Anesthesia E-ssential

AANA Anesthesia E-ssential, June 28, 2018

Vital Signs

Nurse Anesthetists Applaud the House of Representatives' Efforts to Curtail Opioid Crisis

Washington, D.C. – The House of Representatives expanded addiction treatment programs and access to care by enabling Certified Registered Nurse Anesthetists (CRNAs) and other advanced practice registered nurses (APRNs) to administer medication-assisted treatment that will help save thousands of lives across the country.

“The House struck a major blow against the opioid crisis on June 22nd by authorizing CRNAs to administer medication that will assist patients in their recovery and increase access to addiction treatment,” said AANA President Bruce Weiner, DNP, MSNA, CRNA. “This decision will immediately help patients struggling with addiction, especially in rural settings where alternative resources are scarce and addiction is rampant.”

There are more than 52,000 CRNAs who can now treat opioid addictions with medications such as buprenorphine. These medications ease withdrawal symptoms and improve treatment outcomes. Many of these CRNAs are practicing in rural and underserved communities where access to these services is limited – there are either no qualified providers currently working in the area or they’re overwhelmed by the large number of patients, which results in extended wait times.

Section 303 of the SUPPORT for Patients and Communities Act (H.R. 6) was originally introduced by Representatives Paul Tonko and Ben Ray Lujan. Representatives Greg Walden, Frank Pallone, Kevin Brady, and Richard Neal were influential in maintaining Section 303, with help from the House Nursing Caucus, led by Representatives David Joyce, Tulsi Gabbard, Rodney Davis, and Suzanne Bonamici.

“CRNAs have taken a lead role in addressing the current opioid crisis and offering pain management,” said Weiner. “Nurse anesthesia’s support of this bill continues to put the patients first in our efforts to decrease the reliance on opioids by offering interventional pain management that is opioid free or opioid sparing.”
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It’s Time to Renew Your AANA Membership

Thank you for your commitment to your professional association! Your membership helps support the AANA’s mission to advance patient safety, practice excellence, and the profession. Plus, 36 percent of your dues go to support the state associations that protect your ability to practice. There’s strength in numbers. May we continue to count on you?

AANA Federal Government Affairs and CRNA-PAC continue to demonstrate the strength of the CRNA profession in Washington, D.C., despite significant attacks from the ASA. With the support of AANA members, hundreds of members of Congress have sponsored, cosponsored, or supported AANA bills related to ending the opioid crisis, increasing CRNA education funding, ensuring fair and
adequate reimbursement for CRNAs, gaining full practice authority for CRNAs at the VA, and other vitally important issues for the profession.

Every voice counts. If you know a CRNA who is not an AANA member, won’t you reach out to them and tell them how important it is that all CRNAs have a seat at the table? The future of the profession depends on it.

AANA membership also makes it easy to stay ahead of certification requirements. As a member in good standing, you’ll enjoy automatic reporting of recorded CE credits for the year to NBCRNA and 24/7 access to online transcripts. Not only that, AANA members can track Class B credits in real time on AANA Learn®. For more about how to track Class B credits, watch this video.

With your renewal today, we will continue working to protect CRNA practice rights, ensure patient access to high-quality nurse anesthesia care, and provide you with a full year of benefits and services you can rely on. For your convenience, we offer a quarterly payment plan and automatic renewals, so you can set it and forget it. Simply select this option during the online renewal process. If you prefer a print copy of your dues statement, you can expect a letter by the end of July.

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Hot Topics

APSF Trainee Quality Improvement Program

Calling all SRNAs! The Anesthesia Patient Safety Foundation has announced the third annual and expanded APSF Trainee Quality Improvement Program. Students are invited to demonstrate their program’s work in patient safety and QI initiatives. The top two SRNA projects will receive APSF recognition and financial rewards. Don’t wait. The deadline is July 15.
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The Joint Commission Issues Quick Safety Alert on Ways to Identify and Help Human Trafficking Victims

The Joint Commission alert focuses on:
  • Knowing how to identify human trafficking victims.
  • When to involve law enforcement.
  • Community resources to help the individual.
Because the U.S. is one of the largest markets for human trafficking victims, it is likely healthcare professionals will encounter a victim in their healthcare organizations. This resource provides recommendations and resources to healthcare professionals, who are in a unique position to help these vulnerable individuals.
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AANA Communications Committee Recognizes MYA Student Mentoring Program Participants

On April 23, 2018, at the AANA Mid-Year Assembly in Washington, D.C., 51 student registered nurse anesthetists (SRNAs) from around the country spent the day being mentored by practicing CRNAs as part of the Student Mentoring Program, coordinated by the AANA Communications Committee. 

