposure During Craniotomies?

While laminar flow air conditioning systems have been shown to reduce anesthetic gas concentrations in the operating room (OR), questions have surfaced about whether occupational exposure varies according to whether the anesthesia provider is standing up or sitting down. Hungarian researchers captured evaporated sevoflurane during 27 craniotomies, collecting the samples with equipment placed at each patient's side—at two different heights, to reflect standing and sitting positions—as well as in a neutral corner of the OR. Captured sevoflurane was greater at the sitting position than at the standing position, but not significantly so; and both levels of anesthetic gas were within acceptable thresholds. Sevoflurane concentrations were significantly lower, the investigators note, in the independent corner of the OR and were highest at the patient's mouth. Other than the fact that it is unavoidable, the investigators acknowledge there is still much to be learned about exposure of the OR team to anesthetic gases. In the meantime, all precautions should be taken to lessen exposure—including considering the type of inhalational anesthetic and airway device used, the positioning of the anesthesia team, and the capacity of the air conditioning system.

From "Does Standing or Sitting Position of the Anesthesiologist in the Operating Theatre Influence Sevoflurane Exposure During Craniotomies?"
Medscape (02/15/17) Sárkány, Péter; Tankó, Béla; Simon, Éva; et al.

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Peripheral Nerve Blockade for Primary Total Knee Arthroplasty

Researchers know that peripheral nerve block (PNB) alleviates pain after total knee arthroplasty, but they are less certain about what effect it has on resource utilization. For insight, Canadian investigators considered all 178,214 adults in Ontario who underwent their first primary knee replacement surgery between 2002 and 2013. After pairing 38,557 patients who received PNB with matched controls, they examined how blocks impacted outcomes. There was a small, but statistically meaningful decrease in postoperative hospital stay as well as a significant decrease in 30-day readmissions with the nerve block, but not a marked decline in falls or visits to the emergency room. The benefits were more concrete for single-shot PNBs but less consistent when continuous catheter techniques were applied, highlighting a need for additional research.

From "Peripheral Nerve Blockade for Primary Total Knee Arthroplasty"
Anesthesiology (02/17) Vol. 126, No. 2, P. 312 McIsaac, Daniel I.; McCartney, Colin J.L.; van Walraven, Carl

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Ultrasound-Guided L5-S1 Placement of Labor Epidurals Does Not Improve Dermatomal Blockade

According to new research, epidural placement in the L5-S1 interspace is no more effective than placement elsewhere in achieving adequate analgesia, blocking dermatomes, or managing pain. The study led by University of Michigan anesthesiology resident Omar Malas, MD, involved 96 adults in the early stages of labor. About half of the women were randomized for L5-S1 epidural placement using ultrasound guidance, while placement in the remaining patients ranged from L2-3 to L3-4. The mean number of dermatomes blocked was comparable between the two sets of patients, who also required interventions to optimize analgesia—such as catheter retraction or replacement and epidural solution changes—at a similar rate. Pain scores 30 minutes post-epidural placement and at delivery also did not vary greatly between the control and L5-S1 groups. Malas reported the results at the 2016 annual meeting of the American Society of Regional Anesthesia and Pain Medicine.

From "Ultrasound-Guided L5-S1 Placement of Labor Epidurals Does Not Improve Dermatomal Blockade"
Anesthesiology News (02/14/17) Doyle, Chase

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A Comparison of the Postoperative Analgesic Efficacy Between Epidural and Intravenous Analgesia in Major Spine Surgery

Researchers surveyed the current pool of evidence in order to measure the efficacy of epidural analgesia (EA) versus intravenous patient-controlled analgesia (IV-PCA) after major spine surgery. The meta-analysis ultimately included 17 randomized controlled trials, which collectively found that EA offered significantly superior analgesia without higher risk of adverse effects. The approach also resulted in greater patient satisfaction and lower overall opioid requirement compared with IV-PCA. The investigators, representing Changzheng Hospital in Shanghai, China, conclude that EA outperforms IV-PCA for pain management after major spine surgery. However, they note additional large-scale, high-quality studies are needed to verify the findings.

From "A Comparison of the Postoperative Analgesic Efficacy Between Epidural and Intravenous Analgesia in Major Spine Surgery"
Journal of Pain Research (02/17) Vol. 2017, No. 10, P. 405

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Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed bimonthly to AANA members.

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

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February 28, 2017
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