Each year, SRNAs who demonstrate leadership qualities and skills are recommended by their educational program administrators to participate in this popular program. We congratulate the students and their CRNA mentors who made this year’s mentoring program a resounding success.

See a complete list of the mentors and students who participated in the program.
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Soldier Spotlight: Deployed CRNAs

AANA is proud to recognize: Colonel Michelle Beach - Chief Anesthetist, CRNA, Texas; Lieutenant Colonel Catherine Devito, DNP, CRNA, Florida; Lieutenant Colonel Karen Smith, MSN, CRNA, Texas; Lieutenant Colonel Donna Ward, MSN, CRNA, Ohio.

What: Providing anesthesia services for the 75th Combat Support Hospital In Kuwait in support of Operation Enduring Freedom (Spartan Shield).

When: March 2018 - June 2018

The anesthesia department was called on to assist with the transportation of one of our own soldiers, who had recently experienced a closed-head injury on another base located a couple of hours from here. The sight of this young man lying unconscious in the hospital bed, awaiting a transfer to Germany (Landstuhl Regional Medical Center) brought tears.

The detailed assessment of the casualty, three-way effective communication between LTC Smith, the host nation hospital providers and staff, and the CCAT team (the Air National Guard Team receiving the soldier for transport), and the total care of one of our own family members had the adrenaline at 10 all night long. It was a long night, but no one slept till the mission was complete.

"At 06:08 this morning we walked off of their aircraft. It’s just a part of what we do and the reason we find this aspect of our profession so rewarding," said Smith.

From left to right: COL Michelle Beach, LTC Catherine Devito, LTC Karen Smith, LTC Donna Ward.

AANA extends its warmest thanks to our CRNAs in harm's way. We are grateful for all you do.

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NewsMaker: Martha Polizzi Joins International Nurses Association

Martha M. Polizzi, DNP, CRNA, became a member of the International Nurses Association in February, effective with her publication in the Worldwide Leaders in Healthcare.

Polizzi has been a CRNA since 2000, with special expertise in neurosurgical, vascular, general surgery and ENT nursing. 
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Happy Fourth of July!

Due to the July 4th holiday, Anesthesia E-ssential will not be published on July 5, 2018. We will resume publication with the July 12, 2018 issue. The E-ssential staff wishes all of our readers a safe and happy Fourth, and we look forward to bringing you great new stories on July 12, 2018. See you then!
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Meetings and Workshops

AANA 2018 Annual Congress: Tap into the Power of Technology

The 85th AANA Annual Congress will be held September 21 - 25, 2018 at the Hynes Convention Center in Boston, Massachusetts.
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Upper and Lower Extremity Nerve Block Workshop

Expand your knowledge and skills in peripheral nerve blocks with didactic and hands-on training. The workshop is held August 18-19, 2018 in Park Ridge, Illinois.
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Practice Leadership Assembly

Mark your calendar! Business owners as well as practice and facility leaders will gain insight and confidence to lead the way in a rapidly changing healthcare environment. Registration opens in July. Watch for details.

See all upcoming events on the AANA Meetings & Workshops page. 
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Foundation and Research

AANA Foundation: Call for Committee Members, Respond by September 1, 2018

The AANA Foundation is currently looking for committee members to serve on the Research and Scholarship Committees. 

The mission of the AANA Foundation is to advance the science of anesthesia through education and research. You can play an active role in supporting these important aspects of the CRNA profession by participating on an AANA Foundation committee.

The AANA Foundation Research Committees are comprised of CRNAs who are interested in research. Tasks include reviewing applications for research grants, fellowships and poster sessions. The Board of Trustees makes funding decisions based on the recommendations of these committees. Members of the Research Committees also occasionally are called upon to assist on research advisory panels.

The AANA Foundation Scholarship Committee is comprised of CRNAs. The task of this committee is to review student scholarship applications. The Board of Trustees bases funding decisions on the recommendations made by this committee.

Many members of the AANA Foundation Board of Trustees, both past and current, have served on the Research and/or Scholarship Committees. Please consider giving back to your profession by serving on one of these committees.

If you are interested, please submit a statement of interest along with your CV to by September 1, 2018. Any questions, please contact the Foundation at (847) 655-1170.
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AANA Foundation: Call for Silent Auction Items

The AANA Foundation is hosting a silent auction at the AANA 2018 Annual Congress in Boston from September 21-25, 2018. CRNAs and SRNAs are talented in many areas in addition to delivering anesthesia. If you are an artist, jewelry maker, woodworker, etc., or if you love to shop, please consider donating an item to the Foundation’s silent auction. Hand-made, one-of-a-kind items are a wonderful addition to accompany other high-end items such as designer purses/bags and jewelry.

A few of the Foundation’s generous auction item donors include ceramic artist, Minori Thorpe, CRNA, who donates beautiful raku and ceramic pieces on a regular basis; and Jack Hitchens, CRNA, APRN, who donates beautifully hand-carved, intricate items such hand-carved birds. Check out a few of these items on our Silent Auction webpage.

Proceeds of the silent auction benefit the AANA Foundation and its mission to advance the science of anesthesia through education and research.

To donate a silent auction item, please contact Luanne Irvin at (847) 655-1173 or Items to be included in the AANA 2018 Annual Congress Silent Auction should arrive at 222 S. Prospect Avenue, Park Ridge, IL 60068 by August 1, 2018. Items received after this date will be included in silent auctions at future AANA meetings. Thank you!
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AANA Foundation: Make Your FY2018 Donation Today for Annual Report Recognition!

Support nurse anesthesia education and research! Make your tax-deductible gift to the AANA Foundation today on the Foundation’s secure donation page! Donations of $100 or more made by July 1, 2018 will be included in the AANA Foundation Fiscal Year 2018 Annual Report and Recognition booklet. Thank you!
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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.

Neuropsychological and Behavioral Outcomes After Exposure of Young Children to Procedures Requiring General Anesthesia

The Mayo Anesthesia Safety in Kids (MASK) study explored the theory that multiple anesthesia exposures in early life contribute to poor neurodevelopmental outcomes. The sample population included nearly 1,000 children born in Minnesota's Olmsted County between 1994 and 2007, who then underwent neurological assessments between the ages of 8 and 12 years old or 15 to 20 years old. In all, 411 of them had not undergone anesthesia at all before turning three years old; 380 had experienced a single exposure by that age; and 206 had been exposed more than once. Between groups, there was no meaningful difference in intelligence quotient standard scores. Secondary outcomes—including processing speed, fine motor skills, and parent reports—suggest that multiple exposures to anesthesia in the first three years of life may be tied to changes in specific neuropsychological domains associated with behavioral and learning problems. The same did not appear to be true with single anesthesia exposure, however, and the researchers concede that the secondary outcomes must be interpreted with caution.

From "Neuropsychological and Behavioral Outcomes After Exposure of Young Children to Procedures Requiring General Anesthesia"
Anesthesiology (Summer 2018) Vol. 129, No. 7, P. 89 Warner, David O.; Zaccariello, Michael J.; Katusic, Slavica K.; et al.

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Increasing BMI Adds to Risk for Hypoxemia in Monitored Anesthesia Care

While medical providers recognize that hypoxemia is a risk for heavy patients under general anesthesia, new evidence now shows that the threat is similarly high under monitored anesthesia care (MAC). Led by Samion Shabashev, MD, a cardiothoracic anesthesiology fellow at NYU Langone Medical Center, researchers examined the records of more than 11,500 patients undergoing MAC for ambulatory endoscopy over the course of one year at six sites. Participants' body mass index (BMI) ranged from 10 kg/m2 to more than 40 kg/m2, and a restricted cubic spline plot was generated to graphically represent the relationship between BMI and hypoxemia. According to the data, the incidence of hypoxemia started to climb at BMI of about 25 kg/m2 before spiking at 30 kg/m2. "Previous studies have shown that you really have a higher chance of developing hypoxemia once you go over 40 kg/m2," Shabashev noted. "But our study in MAC anesthesia demonstrated that the incidence of hypoxemia starts to increase once you start hitting a BMI of 30 [kg/m2]." Moreover, the investigators determined that older age and the addition of any comorbidity translated to a higher probability of hypoxemia. The findings suggest, Shabashev explains, that even obese people who are relatively healthy are at elevated risk for hypoxemia during MAC anesthesia.

From "Increasing BMI Adds to Risk for Hypoxemia in Monitored Anesthesia Care"
Anesthesiology News (06/25/18) Vlessides, Michael

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Researchers Work to Identify Areas of the Brain That Help Us Wake Up

Scientists are looking beyond the brainstem and other parts of the lower brain for new clues on consciousness. By focusing on the upper and back regions, a team led by George Mashour, MD, PhD, uncovered evidence that the prefrontal cortex could be implicated in coordinating level of consciousness. Study lead author Dinesh Pal, PhD, a colleague of Mashour's in the anesthesiology department at University of Michigan Medical School, explains: "We wanted to see what had the causal power to take an unconscious brain receiving ongoing anesthesia and wake it up." The researchers anesthetized the prefrontal and parietal cortex of rats, exposed those areas to drugs that amplified the effect to two neurotransmitters linked to wakefulness—acetylcholine and norepinephrine—and then measured subsequent brain activity and behavior. Brain waves accelerated when exposed to an acetylcholine-receptor activator, although the animals only began exhibiting awake behavior once the prefrontal cortex was stimulated. These activities occurred although the rats were still under surgical levels of anesthesia used in humans. "Let's say you have a patient in a coma: Could the prefrontal cortex be a site that is modulated to help coordinate events to help improve level of consciousness?" Mashour wonders. "It's very difficult and dangerous to directly intervene at the level of arousal centers in the brainstem because of its location, small size and nearby vital functions. Maybe the prefrontal cortex is an accessible gateway to some of those other arousal systems that could be leveraged in a clinical setting outside of anesthesia."

From "Researchers Work to Identify Areas of the Brain That Help Us Wake Up"
News-Medical (06/22/18)

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Doling Out Pain Meds Post-Surgery: An Ingrown Toenail Not the Same as a Bypass

Amid an opioid crisis, the medical community is seeking guidance on the appropriate pain prescription for patients after surgery. With no one right answer across the board, Johns Hopkins researcher and surgeon Marty Makary decided to look at the needs associated with specific operations. "It's mind-boggling to me," he says, "that so many opioid-prescribing guidelines do not specify the procedure. An ingrown toenail is not the same as cardiac bypass surgery." Makary assembled a group of surgeons, nurses, patients, and others late last year to brainstorm, eventually coming up with guidelines for 20 commonplace surgical procedures. Their recommendations include 5–10 opioid tablets following cesarean section, no more than 12 for some knee surgeries, up to 20 for open hysterectomy, and a maximum of 30 for cardiac bypass. For others, like uncomplicated childbirth or cardiac catheterization, Makary and his team say opioids should be avoided altogether. Although the guidelines theoretically could prevent patients from becoming chronic users or developing a dependence, while also keeping unused supply from ending up in the wrong hands, some states are going even further. About a dozen states have taken legal steps to limit the number of days' worth of opioids that can be prescribed for acute pain. Massachusetts allows up to one week of opioids, for example, with New Jersey restricting the supply to no more than five days. Depending on the state, Makary and others warn, patients could still be discharged with 50 or more opioid tablets.

From "Doling Out Pain Meds Post-Surgery: An Ingrown Toenail Not the Same as a Bypass"
Kaiser Health News (06/22/18) Appleby, Julie

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Opioid-Free Analgesia Use for Postsurgical Pain Limited

Opioid-free analgesia still has not fully caught on in clinical practice, researchers report. Using database information from January 2011 to December 2015, the team identified more than 10,200 patients who received opioid-free analgesia after a surgical procedure and about 255,200 patients who received postoperative opioids. The investigators applied descriptive statistics and logistic regression to flesh out predictors of opioid-free analgesia use at both the patient and hospital levels. Based on the results, predictors for non-opioid pain care after surgery included older age as well as presence of psychosis, diabetes, or neurological disorder. On the other hand, patients were less likely to be treated without opioids if they were obese or suffered from depression. With just 187 hospitals accounting for the opioid-free analgesia recipients, the researchers surmise that "hospital policies, institutional structure, and cross-functional departmental commitment to reducing opioid use may play a large role in the implementation of [opioid-free analgesia]." The findings are published in Current Medical Research and Opinion.

From "Opioid-Free Analgesia Use for Postsurgical Pain Limited"
Clinical Pain Advisor (06/21/18) Dellabella, Hannah

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Opioids Alter Perceptions of Procedural Sedation

Opioid use can make some colonoscopy patients more difficult to sedate, researchers say, causing them to lock horns with their doctor over how much sedation is enough. The investigators worked with a population of 119 chronic opioid users who were undergoing colonoscopies under sedation with midazolam and fentanyl. A total of 16 patients reported that sedation was inadequate, as defined by a score of three or lower on a 10-point visual analog scale. Team nurses were largely in agreement with patients' assessments, while endoscopists were less so. "The conclusion would be in patients on chronic opioid therapy, there is lack of agreement between what patients think is adequate sedation versus what the physicians think," sums up Salman Nusrat, MD, of the University of Oklahoma Health Sciences Center. "Increased risk of poor sedation with conventional sedatives should be discussed with patients, and we should plan ahead and consider propofol use."

From "Opioids Alter Perceptions of Procedural Sedation"
Gastroenterology & Endoscopy News (06/18) Blum, Karen

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

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June 28, 2018
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